May 29, 2020

“Whose fault is that?” the TV news presenter kept asking a floundering Tory MP yesterday morning. The UK death toll from coronavirus is high — by some measures higher than any other country in the world. “So: Whose. Fault. Is. That?”

This, in a nutshell, is the difference between the political and the scientific ways of thinking. Over the past eight weeks, on Lockdown TV, I have interviewed scientists and experts who sometimes disagree sharply with each other, but there’s a humility in their answers that is entirely absent from politics. Generally speaking, they accept that there’s much that they don’t know; very few things in science are anyone’s “fault”; instead scientists use odd words like “stochasticity”, referring to the fundamentally unpredictable aspect of nature.

The very different effects Covid-19 is having in different parts of the world are still not well understood, except as part of a complex context including pre-existing immunities and resistances, underlying health levels, demography, community and transport structures, perhaps even ethnicity and climate. Nobody really understands why it has not really taken off in sub-Saharan Africa, or why despite fears for Florida’s older population that state has not yet been badly hit, or why Japan has fared so well, despite its half-hearted government interventions.

What we do know is that the virus started in China, that it was exported by air travel, that there was already community transmission in Europe and probably America as early as December. London and New York are the two busiest global travel hubs in the world — Heathrow alone had over 20 million passengers pass through it in December, January and February — so knowing nothing else you would expect these two places to be among the worst affected. In one of very few predictable outcomes, they have indeed suffered the world’s two worst outbreaks.

The political argument has zeroed in on the idea that the UK and the US should have acted earlier within the month of March, by 10 days or two weeks. Through a combination of shutting their borders, locking down earlier and ramping up testing and tracing, everything could have been different, or so the argument goes. We’ll never know for sure, but it seems oddly credulous to think that that short period was a silver bullet that would have changed everything — countries that did ban flights from China early, such as Italy and the US, were hardly spared.

How much difference would an earlier shutdown have made?

By Tom Chivers

Back in March, the UK Government was still following its longstanding plan, endorsed by its scientific advisors — it is not spoken about much these days, but it is still there on the website if you fancy looking it up. It was based on the now-heretical principle that there would come a point when containment (with its testing and tracing) would no longer be viable, at which moment we would move to simply  ‘delay’ as much as possible and then ‘mitigate’. That is why contact tracing and community testing were dropped: it was always the plan. Some scientists still think this original approach was the sensible one, but faced with the alarming projections from Imperial College on March 16, the Government understandably ditched it.

To those who say that they should have seen what was happening in Italy, there remains the awkward fact that Neil Ferguson’s projections, based almost entirely on what was happening in Italy, didn’t materialise either. The revised Government plan was precisely designed to avoid becoming like Italy, with its horrible images of overflowing hospitals and triages in car parks — and that meant two urgent things: acquiring ventilators and increasing hospital capacity.

Off Matt Hancock went, brimming with rather more energy then than he has today, trying to succeed in his two big goals. But while the epidemic arrived, and with it a tragic number of deaths, it didn’t behave as expected. Remember the great ventilator race? As many ventilators as our good British companies could make, the Government would buy! Dyson, Rolls Royce and dozens of less glamorous and probably more relevant factories started frantically “re-tooling” for what the Prime Minister grimly dubbed “Operation Last Gasp”.

Turns out, they weren’t needed. Not only did the advertised wave of Covid patients never arrive in the promised number, it became clear that ventilation wasn’t the universally effective treatment everyone had thought. Reports emerged from New York that 88% of patients put on ventilators were dying; for many patients it turned out to be better to simply lie them on their front without ventilation. So the official number of extra ventilators the Government needed dwindled from 30,000, to 18,000, to 12,000 and then, quietly, to zero. James Dyson was sent back to his vacuum cleaners.

As for all those additional hospital beds that the situation in Italy implied we would need — the virus once again had other plans. In a huge Government-led effort, routine procedures were suspended, people were urged to avoid hospital, and existing patients were cleared out of wards. The Nightingale Hospital in East London was opened on time with its 4,000 additional beds, and thousands of further additional beds were created around the country in other Nightingale facilities.

From this unprecedented effort close to zero beds were ever used; these hospitals are perhaps the only example in history of a highly expensive and entirely unused government facility escaping any media criticism. As it turned out, the frantic preparing-for-Italy action plan may have only made things worse, as it led to additional avoidable deaths from other untreated conditions and accidentally seeded devastating secondary infections in care homes.

So, first the flu-like pandemic we had been initially well prepared for didn’t happen; then the Italy-style crisis that we subsequently prepared for with impressive speed didn’t happen either. All these well-intentioned government action plans, scrutinised by the political media, ended up struggling to be relevant amid a pandemic that defied prediction.

Fast forward to today and the big government action plan is now “test and trace” (they seem to have dropped the ‘track’ part, presumably because polling revealed people didn’t want to be tracked). Across the political divide, everyone is signed up to it — it seems modern and proactive and the “winning” countries have done it, so the only question apparently worth asking now is whether or not it will be well-enough implemented. But what are the chances that this plan, like all those earlier plans, ends up creating a lot of noise and finger-pointing but not making much difference to the trajectory of the disease?

I spoke to experts in South Korea and Hong Kong, the countries that pioneered the ‘test, track, trace’ method, and it seems clear that, even more than earlier initiatives, playing whack-a-mole with a virus in this way requires a coming together of surveillance, technology and buy-in from a biddable public. It also requires a manageable number of cases: it has worked in Asian countries as a way of keeping the virus out but it has never been tried in a scenario like the UK which has had millions of infections already and where the virus is now endemic.

The view from Asia: is test and trace even viable in the UK?

By UnHerd

Take South Korea, often held up as the example we should follow. Jerome Kim, Director General of the International Vaccine Institute based in Seoul, told me how on the back of a single individual infecting people in a nightclub the authorities ended up testing 65,000 people. They found 175 connected infections, some of them three or four ‘generations’ away from the original event. Yesterday, on day one of our equivalent scheme, we identified nearly 2,000 new separate infections nationwide, and the ONS estimated that 133,000 people are currently infected — to be as thorough as the Koreans, we would have to be testing the entire UK population every day.

Even in South Korea they are not finding it easy. In the Seoul nightclub example they had to allow people to come forward anonymously (it was a gay club) and then threaten police visitation if they didn’t — bear in mind this is a country which allows government surveillance of both mobile phone GPS data and credit card transactions to establish people’s whereabouts. In Hong Kong, which has also kept the virus at bay, the authorities send people to ‘quarantine camps’ for mandatory isolation.

The UK situation is not comparable. Even without our higher infection levels, we don’t have an all-powerful tech-enabled command-and-control government, and aside from some members of the cabinet, nobody wants one. Test and trace UK-style consists of thousands of hastily-trained agency workers asking infected people who they remember being with, then calling those people up and asking them politely to self-isolate for 14 days. No quarantine facilities, no app (yet), no police enforcement. It’s something to be getting on with, I suppose, but does anyone truly believe this will keep a highly contagious, already endemic virus, contained?

Much more likely, the virus will continue on its trajectory upwards or downwards and it won’t have much to do with government policy. If the estimates that only 7% of the population are immune are correct, and the virus is as contagious now as it ever was, we’ll soon know about it. As it is, with summer upon us, the virus seems to be in retreat everywhere across Europe. If the downward trajectory continues, it won’t be thanks to the ‘test and trace’ call centres.

Meanwhile, if Covid-19 does comes back with force later in the year, it will be because seasonal elements have combined to make it more contagious and effective, and our test and trace system, especially if it’s rusty by then after a long summer in abeyance, stands little chance of defending against it. We’ll soon be back to Plan A, focusing on providing medical care to the sick.

So as you read, in coming weeks, furious news stories about technical incompetence, citizen non-compliance, threats of stricter enforcement and blame in all directions — as if everything was hanging on the latest government policy — remember the humility of scientists instead of the solipsism of the political class. Yes, the Government action plan will most likely be ineffective, but politicians were never in charge of this anyway. It’s bigger than they are — the best they could ever hope to do is tinker around the edges. Coronavirus is nobody’s ‘fault’.