Now into the third month of lock down – confusion remains in Britain

More on covid pandemic 2020

Now into the third month of lock down – confusion remains in Britain

Most people were waiting for the easing of the lock down but when it was announced it came with the confusion and questions we have become used to from the Buffoon and his gang.

Testing, track and trace

A couple of differences of the NHSX app (now being ‘piloted’ on the Isle of Wight) from that produced by Apple/Google (and which is being used in many other countries) is that in the UK version people report their symptoms BEFORE a test whilst elsewhere the reporting comes AFTER a test. Also the Apple/Google version actually helps Bluetooth (the way the Smartphones communicate with each other) work better. But the NHSX is not free of the ‘tech giants’ – it needs their permission to work at all – therefore the tech companies remain the ‘gatekeepers’ of any app.

From the beginning one of the arguments given by States to encourage use was that it was voluntary, that no one would be forced to download and activate it. That’s becoming less of a case as some app will almost certainly play a part of any movement of people between countries. This is already being used in Honk Kong for any international arrival and some version will almost certainly be obligatory in many other copy cat countries – even before it has been proven that these apps are actually any use. Just helps to keep a track on people’s movements.

The rocky road of the NHSX app

The pilot has gone very quiet in the last few days – after the fanfare of its release and the ‘overwhelming’ take up.

By now plans should have been in place to extend the pilot to other parts of Britain, although this has now been delayed – until when nobody is saying.

And needless to say we are still no closer to a resolution of the matter of privacy – presumably the Government hopes that if they say nothing for long enough people will get bored with asking the question. That’s also one of the things unlikely to happen. Security concerns continue with fears that it allows an opening to hackers.

Not only is the roll out of the unproven app been delayed so has the contact tracing. The problem, at least in England, is that there is no strategy which doesn’t rely almost entirely on the app’s information. By now this should all have been up and running – if we had listened to Government promises – but by their own admission the contact tracing won’t be up an running before some time in June. And don’t talk about the figures, or the actual people involved. That also seems to change as often as the British weather.

The latest (20th May) ‘information’ is that there will be 25,000 tracers working from 1st June (world-beating’ according to the fantasist Buffoon). I have no doubt those numbers will be reached (as did the 100,000 tests on April 30th – but few days since) and work will begin on that day but of what use is another matter. One issue that has to be resolved before this contact tracing can be effective is to increase the speed at which results are obtained. It currently takes 4/5 days to get a result – that’s far too slow to make the isolation part of the concept useful.

The ‘Norwich Experiment’ – tacking and tracing

Neil Hall, Earlham Institute, Norwich, on a project to test and monitor the whole population of Norwich; Radio 4, World at One, May 15th;

‘The major problem with this virus, and the reason it’s been so difficult to contain, is that it transmits from people who are asymptomatic, before they get ill, or in some cases, from people who don’t get badly ill at all.

That means if you are only testing for the virus from people who are presenting at a doctor’s or a hospital or even if you’re contact tracing you are always playing catch up with the virus. You’re always a step behind. The idea of mass community testing is that you identify those asymptomatic cases before they become ill or before they are identified in a chain through contact tracing.’

Q. You want Norwich to be a city in which that is done?

‘The size of Norwich is about right, 140,000 people, challenging but doable. Also Norwich has one of the highest proportion of molecular biologists per head of population with government funded institutes and a research hospital, etc., in the city.’

Q. How do you test everybody?

‘The idea we’ve been working on is people would be sent a testing kit to their house. That might involve some self-swabbing but research has shown that simple saliva tests are pretty accurate. The kit is bar coded with peoples’ details and then sent back depending upon the logistics being discussed. People would be informed if they had a positive test and would have to self-isolate.’

Q. How far is the push to make it happen? Is the Government on board?

‘There are a lot of partners involved but no funding from National Government. The national government strategy at the moment is putting its weight behind testing of individuals who are sick or in high risk environments.

Mass community testing will also provide a huge amount of information about how the virus is spreading in the community and that will inform government policy nationally. If we know, for example, how asymptomatic cases are in transmission, how important public transport is, how important work place is or households are in the replication of the virus then the government will know when it can relax restrictions and when it has to reinforce them.’

The Track-Trace-Isolate (TTI) strategy in Scotland

Jason Leitch, Clinical Director, Scotland on extension of the covid-19 symptoms (to include taste and smell) and contact tracing in Scotland, Radio 4, World at One, 18th May;

Q. Why has the list of symptoms changed?

‘Science changes all the time. The WHO (World Health Organisation) has a long list of symptoms for covid-19 none of which are, unfortunately, very specific. So you have to cast a net as wide as you can to detect covid-19 but no tos wide you capture the whole population. The evidence has increased on the loss of taste and smell so this has been now, across the four countries of the UK, been added to the list.

We’ve always wanted those with symptoms to self-isolate. We don’t do this with other infections so we have created a fear in society. We don’t want to put 60 million in isolation so we have to be balanced.’

Q. Is it important to get the contract tracing implemented before easing the lock down in Scotland?

‘It’s a kind of parallel process. The WHO says there are six measures you have to have in place before thinking about any dramatic changes to your lock down.

The first is to suppress the virus. The second is a reliable test, trace and isolate system. We [in Scotland] have added an S to our TTI, which is Support.

People underestimate the level of support some need in order to self-isolate – not everybody lives in an environment where a 14 day isolation, although annoying, won’t be that restricting. So we need to think about the support people might need to do that.’

Q. Do you have enough tracers to do that?

‘Tracing exists already across Europe for sexually transmitted diseases etc., so the public health community are very used to contact tracing. We’ve decided to organise this in Scotland around the 14 regions and we are using staff from various sectors to fulfil the need. We’re aiming for 2,000 by the end of the month.’

Q. Why no app?

‘Not no app, considering the app. A digital solution to help with contract tracing and we’re beginning to test in three of our Health Boards with an app really as a boost for the contact tracer to help them along. Contact tracers are detectives, they are used to doing that, their training is about who you were with, where were you, it’s quite an elaborate interview.

The NHSX app is still in development. We need to know about the privacy of it. When we’re reassured about those three things then we’ll happily embrace it. We don’t need it, we’ll have contract tracing without it but if we feel it adds a layer of information, a layer of data then we will, of course, use it if it is safe to do so.’

‘Easing’ the lock down – how will people respond?

Professor Robert Dingwall, School of Social Science, Nottingham Trent University, member of the New and Emerging Respiratory Virus Threat Advisory Group (NERVTAG), Radio 4, World at One, 18th May, on how people will react to the easing of the lock down;

Q. There are some people terrified of opening their front doors again. What will happen when people start to go out more?

‘The Government campaign to get us all to stay at home has probably been more effective than they would have wanted it to be in terms of raising the level of anxiety among the population. Surveys show we are easily the most anxious country in Europe about the impact of the virus. In the news coverage there’s been this relentless drum beat of death that’s rather overshadowed the fact that most people (80%) won’t need to go anywhere near a hospital and virtually all those that do will come out again in one piece.’

Q. Was that due to the Government message or the sense of community in protecting the NHS?

‘It’s probably the way the Government has gone about it. It’s also the attraction of kinds of stories for the media. Deaths are full of human interest and there are lots of opportunities for ‘intrepid reporters’. It’s a combination of things. The coronavirus has been overlayed on a number of pre-existing tensions and conflicts. We were a fairly divided society to start with. This hasn’t exactly helped.’

Q. What do you think will make a difference?

‘We might see quite a period of tension and possibly some micro-aggression between people who are more or less risk averse, for example visually impaired people who are unable to maintain social distancing rules are already being abused. Conflicts about masks, what two metres looks like and whether two metres is relevant at all. Those things are going to run for quite a while.’

Q. We were told schools had to shut. What has changed to make them safe now?

‘One thing that has certainly changed is out understanding of the science around children and the transmission of infection. With influenza children are clearly super-spreaders – although we never close schools over the winter because of this. What we now understand [with covid] is that children get a relatively mild form of the disease and they certainly don’t transmit it any more than adults. And teachers are no more at risk in school than going about everyday business in the community.’

The Blame Game

In one of the early post on covid-19 I suggested that having the scientists at the regular press conferences was to have a ready scapegoat if things went pear shaped. As the country entered the third month of the lock down – although now with certain caveats – the accusations started to fly around.

Jeremy Hunt, one time Tory Health Minister, now Chair of the House of Commons Health and Social Care Select Committee, on 19th May;

‘… some of the decisions, notably on testing, represent some of the biggest failures of scientific advice to ministers in out life time.’

Therese Coffey, Secretary of State for Work and Pensions, when asked why community testing was ended on 12th March, in a testy reply on 19th May;

‘If the science was wrong I’m not surprised people think we then made the wrong decision.’

The issue can be clarified very easily here. Advice does not equate to decision. The only way to know the facts is for the Government to publish all the documents at the time. The longer this takes (as they will come out at some time in the future) the more it looks like the Government has something to hide.

The Nationalists and Covid-19

I haven’t really quoted extensively from politicians in previous posts but am doing so here with a contribution from Gordon Brown, at one time Labour Prime Minister, who dislikes the Scottish Nationalists as much as I do, Radio 4, World at One, 19th May, on how the pandemic has been approached in the ‘devolved’ Scotland;

‘Half of the deaths in Scotland are in care homes. It’s tragic that even today not all care home residents and workers have been tested. It’s a great failure of public policy to have known about this problem for weeks, to have known that the one way that we could find out whether people are at risk is testing early and testing routinely and not being able to bring in a system as the capacity was simply not good enough. Less than 3% of people have been tested so if we are going to avoid a second wave we’ve got to act urgently to have not just mass testing but routine testing.

We are not talking about thousands of tests a day but hundreds of thousands per day. If we are trying to ease the lock down then we have got to give people reassurances, we’ve got to prevent a second wave, we’ve got to get the R figure down.

With testing [on the return of schools] you can guarantee to people that they can be assured that those who have got this disease are not going to be passing it on. Where are the hundreds of thousands of tests? There’re clearly not here. The contact tracing is not yet working and therefore the strategy which was supposed to be to test, to trace and isolate cannot be working in full. And that was the basis of the Government’s decision to end the lock down and to end it gradually.

In Government you’ve got to make decisions on your priorities and then you’ve got to act of them quickly. Since March 12th when it was decided to give up testing in the communities there has been an absolute failure to recognise that if we are going to end the lock down there were certain things that we had got to have put in place. If you can’t say ‘get vaccinated’ you should be saying ‘get tested’ and you should make it possible for people to get tested.

Q. Do you fear for the Union [that’s the United kingdom] when you see different nations going their own way?

‘We were bound to have differences of approach to issue like schooling when you have different systems in schooling. What the real problem is is the lack of co-operation between the different parts of the Union and the lack of common purpose. The desire to be seen as separate for the sake of being separate is the problem and over time we have got to recognise that we’ll benefit and achieve more by working together than isolating yourself and making a virtue of being apart.’

All in this together?

As with the recovery from economic crash of 2008 (caused by the reckless gambling and rush for easy money by the financial institutions) so in the battle against covid-19, we are supposed to be all in this together, a common fight against a common enemy who knows no barriers such as wealth. The words were empty in 2008 and are as worthless in the present pandemic. There’s one law for the rich and one for the poor.

On the 17th May it was reported that the author Neil Gaiman travelled all the way from New Zealand to the Isle of Skye in Scotland.

A number of issues are raised here;

  • why was he allowed to leave New Zealand in the first place? The country is making a big issue about how well it has managed the pandemic locally, why don’t they help other countries enforce their travel restrictions?
  • why was he allowed to transit the United States?
  • why wasn’t he questioned when he arrived in London? There are so few travellers now surely just so they don’t get bored Border Officials must ask the reasons for people travelling to the country – especially as there has been so much fuss recently about why a quarantine is being talked about in the future but not in the past – don’t these immigration officials have any idea what is being discussed in the country?
  • why are the rich so arrogant that they think they can boast about their activities on Twitter – even when most of the people who would read such social media messages wouldn’t be able to do what he did – another rhetorical question, the rich do what they do because they can.
  • why do the police bother to interview him when they know they are not going to do anything anyway. And even if they do take ‘action’ what’s a £100 fine to the rich?
  • this coming Bank Holiday in Britain there will probably be thousands of people who will be breaking the rules. There will be big coverage of this in the media with politicians (and a number of ‘key workers’) making moral judgements about such ‘thoughtlessness’. But why should they abide by the rules when all you need to flaunt them is money. If the State was serious about ‘we’re all in this together’ they would make an example of the prick Gaiman – but that’s not going to happen.

Travel on public transport

‘Coronavirus (COVID-19): safer travel guidance for passengers’ is the heading of the official guidance published by the Tory Government on 12 May 2020.

This is like something out of the 1940s where those in power regularly talked down to the vast majority of the population. They might argue that its design, and wording, is in an age of hyperlinks but it just reads as if they are addressing small children where repetition of the same phrases is the only way to get people to learn.

It’s been estimated that to maintain social-distancing on public transport it would not be able to operate at more than 15% capacity, some argue even less. That’s not sustainable for any real length of time. For the last seven or eight weeks buses nationally have been running at a much lower capacity – but this is all being heavily subsidised by the Government. If the money can be found during the covid-19 pandemic why wasn’t it there in the past when the public transport system was being run down as it ‘wasn’t financially viable’? These Tory bastards have got a lot to answer for – as are the people who accepted their lies over the years.

On 13th May, the first day of the limited return to work, the ASLEF union complained, on behalf of their drivers on the London Underground, that there were too many passengers. I don’t really understand what they are thinking about. At some time in the future (next week, next month, next year – but by then there’ll be no London Underground) the transport system has to get back to some sort of normality.

Especially in London. There are, on a normal day, 4 million Tube journeys and 6 million bus journeys. If, soon, Transport for London is not able to get the numbers back to that sort of level you might as well abandon the capital. We have heard for years about the social cleansing when it comes to housing in London. The people who keep the capital working (those in mostly poorly paid jobs with awful conditions – night work or getting up a the crack of dawn) don’t live closer than many miles from the centre. They depend totally upon public transport and a fatuous suggestion to walk or go by bike shows a total lack of understanding of how major cities, especially London, function.

Also if you consider how much London (as do many other cities in Britain) depends upon tourism then you will need the transport system up and running, with full capacity, if there is any plan to get London back to anywhere near what it was pre-March 2020.

Neither is the idea of walk, cycle or use you own car really feasible in most of the country. After years of being encouraged to leave their cars at home people are now being encouraged to drive to work. Congestion, air and noise pollution will go through the roof.

So instead of complaining that their members are at risk the union has to do, what the rest of the country has to do, and that’s come up with ways to protect people if they are perceived to be at risk, so they can do their job. The virus will not go away. We can either close down until there’s an effective vaccine or live with it.

All indications, from the very beginning, is that the virus is particularly dangerous for a certain section of society (even though, from time to time others might also get a bad, and even lethal infection). But that happens with any virus, even the common cold or the flu.

Even the Department of Transport understands you can’t have a public transport system and maintain ‘social-distancing’. Public Transport without ‘social distancing’ is called a taxi or a chauffeur driven car.

After a couple of months of trying to instil fear in the population to get them to do what they want the Government has now got to come up with a strategy to get public transport back to running as it should do – together with the virus. It has to happen some time – and sooner rather than later – so why not now?

Following complaints from transport workers and other ‘key-worker commuters’ about ‘overcrowding’ on trains, on 14th May train companies stated there would be more trains in the week beginning the 18th. Why couldn’t the train companies been informed of the policy change in sufficient time for them to arrange for those ‘more trains’ to be available when there was an increase in the number of passengers?

By allowing people to travel, basically as far as they like in private vehicles, the Government is also effectively penalising the poorer section of the population – who don’t have a car and under normal circumstances would travel on public transport. In all the decisions that have been taken since the beginning of March it’s almost impossible to see any structure or strategy at all. Decisions are made but with no thought to their consequences. If Britain is ever to restore some some of normality – for the vast majority of the population – one of the issues that needs resolving is that of public transport and than would need a complete rethink of the concept of ‘social distancing’.

Vocabulary of ‘Opposition’ Parties in a Parliamentary Democracy

‘too soon’, ‘too late’, too much’, ‘too little’, ‘not enough’, ‘more honest’.

Companies abusing the furlough scheme

By 13th May 800 companies had been reported to Her Majesty’s Revenue and Customs (HMRC) for fraudulently claiming on the furlough scheme whilst having people at work.

On Money Box, Radio 4, on both 2nd May and 16th May, there was a section of various ‘anomalies’ surrounding the so-called ‘furlough’ scheme where employers get 80% of their employees wages paid for by the State. But it hadn’t been in place for more than a couple of weeks before abuses of the system were raising their ugly heads;

  • ‘furloughed’ but still being expected to work from home
  • employers cutting peoples’ wages during the lock down
  • using the fear of isolation to get away with illegal practices
  • these matters all should remind us of the importance of unions, which too many people have consigned to history. The idea that ‘most people are only one wage packet away from destitution’ is as true today as when wages actually came in packets.

Ken Clarke (Tory, ex-Chancellor of the Exchequer), Radio 4, World at One, 13th May, said that there would be cases of fraud and there would be some companies that wouldn’t have survived despite the pandemic, but who have taken money from the State in furlough schemes, business grants and loans, but that it was the maintenance of the good companies that was most important.

In the past the State would hound anyone unlawfully claiming state benefits and would spend huge amounts to get a conviction – but company cheats will get a way with murder.

Being open on the ‘scientific advice’

About three weeks ago Hancock said the Government would be open about the advice it was using to arrive at the decisions they want to impose on the population. However, when reminded of this on 13th May (during Prime Minister’s Questions in the House of Commons) his response was ‘in due course’.

This issue came to the fore, once again, on 19th May. At that date of the 110 papers that were part of scientific advice to the Government only 28 had been released.

David Spiegelhalter, Professor of Statistics at Cambridge University, on Radio 4, World at One, 19th May;

Q. Does the Government need to be more transparent when it comes to the evidence upon which it is basing its policy decsions?

‘This discussion has been going on for a long time and many people have been calling for greater transparency. Apart from security reasons advice should be as open as possible. Covid is not an intelligent opponent, it’s not going to find out things.’

Q. What needs to be released now that hasn’t been?

‘Much would have been done rather rapidly and it’s not fair to the researchers who have produced it to put it out in the public domain. SAGE does come up with a summary statement and it would be helpful if that were made available.’

Personal Protective Equipment (PPE) and Care Homes

Nadra Ahmed, Chair National Care Association, in the preference given to the NHS over care homes when it came to PPE, 14th May;

‘PPE had been requisitioned for the NHS but when it came to us it was a sort of supply/demand market which was completely out of control with providers desperate for PPE so here we were suddenly left completely abandoned.’

There have been countless stories of care homes trying to buy PPE on the ‘open market’ and finding that to get even the basics they would have to pay 2, 3 or even 4 times the normal asking price. In any sort of crisis like a pandemic (or war or natural disaster which effects the whole country) the government should take matters in hand to control the price of the necessaries, whether it be food or, as in this case, protective equipment. To do otherwise just stuffs money into the pockets of spivs and gangsters.

The advice on care homes in the early days

Jennie Harries, Deputy Chief Medical Officer for England, on what they thought was the threat to residents (and staff) at care homes in the early days of the outbreak in Britain, 13th May;

‘Throughout the outbreak, and it would have been the same for any other, we look at the background of the epidemiology, they would be monitoring background diseases and so that document [scientific advice to Government] will be looking at where we knew there was a background risk of transmission. I think that, at the time, there weren’t any sustained community transmissions though we clearly had cases around.’

But surely here, from the very beginning, before the first cases were being publicised in Britain, it was accepted worldwide that those over the age of 70 with ‘underlying medical conditions’ were those most at risk. That risk rose sharply the older the person was, not least because they would be more likely to develop these ‘underlying medical conditions’ and the biggest concentration of these old people, certainly in those wealthier countries where a care home structure existed, would have been in care homes. Added to that most care homes are probably both overcrowded (in the terms of the space per resident) and understaffed – another couple to add to the recipe of disaster.

The ‘Swedish Experiment’ – an evaluation

Lena Hallegren, Swedish Health Minister, Radio 4, World at One, 13th May;

Q. Do you have any sense of the level of immunity in Sweden due to the approach you have followed? Do you know how many people have been infected?

‘Not now. In a week or so we will have an opinion about that. We probably have some immunity but we’re not sure. No figures yet. We know more people were infected in Stockholm than in other parts of Sweden. We will have numbers of infected and immunity in a week or two.’

Q. In Sweden half of all deaths have been in care homes and 25% in their own homes. How do you protect those receiving care when those looking after them are mixing in the community without lock down?

‘We are trying to figure out the changes we need to do to protect the vulnerable in a better way. I think it’s a combination of many things. It’s a fact we have to be even better with our guidelines when it comes to basic hygiene rules …. but also looking at part time workers, which means a lot of people are coming into places where there are vulnerable people. … We also have to work out how to use the PPE (Personal Protective Equipment) and we can do more when it comes to testing people, both the residents and the staff in care homes. ….. It’s still a problem. ….. The main issue was in Stockholm. ….. I hope we are better prepared in other parts of the country but I cannot say for sure.’

Q. Even though you don’t have the same sort of lock down it looks like you’ll have the same sort of economic pain as elsewhere?

‘We didn’t make any kind of choice between a lock down for economic reasons or not. We decided we wanted to have a better combination of the legally binding ones [measures] and the voluntary ones but the ones we felt we could stick with all the time, because this virus won’t disappear from our society, unfortunately, so we have to have measures and restrictions to keep all the time.

We also have big suffrance [sic] in our economy, a higher unemployment rate, even if we’re trying to help business, companies, the stores to keep up. But that’s difficult.’

Q. Are you expecting that Sweden will gain higher levels of ‘herd immunity’ because of your approach?

‘We don’t have a goal of ‘herd immunity’ but, of course, we’re interested in knowing about immunity. To know how many people have been infected, how many have gained immunity, what does that mean for our society.

We’re trying to save our health care system from a big amount of patients at the same time, to flatten the curve. We think that has been quite successful, if I may use that word, as we still have 20 – 30% availability in intensive care units. The health care has been able to receive and to care for the infected patients.’

Not too good an interview and she didn’t argue Sweden’s case particularly well, I didn’t think. It’s strange that Sweden hasn’t been collecting infection and death numbers on a daily, rolling basis so don’t really understand why there’s a wait of ‘a week or two’ before they are available. I was surprised to hear that care homes were ‘forgotten’ about in Sweden – as they were in Britain – and that obviously accounts for the high percentage of deaths in them (50%). It’s also interesting that they followed the measure they did, specifically to protect the health care system (as was the lock down in the UK, supposedly) and not for economic reasons – as the country’s economy is also in a bad way.

The most important point in this short interview is the recognition, in Sweden, from the very beginning, that the virus would be around for a long time and any measures taken had to be seen in a longer perspective. Presumably this would also be the type of measures other countries, such as Britain, would have to follow to regain some sort of society so Sweden’s experience could be useful internationally. If the health system was broken by this approach it places more questions on the efficacy of the British approach and also a question mark on how to move forward in a meaningful manner.

Hallegren is a little bit vague when it comes to the situation in the care homes and ‘hopes’ matters will improve rather than providing confidence that it will. On 19th May the situation in the Swedish care homes was questioned – but I’m not absolutely sure that this situation was being discussed in an effort to undermine the more relaxed approach Sweden has so far taken in relation to the pandemic.

Reasons for change

Chris Whitty, Chief Medical Officer for England, 11th May;

‘Really what we’re trying to do is to take very small steps which allow us to be sure that we’re not going to end up with an increase in transmissions again. We recognise that we’re going to have to do change for a long period of time and making things sustainable is extremely important.’

Why it’s safe to be outside

Lucy Yardley, Professor of Health Psychology, who sits on the scientific advisory body, SAGE, on 10th May;

‘There’s a study, for example, in China, of 7,000 people who’d been infected with coronavirus. Only 1 of those 7,000 people had been infected outside and that was during a conversation. We don’t know if they were socially-distancing but I suspect they probably weren’t. So that gives you an idea that the risk outdoors, if you remain socially-distanced, is very,very small indeed, which I think is behind the guidelines.’

Poorer workers more vulnerable – yet again

A report from the Office of National Statistics, issued on 10th May, found that;

  • men in low skilled, low paid jobs are twice as likely to die of covid-19 but there are many caveats over the information – a lot of important facts, such as social and health background, age, ethnicity, smoker/drinker, etc., not known in this study
  • perhaps too partial and thus resulted in knee jerk reactions

The General, Municipal Boilermakers Union (the GMB – should, perhaps, think of changing its name) declared the ‘figures horrifying’.

Len McCluskey, General Secretary of ‘Unite the Union’, in response said, on 11th May, it was the poorer workers who were expected to return to work, and take the most risk;

‘It’s certainly an obvious division that blue collar workers, factory workers, mainly lower paid workers are being told to go back to work while those with a higher earning scale can stay safely at home.’

How many people have been infected in Britain?

David Spiegelhalter, Professor of Statistics at Cambridge University, astounded that people still don’t know how many people have likely to have been infected, on 10th May;

‘They’re hungry for details, for facts, and yet they get fed, what I call, number theatre – which seems to be co-ordinated really much more by the No. 10 communications team rather than genuinely trying to inform people about what’s going on. I just wish that the data, which has been brought together was presented by people who really knew its strength and limitations and could treat the audience with some respect.’

More on covid pandemic 2020

Getting closer to it – but still no real strategy in the UK covid-19 pandemic

More on covid pandemic 2020

Getting closer to it – but still no real strategy in the UK covid-19 pandemic

A review of what has been said in the last few days about the coronavirus pandemic in the UK.

Testing

When testing should have take place

In March the World Health Organisation (WHO) was saying ‘test, test, test’. But on 12th March the UK stopped testing in the community and focussed the limited testing capacity on hospital patients.

Boris Johnson’s government failed to impose mass coronavirus testing after being told that COVID-19 was only a ‘moderate’ risk to the UK (1st April).

Senior advisers admit lack of investment in mass testing ‘may have been a mistake’ as they believed influenza was a bigger threat (2nd April).

At the House of Commons Health Select Committee meeting on 5th May, Sir Patrick Vallance, Chief Scientific Advisor to the Government, said he ‘would have liked testing ramped-up sooner’. [Ramped-up is one of the a new words we have come to recognise.]

Jenny Harries, Deputy Chief Medical Officer for England, at the same meeting, said the changes to the policy in early March was because of ‘ insufficient capacity’.

Mass testing earlier ‘would have been beneficial’ (5th May).

How often should care workers be tested?

Sam Monaghan, manager of a group of care homes, arguing for weekly tests on care home staff and resident, on 2nd May;

‘A member of the resident group was diagnosed with the virus and we know that the highest probability how that came into the home was through one of our members of staff. The difficulty is that none of the staff are showing any symptoms at all so it’s a bit like ‘Where’s Wally’ – but Wally’s taken his jumper off and so the manger’s looking across her staff group asking where has this thing come from?’

The numbers game and the current situation

Stephen Powis, NHS England National Director, 4th May;

‘Testing .. has ramped-up very quickly over the last week or so and we are now at a very high level of testing with over 100,00, a little bit of a dip at the weekend but we anticipate that that testing ability will continue to increase.’

On 6th May the Buffoon was saying the aim now was to get testing up to 200,000 per day by the end of May. But it’s probably as useful in defeating the virusas Hancock’s promise of 100,000 by the end of April – which, for some miraculous reason, has only been achieved on 30th April, numbers dropping into 70-80,000 since. But all the classic questions, Who, What, Where, When, Why, remain.

Who will be tested, just those who show symptoms or a wider, random, cross section of the population?

What will the tests be looking for, just if people are infected or as part of an overall strategy of tracking and tracing?

Where will the tests take place, taking the tests to the people or the people to the tests?

When will the testing be part of a strategy?

Why is nothing forward – not even the numbers. 200,000 by the end of May is too low and too long a period for such a minimal increase in testing in relation to the population in general?

A different type of testing

Professor John Newton, the Government’s testing co-ordinator, on 4th May;

‘There are at least two large commercial organisation who have good lab based tests we are currently evaluating. But also people are looking at ways of doing anti-body tests close to the person, the patient. There are a number of options there including a saliva test. And all of the options are looking quite promising and being evaluated.’

Where is testing going – and when?

Jeremy Hunt, Chair, House of Commons Health Select Committee, on Radio 4, World at One, 5th May

‘Everyone accepts that Germany and South Korea have really done a pretty good job. Korea didn’t report more than 9 deaths on any day during the whole course of the coronavirus crisis and are now saying that are getting no new domestic infections. I think the important thing for us is; have we learnt from what is happening in Korea and do we have the Korean strategy in place? I think what we heard this morning from Sir Patrick Vallance and Dr Harries is that that now really is our strategy and that’s the most important thing.’

[Best practice was known about weeks ago. Why, in Britain, is this still going to happen at some indeterminate time in the future?]

Q. To mimic South Korean strategy?

‘Yes, I mean they are are the ones who did this test, track and trace process, very tech centred, very innovative use of apps, backed up with contact tracing on the ground. And remember they had a worse challenge that we had, they’re closer to China, they had less notice than we had, they had a super-spreader who was part of a religious cult. So they had a real challenge to deal with but they did manage to contain the virus. This is what we are now planning to do starting with the Isle of Wight.’

[South Korea and China are amongst those countries that have embraced technology in a big way, much more than in Britain. Many people don’t have Smartphones, many of the Smartphones don’t have Bluetooth and in those countries where technology was used in this way it was followed by extensive testing on a one to one basis. No plans for that have been presented here in the UK.]

Q. Are we past the peak?

‘That’s what the government is saying and I’m sure that’s what their scientific advice is saying. And there’s a lot of gloom about the death figures and to have 11.500 more deaths than you would expect in one week in April is pretty depressing. But the very last question in the Select Committee Hearing to Sir Patrick Vallance, I thought, was, in a way, the most encouraging because I said to him that if we do the test, track and trace, if we observe the social distancing rules, on balance, do you think we can avoid a second wave, and that’s the thing all over the world people are worrying about, and he basically said, Yes. He was an optimist, he said he thought we could. So I think that they are confident we’re not just past the peak but if we implement all the policies that are now in train, we could avoid a second peak.’

Q. When do we get to the point of being able to ease the lock down? When can that system take over?

‘Well, I think we’re going to hear about that on Sunday. And we tried to shed some light on that today. What it appears is that the absolute rule is that the R, the reproductive – rate mustn’t go above 1. They still think we are between 0.6 and 0.9. But within that there’s a lot of variation. So Sir Patrick Vallance was saying that in the community the R rate is probably a lot lower, towards the lower end of the scale, but in hospitals and care homes it is still running higher. So that’s where the risk is that you can perhaps get community transmission down, because people are staying at home, but you have a re-introduction of the virus through an outbreak in care homes, for example. So that’s why I think it’s a very finely balanced judgement.’

Q. That’s where the app may become critical and as well as that human contract tracers will be important. As far as the app is concerned will you be downloading it?

‘Absolutely. I think all of us who have Smartphones should, when we’re asked to do so and I think it can play a very, very important role. But I don’t think they work for everyone. I think 40% of the population don’t have a Smartphone so there will need to be more traditional methods of contact tracing with them. But I do think it has a very important role to play.’

[The British Government recognises that technology will not solve all the problems but doesn’t have an infrastructure in place to deal with those shortcomings.]

Q. Have we been too slow? The SAGE documents were released this morning, under pressure, and the Government is becoming more transparent, except a lot of those documents have been redacted, some to the point of being useless. Were you surprised by the extent to which they had been redacted?

‘Well, there’s a tradition, obviously I was in the cabinet for nine years, and advice to ministers is kept confidential and that is very, very important because you need advice to be completely frank and people giving the advice need to be able to say exactly that they want to say without having an eye over the shoulder to what happens if the advice gets published. But there is something different when you have a crisis like a pandemic and the Governments says that at every stage ‘we are following the scientific advice’.

If they say ‘we’re following the scientific advice’ but they don’t publish the scientific advice then it’s very difficult for MP’s to hold them to account. That was one of the things I asked Sir Patrick Vallance about and I asked Matt Hancock to day in Health Questions, to whether he would consider publishing the SAGE advice that he’s receiving at the same time as he makes his decisions, so that we all have access to the scientific advice that the Government says it’s following.’

[But when will this ‘transparency’ show itself?]

Q. So it’s too slow and it’s too late?

‘Transparency is very important because that ‘s the way you keep the trust of the public. Also, it’s important because there is a lot of uncertainty in these recommendations because it’s a novel virus and I think it helps if the public understand that some recommendations are clear cut but other’s are finely balanced and it’s helpful for us to understand that as well.’

Experts and transparency

Some members of the Scientific Advisory Group for Emergencies (SAGE), are arguing for more transparency.

Sir Jeremy Farrar, formerly Director of the Welcome Trust and a member of SAGE, on 4th May;

‘Personally I would make the minutes transparently available after a certain time. I think transparency helps people to understand the uncertainty, the difficulty, the fact that actually science does have to change as the facts change. That is certainly sensible and logical. What we know today is very different to what we knew in February and March.’

Breaking the lock down

On news that Neil Ferguson, the senior advisor to the Government had broken the lock down by having his married lover coming around to his house – apart from the issue of breaking the lock down he obviously had no idea of the gutter press in this country who will be looking for any opportunity to undermine anyone if it helps to sell the paper – or get the name of the paper broadcast on other news media (it’s all about advertising).

Jo Hemmings, Behavioural Psychologist, 6th May;

‘What people are now doing, perfectly understandably, is creating their own version of what they believe to be acceptable. You also have people that were behaving in a pretty sensible way for a while, say when we weren’t going out having obvious public group gatherings. Now the situation is so muddled about what is going on a lot of people have been doing for the last few weeks, and will continue to do is ‘the it’s just me thing’.’

Danger of a second wave

On the chances of a ‘second wave’, Robert West, Health Psychologist at University College London, on 3rd May;

‘With the figure that we have at the moment it looks like, probably, around somewhere between 5% and 10% of the population have been infected. That leaves between 90% and 95% who have still not been infected. So the death rate we’ve got at the moment is with that 5% figure, so we have to be very, very cautious and very careful about how we view the lock down.’

Maria Van Kerkhove, World Health Organisation (WHO), on a second wave, on 4th May;

‘What we’re seeing in countries like Singapore is almost like a second wave. Essentially what it is actually outbreaks that are happening in shared dormitories. So the virus has found a place where it can take hold and can resurge again. So all countries must remain on alert for the possibility of additional transmissions.’

The app that will solve all our problems – or not?

There are a number of issues with the Smartphone app – produced by NHSX (together with an unspecified private company) – that will be tested on the Isle of Wight from 5th May;

the test itself,

  • the Isle of Wight has fewer Smartphones than is the avaerage in the UK (older population)
  • there has been a low incidence of infection to date
  • the island is still on lock down so people won’t be going out of their homes much
  • how effective will the test be?
  • even if the results are ‘positive’ the app won’t be used throughout the UK until towards the end of March

the aspects of the app,

  • still not sure if it will work if the app is not showing on the screen
  • there’s the possibility of the app running the battery down
  • still many people have questions and doubts of the reassurances about privacy

This is on top of the issues discussed in a previous post.

Dame Wendy Hall, Southampton University, Government advisor on technology, on 3rd May;

‘It won’t be storing huge amounts of data about us in central servers, that’s not the case. Almost all of it stays on the phone, it’s all encrypted and what they store is anonymous. There’s no absolute right answer to this but I’m pretty convinced the way the UK is going, for the moment, is the right thing to do.’

Professor Susan Michie, Director of the Centre of Behavioural Change at the University College London who is also on the government’s Behavioural Science Committee for Covid-19, on 5th May;

‘I’m slightly concerned that there hasn’t been enough consultation with the public and a lot of concerns have been raised by the public about the governance of it, the security and privacy of it, the private company that’s owning it and so whether or not the public will take the app in the number that’s needed is a question mark. I do hope the Government quickly gets the trust that’s absolutely needed.’

Robert Hannigan, former National Security Advisor and Director at the Government Communications Headquarters (GCHQ), the Radio 4 World at One, 5th May;

‘It’s very good that they have said so much about it, there has been a great deal of technical policy detail published by NHSX [the NHS digital section] in the last week about how they’re doing this and I think that’s a very sensible approach and it’s reassuring to anyone who’s concerned about the technical aspects and the privacy aspects. I think they’re doing really well. This is attempting something which has never really been tried before, to use the Bluetooth technology, on this scale right across the country. It’s unprecedented so fair play to them for moving at such speed and trying to get it up and running. I’m sure there will be lots of things that go wrong and they will be putting right but that’s always true with new technology.’

Q. Is it the right decision to go down their own centralised route and not the Apple/Google decentralised route is correct?

‘It’s a balance but I think the downside of the Apple/Google localised route is that it leaves Public Health England and the NHS with no information about the overall spread of the virus and where it is spreading and all things they need to make really important decisions about public health and about how we may be released from the lock down, which is, after all, the major point in this.

The privacy aspect, I don’t think there’s a huge difference. I think given the steps that the NHS have taken to protect privacy and the involvement of the Information Commissioner in all of this it’s sufficiently anonymous not to be a threat to individuals. All the app records is the first part of a postcode and the make of the phone and, of course, this is co-operating with Apple and Google in a sense that it’s using those two operating systems, albeit not with the model they preferred. But having said all that, of course, there will be a good debate about privacy. My own feeling is that this should be time limited, so at the end of the pandemic we need to pause this experiment and have a proper public debate and parliamentary debate about the use of these apps in the future.’

Q. Are you reassured on the security of the data?

‘Yes, obviously the question of a centralise model, for which we are going down, is that the data has to be kept in one place and then it’s a question of who has access to it and for what reason. They have been very clear that it will only be public health authorities or public health reasons, that it will not be linked to other data about people in their health system. There is a question about how this data is kept and when it is destroyed. It will be useful to academics in the future to tackle future pandemics so we shouldn’t suddenly chuck it out, but equally I think we should bring this experiment to a clear close at the end of the pandemic and review it and have a proper debate about it. The key is that it should not be made available to the private sector, to companies to advertise and everybody agrees that this must be severely limited to public health experts and local authorities.’

Q. Do you think that in the way it has been set up it will be impossible for external users to get to this date?

‘Yes I do because I’ve read a lot of detail about how they’re been doing it in the last few days. You can always construct some edge case for how somebody could subvert this and that’s true of any system you build but frankly the conspiracy theories that I’ve seen put out there are pretty far fetched and would require so much effort and would be almost impossible to scale up.’

Q. You will be very happily downloading it?

‘I will and I think it’s important that it shouldn’t be compulsory to downloaded but it is going to help all of us stop the spread of this virus which is affecting all of our families and help all of us to get out of the lock down. So it’s in our interests to download this. It will not keep any personal data about you and I’m satisfied that the very limited data it does have will be properly protected.’

Q. You say is shouldn’t be compulsory but you sound if it’s everyone’s duty to download this app?

‘It’s in everyone’s interest and so far everybody I know, who I meet, wants to stop the spread of this virus, wants to protect the NHS and wants to get out of lock down as quickly as possible and are really desperate for that. And this is a really helpful way of doing it. It isn’t a major solution, it’s only part of a system that really depends on testing and proper tracing. It won’t be perfect, there will be problems, there will be false positives but it’s definitely worth a try.’

If someone who is (or was) a part of the British intelligence ‘community’ likes the idea then that alone is reason to be suspicious. And why is there a former (and not a present) Director giving this interview. That’s a way for the State to distance itself from any comeback.

Contact tracing and the lock down

David Nabarro, World Health Organisation (WHO) Special Envoy for Covid-19, on getting contact tracing up and running, 1st May;

‘This is something that every government is having to make a choice and I understand that the contact tracing process is now well advanced. You don’t need to have 100% tracing in order to get the R number down. You certainly can release the lock down while you’re building up the case finding and contact tracing capacity. That’s what most other countries are doing. They don’t wait until things are absolutely ready.’

Professor Susan Michie, Director of the Centere of Behavioural Change at the University College London who is also on the government’s Behavioural Science Committee for Covid-19, on 3rd May;

‘The Government message has become a lot more complicated, partly because this will need to be a different message for different people. Some people will be asked to go back to work when they are not happy doing that, concerned that there won’t be enough social distancing, giving risks of bringing back infections to the household whilst others, who are wanting to get out of their houses, won’t be able to.’

Chances of dying from the covid-19

David Spiegelhalter, Professor of Statistics at Cambridge University, on Radio 4, the Today Programme, 1st May;

‘If you’ve got the virus your chance of dying is roughly about the same as you would have had this year anyway. And if you’re worried about dying this year you shouldn’t be so worried at getting the virus. But I think we do need to have some sort of campaign to encourage people who are at very low risk to actually get out and start living again, when we’re able to.’

Ending the lock down

Robert West, Professor of Health Psychology, University College London, on how we should get to the easing of the lock down on Radio 4, World at One, 1st May;

‘It’s going to be a very odd moment and people will react to it very differently. Some people will say, ‘well actually I don’t really want to because I feel frightened and others will be champing at the bit and perhaps take it too far. I think it’s really important to say that it won’t be juts an all or nothing, it will be a very graded thing and this is going to present some quite significant challenges, in the sense of how you communicate that.’

Q. What sort of challenges does the nuance present?

‘It’s hard enough to get the message across when you are saying thinks that are black and white like ‘Stay at home, protect the NHS, Save lives’. Even there you get exceptions with people saying, ‘well, actually, I realise one should do that but in my case it differs’. When you make a more nuanced message which is that you can go out more, there are certain things you can now do that you weren’t able to to do before you can imagine the problems that you’ve got with people interpreting that is all sorts of different ways. Ad that means that the politicians who are giving the messages are going to have to chose their wording very carefully because a single throwaway remark could be misinterpreted and cause all sorts of critical problems.’

Q. How do you solve that because you have to come down on one side or the other?

‘Yes, the way you handle it is that you, whatever message you put across, you make it very clear who it applies to, what the situations are and give specifics about the situations you are referring to and, as always, you give very clear reasons as to why that is the case and a very important part of that is that if you’ve got an easing of the lock down which applies to some group in society more than it does to others you can imagine that it’s going to start to create problems with a resentment in some cases and people saying, ‘well, why should they be allowed to do this and I can’t’.

Q. The Government says even talking about that is dangerous, do they have a point?

‘They have no choice. They have to talk about it because what people can very clearly see is movement in other countries and that when this Government is already saying, ‘well, we have turned the corner on this one’, they can’t just pretend that it’s business as usual. So they have no choice. They have to talk about it. So then we come to how do you talk about it. The key thing is to help people to realise that this is a very risky time, tight now. This is probably as risky as it has been on any part of this crisis. If we get this wrong then we will be back where we started, possibly even worse. So people have to know that whatever the easing of restrictions, they don’t go beyond it.’

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