Covid-19 How is the UK doing?

Introduction

From HMG’s perspective, now that the UK has left the EU, the Covid-19 pandemic provided an opportunity to show the UK’s true genius, unshackled from an allegedly moribund Europe. What better opportunity to showcase the true and exceptional greatness of Great Britain?

The UK is world-leading (almost). According to the Global Health Security Index (GHSI), the UK is the second best-placed country in the world to fight a pandemic. It’s one of the wealthiest countries in the World, ranked in 5th place in terms of GDP. Britain has the NHS, regarded by many as the world’s best health system. It has some of the best universities and scientists in the world; first-class scientific advice is on tap. The country, unlike for example Italy, was hit fairly late by the virus and had plenty of time in February and early March to prepare.

Britain is also a sovereign island, which as New Zealand has shown, can add very much to enhanced protection. Unlike the EU which is crisscrossed by land borders, there are none in Britain. Hermetic sealing of the border is possible and was used to great effect in NZ.

In the UK there is, of course, Northern Ireland which shares a border with Ireland. A country ranked 23rd in the GHSI, 32nd in terms of GDP and with a very complex health system, a mix of public and private, which might find it difficult to respond well in a crisis. The Irish Border is of course totally open and NI could be overwhelmed. This would be regrettable but largely outsides HMG’s control. Blame for this singular failure could easily be placed on Ireland, or on the polarised politics which causes deadlock in NI.

In addition to all these advantages, by coincidence, HMG had only recently been elected with a landslide majority. This landslide majority should also ensure that there is a depth and breadth of talent available for cabinet positions. In the honeymoon period, tough and decisive measures could be taken. With no GE for 5 years, short-termism could be ditched and strategic choices made.

The superiority of the First Past the Post electoral system would also be demonstrated. Ireland which also had a recent GE under the single transferrable vote PR system and has yet form a new Government, and Germany with a lame-duck German Chancellor fighting to keep a coalition together, would surely fare much worse.

Whatever one’s views of PM Johnson and his special advisor D. Cummings, in terms of communicating they had been excellent throughout the Brexit Referendum and GE 2019. One could expect more of the same.

It was obvious to HMG that with the exception of Northern Ireland, the UK went into the Covid pandemic in a commanding position, further underlined by having completed a pandemic simulation in 2016. Confidence was high in March that the UK would cope brilliantly. The superiority of the UK response to that of Germany in particular, ranked in 14th place in the GHSI, with a decentralised health system and sharing a border with 9 separate countries was surely predestined? It was particularly glorious that this “win” over the Germans should be evident by the 75th anniversary of VE day.

Strategists in No. 10 must have been over the moon as a major boost in popularity from the adoring Brexit voting fraction public seemed assured.

Given that health is a devolved competence in the UK, the superiority of the English response in particular should dampen calls for an independent Scotland, an increasingly fractious Wales and a United Ireland.

The only country ranked higher in the GHSI, is the US. If it panned out that the US coped better than Britain, that would be understandable and indeed strategically advantageous, given that the UK is moving away from the EU’s orbit and towards that of the US.

All seemed set fair back in early-March. How did things actually pan out?

The Current UK Position

The official UK pandemic figures for deaths for example (standing at 34,546 at the time of writing) are widely disbelieved and the suspicion is that actual deaths are around twice that number. Until recently the official figure reported only deaths in hospital of people who had tested positive for Covid-19. Since the UK overtook Italy with the highest number of headline deaths in Europe, this figure has included some Covid deaths outside hospital and was spun by HMG as “all deaths”.

Fig.1 Excess Deaths England and Wales. (By the author. Data from the ONS).

Fortunately, the UK has the Office for National Statistics (ONS) which is truly independent and professional and produces data to the highest international standards. The total number of registered deaths is released once per week (here) at 9:30 on Tuesday mornings in the form of an Excel spreadsheet. Fig. 1 shows excess deaths above a 10 yr average (2010-19) to the 1st May (week 18) at 49,126. With a 5 year average (2014-19) the figure is slightly higher at c.50k.

Though the data is of gold-standard quality, it is about two weeks out of date. It includes all registered deaths to 10 days before the publication date, but registration typical takes a number of days. Registration should be within 5 days of the actual death, but this limit is often breached.

The spikes and troughs on the mean, maximum and minimum graphs are artefacts caused by bank holidays. Notable is the drop around the Christmas period and the spike in January when registry offices reopen.

It is then possible to project the model forwards using daily hospital deaths and adjusting this to include deaths in other settings and adding the figures from Scotland and Northern Ireland. This produces a number of around 60k deaths.

A similar methodology is also used by Jamie Jenkins @statsjamie (a former statistician at the @ONS) who has estimated the number of 60.5k to the 11th May, as illustrated in Fig. 2. He uses the average of deaths from 2015-19 as a baseline. The lack of artefacts indicates that this data has been corrected to the actual date of death. The winter/summer trend is evident with deaths being higher in winter.

Fig 2. Estimate from Jamie Jenkins

Chris Giles of the FT has also used a variant of this methodology and comes up with an estimate of 59,700 deaths as of the 11th May.

Fig. 3 Number of Covis-19 UK related deaths from Chris Giles

It can be said with high confidence that the excess number of UK deaths as of the 11th May was c.60,000. Both Jamie Jenkins and Chris Giles keep a running total and their estimates are 62,430 and 61,200 deaths respectively as of the 16th May. To be clear, excess deaths are those higher than ordinarily expected and likely attributable directly or indirectly to the pandemic.

How Does the UK Position Compare to Peer countries?

There is no question that many of the Asian countries have done very well. South Korea, Japan, Taiwan and Vietnam, for example, reacted swiftly and appropriately, keeping well ahead of the curve. So too have Australia and New Zealand. It is fairer, however, to compare the UK to European countries.

International comparisons are difficult, as testing and reporting regimes vary from country to country. Other governments are not above putting a gloss on their data. Fortunately just as the UK has the ONS, all European countries have an independent statistics office and other bodies free of political spin.

The Danish Statens Serum Institut has a project to collate European data on excess mortality and the Euromomo Group have produced an interactive mapping and data tool. This is produced for participating countries and regions. In Germany, only Berlin and Hesse are taking part. Very usefully however for the UK, England, NI, Scotland and Wales are all treated separately.

Mortality rate follows a Poisson rather than a Gaussian (Normal) distribution. (One of the classic historic examples following a Poisson distribution is the number of cavalrymen kicked to death by horses in the Prussian army.) The z-score is effectively the number of standard deviations the measurement is away from the expected value.

Fig. 4 from the Euromomo tool shows the z-scores for participating countries, from the peak of the pandemic, for weeks 15 (top left), 16 (top right), 17 (bottom left) and 18 (bottom right) – click on images to expand. In week 15 Spain, France, Italy, Belgium, the Netherlands and England all had extremely high excess. By week 18 England was the only country with extremely high excess. Sweden is rated at high excess and Scotland, Belgium the Netherlands and Italy moderate excess.

Fig. 4 Excess Deaths in Europe (participating countries and regions) wks15-18 Euromomo.

Euromomo also produces time-series graphs (Fig. 5) – I recommending exploring the data on the tool itself. It seems in terms of z-scores that England is easily the worst-performing country in Europe. At the height of the pandemic, the top five in terms of peak z-score were England 42.75 (Wk 15), Spain 34.41 (Wk 14), Belgium 29.91 (Wk 15), Italy 22.16 (Wk 14) and France 21.17 (Wk 14).

Fig. 5 Z-score time series for selected countries.

England is also the worst-performing country on these islands. The peak z-score was 19.71 for Wales (less than half that of England), 8.90 for NI, 7.03 for Scotland and 3.95 for Ireland all in week 15.

What is more frightening, however, is that the English z-score is still around 20 in the latest data – easily the worst in Europe. All other countries are below five. The next highest is Sweden at 4.8.

Something must have gone very badly wrong. In a fast-moving crisis, mistakes will naturally be made by all governments, but HMG seems to have failed on nearly all fronts.

What went Wrong?

Far from being the best-performing country in Europe, the UK is the worst. England, in particular, has been a disaster. With all the UK’s advantages going into the pandemic clearly this has been a catastrophic failure. The response of the BMJ is worth reading.

A full-blown enquiry is needed however a few mistakes seem obvious.

  • February and the first half of March was a golden opportunity for the UK to prepare, particularly in the building up of Personal Protective Equipment (PPE) and a fit for purpose Test Trace and Isolate (TTI) System. This time was largely squandered.
  • Rather than keeping ahead of the exponential curve, the UK locked down very late in comparison to most European countries, who looked on in horror as major events such as the Cheltenham Festival were allowed to go ahead.
  • Whereas it is true that the NHS has coped brilliantly, this has been at the expense of in particular the Care Home sector, where lack of testing before discharge from hospital, lack of PPE, training and resources has produced an unfolding tragedy, and has taken a terrible toll of lives of, in particular, BAME NHS staff.
  • The Elective Dictatorship nature of the British constitution may work when competent Prime Ministers, Cabinet and advisors are in charge. This seems far from the case and both Germany and Ireland for example have handled the crisis far more competently.
  • Far from having a cabinet of superstars, we seem to have one filled with sycophants and incompetents; probably the least talented cabinet in living memory.
  • The”Scientific Advice” coming from SAGE seemed so far from international best practice that it was suspected, rightly, as having been politically constrained all along. So much so, in fact, that the former and highly respected Chief Scientific Advisor Sir David King felt it necessary to set up his own independent SAGE committee.
  • The abandonment of TTI and the decision to go for “herd immunity” in mid-March is so totally at odds with WHO best practice it needs to be singled out as a catastrophic error.
  • Communication has been a disaster. Industrial-scale dishonesty may be par for the course now but the sheer ineptitude of the “Stay Alert” messaging has been breathtaking. It was described as An Unholy Shambles by Ian Dunt.

Conclusion

England is relaxing lockdown at a time the z-score is the highest in Europe without a fit for purpose TTI system in place. The potential for things to go catastrophically wrong is high, and even more so in a potential 2nd wave as summer winds down and people spend more time indoors. If the z-score of 20 is correct, this is only marginally lower than France’s as the height of the pandemic.

Few countries have responded worse than the UK. The major exception has been the US, which under Trump’s leadership has been truly disastrous. As Fintan O’Toole has written, the US is to be pitied rather than envied. This sadly gives some limited cover to HMG. The superiority of the UK’s Covid-19 response to that of the US is evident. Doing less badly than the US may be perceived as a success by many Brexit fans.

In the background is the fact that the Brexit talks are likely to end in failure. I agree with Tom Hayes that a “No-Deal” outcome seems inevitable as argued powerfully on his BEERG blog. This has the potential of tipping the UK from a post-Corona recession to a full-blown depression.

On a more positive note Scotland, Wales and Northern Ireland seem to be doing a lot better. For Scotland, this comes as no surprise, but seeing the DUP having a more sensible position than the British Government is refreshingly unexpected. The NI approach is in fact not far off that of Ireland in some respects but it has been comparatively behind on testing (eg, from 5-11 May, ROI tested 44,027, NI: 7,642), and it seems that NI will suffer least in the UK from the pandemic.

It is positive also that it now seems the Northern Ireland Protocol may be adhered to. The realisation that any US trade deal would be blocked by Congress seems to have finally dawned, likewise a clear idea that the EU was likely to suspend talks without evidence of good faith in terms of preparations to put what was agreed into effect.

Comments

  1. Charles Adams -

    “This other Eden, demi-paradise, This fortress built by Nature for herself Against infection…..
    This blessed plot, this earth, this realm, this England.”

  2. Graham -

    Excellent. A thorough, illuminating and devastating analysis. I hope it is widely shared.

    I wonder what on earth it will take for people to turn against this government.

  3. Ken Mathieson -

    First class analysis and accuracy. Shared with Canadian cousins who look on in disbelief as their southern neighbours appear to have taken leave of their senses and the UK appears little better

  4. Samuel Johnson -

    The failure of the SAGE Committee is one that many will have difficulty with, with politicians repeatedly saying they were at all times being guided by “the science”. This was and remains a complete smokescreen to deflect responsibility. The composition of SAGE was unsuited to the task at hand – – it had no experts in public health or infectious diseases. It was not truly independent, with most members dependent on the govt for employment. Its recommendations were constrained by policy choices already made for ideological reasons and their outcomes: effective defunding of public health following top down reorganization of NHS; prioritizing Brexit over acting on the Project Cygnus pandemic simulation recommendations (resulting in shortages of PPE & ventilators & inability to get testing up and running efficiently).

    This “Covid Report” video has a useful discussion between two journalists, Paul Mason and Afua Hirsch, and several medical professionals. It clearly documents the deficiencies of the SAGE committee, and the lack of transparency about its operations.

    https://youtu.be/05-jbrHRmrs

    Since this was made it turns out that Dominic Cummings and a crony attended. Initially, it was alleged, they did so as observers; then we were invited to believe that Cummings pushed the scientists to support a lockdown, preventing a catastrophe. A man with a £600m budget for science making recommendations to a committee that is supposed to be “independent” of govt is plainly inappropriate and not guaranteed to produce advice that may be necessary but unwelcome.

    The issues with membership are enumerated here

    https://twitter.com/globalhlthtwit/status/1254093714139553793?s=19

    Had SAGE operated with more transparency critical errors in its assumptions would have been corrected, most notably modeling being conducted for the wrong disease: pneumonia.

    It’s worth noting that the UK only went into lockdown when it did when President Macron told Boris Johnson that if he didn’t do it he would close French ports to UK traffic. The UK govt being a danger to the citizens of other countries was not just an issue for the French. On the island of Ireland the politics of two public health strategies caused contention in NI, with unionists looking to London & nationalists to Dublin and to WHO. Nationalists simply declined to trust London, kept their children home from school in line with policy in the Republic, stopped all sporting events and going to the pub. This cannot have failed to help in limiting transmission of the disease and reducing the impact on NI. Nevertheless, adjusted for population that impact appears to have been larger than on the Republic. In addition, it appears that some anomalously high levels of Covid-19 in the Republic are associated with proximity to the NI border. The island has common rules for plant and animal health, but not for people.

    1. Sean Danaher -

      Samuel,
      If we go by Z scores NI had about twice the excess deaths per head of population than IE.
      A common approach North and South of the border would be sensible but the approach is not too different, but testing is much lower in NI. As you day https://www.irishtimes.com/news/ireland/irish-news/covid-19-cases-in-cavan-exceed-dublin-as-incidence-in-border-counties-rise-1.4238907 it is worrying that border counties now seem to have the greatest number of cases.

    2. Samuel Johnson -

      I forgot (there is a lot that could be added but I think this one is important):

      Something one could add to the list of advantages the UK had before the pandemic arrived was advance notice from intelligence sources that were not shared with other European countries.

      We now know that Trump was warned repeatedly by US intelligence about the virus and Chinese efforts to control it, and he did nothing. It is simply not credible that the “Five Eyes” organizations didn’t circulate actionable information to govt insiders. Indeed, we know for sure it happened as the first thing some members of the GOP did was to sell stock.

      What are the chances that the UK relied only on WHO information, rather than intelligence from China? Zero.

  5. Jeni Parsons -

    I favour a Celtic Federation, on German lines, including the Irish Republic plus Northern Ireland, Scotland and Wales. Northern England? There were Celtic remnant kingdoms there. And also in Cornwall, which could be the Federation’s outlier, rather as Northern Ireland is in the United Kingdom.

    1. Sean Danaher -

      Germany seems to be far better at regional development than the UK. I agree the UK needs restructuring. London is far too dominant – too much wealth is concentrated in the SE. A Celtic Federation is certainly worth exploring.

    2. Samuel Johnson -

      When Ireland finally frees itself of the baneful influence of the English establishment who raped, beggared and partitioned the country there will be many who wish to maintain an arm’s length or two from any further entanglement with the politics of the neighbouring island. For most the EU is the right framework and there’s no doubt in Ireland that Scotland would be a successful independent country. Wales may be too colonized by the English to achieve independence.

      An intergovernmental council and a consultative group in the EU, like the so-called Hanseatic League 2.0, would be fine, but federation outside an EU framework would be a very difficult sale in Ireland, however sympathetic the Irish might be. It’s not totally inconceivable as a framework for resolving the NI problem, but NI unionists look to English dominance for their security and identity not to any Celtic heritage despite most having Scottish antecedents.

      1. Tony_B -

        Samuel,

        I agree with your sentiment “Wales may be too colonized [and weakened] by the English to achieve independence.” And added ‘weakened’ to reflect its economic decline and the atomisation of a once vibrant and intelligent working class.

        But we have to fight! And get away from the incompetence of total Toryism.

  6. Tony_B -

    Great article.

    Welsh z-score for week 15 was inflated by catch up of one area that had non-reported, a local failure. If that data is returned to earlier weeks to reflect the true excess deaths with time then the Welsh z-score would peak below 19 and perhaps follow Scotland’s trend line.

    And a big YES to Jeni Parsons of a Celtic Federation. Welsh Greens are collaborating and discussing such ideas with their Celtic cousins. I am not a nationalist but continued Tory dominance in politics and media control is an unmitigated disaster we need to rid ourselves of.

    1. Jeni Parsons -

      Tony – were it not for Covid-19, I’d probably be in the process of moving to Wales from my present domicile on the south coast of England. (not Cornwall!). I’m not a nationalist either, and am delighted the Welsh Greens are discussing federation ideas, among others. Look forward to being with you in the future!

    2. Sean Danaher -

      Thanks. I was wondering why Wales seemed to do so much worse than Scotland. On federation had the NI Unionists been accepting of Home Rule (devolution) a century ago a very different path might have been followed. There was also a Scottish Home rule bill which was abandoned.

  7. Samuel Johnson -

    @BrexitBin: WTF !!!
    Sage member Prof John Edmunds on herd immunity, lockdown and complete ruddy incompetence! https://t.co/w18uym5C8g

    This Twitter thread and the replies are worth a look, in particular the 2nd video.

    See also this interesting article today by Robert Peston:

    https://www.itv.com/news/2020-05-18/why-didn-t-the-government-protect-us-earlier-from-coronavirus/

    He asks why the govt didn’t take the problem seriously, but a possible reading of it is that he is distancing himself from the Lobby whose failure to challenge the government narrative now looks as unforgivable as the herd immunity decision in the first place. I had not seen the 2nd video above before, but others, including journalists had. How is possible that UK journalists were so willing to subscribe to a govt narrative so plainly at odds with the advice of WHO and the actions of other governments in the face of international incredulity?

    Boris Johnson’s speech at Greenwich surely articulated part of the “plan” for the UK to gain competitive advantage over others by letting “a few pensioners” die, as Cummings allegedly put it. The question remains whose idea was it really?

    Millions have now seen this

    https://twitter.com/ThatTimWalker/status/1258891604301099008?s=19

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