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Resolving the COVID-19 crisis in the UK

The UK has the ninth worst death rate (per head of population) from COVID-19 in the world at 120 per 100,000, and this is the third worst of the 20 most affected countries (Johns Hopkins, 9 January 2021; just behind Italy and Czechia); the total number of deaths (within 28 days of a positive test) now being more than 80,000 BBC, 9 January 2021). More worryingly the number of new cases remains around 60,000 despite the recent partial lockdown, and deaths per day are currently over 1000 (UK Government, 9 January 2021). Furthermore, the number of deaths is likely to rise rapidly perhaps to around 2000 a day in a fortnight as the effects of the recent surge in infections work their way through over-stretched hospitals.

None of this need have happened if:

  • the UK government had acted with leadership, foresight and wisdom over the last year; instead it has always acted too little and too late, often with calamitous mis-judgement (see critique of the government’s failures written in April 2020); and
  • more people had responded to the crisis responsibly and wisely, caring for others as much as they did for themselves, and not trying to push the boundaries of what limited restrictions the government had put in place.

What little we know, but what we should have acted on

It is remarkable how much we still don’t know about COVID-19, despite all of the valuable research that has been done such as the creation of new vaccines and the discovery of treatments that can reduce death rates of the most seriously ill. However, we do clearly know enough for the UK government to have acted very differently over the last year. Among the most important things we do know are that:

  • Countries that rapidly put in place comprehensive lockdown measures and keep them in place until the number of remaining cases is very low, have not only had lower overall mortality rates, but their economies are also recovering more quickly. The UK government has consistently gone into lockdown (or restrictions) too late, eased lockdown too early, and has never therefore got on top of the coronavirus. Particularly stupidly, the lockdown in November-December 2020 was nowhere near strict enough, and was foolishly eased in the anticipation that people could see their families over Christmas.
  • Many countries with a history of using masks (such as China, including Hong Kng and Macau) or that have made them mandatory (such as Malaysia and Vietnam; but also many African countries) have been able effectively to limit or reduce infection rates. Much of the debate around mask use has been because of unwarranted confusion about whether masks reduce the chance of the wearer catching COVID-19, or of this actually protecting others (see my post in March on Face Masks and COVID-19). Selfish, individualist societies, where people care much more about themselves than about others and therefore don’t wear masks have generally suffered badly from COVID-19.
  • The fetishisation of the R-number has caused unfortunate misunderstandings and led to many more deaths than would have otherwise been the case. The UK government has seemed to place inordinate emphasis on the reproduction number (R = the average number of secondary infections produced by a single infected person), rather than on the actual numbers of people dying. R is obviously important, but there is a huge difference in impact between a higher R number when total infections are low, and a lower R number when infections are high. Many more people in the short term are going to catch the infection (and die) when thousands are already infected even with a R-number well below 1, than will catch it if only a few people are infected and the R number is 2 or 3. This is crucial, because the government should have done much more to reduce new infections in the summer to virtually zero, and should have acted much more quickly in October when numbers started to rise again (lessons should have been learnt from the experiences of Australia and New Zealand).
  • Too much reliance was placed on digital technologies. It is remarkable how the much-lauded NHS app (in its various incarnations) is now never mentioned by the government. Moreover, it was very expensive: in September 2020, it was estimated to have cost more than £35 million. The entire UK test and trace service has been a catalogue of disasters, but the expenditure on an app that was meant to be a silver bullet was truly misplaced, and the only people to have benefitted were the companies involved in developing it! As many people warned, digital technologies are invariably a solution in search of a problem, and the failure of previous digital initiatives should have been a clear warning to the government.
  • Islands have a clear potential advantage in protecting their inhabitants from COVID-19. The UK has very clear borders that are relatively easy to “protect”, unlike so many other countries in Europe, and yet it has been very tardy in introducing restrictions for those croissing its borders (either way). Island states, especially New Zealand (only 25 deaths) and Iceland (only 29 deaths) with wise governmetns have been able to ensure that infections and deaths have been kept to a minimum by imposing very strict controls. Thus New Zealand specifies unequiovocally that “All people entering New Zealand must go immediately into managed isolation or quarantine facilities. They will remain there for at least 14 days and must test negative for COVID-19 before they can go into the community”.
  • People respond to clear and simple messages, when they are delivered by trusted leaders. Unfortunately, the UK’s blustering leadership has prevaricated and vastly over-complicated the messages to those living in the UK during the pandemic. Things were made far worse, and trust evaporated, when Dominic Cummings did not resign following his breach of COVID restrictions in May 2020, which made many people in the country think that there was one rule for those in power, and another for everyone else. With confused (and weak) messages, alongside a growing belief that it was alright to tweek the rules a bit, it was scarcely surprising that so many people failed to act responsibly in the latter part of 2020 when COVID-19 ran out of control.
  • It is not the new variants that have caused the recent dramatic rise in infections; it is people’s behaviour. Put simply, if everyone focused on protecting others from catching COVID-19, then regardless of the variant the number of infections would be minimised. Yet the government and news media persist in “blaming” the new variant for the recent dramatic increase in infections, which gives completely the wrong message to people. It is high time that we were open and honest about the fact that these recent very high infection rates have been caused primarily by people’s behaviour in December; if people were not giving the infection to others, then there would be no way that these others would catch COVID-19 – regardless of how infectious the variant is. We need to realise that perhaps one-third of infections are asymptomatic, and therefore that many people who feel perfectly well are probably giving COVID-19 to others.

What we should have done; but it’s never too late to take action

Based on the above, it seems fairly clear what the government should have done, but didn’t. This is not that dissimilar to what wise voices were saying back at the start of the pandemic (see my list in April of questions tbe government still needs to answer over its failures). Neil Ferguson and his team’s modelling back in March, although decried by some not only at the time but also subsequently, does indeed seem to have been quite an accurate prediction of what was going to happen, particularly as far as a second wave was concerned and especially given the lack of knowledge at the time about the precise dyamics of COVID-19. Anyone who read that March paper should have been left in no doubt that we were going to see at least 80,000 deaths from COVID-19. Those who argued vociferously and publicly otherwise should acknowledge their mistake and share some of the responsibility for the subsequent national vaccilation about the direction in which the pandemic was heading. We are already past this level, and many, many more are sadly going to die. Each one is a tragedy for their families and those cloe to them. There are absolutely no excuses for ayone saying that they were not aware of how serious the scale of the pandemic was going to be in November 2020-March 2021.

The creation of vaccines to counter the effects of COVID-19, as well as better treatment protocols identified over the past year, provide some hope for the future. However, drawing on the above evidence, the government still needs to take further steps immediately if the UK population and economy are going to be able to reduce the scale of suffering and damage that it has already caused. The following would seem to be wise actions (in approximate order of priority):

  1. Lead rather than react; be ahead of the pandemic. The Government must take control of the situation, and show real and decisive leadership in tackling it. All too often the Prime Minister and his cabinet have dithered, and as a result failed to protect the British people. If tighter restrictions had been in place in December, there wouldm have been many fewer than the 417,570 people tested positive in the last seven days. They should have known and planned for the scale of what has happened. They are culpable for their failure.
  2. Much tighter restrictions should be placed on personal mobility immediately, and they should be kept in place until the number of new infections is in hundreds rather than tens of thousands. This is likely to be a minimum of six weeks and possibly much longer, regardless of the hopefully positive effects of the vaccinations. The long term economic impact of COVID-19 would be far less severe with a shorter sharper lockdown than it will be if the government continues to try to pursue its on-off policy while maintaining relatively high levels of infection.
  3. Face masks should be made compulsory for all people both outdoors and indoors at all times (other than in a person’s own home). This should apply to those jogging, running or cycling, as well as to those just walking. Sanitation points should be made freely available in all workplaces, shops, bars/restaurants and entertainment areas.
  4. All people arriving in the UK should be required to show evidence of an appropriate negative COVID-19 test within 72 hours of arrival. As an island, the UK has the advantage of being able to manage its borders, and it needs to do so effectively so that additional infections are not brought into the country, especially of the inevitable new variants of COVID-19 that will emerge. It would also be a great gesture of our national care for others if we insisted on everyone leaving the UK also being tested.
  5. The vaccination programme must be delivered effectively and efficiently. In general, the priority system seems broadly appropriate, but insufficient priority has been paid to those aged over 90, staff working for companies that provide care at home for the elderly, as well as GPs and other medical staff (all of these should be in the highest priority category) and indeed teacher. With 46,000 healthcare staff off work, an already over-stretched NHS has become even less able to manage the impending crisis. This is unacceptable carelessness on behalf of the government. Moreover, the vaccination policy and practice needs to be very much more transparent than it currently is.
  6. A really efficient and effective test, trace and control system must be put in place once the number of new infections has reached less than 1000 a day. It is impossible for testing and tracing to work effectively with the level of infections that we now have. However, for longer term viability and success, once numbers have reduced to a manageable level (as they were for much of the summer of 2020) it is critically important that we have in place an appropriate and high quality epidemic montoring system that can prevent COVID-19 and its successor pademics from catching hold.
  7. We should put in place now mechanisms to ensure that effective control against COVID-19 is in place for the latter part of 2021. This must ensure that sufficient vaccines are in place (preferably of the Oxford-AstraZeneca vaccine) for GP surgeries to deliver them effectively as they have done for may years with the annual influenza vaccine over the next year, and indeed in future years as well.

Each of these seven action points could have easily been put in place by the government during the summer and early autumn of 2020. It failed to do so and is therefore culpable for the excessive numbers of deaths that we are now seeing. It seems that Johnson, his advisers and senior ministers all seemed to prioritise a focus on getting an easy deal done over post-Brexit trade and relations with countries in the European Union, and therefore took its collective eye off the COVD-19 ball.

It is, though, not just the goverment’s fault. Everyone who has given COVID-19 to someone else is also partly responsible. We should not have needed the government to order us what to do. Surely, knowing what we do about COVID-19, we should all have acted reponsibly and wisely by limiting our personal contacts as much as possible. It is self-evident that we have failed to do this. We can, though, all make a difference now. Wherever we can over the next two months as many as possible of us should choose to stay at home. It only needs one contact to start a new chain of infection. Sadly, trying to circumvent the regulations that have been put in place seems to have become a national pastime; perhaps this is Dominic Cummings’ lasting legacy. Any excuse for not adhering to them seems to be acceptable to the person making it. In part this is again the government’s fault. Why on earth, for example, was “local area” not defined when the government permitted outdoor exercise within it? For one person it is somewhere within a 30 minute drive; for another it might just be within walking distance of home. However painful it is, we all need to act even more responsibly than we did in March-April. I hope Chris Whitty (the UK’s Chief Medical Officer) is right when he said on BBC Radio 4 this morning that we are at the peak of the outbreak, but I fear he is not. Given the very large number of new infections that we are still having, death rates are bound to increase further for at least two more weeks. At least Matt Hancock said yesterday that “every time you try to flex the rules that could be fatal“; such a shame that this message has not been clearer from the government before. We, the people, need to act where the government has failed. We can make a difference, but we need to care for each other more than we do for ourselves – as the brilliant staff in our NHS strive to do every moment of every day.

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Questions the UK government must answer over Covid-19

Downing Street

Downing Street, London

With the UK now accounting for about 10% of global deaths from Covid-10, many of my friends from overseas keep asking me why the UK seems to have suffered so badly from the new coronavirus.  As of 23rd April, we had the fourth highest number of deaths as a ratio of total population of any country in the world (at 28 per 100,000), behind Spain (at 47 per 100,000), Italy (at 42 per 100,000), and France (at 33 per 100,000).  My previous posts on Data and the scandal of the UK’s Covid-19 survival rate (11th April) and Face masks and Covid-19: communal not individual relevance (29th March) go part of the way to explain why this is, but they do not fully take into account the increasing amount of evidence that the government has not sufficiently explained, and I thought it might be helpful (at least for me) to try to pull this together into a straightforward list of the key issues (in broadly chronological order):

  • Why did the government not take action following Exercise Cygnus in 2016, and why has it not made the information about this publicly available?  As I have commented before, this exercise  “was undertaken to simulate the impact of a major flu pandemic in the UK. The full conclusions have never been published, but sufficient evidence is in the public domain to suggest that it showed that the NHS was woefully unprepreard, with there being significant predicted shortages of intensive care beds, necessary equipment, and mortuary space”.  The government has also refused to respond to a freedom of information request about this as recently reported in The Guardian (26th April)
  • Why did the government fail to act on warnings in 2019 that we were unprepared for a pandemic? The Guardian (24th April) has also reported that in a leaked document “Ministers were warned last year the UK must have a robust plan to deal with a pandemic virus and its potentially catastrophic social and economic consequences in a confidential Cabinet Office briefing leaked to the Guardian.  The detailed document warned that even a mild pandemic could cost tens of thousands of lives, and set out the must-have ‘capability requirements’ to mitigate the risks to the country, as well as the potential damage of not doing so”.  A recent investigation by the BBC’s Panorama also shows clearly that the government had not stockpiled sufficient protective equipment despite being warned that it needed to do so.  Apparently “There were no gowns, visors, swabs or body bags in the government’s pandemic stockpile when Covid-19 reached the UK”.
  • Why did the government not heed early warnings in January and February of the need for urgent action?  I am neither an epidemiologist nor a medical doctor, but I was already writing in late January about the outbreak of a new coronavirus in China and its potential to have a severe global impact.  If even I was aware, the government has absolutely no excuse for inaction.
  • To what extent did the government’s focus on Brexit mean that they were distracted from the potential havoc of Covid-19?  The Prime Minister’s overarching attention on Brexit and his determination that Britain’s departure from the EU on 31st January was appropriately celebrated, must have taken up a considerable amount of time, and it seems likely that the government simply did not have the systems in place to be able to consider the potential of a new coronavirus that had emerged in a distant land (see also links to racism below).
  • Why did the UK take so long to implement lockdown measures?   The BBC on 7th April provided graphic illustrations of the dates when different countries across the world began to introduce local and national recommendations and lockdowns, and it is very striking that the UK’s lockdown only announced on 23rd March was among the last in Europe.
  • Why has the government’s rhetoric persistently focused more on protecting the NHS than it has on saving lives? My comments here may be controversial, but I have been very struck by the fact that one of the government’s dominant slogans over the last few weeks has been “Stay at home, protect the NHS, save lives“, often shortened to “protect the NHS and save lives”.  The order is always the same, with protecting the NHS coming before saving lives.  This was overwhelmingly emphasised once again in the Prime Minister’s briefing on 30th April where he reiterated that protecting the NHS had been at the centre of the government’s policies, and he paid scant attention to deaths.  It seems to me that this priority largely reflects the government’s desperate wish to protect itself from criticisms of its previous failures to ensure that the NHS was in a fit place to deal with a pandemic.  The slogan could easily have been “Save lives: stay at home and protect the NHS”.  I just get this persistent feeling that many in government really don’t care much about preventing the most vulnerable from dying (see also next item below).
  • Why does so much reliance appear to be being placed on a few (flawed) Prime Ministerial advisors? Again, this question is controversial, but it does seem that there was a dominant view at senior government levels in the UK at the end of February that protecting the economy was more important than saving the lives of some elderly people who were likely to die soon anyway.  This has been traced back by the Sunday Times (22nd March) to a private engagement at the end of February, when Dominic Cummings (Senior Advisor to the Prime Minister) is claimed to have said words to the effect that “herd immunity, protect the economy and if that means some pensioners die, too bad”.  No. 10 immediately issued a very strong rebuttal, claiming that the Sunday Times article was “highly defamatory”.  Nevertheless, detailed examination of the  government’s actions at that time, and before the  change in policy on 16th March would indeed appear to suggest that in general the government was willing to sacrifice the lives of many elderly people, despite claiming that they were caring for the most vulnerable.  The role of Cummings in attending meetings of SAGE (the Scientific Advisory Group for Emergencies) has also been controversial, with The Guardian (26th April) for example reporting that attendees at these meetings were worried about his participation.  Furthermore, Cummings’ personal connections with one of the data-mining companies (Faculty) working with the UK government on Covid-19 (and mining patient data) has also caused concern and controversy (see for example Byline Times 22nd April, The Guardian 24th April and The Times 1st May).  There is enough murkiness about Cummings’ role, for there to be a transparent enquiry into his influence in shaping the government’s flawed Covid-19 response.
  • Why has the government persisted in saying that most UK citizens should not wear masks?  The government has so far persisted in saying that people in the UK should not wear masks (of any kind), despite the very considerable evidence that these can indeed help prevent the spread of Covid-19.  I have written at length about this before, but it seems fairly clear that the reason why the govenrment has done this is because it is afraid that the NHS will not have enough supplies if people try to buy medical face masks for themselves.  Again, this comes back to the issue that Ministers do not want to be shown up for their failure to prepare for the pandemic sufficiently rigorously.  While it seems likely that the government may well soon recommend the use of scarves or homemade cloth coverings as part of its package of actions following the lockdown (The Financial Times, 23rd April), this only further exacerbates their failure to have done so before!
  • Why has the government been so slow to support vulnerable people being supported at home and in care homes? The lack of provision of Personal Protective Equipment (PPE) and other support for staff in care homes, and helping to support elderly people in their own homes has been shocking.    This seems primarily to have been driven by two agendas: the focus on preserving the NHS at all costs for the government’s own political protection; and a willingness to let the vunerable elderly die.   The net outcome has been that very many people have died, both directly and indirectly from Covid-29 in care homes.  In the week ending 10th April there were more deaths (from all causes) in care homes (4,927) and at home (4,117) combined than there were in hospitals (8,578); 1,156 of these deaths in care homes and at home were Covid-19 related (The Health Foundation, 22 April).  More recent figures on 27th April indicated that the number of Covid-19-related deaths  in care homes in the previous week had doubled to more than 2000, meaning that around 3000 Covid-19-related deaths in total have occurred so far in care homes (BBC, 28th April).  The government in its regular briefings, though, only reports deaths from Covid-19 in hospitals, which in the short-term significantly reduces the perceived overall level of deaths from this new coronavirus (for a wider discussion of Covid-19 data, see my Data and the scandal of the UK’s Covid-19 survival rate).  Furthermore, recent evidence from the Chief Scientific Officer indicates clearly that “The risk of the coronavirus spreading in care homes was ‘flagged up very early on’ to the government” (The Times, 28th April).
  • Why have vulnerable people not been directed to hospital sooner: NHS 111 and the need for oxygen? There is much anecdotal evidence that many hospital trusts, at least in the early days of Covid-19 were turning elderly vulnerable people away from hospital, and that NHS 111 (the online and phone service) only told people to go to hospital after being ill with symptoms for more than a week and if they were having severe difficulties breathing.  At the same time, there is good evidence emerging that by the time most people have been taken into hospital in the UK it is probably too late for perhaps half of them to survive. The Independent (9th April) thus reported that over 67% of coronavirus patients put on ventilators go on to die.  It now seems that other forms of treatment may be more effective.  There is a growing  body of evidence that patients are often seriously ill before they begin to have breathing difficulties, and that early oxygenation is key to their survival (New York Times, 20th April 2020).  Hence, if NHS 111 and the government more widely had been willing for Covid-19 patients to go into hospital earlier to increase their oxygen levels before they started having breathing difficulties, many more of them would have been likely to have survived (it is interesting to note also that official NHS guidance on 9th April instructed medical staff to lower oxygen prescribing targets, seemingly to help manage the supplies of oxygen that they had available).  It is shameful that so many beds in the rapidly constructed Nightingale hospitals still remain empty, when they could be used to give patients much needed oxygen.  Indeed, the government announced on 4th May that the London Nightingale hospital would be placed on standby because it was no longer needed (BBC News; see also The Financial Times, reporting on 4th May that the NHS employed 60 KPMG consultants to build these temporary hospitals).
  • Has the government really been acting on the scientific evidence?  Another of the oft-quoted phrases to come out from the government’s media spinners is that they have always been acting on the scientific evidence.  Prime Minister Johnson frequently uses the term, as in “that is why we’re following the scientific evidence in the way that we are” (Bloomberg, 9th March); “Matt Hancock likewise uses the term, as in “The scientific evidence is absolutely critical in underpinning our response” (Financial Times, 15th March).  This is complete and utter nonsense.   There has never been complete uniformity among scientists on anything – and there shouldn’t be; debate and discussion is the lifeblood of healthy science!  Moreover, many academics (see for example Helen Ward in The Guardian, 15th April) have also made it clear that the government has not even acted on the advice given, perhaps in part because of the Cummings’ spin noted above.  Neil Ferguson, leading the team of epidemiologists at Imperial College modelling Covid-19 has recently made two pertinent observations (quoted in The Sunday Times, 26th April): “What I worry about more is people who have a particular political agenda or point of view, distorting the science to support that point of view”; and We have given insight into how different causes of action would lead to certain consequences but we have not made politicians decisions for them. Politicians have made the decisions”.  This is absolutely right.  It is up to governments to make the difficult political decisions, and they cannot hide behind claims that there is something called science which provides all of the definitive answers!
  • Why has the government adopted such an arrogant and racist stance?  In the early stages of the pandemic, far too many people in government, and indeed the British public more generally, conveyed the impression that the new coronavirus was a “Chinese” problem, and that the difficulties faced by the Italians were basically because they were less competent than people in the northern European countries who would easily be able to deal with it.  To be sure this was less blatant than US President Trump’s very clear and explicit racism (The Washington Post, 20th March), but it seems to come from the same stable.  In part this is linked to the ongoing global geopolitical “tensions” between China and “The West” (for my more detailed comments on this see Digital-political-economy in a post-Covid-19 world: implications for the most marginalised),  but it also reflects unwarranted arrogance that the UK’s scientists and systems are better than those in China, other east Asian countries and our southern European neighbours (see, for example, The Sunday Times, 26th April, and The Sunday Times, 26th April).  Perhaps too, this is linked to our government’s mistaken determination to leave the EU with its Mediterranean members, and be “Great” again alone (see The Great Britain Campaign).
  • How and why were the companies selected to work on the data analytics and people tracing technologies associated with Covid-19?  This issue was touched on above with respect to the involvement of Dominic Cummings in the development of digital technology solutions for tracing people with Covid-19 in the UK during and after the lockdown.  I have already discussed the wider and long-term implications of this for the future of privacy and surveillance (see Digital-political-economy in a post-Covid-19 world: implications for the most marginalised), but there are also many questions to be asked about the process which led to companies with at best dubious track records in the field of big data analytics such as Palantir and Faculty (see The Guardian, 12th April, and Byline Times, 27th April) being involved in this development.  The lack of transparency and openness around this by people at the heart of our government is deeply concerning.

These questions raise huge doubts about the judgement and performance of all of the leading figures in our goverment (many of whom have spoken at the daily briefings), as well (sadly) as those senior government advisors who have all too readily towed the goverment’s line in public on these issues, such as Sir Patrick Vallance (Chief Scientific Adviser), Prof. Chris Whitty (Chief Medical Officer) and their deputies.  Whilst it would seem that these advisers have sometimes struggled with following the No. 10 mantra, I do wish that they had been more willing to stand up and be counted for the sake of truth and of UK citizens’ lives.  We must indeed be united as we seek to overcome the challenges posed by Covid-19, but when there is a reckoning afterwards I very much hope that praise is given out where it is due, and failure is also dealt with appropriately.

[This post will be regularly updated as further evidence comes to light]

[Update 29th April: The Guardian today published quite a useful account entitled “Revealed: the inside story of the UK’s Covid-19 crisis” which covers some of the above issues in  more detail]

[Updated 4th May: see The Financial Times report on how the large consultancy firms such as KPMG and Deloitte were contracted by the government without the usual competitive tendering processes to work on projects such as the Nightingale Hospitals]

[Latest update 16.26 4th May 2020]

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Data and the scandal of the UK’s Covid-19 survival rate

Govt CovidI have held off writing much that is overtly critical of the UK government’s handling of the Covid-19 pandemic, but can do so no longer. We have known for a long time that data published by governments across the world about infections is highly unreliable, although figures on deaths are somewhat more representative of reality.  The UK governments’s lack of transparency, though, about its Covid-19 data is deeply worrying, and suggests deliberate deceipt.  The following observations may be noted about the figures that are currently being published, and the ways in which official (and social) media use them.

  • Official infection rates are very unreliable and largely reflect the number of tests being done.  These figures are so meaningless that they should be ignored in public announcements and media coverage because they give the public completely the wrong impression.  Countries such as Germany are believed to be able to produce up to 500,000 tests a week (although their aim is to do 200,000 tests a day), whereas by 7th April there had only been 218,500 tests in total in the UK since the start of January. The UK government aims to achieve 100,000 tests a day by the end of April, but seems highly unlikely to meet this target; a figure of more than 10,000 tests per day in the UK was only first achieved on 1st April.  The official reported number of infected cases in Germany at 119,624 on 10th April is  likely to be somewhat nearer reality than the paltry 73,758 reported cases in the UK (Source: thebaselab, 10th April).  In practice, it seems that most of the UK figures actually refer to those who are tested in hospital as suspected cases, since there is negligible testing of the public in general to get an idea of how extensive the spread really is.  By keeping this figure apparently low, the UK government seems to be deceiving the population into believing that Covid-19 might be less extensive than in reality it is.
  • Figures for the number of deaths should be more reliable, but are also opaque.  Even with figures for deaths there is increasing cause for doubt, not least because of differences between countries reporting whether someone has died “from” or “with” Covid-19.  In practice, it is even more complex than this, since some countries (such as the UK), are publishing immediate data only on those who die in hospital.  Those who die in the community are only added into the total official figures at a later date.  By manipulating when these figures are officially added, governments can again deceive their citizens that the deaths may in the short-term be lower than they are in reality.  A good analysis of the situation in the UK has recently (8th April) been produced by Jason Oke and Carl Heneghan for The Centre for Evidence-Based Medicine (CEBM), which highlights the considerable discrepancies between data made available by the National Health Service (NHS) and Public Health England (PHE).  Not only does this make it difficult in the short-term for modellers and policy makers to know what is really happening, but it also gives a distorted picture to the public.  As this report also concludes “The media should be wary of reporting daily deaths without understanding the limitations and variations in different sources”.
  • Hugely unreliable mortality rates.  Combining published figures for infections and deaths gives rise to figures for mortality rates.  These figures are also therefore very unreliable.  Because of the low levels of testing, and yet the high number of deaths in the UK (8,958; Source: thebaselab, 10th April), the UK mortality rate is reportedly the second highest in the world at 12.15%.  This can be compared with Germany’s 2.18% (undoubtedly a much more accurate figure), Italy’s 12.77% (the highest in the world), and a global average of 6.06%.  As I have argued previously, though, these figures are largely meaningless, and the figures that really matter are the total number of deaths divided by the total population of a country.  Accordingly, to date, China has had only 0.23 deaths per 100,000 people, whereas Spain has had 33.88, Italy 30.23, France 18.80 and the UK currently 11.75 deaths per 100,000 (Source: derived from thebaselab, 10th April).  Put another way, the UK figure is 51 times more than the Chinese figure.  Such figures are far more meaningful than official mortality rates, and should always be used by the media (preferably using choropleth maps rather than proportional circles for total deaths).
  • Extraordinarily depressing recovery rates.  The UK’s current “recovery rate” is by any standards appalling.  As of 9th April reported figures for the number of people who have recovered from Covid-19 in the UK were between 135 (by the baselab, and worldometers) and 351 (by Johns Hopkins University).   This suggests a “recovery rate” of possibly only 0.18% in the UK (Source:  thebaselab, 10th April), in contrast with China’s 94.56%, Spain’s 35.45% and a global average of 22.2%.  In part this is again a result of data problems.  We simply don’t know how many people have been infected mildly, and how many have survived without even knowing they have had it.  It also reflects the fact that it takes time to recover, and many people are still in hospital who may yet recover.  However, the UK’s figures is the worst in the world for countries where there have been more than 50 cases of Covid-19.

Such figures raise huge questions for the British government and people:

  • Why are UK reported survival rates so low? Surely the government should want to do all it can to show the success of the NHS in treating patients and it should therefore publish the real figures?  That is unless, of course, these figures are truly bad.
  • What is the balance of numbers between those dying in hospital from Covid-19 and those leaving having recovered?  The rare euphoria that greets those who leave hospital having recovered (as with 101-year-old Keith Watson who was recently discharged from a hospital in Worcestershire) suggests that very few people have actually left hospital alive having been admitted with Covid-19.  Is the government trying to hide this?  Is the grim truth that you are likely to die if you go into hospital with Covid-19?  Does this mean that people are being admitted to hospital far too late because of the advice given by the NHS and its 111 service?  Should the NHS simply stop trying to treat patients with Covid-19? (An update noted below suggests that more than half of the people going into intensive care in UK hospitals with Covid-19 die).
  • Why did the government not act sooner?  Some of us had argued back in January of the threat posed by the then un-named new coronavirus (I first raised concerns on 20th January, and first posted about its extent in China on social media on 27th January).  It was very clear then (and not only with hindsight) that this posed a global threat.  Undoubtedly the WHO failed in its warnings, and did not act quickly enough to declare a pandemic, but many governments did act to get in supplies of Personal Protective Equipment (PPE), testing equipment, and ventilators.  The UK government has failed its people.  One quarter of my close family have probably already had Covid-19; many of my friends have also had it – some very seriously.  I guess therefore that between a quarter and a third of those living in the UK may already been ill with the pandemic (Update 13th April: this must be an exaggeration, as news media over Easter suggest that experts think the current figure of infections is only 10%; Update 26th April, the MRC-IDE at Imperial College modelling back from actual deaths, suggest that only some 4.36% of the UK population is infected).  They are individual human beings, and not just statistics.

These questions are hugely important now, and not just when a future review is done, because it is still not too late to act together wisely to try to limit the impact of Covid-19 in the UK.  The fact that the government has not yet been transparent and open about these issues is deeply worrying.  In trying to explain them the following scenarios seem likely.  I very much hope they are not true, and that the government can provide clear evidence that I am wrong:

1. Throughout, the government knew that the NHS would be overwhelmed by Covid-19, and has been doing all it can to cover up its own failings and to protect the NHS.  In 2016, a review called Exercise Cygnus was undertaken to simulate the impact of a major flu pandemic in the UK. The full conclusions have never been published, but sufficient evidence is in the public domain to suggest that it showed that the NHS was woefully unprepreard, with there being significant predicted shortages of intensive care beds, necessary equipment, and mortuary space.  In December 2016 the then excellent Chief Medical Officer Dame Sally Davies, conceded that “a lot of things need improving”.  It is now apparent that the government (largely including people who are still leading it) did nothing to rectify the situation, and must therefore be held in part responsible for the very high death rate in the UK.  Its failure to fund the NHS appropriately in recent years is but a wider symptom of this lack of care and attention to the needs of our health system.  I therefore find it very depressing that this government is now so adamant in asking us to protect the NHS; as shown on the cover of the document sent to all households in the UK (illustrated above), it seems to be more concerned with protecting the NHS (listed second) above saving lives (listed third).

2. The government has consigned those least likely to survive Covid-19 to death in their homes.  Despite claims that the government is caring for the most vulnerable, it seems probable that its advice to the elderly and those most at risk to stay at home was not intended primarily for their own good, but was rather to prevent the NHS from being flooded with people who were likely to die.  This is callous, calculating and contemptable.  On March 22nd, The Sunday Times published an article that stated that “At a private engagement at the end of February, Cummings [the Prime Minister’s Chief Advisor] outlined the government’s strategy. Those present say it was “herd immunity, protect the economy and if that means some pensioners die, too bad”. Downing Street swiftly denounced this report, but it remains widely accepted that even if these were not the exact words Cummings used, this was indeed the view of some of those at the top of the UK government at that time.  Subsequent evidence would support this.  Some, perhaps many, hospital trusts, for example, have clearly told their staff not to accept people who are very old and fall into the most vulnerable category.  Likewise, Care Homes have been told to care for Covid-19 patients themselves, since they may not be accepted in hospital. The British Geriatrics Society thus notes (30th March) that:

  • “Care homes should work with General Practitioners, community healthcare staff and community geriatricians to review Advance Care Plans as a matter of urgency with care home residents. This should include discussions about how COVID-19 may cause residents to become critically unwell, and a clear decision about whether hospital admission would be considered in this circumstance”
  • “Care homes should be aware that escalation decisions to hospital will be taken in discussion with paramedics, general practitioners and other healthcare support staff. They should be aware that transfer to hospital may not be offered if it is not likely to benefit the resident and if palliative or conservative care within the home is deemed more appropriate. Care Homes should work with healthcare providers to support families and residents through this”

This  policy incidentally (and also helpfully for the government) lowers the daily reporting death rate because such people are not counted as “dying in hospital”.

3. The use of digital technologies may be used to identify those unlikely to be given hospital treatment.  The government quite swiftly introduced online methods by which people who think that they fall into the extremely vulnerable category could register themselves, so that they might receive help and such things as food deliveries.  Whilst aspects of this can indeed be seen as positive, it also seems likely that this register could be used to deny people access to hospital services, since they are most likely to die even with hospital treatment.  If true (and I hope it is not), this would be a very deeply worrying use of digital technologies.  Nevertheless, care homes are being forced to hold difficult discussions with those they are meant to be caring for about end-of-life wishes, and all doctors and medical professionals are increasingly having to make complex ethical decisions about who to treat (see Tim Cook’s useful 23rd March article in The Guardian).

4. The government has tried to pass the blame onto the scientists. Early on in the crisis I was appalled to see and hear government spokespeople (including the Chief Medical Officer – so beloving of systematic reviews) saying that they were acting on scientific advice.  As some of us pointed out at the time, there is no such things as unanimity in science, and so it was ridiculous for them to claim this.  However, they seem to have been doing so, and in such a co-ordinated manner, because they were seeking to shift the blame in case their policies went wrong.  Leading a country is a very tough job, and those who aspire to do so have to make tough decisions and stand by them.  Fortunately, this position by the government is no longer tenable, especially now that academics are competing visciously in trying to prove that they are right, so that they can take the credit. Nevertheless, there remains good science and bad science, and it is frightening how many academics seem to be pandering to what governments and the public might want to hear.  Tom Pike (from Imperial College), for example, predicted (against most of the prevailing evidence) in a pre-print paper with Vikas Saini on 25th March that if the UK followed China (which it clearly wasn’t doing) the total number of deaths in the UK would be around 5,700, with there being a peak of between 210 and 330 people, possibly on 3th April.  Although he retracted this a few days later when it was blatantly obvious that his model was deeply flawed, news media who wanted a good news story had been very eager to publish his suggestion that the pandemic would not be as bad as others had predicted (he certainly got lots of pictures published of himself in his lab coat).  Likewise, at the other end of the scale, the IHME in the USA predicted that the UK would have 66,314 deaths in total by 4th August, rising to a peak of 2,932 deaths a day on 17th April.  This  might have been wishful thinking, because on 7th April, UK reported deaths were only 786, which was substantially below their model prediction of around 1250.  By then, though, their research had already hit the news headlines with lots of publicity.  Subsequently (as at 11th April), they revised their predictions to a peak of “only” 1,674 deaths a day (estimated range 651-4,143) with a cumulated total of 37,494 deaths.  These differences are very substantial, and emphasise that scientists often get it wrong.  Put simply, the UK government cannot hide behind science.  They can try to take the credit, but government leaders must also admit it openly when they have been wrong with the policies that they make based on the evidence.

In conclusion, by sharing these thoughts I have sought to:

  • Ask the UK government to be more open and transparent in the information that it provides about Covid-19;
  • Plead with media of all sorts to use data responsibly, and to be critical of claims by governments and scientists who all have their own interests in saying what they do; and
  • Encourage everyone to work together for the common good, openly and honestly in trying to respond to the Covid-19 pandemic.

Above all, I write with huge respect for the many people in our NHS who have been working in the most difficult of circumstances to try to stem the tide of Covid-19.  Too many of them have already died; too many of them have become sick.

[Update 12th April: A report in The Times notes that “The death rate of Covid-19 patients admitted to intensive care now stands at more than 51 per cent, according to a study on a sample of coronavirus patients”.  The original report is by ICNARC, which showed that “Of the 3883 patients, 871 patients have died, 818 patients have been discharged alive from critical care and 2194 patients were last reported as still receiving critical care”. I should add that this is despite the very valiant efforts of our NHS staff]

[Update 14th April: Great to see that the BBC is at last reporting more responsibly about government reported deaths (based on those in hospital) being a serious underestimate of total deaths, and comparing trends of deaths with previous years – two useful graphs included and copied herewith below

deaths well above normal range - line chart      daily death updates are an underestimate since they exclude deaths outside hospital and are subject to reporting delays

Thanks BBC]

Updated 14th April

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