Sunday, May 03, 2020

Boris and his ministers' claims to have “followed the science” don't mean much - They didn't prepare properly, they were careless & they acted too late

It seems all that any member of the UK government has to do to silence criticism of their handling of the virus epidemic is to say “We were following the science. Are you questioning the expert advice of scientists and medical experts?”. This immediately gets the desired “of course not” response from the journalist, like a hypnotist saying “look into my eyes, you are feeling very sleepy” to someone very susceptible.

Nor are Keir Starmer or the Labour front bench ready to bring up such obvious questions as why, with the exception of 200 British citizens who had been in or near Wuhan, most people flying into the UK from then covid-19 outbreak centres like China, Italy and Iran were not put through mandatory quarantine or testing (1) – (2).

The assumption seems to be that to question any expert’s claims or opinions is to commit the unforgivable sin of “populism” and become a demagogue who ignores facts.

This is based on a view of scientific and medical opinion on any subject as always unified, or that the majority opinion among experts must always be accepted. Yet there are often disagreements among experts. For instance on 12th March the UK’s Chief Scientific Officer Patrick Vallance held a press conference along with Boris Johnson in which he explained that the government’s strategy was based on spreading the virus through enough of the non-vulnerable population that they would develop “herd immunity” and not pass it on to those most at risk (3).

This was immediately met with criticism by hundreds of experts . Professor Hugh Pennington later said such a strategy was impossible without vaccines, which are likely a year to 18 months from having gone through enough trials to be proven safe and effective. The response was so negative that it contributed to the government disowning herd immunity and claiming it had never been their strategy (4) – (6).

Yet the Chief Medical and Scientific officers who approved that strategy are seen as beyond criticism. So when they tell us that “there is no evidence” that mandatory quarantine and testing of people flying into the country from countries with outbreaks of it would have slowed the spread of covid-19 we’re meant to accept it without question (7).

The other line used was that it had been tried in Italy and failed. This ignores the fact that air travel is the obvious means by which the virus spread so fast. And that Italy brought in a flight ban too late. Yes, many people with covid-19 will have flown into the UK before we knew about it. So maybe it’s too late to make a difference now. But surely if they’d done it early on, reducing the number of additional infected people entering the country would be a way of at least slowing the spread of the virus until we have done enough trials to find effective treatments and/or vaccines for it?

And every government in the world says it’s basing its policies on the science, yet different countries have very different policies. Sweden has no lock-down at all. The UK still has 15,000 people a day flying in even during “lock-down”, while Singapore banned all flights entry except cargo and humanitarian ones. And the UK has also said it plans to implement quarantine on anyone arriving in the country for the second phase of the virus (8) – (9).

 The UK government’s own advisers even disagreed among themselves on what lockdown measures to take, and opinion polls, as much as WHO advice and numbers of deaths and cases, drove changes in policy in mid-March (10).

Then there are Boris’ speeches – like one on 3rd February in which he said “And in that context, we are starting to hear some bizarre autarkic rhetoric, when barriers are going up, and when there is a risk that new diseases such as coronavirus will trigger a panic and a desire for market segregation that go beyond what is medically rational to the point of doing real and unnecessary economic damage, then at that moment humanity needs some government somewhere that is willing at least to make the case powerfully for freedom of exchange, some country ready to take off its Clark Kent spectacles and leap into the phone booth and emerge with its cloak flowing as the supercharged champion, of the right of the populations of the earth to buy and sell freely among each other. And here in Greenwich in the first week of February 2020, I can tell you in all humility that the UK is ready for that role.” (11).

This sounds like Boris was initially more worried about “over-reaction” to covid-19 harming the economy than he was about covid-19 killing lots of people. The Conservative party from Thatcher on has always prioritised the economy above everything, even when policies based on this actually damaged the economy in practice. Thatcher was strongly opposed to Apartheid in South Africa, not so much because it was racist, undemocratic or morally wrong, but because she saw it as economically inefficient (12).

Add that to the “herd immunity” press conference and the failure to quarantine or test people flying in, and it looks a lot like the UK government’s initial strategy was initially the one it later disowned – “herd immunity” and “letting the virus, as it were, spread through the population” as Boris put it in a daytime TV interview, though he did not explicitly say this was his position, only “one of the theories” (13).

Then, when Professor Neil Ferguson of Imperial College London estimated a worst case scenario of half a million people dying as a result, and the opinion polls on the government’s handling of the crisis didn’t look good,  the government decided it better do something fast (14).

Failures by May’s Government in 2017
– And by Johnson’s in 2020

True the WHO didn’t say covid19 was a pandemic and a serious threat until 11th of March. But epidemiologists had been warning for years that another respiratory virus pandemic like the Spanish flu of 1918 was only a matter of “when and from where?” not if”, especially after SARS , MERS and Swine flu epidemics (15) – (16).

In 2017 the UK Department of Health rejected advice from its new and emerging respiratory viruses threat advisory group (nervtag) to stockpile personal protective equipment (PPE), for all NHS staff, on grounds of cost. Telling them to change the advice to exclude eye protection on grounds of cost (17).

In the same year the NHS held Exercise Cygnus simulating how it would deal with a respiratory virus epidemic The final report was made classified (18). So it is not credible for the government to claim no one could have predicted this. The only parts that were unpredictable were when it would arrive, and where it would start.

And it was no secret to anyone that the Chinese government’s public statements can’t be trusted, nor that big, powerful countries like China have disproportionate influence in bodies like the WHO. China had previously tried to cover up SARS at first too. So any government that didn’t assume the worst case scenario on covid-19 – and that the reality could well be much worse than the Chinese government or the WHO were saying – was being negligent.

This, again, was excessive faith in experts, and in this case experts operating under major political pressures from the bigger members of their organisation.

Graph - Excess deaths are the amount that deaths in a particular week exceed the average number of people who died in that week in the previous 5 years. Many experts believe this is a good indication of the impact of covid-19, though not all excess deaths will be due to it. Source – Sky News report using data from the EUROMOMO project at the University of Copenhagen.

Trump’s accusations against the WHO, while obviously an attempt to distract from his own failures, have some basis in fact. Taiwan had sent experts to Wuhan to talk with doctors there in January. On January 16th they reported that the virus could be transferred between humans. At the time the Chinese government was still claiming it could only be caught from bats ; although a WHO official had told the press on the 14th that given the SARs and MERS pandemic, it would not be surprising if it could be transmitted between humans, and that this may have happened in 41 cases. Taiwan being excluded from WHO meetings also helped the Chinese government give a false impression of the threat level from the virus. (19) – (20)

We shouldn’t ignore experts,  but remember views among experts in the same field may differ. Those in official positions working for governments or international organisations may be chosen for having the views those in power prefer to believe. Senior ranks of some expert bodies may be more politicians than experts, willing to modify their views to keep their position, or rise higher. Then CIA director George Tenet’s assurance to President Bush that proving Iraq had weapons of mass destruction would be a “slam dunk” was one example.

And if opinion among the government’s expert advisers is divided, as we know it has been in the UK, the advice is likely to end up being to take less action rather than more, to get concensus.

True, Boris and the current cabinet were not the government in 2017. But they were the government by December 2019, when we first knew of the virus in China. And in late January, when the UK got its first confirmed case.

A study in the Lancet in early as January 24th warned that the virus could be transmitted between humans, and that the estimated mortality rate of over 3% was similar to that of the Spanish Flu at an estimated under 5%, with both diseases killing so many people because they were so contagious.

On the 31st of April another study in the Lancet said that ‘Therefore, in the absence of substantial public health interventions that are immediately applied, further international seeding and subsequent local establishment of epidemics might become inevitable. On the present trajectory, 2019-nCoV could be about to become a global epidemic in the absence of mitigation. Nevertheless, it might still be possible to secure containment of the spread of infection such that initial imported seeding cases or even early local transmission does not lead to a large epidemic in locations outside Wuhan. To possibly succeed, substantial, even draconian measures that limit population mobility should be seriously and immediately considered in affected areas, as should strategies to drastically reduce within-population contact rates through cancellation of mass gatherings, school closures, and instituting work-from-home arrangements, for example.’ (21)

A summary of the last sentence was tweeted by the editor of the Lancet, Richard Horton, on the same day.

The first confirmed case of covid-19 in the UK had been 2 days earlier on January 29th. No serious measures were taken. A month later on 28th February the first proven case of transmission  between people in the UK. Still no action. The Cheltenham Festival even went ahead in early March (23).

It would be two more weeks before any serious measures were announced. Implementing lock-downs sooner, and making them include more limits on numbers flying in and quarantine of those allowed in, could have contained and slowed the spread of the virus, reducing deaths.

The government claim this would have resulted in people not obeying lock-down measures because some would think it an over-reaction. But New Zealand seems to show otherwise. While its lockdown didn’t come till around the same time as the UK’s, it began it before there were any confirmed deaths in the country – and its public are mostly abiding by it. The government in the UK could have explained the seriousness of the situation at any time by using the Lancet studies and other evidence as back up. They chose not to. It’s hard to believe that Boris’ reckless character and his and his party’s ideological beliefs weren’t a big factor here. It was a huge mistake and many people thought at the time that the government was crazy not to be bringing in more measures sooner (24).

Even on the economic impact the evidence from studies of lockdown decisions by different US cities in the 1918 pandemic is against the idea that there is a trade off between economic impact and avoiding virus deaths. The cities which locked-down soonest and for longest had both the least deaths and the fastest economic recoveries – though most of their lock-downs didn’t last more than 6 weeks (25).

The 1918 pandemic also gives some grounds for hope though. It killed so many people partly due to poor hygiene and not enough social distancing or isolation, especially among patients in field hospitals – things we’re partly avoiding. And the Spanish Flu is thought to have ended not due to immunisation – as it ended before vaccines were available, but because deadlier strains of a virus are less likely to survive as a dead host can’t continue passing the virus on, so evolution favoured mutation into less deadly strains. Might covid-19 do the same? (26)

 

(1) = BBC News 29 Jan 2020 ‘Coronavirus: Britons on Wuhan flights to be quarantined’, https://www.bbc.co.uk/news/uk-51292590

(2) = Daily Mail 22 Mar 2020 ‘Coronavirus chaos at UK borders as flights from Italy, China and Iran - the countries with the biggest coronavirus death tolls - continue to arrive, with up to 7,500 travellers entering Britain in a week’, https://www.dailymail.co.uk/news/article-8139529/Flights-Italy-Iran-China-landing-Britain-despite-UK-coronavirus-lockdown.html

(3) = ITV News 13 Mar 2020 ‘UK's chief scientific adviser tells ITV News he hopes Government's approach to coronavirus will create 'herd immunity'’, https://www.itv.com/news/2020-03-13/uk-s-chief-scientific-adviser-tells-itv-news-he-hopes-government-s-approach-to-coronavirus-will-create-herd-immunity/

(4) = Press & Journal 23 Mar 2020 ‘Professor Hugh Pennington: ‘Herd immunity is a crazy idea, not really supported by any sound science’, https://www.pressandjournal.co.uk/fp/news/politics/uk-politics/2093482/professor-hugh-pennington-herd-immunity-is-a-crazy-idea-not-really-supported-by-any-sound-science/

(5) = BBC News 14 Mar 2020 ‘Coronavirus: Some scientists say UK virus strategy is 'risking lives'’, https://www.bbc.co.uk/news/science-environment-51892402

(6) = Politics Home 15 Mar 2020 ‘Matt Hancock insists 'herd immunity' not part of government's plan for tackling coronavirus’, https://www.politicshome.com/news/article/matt-hancock-insists-herd-immunity-not-part-of-governments-plan-for-tackling-coronavirus

(7) = Telegraph 09 Mar 2020 ‘Banning flights and screening arrivals will not stop coronavirus spread, says Chief Medical Officer’,    https://www.telegraph.co.uk/news/2020/03/09/banning-flights-screening-arrivals-will-not-stop-coronavirus/

(8) = Metro 18 Apr 2020 ‘Flights still bringing 15,000 people a day to UK with no screening’, https://metro.co.uk/2020/04/18/flights-still-bringing-15000-people-day-uk-no-screening-12574861/

(9) = www.independent.co.uk 27 Apr 2020 ‘Self-isolate for two weeks’: What a new government quarantine policy for arrivals to the UK could mean’, https://www.independent.co.uk/travel/news-and-advice/coronavirus-flights-ferries-tests-heathrow-airport-a9484616.html

(10) = New Statesman 01 Apr 2020 ‘The real reason the UK government pursued “herd immunity” – and why it was abandoned’ , https://www.newstatesman.com/politics/uk/2020/04/real-reason-uk-government-pursued-herd-immunity-and-why-it-was-abandoned

(11) = www.gov.uk 3 Feb 2020  ‘PM speech in Greenwich: 3 February 2020’, https://www.gov.uk/government/speeches/pm-speech-in-greenwich-3-february-2020

(12) = www.theguardian.com 10 Apr 2013 ‘How Margaret Thatcher helped end apartheid – despite herself’, https://www.theguardian.com/world/2013/apr/10/margaret-thatcher-apartheid-mandela

(13) = Full Fact 10 Mar 2020 ‘Here is the transcript of what Boris Johnson said on This Morning about the new coronavirus’, https://fullfact.org/health/boris-johnson-coronavirus-this-morning/

(14) = See (10) above

(15) = The Lancet 01 Jul 2018 , Editorial ‘How to be ready for the next influenza pandemic’,
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30364-5/fulltext

(16) = JAMA 09 May 2007 ‘The Next Influenza Pandemic: Can It Be Predicted?’,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504708/

(17) = www.theguardian.com 27 Mar 2020 ‘Advice on protective gear for NHS staff was rejected owing to cost’, https://www.theguardian.com/world/2020/mar/27/advice-on-protective-gear-for-nhs-staff-was-rejected-owing-to-cost

(18) = www.telegraph.co.uk 28 Mar 2020 ‘Exercise Cygnus uncovered: the pandemic warnings buried by the government  ’, https://www.telegraph.co.uk/news/2020/03/28/exercise-cygnus-uncovered-pandemic-warnings-buried-government/

(19) = The Nation 03 Apr 2020 ‘The WHO Ignores Taiwan. The World Pays the Price’, https://www.thenation.com/article/world/taiwan-who-coronavirus-china/

(20) = W.H.O 27 Apr 2020 ‘Timeline – COVID-19’,
https://www.who.int/news-room/detail/08-04-2020-who-timeline---covid-19

(21) = The Lancet 15 Feb 2020A novel coronavirus outbreak of global health concern’, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30185-9/fulltext

(22) = The Lancet 31 Jan 2020 ‘Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study’, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30260-9/fulltext

(23) = Metro 19 Apr 2020 ‘When did coronavirus first come to the UK?’,  https://metro.co.uk/2020/04/19/first-case-coronavirus-uk-covid-19-diagnosis-12578061/

(24) = New Scientist 13 Mar 2020 ‘Why is the UK approach to coronavirus so different to other countries?’, https://www.newscientist.com/article/2237385-why-is-the-uk-approach-to-coronavirus-so-different-to-other-countries/

(25) = www.dailymail.co.uk 11 Apr 2020 ‘How lockdowns could also flatten the 'economic damage curve': Study shows cities that cracked down harder during 1918 Spanish Flu pandemic recovered quicker financially than those that didn't’,  https://www.dailymail.co.uk/news/article-8210647/Study-suggests-lockdowns-economic-damage-alternative.html

(26) = The Conversation 17 Mar 2020 ‘10 misconceptions about the 1918 flu, the ‘greatest pandemic in history’, https://theconversation.com/10-misconceptions-about-the-1918-flu-the-greatest-pandemic-in-history-133994

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