The overall HMG response to the Covid-19 pandemic has been flatfooted, slow and confusing. Mixed messages have been given as in Fig. 1. This video from Joe.uk shows total inconsistency from PM Johnson. This mixed messaging has the potential of being disastrous. According to Sonia Sodha: Media experts despair at Boris Johnson’s coronavirus campaign.
Warnings from Italy have been ignored. The belief than the NHS is the best health system in the world and that it couldn’t happen here are ill-founded. In a recent Lancet Study the NHS was ranked in 30th place, well behind Italy on 12th. Warnings from China were dismissed despite the fact that President Xi Jinping phoned PM Johnson personally on the 18th Feb to warn of necessary virus control measures.
Only a week ago Herd Immunity was being pushed as a strategy. While other similar countries in Europe were putting in various social distancing communication strategies and isolation measures, the UK was very slow to act and it was not till the 23 March decisive measures were taken.
As Charles Adams has previously discussed on this blog, the rate of exponential growth of Covid-19 cases is staggering. The speed at which it can overwhelm the country is unprecedented for over a century. The 1918 so-called Spanish ‘flu (it was probably American) was the last pandemic on this scale. It killed an estimated 50-100M people including President Trump’s grandfather.
Though it is undoubtedly true that all countries should have reacted earlier, the UK has been an outlier in Europe almost to the extent of being an international pariah. The US response has also been chaotic.
For Northern Ireland, preparedness is considerably worse than for Great Britain. The NI NHS was badly overstretched already and the critical care base very low. Health is a devolved competence and depressingly sectarian instincts have informed policy. HMG decision making has been determined by GB-specific factors which may be entirely inappropriate for NI.
Why has the UK response been so dismal? There are a number of theories.
There are strands from Behavioural Science, British Exceptionalism, cold callousness and herd immunity, philosophical inability and disaster capitalism, which need to go into the mix. These will be examined in turn. The specific problems for NI will then be discussed. Finally, conclusions will be drawn.
The official line is that the UK response has been based to a large extent on Behavioural Science. Too early a lockdown will cause people to get bored and to ignore social distancing guidelines just at the time the epidemic is hitting its peak. Better shutting down later rather than risking people ignoring guidelines later.
This may have made sense if the guidance from the epidemiologists was correct and that fatalities would be similar to seasonal or even pandemic ‘flu. This, however, seems to have been a major miscalculation and only possible because of British Exceptionalism.
British Exceptionalism was, of course, very evident throughout Brexit, not only during the referendum campaign but has continued ever since. Believe in Britain!
A classic of the genre is this tweet from Sir Christopher Meyer (former Ambassador to the US).
The sheer hubris, arrogance, stupidity and contempt for other nations is staggering.
HMG ignored international advice, preferring its own small circle of experts. The drive to show that Britain is a world leader is an imperative in the post-Brexit world.
The New Statesman article: The United Kingdom is flying blind on Covid-19 sums up the pig-headed dismissal of international advice and data:
The British government did not listen. We had two months to get prepared for large-scale tests in the population, contact tracing and quarantine, to be like Guangzhou rather than Wuhan. Yet the advisory committee, comprising clinical knights of the realm, virologists, mathematical modellers, and behavioural scientists led by a former director of David Cameron’s Behavioural Nudge Unit, decided British science knew best.
No matter how brilliant or elegant the models are, results are only as good as the underlying assumptions and the accuracy to which various key parameters are known. Peer review and disseminating the models widely is essential. The complexity of such models is normally so great that even the most brilliant can miss something.
In the case of Covid-19, there are so many unknowns such as R0, the average number of people a carrier can infect. Estimates vary from 2.2 to 6.6, with 3 being a likely figure without social distancing. As Prof Hugh Montgomery explains in this video it makes Covid-19 far more dangerous than normal ‘flu.
The overall mortality rate is also unknown. While the WHO figure is 3.4%, it may well be that many cases are so mild as to be essentially asymptomatic and the true figure may be around 1%. Can asymptomatic people spread the infection? It seems so and I highly recommend How the Coronavirus Could Take Over Your Body (Before You Ever Feel It) by Jeff Wise. The incubation period (how long it takes from catching Covid till the time symptoms occur) is also unknown, but maybe around 10 days.
An interactive epidemic calculator is shown in Fig 3. Outcomes vary widely depending on parameter assumptions and I highly recommend spending a few minutes trying various scenarios.
According to the Byline Times article by Nafeez Ahmed, Prof Neil Ferguson head of the Imperial College epidemiology group advising HMG admitted that some of the key assumptions made by the Imperial College (IC) team were wrong.
[The] model assumptions were written more than 13 years ago and based on the specific dynamics of a flu pandemic. In other words: the model was not calibrated for COVID-19 and failed to sufficiently incorporate new relevant data.
I’m sure the IC group is very good, but even within the UK, there are a number of excellent epidemiology groups. Had the model been peer-reviewed such errors could and very likely would have been caught earlier.
Cold Callousness and Herd Immunity
It seems the Sunday Times (22 March) confirms that the herd immunity strategy originated from Dominic Cummings (article behind a paywall). As Richard Murphy has written on his blog: There is a choice on coronavirus: we can save people or the economy but not both, and the government is choosing the economy.
It seems that only when “some pensioners” turned out to be potentially hundreds of thousands the strategy was dropped as being too politically damaging. Alternatively, as reported in Libération, it was only after France’s Macron threatened UK entry ban without more stringent measures that he acted and introduced distancing measures.
Has the “Herd Immunity” strategy really been dropped? Testing is still at an abysmally low rate. It is also the strange there has been no social media campaign to explain the new social distancing strategy. From True Republica:
There was a Herculean effort to drag Brexit across the line in 2016. It involved the efforts and money of billionaires, hedge fund managers, corporate leaders and some seriously dodgy Russian characters. It involved front charities, think tanks and dark money from America. It involved military perfected systems designed for the battlefield to win ‘hearts and minds’, specific technologies, algorithms and the world’s largest social media giant to wage a war against British democracy.
And yet, our government, in the face of a true crisis hasn’t run a single advert about coronavirus from its official Facebook or Instagram accounts. Or the PM’s official account. Or Boris Johnson’s personal account. And this is despite being offered millions in free ad credits by Facebook. The herd immunity programme has not really been abandoned, has it?
Philosophical Inability to handle the Crisis
The current populist government seem unable to judge risk. The current HMG consists of people who “Believe in Brexit” and seem incapable of objective judgement. Their approach is that of Newt Gingrich’s “what people feel about an issue is more important than what the actual facts behind the issue are“.
As George Monbiot has written in the Guardian: Our politics isn’t designed to protect the public from Covid-19.
The worst possible people are in charge at the worst possible time. In the UK, the US and Australia, the politics of the governing parties have been built on the dismissal and denial of risk. Just as these politics have delayed the necessary responses to climate breakdown, ecological collapse, air and water pollution, obesity and consumer debt, so they appear to have delayed the effective containment of Covid-19.
The theory on which this form of government is founded can seem plausible and logically consistent. Then reality hits, and we find ourselves in the worst place from which to respond to crisis, with governments that have an ingrained disregard for public safety and a reflexive resort to denial. When disasters arrive, its exponents find themselves wandering nonplussed through the wastelands, unable to reconcile what they see with what they believe.
This indeed seems to be where we are, compounded by the fact that we have the least talented Cabinet for a generation, one whose only criterion for appointment is “Belief in Brexit” rather than any capability of doing the job.
Some of the Tory Pary’s major backers have made fortunes on the back of the Covid-19 crisis. Crispin Odey, for example, made £115 million from this month’s coronavirus stock market crash.
Uncertainty is key. In this analysis, the mixed messaging and incompetence of HMG was deliberate and the fact that thousands of pensioners would die as a result, mere collateral damage.
It is possible that I am being cynical about the Tories but as Nye Bevan famously said “So far as I am concerned they are lower than vermin” and “They have not changed, or if they have they are slightly worse.”
As a general rule, it’s recommended never to attribute to malice that which can be explained by incompetence, but with the Tories one does, sometimes, have to wonder.
Northern Ireland Specific Factors
Northern Ireland is the only part of the UK that shares a land border with the EU. It has two dominant communities: Nationalist and Unionist. The Nationalist Community historically looks towards Dublin for a lead, the Unionist towards London.
The Nationalist community is overwhelmingly pro-EU and anti Brexit. Faith in London was at an all-time low even before Covid-19 struck. Nationalists didn’t understand why London was so far out of line with international guidance and in any case have no confidence in HMG.
Unionists, as usual, were being “More British than the British Themselves” and were desperate to believe in HMG’s approach. Many have an exceptionalism which would make Sir Christopher Meyer proud (Fig. 2). One may have thought their faith would be dented by the introduction of an “Irish Sea Border“, but this seems to have made them even keener to show their loyalty to HMG and the Tories.
The fundamental difference between the two communities has caused major tension in the past few weeks. Dublin has been much faster to act in response to the pandemic than London, despite the fact that it has a caretaker government rather than one with a large majority. Varadkar’s handling of the crisis has been widely praised, in total contrast to Johnson.
There is no question that the Dublin approach, though by no means perfect (it too should have reacted far earlier), was far superior to that of London and very much based on international advice from the EU and WHO.
Nationalists were pushing for an all-island approach, which to me makes absolute sense, given the totally open border. The island is already treated as a single epidemiological unit for for plants and animals with common Sanitary and Phytosanitary Measures.
When schools “south” of the border were shut, immense pressure was put on both Sinn Féin and the SDLP from the Nationalist community to do the same. Rather than any understanding from the hard-line Unionists, headlines such as Nationalists for political ends tried to overturn measured advice to schools on coronavirus appeared in the fiercely pro-Union News Letter seem to indicate panic and desperation in the Unionist community.
Hopefully, now that measures are very similar on both sides of the border tensions will decrease and a joint approach can and will be taken.
State of the NI and IE Helth Services Ventilators
It seems all the rage to praise the NHS and look at the IE Health System as a poor cousin. The above mentioned Lancet Study, however, ranks the IE system in 13th place well above the 30th placed UK.
In addition, the NI health service is on its knees. Waiting lists are a total disgrace as opposed to England and Wales as illustrated in Fig 4.
In terms of ventilators which will be of crucial importance in saving lives, NI has only 139 ventilators with 40 on order (though some of the Dyson ventilators may be earmarked for NI ), whereas there are 1,229 ventilators in the “South” now plus 900 ventilators ordered. This is 12x the provision with only c 2.5x the population.
Ireland, of course, had the advantage that one of the worlds largest and most widely respected manufactures of ventilators, Medtronic, which is based in Galway. They are unsurprisingly ramping up production to 24/7 operation.
In terms of testing, Ireland is ramping up the number of tests to South Korean levels and converting Naval Ships and sports stadia such as Croke Park (Dublin) and Páirc Uí Chaoimh (Cork). Best WHO practice of identifying victims, isolation and contact tracing is being used.
The approach in GB and NI seems to assume that Covid-19 is so rampant that the horse has bolted and this strategy will not work. Testing is at very low levels and there are anecdotal stories of sick frontline medical staff who remain untested.
This may well be the case for London, but probably not so for NI, Scotland, Wales and some remoter parts of England such as Northumberland.
It seems that British Exceptionalism is again a factor. There seems an attitude that the WHO is just for poor countries and “we know better”.
HMG seemed totally unprepared. It used to produce a National Risk Register of Civil Emergencies. This stopped in 2017 presumably because HMG devoted all available resources to Brexit. Each and every edition of the Register had pandemic flu as the most probable and devastating threat to the UK. The government knew it would likely happen and that it had cataclysmic potential.
The “exceptionalist” approach of HMG was a combination of a variety of factors. I suspect primarily the need to show the world that British exceptionalism was indeed real – that the UK was truly World-Leading. This seems to have backfired, first in needing to get into line with the rest of the world, second in the higher cost it will surely entail, both in lives and economic impact.
It may even prove disastrous. Again from the Byline Times article by Nafeez Ahmed:
My back-of-the-envelope projections suggested that the Government’s refusal to attempt to slow and curtail the spread of the virus could lead to as many as 458,752 deaths – possibly as high as 1.6 million in an absolute worst-case ‘do nothing’ scenario.
We need to hope and pray that this is not the case. If the truth is remotely like this it makes the Brexit miscalculation seem minor by comparison.
Another very worrying issue that, as Peter May has written, obesity seems to significantly increase susceptibility to Covid-19. The UK with a 28.1% obesity rate is one of the highest in Europe. Italy’s rate is 21%. The US on 33.7% is even worse.
The way the epidemic may play out is outlined in this excellent article by Tomas Pueyo: Coronavirus: The Hammer and the Dance. It seems that the WHO may know what it is doing after all.
We will not know for some months, but within the next few weeks, the UK could have a higher death toll than Italy. Covid-19 may well be rampant in the UK population and the official number of infections (8,264 at 9am 26th March) may be a vast underestimate as testing levels are very low.
Ireland which has much higher testing levels has 1,564 cases with 1/14 of the population. IE has only reported 9 deaths but the UK 435. This corresponds to a c 5% death rate in the UK but a less than 1% death rate in IE. The likely explanation is that far more people in the UK are infected than the official figure indicates.
There is a very useful dashboard from Johns Hopkins University shown in Fig. 5. this is interactive, click on the figure to open. (For a quick summary statistics of the situation in the US see https://covidtracking.com/data — a site created by open source software developers and journalists to attempt to remedy the CDC’s inability to collate and share data, purportedly as result of Trump administration cutbacks).
There is also a UK specific dashboard from Public Health England.The priority now must be to save as many lives as possible. I hope the strange decision to use Dyson as a source of ventilators, rather than established EU manufacturers proves a wise one.
In Ireland, given the asymmetry in preparedness, any spare resources in IE should be made available in NI. Given the impossibility of closing the border if it is not done, NI would well become a “petri dish” of infection for the entire island. We are definitely all in this together.
The UK, Ireland and the wider world are in for some very difficult months, and the overall death toll could well be at levels not seen since World Wars I and II. I do hope when this is over a better, more equal and caring society results in both Islands. This is not, however, a given. As Martin Kettle wrote in the Guardian:
We are sailing in the dark towards an unknown future. Britain’s mood after the first world war and the flu pandemic has been described by the historian Richard Overy as “the morbid age”. It was, Overy says, an era of fear and paranoia about a dystopian future. Few put their faith in traditional politics. Britain after the second was very different. “Never again” was its more optimistic motto. No one can say which of these moods, or what other mood, is likely after the Covid-19 pandemic. Instead of insisting that the pandemic confirms everything we thought beforehand, it would be better to start thinking about all the unwelcome changes that the pandemic may bring in the decade to come.