Why we need lockdown and some reasons to be optimistic

As the world comes to grip with the Covid-19 Pandemic I feel called to offer some personal thoughts and reflections.
Like most in the medical profession I have been enormously frustrated by the lacklustre response of the UK government to this crisis and so the recent tightening of controls is something that we must embrace, even if it causes inconvenience.

Worse than ‘flu?
First, though, I want to answer the question recently put to me by Peter P: ‘What makes this infection so much worse than influenza?’
• It is more infections than ‘flu. Each person with ‘flu can be expected to infect about 1.5 other people. Each person with Covid-19 is expected to infect about 2.7 other people.
• It is more likely to kill you if you catch it.
• It has a longer incubation period. Typically the symptoms of ‘flu appear about 2 days after being infected. Then, because you feel unwell, you are likely to stop mixing with other people. Covid-19 has an incubation period typically of around five days but it can be up to fourteen days or even more. All that time you can be spreading the infection, even though you do not know that you have been infected.
• We do not have any immunisations against Covid-19.

How have we done so far?
Why has the response of the UK government been so disappointing.?
By the time Covid-19 reached the UK we could already see the results of different approaches in China, S. Korea, Singapore and Italy. Within weeks we could also see what was happening in Spain, Germany, Sweden and Norway.
Perhaps we should not have been surprised that a government with a ten year record of running down public services, and in particular the NHS should have let us down, but the response has been so inadequate as to give credence to the allegations that “Do nothing” was a deliberate policy.
The Sunday Times carried a story that suggested that it had been deliberate government policy to allow more people to get infected with the New Corona virus. It was claimed that Dominic Cummings had promoted a policy of ‘herd immunity, protect the economy, and if that means some pensioners die, too bad.’ It might be added that No 10 (does that mean Dominic Cummings himself?) vigorously denied the story saying that it contained invented quotes.
However, it may matter little whether it was deliberate policy or incompetence. After the first few cases when contact-tracing, testing and isolation was effectively pursued standard Public Health practice seems to have been abandoned.
Unlike S. Korea, where contact tracing and testing were rigorous and effective, the UK repeatedly failed to test and failed to trace and isolate contacts. When a government minister developed Covid-19 after attending a meeting at 10 Downing St we were told that other ministers would not be tested. NHS staff who had been in contact with Covid-19 were not tested, and we are still getting reports of ill patients, seen and treated in Accident and Emergency Departments who are being sent home without testing. To compound the problems with inadequate testing and a failure to trace and isolate contacts our front-line NHS staff have been expected to treat patients without adequate personal protective clothing.

So what changed?
What persuaded our reluctant government to change track? I would like to think that it was down to my tweet:
“Compare Norway, Sweden & UK.
Norway, tests and lockdown: 7 deaths i.e. 0.3% of cases.
Sweden, a bit lax: 21 deaths i.e. 1.1% of cases.
UK, even more lax: 281 deaths i.e. 4.9% of cases.
Lesson is stark: lax policy kills.
UK needs to wake up. #SocialDistance #Selfisolate”

Somehow I think that it might be more to do with a paper from Imperial College which modelled a number of responses to Covid-19. The authors pointed out that the ‘Do nothing’ or Dominic Cummings policy would mean half a million deaths and a demand for critical care beds that was at least thirty times the maximum number of beds available. About the only thing to be said for such a policy is that it would all be over in about six months: by that time would would all either be dead or immune. By announcing some rather half-hearted attempts to reduce social contact the government claimed that they would save 250,000 deaths.

In this as in most of the announcements that followed the UK government seems to have followed rather than lead public opinion. They announced the closure of schools after many schools had had to close, or partially close. They announced that public sports events should not go ahead after the FA had already cancelled all major football matches and Formula 1 races had been cancelled. They asked people not to go to pubs, but did not make it mandatory, thereby leaving licensees in an impossible position: unable to claim on Business continuity Insurance, but without any income.

The UK’s Westminster government is rather like the Duke of Plaza-Toro in the Gondoliers:

In enterprise of martial kind,
When there was any fighting,
He led his regiment from behind —
He found it less exciting.
But when away his regiment ran,
His place was at the fore, O —
That celebrated,
Cultivated,
Underrated
Nobleman,
The Duke of Plaza-Toro!

The Imperial College paper modelled the likely outcomes in terms of number of cases, severe cases sufficient to warrant admission to Intensive Care Units and deaths across a number of options. They looked at Case isolation in the home, Voluntary home quarantine, Social distancing of those over 70 years of age, Social distancing of entire population and Closure of schools and universities. Only by adopting all these measures would we keep the demand for Intensive Care beds within the maximum possible provision of such beds.

Still the government delayed and was only after interventions by a string of Public health experts that they announced the “lockdown”. Even now we have conflicting and confusing advice coming from different cabinet ministers, or even from the same cabinet minister at different times.

What happens after lockdown?
The Imperial College paper carries good news and bad on this. They suggest that as soon as the social distancing measures are relaxed Covid-19 numbers will start to surge at the same rate as they were at the beginning of the epidemic. They suggest that we would therefor have to continue some sort of social distancing for 12-18 months until large quantities of vaccine are available. Their good news is that by switching on and off the most onerous aspects of social distancing in response to the numbers of patients in Intensive Care we would only need such lockdown policies in place for about two thirds of the time. All other scenarios were worse.

My additional good news.
The Imperial Paper is based on mathematical modelling and cannot reflect everything in the real world. They acknowledge that they are only looking at “non-pharmaceutical interventions” i.e. they are ignoring the possibility that we may find some drugs that will modify the course of the illness and avoid or reduce the need for intensive care. There is also a major unknown around asymptomatic cases. It is suggested from the Italian experience that there may be as many as ten times as many asymptomatic cases and cases with symptoms. This could explain partly why it has been difficult to prevent the spread of Covid-19 but it would also mean that each time we relax the lockdown there will be more immune people in the population. The caveat in this is that RNA viruses are very liable to mutate, and we cannot know if future mutations will be more or less virulent or whether there would be cross immunity from one version to another.

Hold onto this one.
The ultimate good news for all of us is that we can avoid the distressing chaos seen in China, Italy and Spain (where ill patient were lying on the corridor floor of a hospital, untreated and coughing). But we can only do this if we all follow the Social Distancing guidance. Let us hope that our government’s dilly dallying has not delayed the start of the lockdown until it is too late. Let us also hope, and ask, that those who know and understand these issues continue to speak out so that The Duke of Plaza-Toro knows who to follow.

 

PS
An excellent letter from Professor Allyson Pollock in the British Medical journal.
Covid-19: local implementation of tracing and testing programmes could enable some schools to reopen BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1187 (Published 24 March 2020) The full letter is behind a paywall, but among the points she makes are:
• Tracing and clinical observation of contacts, isolation, and quarantine are the classic tools in public health to deal with infectious diseases.
• Rapid and effective contact tracing could reduce the basic reproductive ratio from 3.11 to 0.21—enabling the outbreak to be contained. (This means that each infected person would infect less than one new person, whereas now they are spreading the infection to more than three people: hence the rapid spread.)
• public health (doctors) in local authorities say that they have received very little information. This, combined with the devastating cuts to community based communicable disease control and the changes wrought by the Health and Social Care Act 2012 (which carved out public health from health services in England and then further fragmented communicable disease control by removing it to Public Health England) have created a perfect storm.
• Even now it is not too late to institute effective contact tracing on those parts of the country where there are still relatively few cases.

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The Last Dying Days of Brexit?

One day someone wiser than me will catalogue all the errors made by politicians in this whole Brexit debacle.
David Cameron promised his warring Party that he would call a referendum fully thinking that he would not win an outright majority in the 2015 General election.
He called the referendum fully thinking that Remain would win.
From there on error compounded error.
A simple yes/no poll was allowed when most organisations would expect either repeated votes or a two thirds majority before undertaking major constitutional change.
There were major breaches of electoral law and campaign expenditure. It is also pretty clear now that there was also foreign interference.
It is a sad irony that if the referendum had been mandatory then it could have been overturned because of the law-breaking, but as it was only advisory that did not apply.
Despite the clear position that the result was only advisory, Theresa May has apparently been determined to carry it through whatever the cost to the UK, or anyone else.
The Prime Minister triggered Article 50 without having a clue what sort of deal she would get, or even what she wanted.
The government sent a continuous succession of incompetent ministers to negotiate on our behalf.

At the eleventh hour it seems that both the country and its politicians are drawing back from this massive act of self-harm. A large march will promote the modest and reasonable request for a second referendum. And in less than 24 hours over a million people have signed a petition to revoke Article 50.

At the time of writing I have no idea what will happen, nor I suspect does anyone. What is certain is that whatever the outcome, those who promoted the proposal that the UK should leave the EU have done enormous and permanent damage to the economy, the reputation and the social cohesion of our country.

The Death of Europe, or just the UK?

You can drive a car with three wheels, but why would you?

 

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A slice of Agricultural History

The air was fresh at 12 ºC and a gentle cool breeze was blowing, but the skies were clear blue and the warmth of the sun surprisingly strong for the time in the morning.

The Fête de la moisson was set to last most of the day and a large field near the edge of the village would accommodate both the fête and a car park. Noticeable by its absence was any attempt to squeeze money out of the visitors. Yes, there were stalls selling home made honey, olives, walnut oils and crafts made of wood or lace; but one of the most spectacular displays of sculptures made from scrap metal seemed to make no attempt to sell anything to anyone. The whole show was free, and reflected a pride in local French farming history.

There were old tractors, some in immaculate condition and some obviously in full working order, but mostly they seemed to act as props for excited children to climb and have their pictures taken. There were cutters, binders and old balers. Some of the equipment was belt driven, and I had seen similar items in agricultural shows in Britain, but there was also an awesome wooden baler that compressed straw using a series of levers and ratchets and was powered only by three men, all wearing what seemed to be the agricultural worker’s uniform of white shirt black hat and trousers with braces.

A number of events reflected the local importance of forestry. There were two man saws. One of these involved strapping a tree trunk on a frame so that it pointed up at an angle of 40º. One of the men climbed high up onto the log while his mate stood on the ground below. They then proceeded to cut the tree trunk along its length, and incidentally towards the feet of the man balanced on the log. A rather more conventional two man saw was available of anyone to try and a small queue developed as anyone from about five year upwards had a go at sawing off a slice of wood.

Next along a couple were cooking lardons. Their fires consisted of a two logs standing on end. The middle had been cut out, and a slot made near the bottom to allow air entry, then they set fire to the middle of the log. It would have burned for hours, and indeed did burn for three or four hours before being dowsed with water.

Running along the whole of one end of the field was an open sided tent with a long table running from end to end. There they served a hundred or more meals: all the same, four courses for 14€. We did not stay to eat, nor did I try to throw a bale of straw three metres up in the air, but I enjoyed the atmosphere, enjoyed the pride in country skills, in simple food and in local heritage. I enjoyed the pride that I felt in being part of it all. I may speak a different language, but I am a part of the same humanity and I share so many of the values shown at the show. I am proud to be European.

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Is another war inevitable?

I want to start with a quote:
“Every modern state is governed by the privileged, that is, by those who control industry by owning railroads, lands, mines, banks, and credit. These men thus obtain enormous and unearned capital, for which there is no use in the country where it is produced, because the poverty of the workers limits the home market. Those who control this surplus capital must seek new countries and new people to exploit, and this clash of selfish interests leads to war.”
… and to ask you “When do you think that was written?”

But first I would like to consider the idea and whether it has any lessons for us today.
Few will need convincing that wars are often fought over resources: access to resources themselves or access to trade in resources. Some examples are obvious. The Opium wars, the First Anglo-Dutch war, the Battle of Plassey when the British consolidated their hold on India, the Finnish-Soviet War over Nickel and Iraq’s invasion of Kuwait were all over resources directly or the right to trade in resources. Others are less obvious. Many would say that the American War of Independence was about taxation and votes, but control of trade routes was of key importance, and that is why the French joined in on the side of the Americans. The American Civil War was at least partly about slavery, but cotton was central to the dispute between the northern states and those in the south who used slaves to grow it. When Germany invaded Russia in the Second World War it was largely to gain access to Russian and Ukrainian oil and grain. (References 1, 2, 3 )

Next we might consider the effect of giving more money to the rich as opposed to giving it to the poor. Trickle-down economics has been roundly discredited. This excuse put about by the wealthy for being allowed to acquire even more wealth has been demolished by Nobel Prize winning Joseph Stiglitz, and the IMF (Causes and Consequences of Income Inequality: A Global Perspective. 2015) among others.
If you want more evidence for the damaging done of inequality there is a wealth of information and statistics in the excellent book The Spirit Level by by Kate Pickett and Richard Wilkinson.

Now let us consider whether the allegation that we are governed by the privileged stands up to scrutiny. Consider the educational backgrounds of cabinet ministers. Consider the revolving door between government service and work in “the City”. Robert Peston has written a book on the rise of the ‘super-rich’ called Who Runs Britain? How the Super-Rich are Changing Our Lives . For a wider look at the way money buys power and influence and the way the UK is governed by a small coterie of very rich people who are either directly in government or buy influence with the government I suggest Donnachadh McCarthy’s book The Prostitute State. Then consider, perhaps, how New Labour surrendered so many of the traditional Labour Party values when they sought the support of Rupert Murdoch and big money in ‘the City’, or the  way Nick Clegg fitted in with his Tory coalition partners to the distress of traditional Liberal Democrats. All in all, it would seem to me that the case is made; Robert Peston is right: Britain is ruled by the super-rich.

It is now time for me to answer my own question. The quotation that I started with was written to the President of the United States, Woodrow Wilson, by his friend George L. Record in 1919. He was criticising the settlement in Europe post World War I. He suggested that another war was inevitable. As we all know it was only twenty years until his (and President Wilson’s) worst fears were realised.

So, now let us look again at the decision of the UK to leave the European Union. Despite all the undoubted economic gains, the cultural and scientific advantages, the benefits to the environment and the advantages in pursuing criminals and terrorists across borders, the greatest benefit of the EU has been the prolonged period of peace in Europe. When I think of the improved employment and maternity rights promoted by the EU, the presence of workers on company boards in Germany or the experiments with a universal income in Finland it seems to me that the EU has to a limited degree promoted a more egalitarian society than has been traditional in the UK. When I think of the wealthy politicians and newspaper proprietors who persuaded British voters to vote for Brexit, I find myself wondering if they were finding the EU too egalitarian for them.

Was the key interest of those who promoted leaving the EU a desire to de-regulate, to strip away workers rights, to remove regulations relating to food hygiene and animal welfare with the ultimate objective of increasing further their own dominant wealth?

If that is true and George Record was right then the UK is set on a path of inevitable conflict with other countries. The prospects for the future peace of Europe do not look good.

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My Cassandra Moment

Sometimes I feel a bit like Cassandra, remember her? She was the lady blessed with the gift of prophesy and the curse that no-one would believe her.
Today’s “news”:
1) Owen Smith warns that the Conservatives have ‘secret’ plans to privatise the NHS.
2) Some people have been taking too much money out of their pension pots.
On 1) I have been campaigning against the privatisation of the NHS for years. I successfully took an amendment on the subject to the Liberal Democrat National Conference in 2008. That was when Owen Smith’s New Labour colleagues were at it. And I fought hard against the Lansley sponsored Health and Social Care Act of 2012, a bill that was shamefully supported by Nick Clegg, Paul Burstow and Norman Lamb.
On 2) it was obvious (and I said so) that when the government allowed people to take out the capital from their pension funds some would leave themselves without an adequate pension. If you tell someone who feels poor that their pension fund is worth £100,000s some will be tempted to get their hands on it without realising that they will need that if they live another 30 years. It all seems rather cynical when one considers that those who have accessed funds in this way pay tax at their top rate.
In a rare departure from good sense Steve Webb even said he was quite happy if people drew out their pension funds and bought a Lamborghini.
So do you want to know what disasters I am predicting today?
No you don’t because you won’t believe them anyway.

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You can drive a car with three wheels, but why would you?

I have come to realise that I mustn’t go on beating myself up about the result of the EU referendum vote. If I spend all my time agonising about the prospect of the UK leaving the EU, or reading articles by other people who are agonising about it I shall make myself ill.

It is time to look on the bright side. There must be some good that could come out of it. Don’t get me wrong, I still regard the prospect of our leaving the European Union with great concern. I still believe that such a move will reduce jobs and trade, reduce our influence in Europe and the world and put up the cost of living in the UK. But we shall survive. It feels as though someone has removed a wheel from our motor car. You can drive a car with three wheels. They used to make three-wheeled cars, but they have less space and less grip, they are less stable and you can’t avoid potholes.

Three wheels anyone?

Three wheels anyone?

So you can drive a car with three wheels, but why would you when you could have a car with four.

But, and here comes the good news, I have found a bright spot to cheer myself up; and perhaps, I hope, to cheer you up a little too.
For many years I have argued that the world would be a better place and a safer place if it were more equal, just as this country would be a safer, happier and better place if it were more equal. Others have put the case in great detail and with greater authority than I can, but a good place to start would be by reading ‘The Spirit Level’.
When I was discussing ‘Brexit’ with an American lawyer friend he said:
“Oh, I don’t know, it won’t be too bad, we shall just see the managed decline of the UK which has been going on for a hundred years or more.”
I realised that he is right. In global terms Britain has been declining in influence, power and wealth for many years. With the loss of empire and the loss of status of Sterling as a world currency, with the loss of food production, motor manufacturing, white goods and television sets, Great Britain is not as great as we used to be, or perhaps as we used to think we were.
Maybe in global terms that is no bad thing. As fuel becomes more expensive and our disposable wealth falls we shall learn to use less oil. In global terms that would be no bad thing. The tricky thing about equality is persuading the wealthy that they need to reduce their wealth a bit and that in so doing they will benefit everyone. So maybe the continuing managed decline in UK PLC is no bad thing. Maybe the loss of some of the finance sector to Paris and Frankfurt would be no bad thing.

So we need to cheer up. The world will not end. We shall be poorer, but maybe, just maybe, the world will be a little bit fairer.

Some challenges remain of course. If the managed decline of the UK makes the world a fairer place, what do we need to do to make the UK a fairer country? That is a massive challenge, and with the current state of our political parties I am not sure how we do it.

There is also the challenge of social cohesion and peace on our streets and in our communities. We have seen how the intemperate language of politicians has permitted (I would say ‘encouraged’ but you may feel that that is going to far) a rise in hate crime and racism. We can all play our part in standing up to this dangerous inflammatory behaviour. Do not remain silent. Do not nod your head or walk by on the other side of the road. We must all speak out when we see intolerance, discrimination or hate raising its ugly head in our communities. This, I acknowledge, is a massive challenge and others may have more to offer on the subject than I can.

And so, Dear Reader, Cheer up and Good Luck.

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We needed a revolution, but not this one

It feels as if I am waking from a nightmare; a nightmare where we have turned out backs on our friends, we have turned our backs on cooperation over trade, culture, science, care of the environment, security and the control of crime. We have turned our backs on our neighbours. Worst of all we have turned out backs on an organisation that has promoted peace and the peaceful transition of totalitarian states to democracies.

And then I wake and realise that it was not a dream, we are living that nightmare.

I promised to come back with some thoughts on the outcome.

Some commentators, in an attempt to appear balanced have criticised the lack of honesty in both campaigns. The remain camp were accused of scaremongering. They said the pound would fall and the value of shares would fall. They said that the financial credibility of the UK would suffer. All three things happened. In addition we have plenty of anecdotes of small businesses and creative projects suffering either because EU grants have been withdrawn or customers from France and Germany have disappeared.
Some of the claims made in particular by the Chancellor seem to have ben exaggerated. He threatened us with an emergency budget that would need to increase taxes or cut spending. That has not happened yet.

The Leave campaigners promised an additional £350 million to the NHS.   Despite being

False promises to the NHS

What lies at the centre of the Leave Campaign!

challenged repeatedly over the figure itself (a large chunk of the notional £350 million is never sent to the EU at all, and even of the amount sent a large proportion comes back to the UK in grants) the leave campaign continued to make it a central plank of their campaign. It is perhaps of note that they also promised to spend that money on Cornwall and the regions, on farmers, on scientific research and on removing VAT

Iain Duncan Smith claims he never promised money to the NHS

Iain Duncan Smith claims he never promised money to the NHS

from domestic fuel bills. They now acknowledge that such promises were ‘a mistake’.
They promised to control immigration. They talk of a points system, which we already use for non-EU immigration. They said that we would never reduce net migration to below 100,000 if we stayed in the EU, conveniently ignoring the fact that we already have 180,000 non-EU immigrants, and they were claiming that in a post-Brexit UK migration from outside the EU would be easier. They now admit that they will not and cannot deliver this.
They claimed that Turkey was just about to join the EU and that millions of Turks would flood into the UK.
They promised more fish for fishermen. That too seems to have been a chimera.
And Lastly, they promised that the people of the UK would take back control, would return sovereignty to a democratic government in the UK from a non-democratic one in Europe.
Almost every part of this assertion is false.
The UK like every other State in the EU is already a sovereign State.
The System of government in the EU, whilst a little complex is notably more democratic than that of the UK.
And far from giving control to the people of Britain we seem set to transfer the reins of power from one product of Eton, Oxford and the Bullingdon Club to another one.

Before I move to what might come next, there are two more predictions that, sadly, have come true.
Scotland does not wish to leave the EU. If the Scots’ wish to remain part of the EU is stronger than their wish to remain part of the UK we shall see the break up of the united Kingdom.
The second thing is even more sinister. We have seen, as predicted, a rise in hate-crime, xenophobia and rascism. After months of politicians talking about threats and possible violence some of the basest instincts of our compatriots have been released. Some of our citizens seem to have been given permission to give expression to their nastiest feelings.

If I now talk of dire threats and possibilities it is not because I believe or know that these things will happen, but because I believe that these things might happen, that history should teach us how to avoid making desperate mistakes, though history, alas suggests that we are poor learners.

I have made much of the EU as an organ of peace. No-one claims that the EU is perfect, but while we talk we do not fight. No-one would claim that all the nation states of the EU will always have nice liberal governments, but while the EU exerts a moderating influence the risks of extreme governments of either Right or Left is greatly reduced. The existence of the EU does not prevent one of the European Nations electing an extremist leader, but it would prevent such a person abolishing the democratic institutions of their country and setting up a dictatorship and it would almost certainly be able to contain or limit extremist behaviour. To put it in stark historical terms: the EU would not prevent a country electing another Hitler, but it would prevent him setting up a dictatorship and declaring war on his neighbours.

So what might happen?
We might see the collapse of the EU. There are other break-away groups would would love to hold referenda in their own countries.
We might see the rise of extremist far right governments.
We might see the rise of extremist far left governments, though I suspect that that is less likely.
We might see Russia flexing its muscles more aggressively and with Europe in disarray we would be less likely to stand up to such threats.
We might see the the rise of the far right in the UK, particularly as those who thought that Brexit would bring jobs and homes to everyone.
We are almost certain to become poorer as a country.
If we continue to have neo-liberal governments such as those of the last thirty years there will be a continued run down in public services, with Health and Welfare the first to go.

This contest, like all wars of the past has been fought with the lives and livelihoods of the poor to satisfy the ambitions of an elite. The ambitious politicians have played the same game as ambitious politicians for thousands of years. They have encouraged to poor to blame all their difficulties on the even poorer. The gap between the rich and the poor in Britain has been widening. Instead of the obvious explanation (that the rich are taking from the poor) somehow the elite have managed to peddle the myth that the poor of Hartlepool are poor because there are starving, homeless Syrians.

inequality

The Rich are getting richer, while the poor pay the price.

I shall leave you with two maps and a plea.
First a map of where the UK voted to leave.
Secondly a map of the ten richest and the ten poorest areas in Northern Europe.
And the plea? We have done a monumentally stupid thing. We must now all be constantly on oug guard against extremism, against hate-crime, and against simplistic attempts to blame ‘the other’ for our own misfortunes or disappointments.

Votes by region

Eu Referendum results

 

Rich and poor in Northern Europe

Rich and poor in Northern Europe

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