Friday 8 May 2020

How has the UK Government done re Covid-19?

Here are we, about 10 weeks into the depths of the crisis. It came very suddenly and took the whole of the West by surprise. East Asian countries, more used to China's lies and the SARS pandemic, were much better prepared overall.

With Lockdown weeks long now and the media going from one panic about not long enough to another about it being to long depending on what day it is, it is hard to judge what is going on.

The media are obsessed by narrative and story. They can whip up a storm about the danger of covid just as easily as downplaying it to a mild flu. I give the Labour party some credit here, they are manipulating this well with constant placemen and women able to go on about lack of PPE - following and feeding any negative narrative on the Government. Fine practice at the dark arts.

So how do we think they have done overall. We wont really know for a year or so when this horrid thing has swept around the world, but two months in is enough to make some statements -

A) Preparedness - the NHS has not been tested like Spain or Italy, the Nightingales were built but not needed. Overall, very creditable on this front. The lack of testing and PPE is a global issue for the most part but does show up some failure as does the miss of how important it was to protect care homes and care home staff. 6/10

B) Reaction Speed - Way too slow to close airports from key countries like Italy and Spain where we knew the infection was. This alone has led to a much bigger outbreak. On the other hand, they were much better with holding off on lockdown, knowing it would only last effectively for a few weeks - despite media madness at either end of it. 4/10

C) Medical Policy - By following SAGE the Government has both been senisble and given itself a get out of jail free card. The arguments about whether SAGE is right or not dont matter - literally know one knows better in the Country, it is just that answers are not easy. 8/10

D) Leadership - As the polls show, Boris is flying and Hancock and Sunak have been overall very assured. Raab did a good job standing in at a tough time. In comparison to the endless campaiging and whining from Labour, plus with a very hostile media to cope with, they have been excellent. 9/10

E) Economics - A generous furlough scheme has kept the Country in stasis for now. The scheme was delivered well too in short order. Other elements of the package are expensive but no one seems to care for now, the bill comes later. Hard to fault what has been done, but I fear extending furlough too long will be costly move and affect people too much. 8/10


DJK said...

The overriding fear seems to have been that the NHS would be overwhelmed, and on that basis, the government has done well.

Unfortunately, there are widely published international comparisons of death rates, and the UK compares very badly. With 32000 dead and counting, it's hard to argue that this has been a policy success, when compared to pretty much any other country.

E-K said...

It's an awful situation to be landed with. There are no easy choices and fair play to anyone who hasn't run away.

It's not just the disease but that the country is clearly fragmented and there can be no decisive and brave direction.

The outbreak was clearly well under way when Boris was elected.

Any lack of supplies or contingency planning are down to the PMs elected since the 2009 Swine Flu epidemic at least - not the PM in office for several months.

Sobers said...

I wouldn't give them such high marks for economics - wait til the bill arrives, and I don't mean the government borrowing figures, or even tax increases to pay for it. I mean the return of 1980 style unemployment figures which are baked into the pie by the lockdown. Everyone currently sat around on 80% wages enjoying the sunshine will feel a bit different when they attempt to return to work and find all thats waiting for them is a P45. Thats who is going to pay for all this, the massed ranks of the newly unemployed. Anyone under 50 will never have personally experienced such times. They may come to wish we'd just got on with it, rather like the generation of 75 years ago did, instead of pretending that no-one must ever die of anything. Perhaps those assaulting the Normandy beaches should have refused because they didn't have the correct PPE, that would have showed Adolf.

Nick Drew said...

Sobers - are we sure many NHS workers are "refusing to work because they don't have the correct PPE" ? Not the ones I know

Believe me, soldiers complain bitterly when they don't have the kit they think they'd like. They bloody get on with it, though

And let's remember there were strikes all through WW2. At the height of the B of B (as Londoners of my father's generation would often recall), the Liverpool dockers came out on strike. The London buses were on strike on VE day!

There's no golden age, and plenty of bastards

Nick Drew said...

Pretty much agree on all scores, CU. Also that the real reckoning will be many months from now

I'm not sure capital-L Labour deserves the credit for the carping - the Beeb, C4 and various bitter freelance lefties do the business for them

Starmer has a lawyerly 'strategy' - well, more a lawyerly proclivity - which is that he's sure he'll always be able to find a logical flaw in anything written on paper. He probably can - indeed, probably anyone with half an education could - but it's not remotely enough to score heavily, because it's transparent and at the same time boring to the masses. Clever-clever never worked with John & Mrs Bull

there's a telling passage in Wolf Hall, where prosecutor Cromwell is grilling More in the dock. More pulls out a brlliant but lawyerly point, and looks around smugly, expecting the jury to be suitably impressed. They are not. Starmer is that complacent lawyer

and of course he's brimming with confidence, and Won't Be Told - by anyone on anything, it seems. Plus, behind him the Labour Party is gearing up for some serious internecine stuff. If there's anyone strategising properly for him, it'll probably be (a) the internal bloodletting has to happen sooner or later, let's have it now; (b) in the meantime, go with whatever you think, provided you put down a few markers and avoid giving too many hostages to fortune

Sobers said...

My point is that other generations have had to face far greater personal risks than covid-19, and got on with it. Just as we should have done. 30k deaths is nothing more than a bad flu winter. Hell we had 44k excess flu deaths as recently as 2014/15, and we didn't turn the economy into a crater then, so why now? People have become soft, everyone thinking someone else must take responsibility for them, to protect them from everything.

Well they're going to have to face this one, one way or another. There will be no vaccine, not a magic bullet one anyway. The economy will have to be opened up soon, and people return to work and risk infection, otherwise we will all be in a Depression. This virus is going to be around permanently from now on in one form or another, its going to come back again and again, winter after winter, in new guises. Just as generations before us had to cope with the idea that death was never far away, regardless of age, so are we. All this wishful thinking about vaccines and returning to 'normal' needs to be replaced with some hard truths - its here, there's little we can do to stop it, we are all going to get it eventually, probably multiple times in our lives and it will be the death of many of us, eventually. Life's hard, deal with it.

david morris said...

Interesting - as ever - CU

a) Preparedness : How do the NHS procurers of equipment get a free pass ?

b) Reaction speed : Airports (& Channel) are still open with no/minimal checks. Absolute madness.

c) Medical Policy : SAGE are there to give advice. Guvmint decides if the advice is to be followed. That they followed clearly iffy advice (vide Ferguson & his
crappy pandemic modelling) will come back to bite them. Big time.

d) Leadership : Apart from a wobbly time when Boris was away with the nurses they seem to have performed as well as the low bar we set for pols these days allows.

e) Economics : The final bill has yet to be calculated, let alone presented.
We are in real unknown/off the charts territory, but would you buy a second hand car from any of the present political class ?

E-K said...

What if Sobers is right ? That there might never be a vaccine ?

In which case even the most competent of nations are going to have to suffer the fatalities in the end.

Per million we are still better than Italy, Spain, Belgium and France is not far behind - assuming equal counting.

dearieme said...

"there are widely published international comparisons of death rates, and the UK compares very badly. "

Really? Compared to Italy, Spain, France, Belgium?

Of course there's not much chance that the data are gathered in compatible form, but insofar as you want to make comparisons on iffy data, we've not done badly. Not as well as Germany, I'll grant you. There the difference is so big that I find it hard to believe that it's all an artefact of definition.

And we carry one huge handicap compared to the rest of industrial Western Europe. We've got London.

Nigel Sedgwick said...

Concerning the different effects of government policy in Sweden and the UK, also Germany and the UK, there is another potential explanation of why the UK does worse with lockdown than Sweden does without; also the UK doing worse than Germany with similar lockdown policy.

This is an argument to be made that smoking - or more specifically nicotine intake - is (somewhat significantly) protective against infection by the coronavirus. It is more common to ignore this in comparing the lockdown policies of otherwise similar nation states in similar geographical zones (eg UK and Sweden, northern hemisphere temperate zone, population density with London somewhat disadvantaging the UK). Improving on this by using knowledge of potential nicotine proteection, we have:
- Sweden smoking proportions: male 17.5%; female 17.6%
- Germany smoking proportions: male 30.7%; female 27.7%
- UK smoking proportions: male 17.3%; female 15.9%

Going further there is this stuff called snus (a bag of moist smokeless tobacco product, sucked on in the front of the mouth), of which the Swedes are inordinately fond. So for that (and any German and UK smokeless equivalence) we find in Table 2 and Figure 1:
- Sweden smokeless intake population proportions: male 24.0%; female 7.0%
- Germany smokeless intake population proportions: male 3.4%; female 3.4%
- UK smokeless intake population proportions: male 1.6%; female 0.5%

Combining all this, including the boys and the girls, and ignoring overlap of smoking/smokeless behaviour (which has support elsewhere) gives:
- Sweden tobacco nicotine takers: 33.1%
- Germany tobacco nicotine takers: 32.6%
- UK tobacco nicotine takers: 17.7%
[Aside: Note that Norway too has a high level of smokeless tobacco consumption.]

So, by rather simple but probably OK modelling, the Swedish 'herd protection level' is around 1.87 times that of the UK (and not the smoking only ratio of 1.06), and the Rt/R0 ratio is scaled down by a factor of around 0.81 times. This is just from the nicotine intake, and a very useful counterweight to the UK's more stringent lockdown policy - whatever that might contribute. The equivalent figures for Germany compared to the UK are the possibly nicotine 'herd protection level' being 1.84 times greater for Germany and the Rt/R0 ratio being better for Germany by a scaling factor of 0.82

I don't know whether the nicotine effect is true at all, or has the full effect assumed above, or has some partial effect in between - with the rest covered by other causes including potentially optional protective measures. However, it strikes me as being a plausible hypothesis for explaining much of the poor COVID-19 protection of the UK compared to each of Sweden and Germany.

Keep safe and best regards

Nick Drew said...

@ EK What if Sobers is right ? That there might never be a vaccine ? In which case even the most competent of nations are going to have to suffer the fatalities in the end.

A longtime friend of mine who's a retired NHS consultant (yes, I know how hackneyed that intro sounds ...) opines that after a few months of "success", hermetically-sealed New Zealand won't know what to do next - they have no herd immunity effect whatsoever, and as soon as they finally open their borders ...

whereas good old chaotic, freedom-loving, half-apologetic UK is getting a herd-immunity regime (whether acknowledged or not) that's actually working. My man cites his own son, a currently practising ICU specialist, who's (a) had the virus & (fortunately) come out the other side unharmed; (b) is blasting around doing good stuff 12 hours a day in his big city NHS hospital, unphased by "risks".

(Incidentally, said son reports his ICU unit has 100% all the kit it needs. The problem is the rest of the hospital, where they know that statistically there will be some Covid lurking, but they indeed don't have full heavy-duty PPE for all staff)

Nigel Sedgwick said...

Concerning the (IMHO excessive) pessimism over "hermetically-sealed New Zealand ...[will] have no herd immunity effect whatsoever"

Note that, should better treatments be found with that extra time (anti-virals and non-pharmaceutical interventions (NPIs) especially), many more New Zealand lives may well be saved overall and many more contingent and lasting New Zealand morbidities reduced or prevented.

It's like a military tactic to delay the enemy, so reinforcements have time to arrive.

And those potential reinforcements are not only immunisation.

Keep safe and best regards

Raedwald said...

Another fine post CU and I agree that *at this stage* we're not doing too badly. However, the big battles are still to come - so it's useful to start with the skirmishes to judge how the generals shape up, and make some adjustments before the storm hits. Alan Brooke's diaries provide excellent examples of how to do it.

The Nicotine prophylaxis is still giving the health lobby the heebie-jeebies. Austia has the highest smoking rate in Europe and also very low levels of infection. They'll resist nicotine vapes on the NHS with everything they've got - but I suspect we'll see asthma inhalers dispensing nicotine somewhere alone the line. Alkaloids are not our enemy - caffeine is also our friend.

And the latest suggestions are that we don't have to have 60% of the population infected to get herd immunity - we can skew it by those with greatest contacts / crowding / risk gaining immunity and it's possible that a level of only 10% - 20% will do the job.

London may be an immunity asset rather than a disease liability. And we'll need London to function - the recession that's about to hit will need the Temple to the Isle of Dogs running hot, for not only will our economy depend on it but the City will be vital for the EU's rescue plans. So we need to get Sadiq to re-open London Transport and take the bullet.

Raedwald said...

Mr D -

There's no golden age, and plenty of bastards

Ain't that the truth.

Nick Drew said...

@ will need the Temple to the Isle of Dogs running hot, for not only will our economy depend on it but the City will be vital for the EU's rescue plans

correct, Mr R - i have a current tale to tell about that, maybe next week

Spoiler alert: it doesn't much rely upon TfL, nor indeed Sadiq ...

Don Cox said...

Drew sayeth: "There's no golden age, and plenty of bastards"

True O Prophet. I was reading some of Plutarch's Lives of famous ancient Greeks and Romans recently. Human nature hasn't changed.

Here and there good, sensible, competent and bold people do occur -- I would quote Queen Elizabeth I as an example -- but generally the planet has to be run by us ordinary people: out of our depths, indifferent honest, greedy, and brilliant at inventing excuses and self-justification.

Don Cox

jim said...

About as well as could be expected. But where do we go from here, what lessons can be learned.

We are between a rock and a hard place and as a guess, about 70 days and a further 25,000+ deaths from the 'end'. And the prospect of upside to that 25,000 if lockdown is eased too clumsily. If that idea is right then the overall bill will be of the order 60,000, rather less than previous heavy flu outbreaks. But that is with a severe lockdown and its economic consequences. Professor Pants-Down may not be so far adrift.

Small wonder some may be considering Boris to be a broken reed, in need of a good stiffening, or replacement. But we are in the internet age and the public are not a conscripted or volunteer army or a daft one. So 'can't take a joke, you shouldn't have joined' does not fit. But perhaps we might take a leaf out of Trump's book. A bit of constructive ambiguity and mixed messages, say one thing and do another and see how it goes. No-one else seems to have any better ideas.

Bill Quango MP said...

One of the biggest shocks I ever received that showed how fragile our pre-1940s life was, was the death of Calvin Coolidge .

“On June 30, 1924 Calvin Jr. had played tennis with his brother on the White House tennis courts without putting on socks and developed a blister on one of his toes. The blister subsequently degenerated into sepsis and Calvin Jr. died a little over a week later.”

This was the President’s very healthy, very fit, very well nourished and clothed boy. He was sixteen years old.
The infection was a pretty common bacterial infection. Nothing special about it.

But it was incurable. Because even the President of the United States could not will into being vaccinations and the future discovery of penicillin. His favourite son passed away. Over an absolutely, nothing infection.

History is absolutely littered with famous people dying from what we regard as inconsequential illnesses. Or crippled by it.
We don’t have to go back as far as Prince Albert’s days and no modern medicine. Franklin Roosevelt was crippled by polio when care and hospitals were plentiful..
The biggest killer in the western world, until the 1930s, was, consumption. Tuberculosis. Killing millions.

The shock for myself, was I only found out about Calvin’s death, because I was reading about the rise of superbugs. And what would happen if we didn’t have penicillin available. It was a frightening thought. That death would come from a bad toenail clipping. Or being caught in a rain shower. Or from fog. Or a fence splinter. The most famous Detective in the world, in the 1850s,Allan Pinkerton, reportedly slipped on an uneven paving slab and bit the tip of his tongue. The resulting gangrene killed him.

On the plus side, this disease, isn’t that. It is taking those who are already going. Or have other issues that would kill very many of them anyway. Or are medically challenged in some way. Surely this is better?
President Coolidge, if he had been able, would have swapped places with his teenage son.

Oh the bad side, all those pre modern-modern medicine deaths were with us for centuries before. And they were, in the main, what made everyday life short and deadly. So we had better hope there is a vaccine. Or some of our modern world, travel and social events, will be over.
Or we will have our own, ‘virus suits,’ like astronauts. Not very appealing.

Nigel Sedgwick said...

Bill Quango MP + 1

Nessimmersion said...

Open up nightclubs, casinos, restaurants and bars to smokers only.
We already know that there is a reduced risk to smokers but not why, so open up to smokers only, non-smokers are still subject to lockdown to limit any possible spread.

Don Cox said...

E M Forster's story "The Machine Stops" gives a vivid picture of a future in which everybody is self-isolated in individual cells, which they never leave. Communication is by Internet, and food is delivered.

It was written in 1909. Strongly recommended if you want to see where we are heading.

Don Cox

Don Cox said...

Forgot the link:

Anonymous said...

Sobers - "30k deaths is nothing more than a bad flu winter. Hell we had 44k excess flu deaths as recently as 2014/15"

Got a source for that? I can't find any. "Excess winter deaths" are the difference between death rate in winter months and death rate in rest of year. This is usually around 26,000. There were 44,000 excess winter deaths in 2014/5, that's an increase of 18,000 on previous years, NOT 44,000, because 26,000 extra people die in an AVERAGE winter.

"Respiratory diseases were the underlying cause of death in more than a third of all excess winter deaths in 2014/15"

Let's say 40% and that they were all flu, that generous maximum estimate gives us 17,600 flu deaths in 2014/5. IIRC it was the year the flu jab targeted the wrong variant.

Bad flu years were 1957/8 and 1968. It's incredibly hard to find UK death figures for those epidemics, and some of the Government reports have vanished from Google Scholar. If anyone can find "Ministry of Health. (1960). Influenza epidemic in england and wales, 1957-58." please shout. However I did find this for 1967/8, the "Hong Kong flu".

"The number of deaths attributed to influenza from December 1967 to March 1968 (inclusive) exceeded those for same period in 1966-7 by 4,444; the excess for pneumonia was 10,595, for bronchitis 6,579 and for all causes 46,408... it is estimated that in the total population of England, Wales and Scotland there was an excess of 1.9 million cases diagnosed as influenza in the period."

So 46,000 more deaths than the previous winter, that would (assuming 26,000 as average winter) mean 72,000 excess winter deaths - which is why we remember the outbreak more than 2014/5. But we have nowhere near 1.9 million diagnosed cases of CV19 (remember the victims of 1967/8 will have been sick enough to be in bed, 1.1 million sick notes were written). We currently have 223,060 diagnosed cases and 32k deaths, imagine 1.9 million diagnosed cases and what that death toll would be.

Management summary - it's not just a bad flu year.