The British Way

by Les May

MY wife and I are old enough to be considered ‘vulnerable’.  We chose to isolate ourselves from 21 March, which is a few days before the government introduced the ‘lockdown’.  At this moment I have no expectation that we shall ever be able to take up what we thought of as normal life before this; seeing our grandchildren, spending time with our friends, an occasional meal out or a visit to the theatre.

Though I have watched hours of news reports, daily briefings, read innumerable reports and searched the World Wide Web for information, I have been left puzzled by one thing; why did the government allow the SARS-CoV-2 virus, the causative agent of Covid19, to become established in the British population?
Yesterday the BBC Parliament channel repeated a broadcast of a Select Committee hearing of 25 March 2020 which included oral evidence given be Professor Neil Ferguson of Imperial College.  At the time Ferguson was recovering from a Covid19 infection and it was not always easy to hear clearly what he was saying, but he said, or appeared to say, that the reason attempts to confine the virus and so prevent it becoming established, was a lack of testing and contact tracing capabilities.

At this point someone, and I am not pointing the finger at Ferguson as this was clearly a political decision, shifted the goal away from preventing further deaths to just controlling the spread in such a way as to prevent the capacity of the NHS to deal with cases becoming overloaded, or as it came to be called ‘to flatten the curve’, and accepting the additional deaths which would be the inevitable consequence.

If indeed lack of testing was one of the reasons for abandoning efforts to confine the outbreak then I find this rather strange.   The WHO guidance on contact tracing does not make reference to testing, it seems that a medical diagnosis is sufficient to initiate contact tracing. Ebola was initially recognised in 1976 though no specific test was available for several years. The guidance is given below.
‘People in close contact with someone who is infected with a virus, such as the Ebola virus, are at higher risk of becoming infected themselves, and of potentially further infecting others.
 

Closely watching these contacts after exposure to an infected person will help the contacts to get care and treatment, and will prevent further transmission of the virus. (my emphasis)

This monitoring process is called contact tracing, which can be broken down into 3 basic steps:

Contact identification: Once someone is confirmed as infected with a virus, contacts are identified by asking about the person’s activities and the activities and roles of the people around them since onset of illness. Contacts can be anyone who has been in contact with an infected person: family members, work colleagues, friends, or health care providers.
Contact listing: All persons considered to have contact with the infected person should be listed as contacts. Efforts should be made to identify every listed contact and to inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms. Contacts should also be provided with information about prevention of the disease. In some cases, quarantine or isolation is required for high risk contacts, either at home, or in hospital.
Contact follow-up: Regular follow-up should be conducted with all contacts to monitor for symptoms and test for signs of infection.’
https://www.who.int/news-room/q-a-detail/contact-tracing

But having ruled out the labour intensive process of contact tracing and isolation, and moving to the present containment/mitigation strategy it seems likely that at some future date that is precisely what will have to be implemented. This is what Neil Ferguson is quoted as saying on the Imperial College website
‘The challenge that many countries in the world are dealing with is how we move from an initial intensive lockdown… to something that will have societal effects but will allow the economy to restart. That is likely to rely on very large-scale testing and contact tracing.’

https://www.imperial.ac.uk/news/196477/j-ideas-neil-ferguson-tells-mps-lockdown/

If the government is hoping that the ‘testing’ will be a reliable antibody test it is possible it will have a long wait as this does not seem to be on the horizon at the moment, so we are back to asking why contact tracing cannot follow a medical diagnosis.

https://www.klfm967.co.uk/news/world-news/3085229/coronavirus-no-evidence-that-covid-19-survivors-have-immunity-who-warns/

I have previously commented on the proposal to develop an ‘app’ for use in contact tracing.  Even the USA is recruiting staff involved in census data collection to assist in contact tracing.  Perhaps the UK should do likewise now and not leave it until ‘they get round to it’.

http://northernvoicesmag.blogspot.com/2020/04/test-isolate-track-and-trace.html

http://northernvoicesmag.blogspot.com/2020/03/we-have-cunning-plan.html

Rigorously making sure that no potential virus carriers enter the country without being quarantined and tracing and isolating contacts if this fails, would have been costly to the economy because of its effects on trade as well as to our personal freedom to move freely to and from other countries. But are the uncertainties of the present situation really better? 

 

In case you think I am using 20/20 hindsight in constructing my comments I’m not. On 14 March just at the time the UK government was abandoning any attempt to confine the outbreak Martin Hibberd, professor of emerging infectious disease at London School of Hygiene and Tropical Medicine, was quoted in The Times (page 7) as expressing concern about government planning that the virus cannot be stopped and instead aiming for a controlled peak in the summer which assumed a large proportion of the population would become infected and recover.

Even before there were any cases in the UK on 25 January the website ‘Technical Politics’ published a long article about Covid19 which ended by saying ‘Our Government needs to be ahead of the game: ahead in its thinking and in its action’ and included the following questions;

Does the Government have a plan to quarantine parts of the UK if there is a localised outbreak?

If the pandemic reaches the UK, where will suspected sufferers be treated? 
 
What facilities will be designate for the treatment of sufferers? 
 
Who will staff those facilities?
What palliative care can be provided prior to the development of a vaccine?
Who needs to go to work, and who can stay at home?
If school is cancelled, will teachers get paid?
How will the supply chain bear up under the circumstances?
What happens if Britain is not able to import that which it does not produce?
What about people working in the private sector?
How will the economy bear up?
Will companies lay off workers and if so, are we ready for an increase in unemployment?
How to make sure that public finances don’t take such a great hit that a debt crisis is caused?
What about the risk of civil unrest?

https://web.archive.org/web/20200222131735/https://www.technicalpolitics.com/articles/too-weak-too-slow-the-uk-governments-dithering-response-to-the-wuhan-coronavirus-increases-the-risk-of-major-loss-of-life/

Whilst I think the government response to this pandemic has been shambolic, contradictory and even duplicitous in so rapidly abandoning attempts to confine and eliminate the virus so that it did not become endemic in the UK now is not the time to hold an inquest because there is still plenty of time for the foolishness of this strategy to become even more apparent.  But I hope that pressure will build for the establishment of an independent and public inquiry into the government’s response including its use and reliance on ‘modelling’.
http://northernvoicesmag.blogspot.com/2020/03/we-are-following-science-oh-really.html

***********************************

Test, Isolate, Track and Trace

by Les May

THAT’s the strategy to eliminate the SARS-CoV-2 recommended by the World Health Organisation (WHO).  Professor Christophe Fraser, of Oxford University’s Big Data Institute has said “Our mathematical modelling suggests that traditional public health contact tracing methods are too slow to keep up with this virus.”  A team of medical researchers at Oxford University are currently exploring the feasibility of a coronavirus mobile app for instant contact tracing.  However it has been suggested that this approach will only work effectively if at least 60 percent of people use the ‘app’.

There does not seem much evidence that the government adopted the WHO strategy with any degree of seriousness during the so called ‘containment phase’ of the Covid19 pandemic in the UK and some people might think this is a cheapskate approach instead of making a serious effort to implement the tried and tested ‘traditional’ approach which has been used in tackling such diseases as Ebola.

Such an ‘app’ would give the Government access to health and location data and might be considered too intrusive and represent an unprecedented level of surveillance.

However there are two points which may make some users less uneasy about the privacy implications.  The first is that so far as I am aware the technology will be based on Bluetooth equipped phones communicating with each other and Bluetooth has a very limited range, typically 5 to 10 metres.

https://en.wikipedia.org/wiki/Bluetooth

The other which I think is more significant is that the computer code which will enable devices to communicate with each other will be ‘open source’.  What this means is that the eyes of thousands of programmers anywhere in the world will be able to examine the code to ensure that there are no ‘backdoors’ which security agencies can exploit to conduct covert surveillance.  I have been using an open source operating system and open source software for nine years.  That means I don’t have to endure the horror that is Windows 10 and I the additional pleasure of not contributing to Microsoft’s profits.

******************************** 

Why We Should Be China Centric

by Les May

WRITING on the Conservative Home blog Damian Green MP has said ‘The World Health Organisation, as the Coronavirus crisis has developed, has seemed to be completely indulgent towards the Chinese authorities while being ever-ready (as they should be) to criticise other governments, and that the Chinese authorities were ‘dilatory in informing the WHO about the outbreak’.

https://www.conservativehome.com/platform/2020/03/damian-green-coronavirus-huawei-and-what-to-do-about-china-in-the-long-term.html

Green’s claims seem to be written more from prejudice than a quest for accuracy. This is what the Al Jazeera news channel has to say.

‘On December 31 last year, China alerted the WHO to several cases of unusual pneumonia in Wuhan, a city of 11 million people.  The virus was unknown.’

https://www.aljazeera.com/news/2020/01/timeline-china-coronavirus-spread-200126061554884.html

And the WHO tends to confirm this.

https://www.who.int/westernpacific/emergencies/covid-19

The full genetic sequence of the new virus, essential for the development of a test for infection by the virus, was released on 5 January 2020 based on a sample swab taken from a patient in December 2018 (probably 26 December)

You will note that at that time it was referred to as the ‘Wuhan seafood market pneumonia virus’ which is unsurprising as it was previously and unknown virus.

https://www.ncbi.nlm.nih.gov/nuccore/MN908947.2

https://edition.cnn.com/2020/01/06/health/china-pneumonia-intl-hnk/index.html

This points to doctors and researchers in China being initially mystified by the new illness and working to find out more about it, rather than to ‘dilatoriness’.  As for the WHO being ‘indulgent’ to China I’m not sure what Green has in mind.

Green of course is not the only politician to blame China for the ongoing pandemic, Donald Trump initially adopted a similar stance but now seems to have chosen to direct his ire at the WHO for ‘Calling it wrong’, which is a bit rich coming from a man who takes no notice of anyone who actually knows what they are talking about.

I take a different view. For 76 days after 23 January China conducted a massive experiment on its own population at no cost to us or the rest of the world.  To tackle the Covid19 pandemic it introduced what has come to be known as a ‘lockdown’ instructing the residents of Wuhan not to leave their homes. As this seemed to be effective in reducing the infection rate other countries introduced similar measures. Having reduced the number of person to person transmission of the virus to a very low level, China is now conducting a second experiment by a phased lifting the restrictions on the population, again at no cost to us or anyone else in the world.  They are experimenting with one possible ‘Exit Strategy’. We should be watching what is happening in China in the next few weeks very carefully to see if it works.

https://edition.cnn.com/2020/04/07/asia/coronavirus-wuhan-lockdown-lifted-intl-hnk/index.html

Thankfully we have not emulated China’s methods of imposing a 76 day lockdown.  But there is the dilemma.  The more complete the lockdown the more effective at reducing the infection rate it will be and the shorter the time it will be necessary for it to be in place.  China is totalitarian and coercive, we are a democracy, and work by persuasion and consent. If we want to prove that our system is superior we’ve got to accept social distancing and no unnecessary journeys out of the house.  The more we flout these rules the less effective the lockdown will be and the longer it will have to last to achieve the desired result.

*******************************

At Last a Candle in the Darkness

by Les May

A FEW days ago I heard an assertion by Tory MP Damian Green that China needed to be 'brought to account' about its handling of the Covid19 outbreak.

https://en.wikipedia.org/wiki/Damian_Green

I would not want to live under the Chinese system of surveillance and make absolutely no apologies for it, but I think it is important to separate our opinion of the political system from how we think and act about the Covid19 pandemic.

If people want to criticise the figures coming out of China they should produce the evidence that they are untrue.  There are well understood ways of doing this in a procedure called 'forensic economics'.  It has been used to show that stock (share) options which are based upon how the business performs over a period were being backdated so that those receiving the options benefited from the fraud.  It has also been used to show that 'spread betting' on baseball games had all the hallmarks of being rigged by bribing players to play less well in some games. It is up to the people who want to say the Chinese figures are phony to do the work needed to demonstrate it.

There are an abundance of data for the numbers of infections and deaths in the different provinces of China for such an investigation.  Should we not be at least equally sceptical about the single figures for testing in the USA which Trump produces at every news conference?

China has been criticised for not including cases of Covid19 when the person shows no symptoms but shows as infected when tested.  The WHO says they should be and China has had to revise its figures to reflect this.  But look at the situation in the UK.  Using the figures released recently about one in five of the people who are tested are found to be infected with the virus.  This is the number which goes into the published figures.  But what about the people who show mild symptoms?  These people are told to quarantine themselves for 14 days along with anyone else in their family.

Crucially no one is officially collecting figures for these people nor are they being tested.  As a result we are underestimating the true number of infections in the UK and we do not know how much.  In addition it is now known that the first death occurred on 28 February not 5 March as originally declared. France has also had to make an amendment to its figures.  Admitting such an error does not mean that from now on we have to doubt everything the UK or French government says about the scale of the infection.   So why single out China?

Yesterday in what Matt Hancock had to say there was a tiny glimmer of hope that the fog around the true number of people in the UK who are or who have been infected with the virus may begin to clear.

Hancock made a brief mention of an accurate test devised at Porton Down which detects anti-bodies in a person’s blood if they have been infected with the virus in the past and the intention to undertake ‘surveillance testing’.   This means testing a random sample of the population, i.e. one that is not biased with respect sex, age, ethnic origin, location etc. From the results of such testing it is possible to draw inferences about what proportion of the population has been infected.

https://en.wikipedia.org/wiki/Antibody

As it is an estimate based upon a sample of the whole population it will be subject to a small amount of error, though the larger the sample the smaller the error. Such estimates are normally published together with a ‘confidence interval’ or ‘credible interval’ which can be taken to mean that the true value for the proportion of the population infected can be expected to lie within this interval (range).

If the sample is ‘stratified’ it is possible to make similar estimates for different age groups, either sex, ethnic origin, occupation etc.

Ideally such a test should be administered a month after a person has recovered from the infection.  If anti-bodies are still present it means that immunity to further infection is long lasting.  This is an important criterion if a population is to develop ‘herd immunity’ and for the development of a vaccine.

https://www.ncbi.nlm.nih.gov/books/NBK11770/

**********************************

Would You Adam And Eve It?

by Les May

THOSE of us who had the benefit of a ‘Good Sunday School Education’ are familiar with the story of Adam and Eve.  You remember the one, Adam picks fruit from the forbidden tree, God gets grumpy and banishes the pair of them from the Garden of Eden.

Christians interpret this as ‘mankind’s fall from grace’; I interpret as, ‘when you are in the deep doo-doo look around for someone else to blame’; Adam blamed Eve, Eve blamed the Serpent.  No one said, ‘you’ve got me bang to rights Gov, I done it’. And that’s the story of mankind in a nutshell!

The latest example of this is Michael Gove blaming China for failing to curb the spread of the SARS-Cov-19 virus which causes the disease Covid19.

https://www.independent.co.uk/news/uk/politics/coronavirus-michael-gove-china-wuhan-covid-19-pandemic-a9432496.html

So do Gove’s comments stand up to close scrutiny or are they best interpreted as an attempt to deflect from the fact that his government was unprepared for any kind of health crisis?

This is what the World Health Organisation (WHO) had to say in it’s first Situation Report published on 21 January 2020:

On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan City, Hubei Province of China. From 31 December 2019 through 3 January 2020, a total of 44 case of patients with pneumonia of unknown etiology were reported to WHO by the national authorities in China. During this reported period, the causal agent was not identified.

On 11 and 12 January 2020, WHO received further detailed information from the National Health Commission China that the outbreak is associated with exposures in one seafood market in Wuhan City.

The Chinese authorities identified a new type of coronavirus, which was isolated on 7 January 2020.

On 12 January 2020, China shared the genetic sequence of the novel coronavirus for countries to use in developing specific diagnostic kits.

From 3 January Thailand and South Korea introduces screening measures for travellers from parts of China. On 9 March The Independent was reporting that travellers from Italy entering the UK from Italy faced “zero checks” for coronavirus at the airport.  At this time 16 million people, a quarter of the population were under ‘lockdown’, there were more than 7000 cases and the death toll was 366.

https://www.independent.co.uk/travel/news-and-advice/coronavirus-italy-flight-uk-quarantine-gatwick-heathrow-airport-a9387072.html

As I pointed out in my article of 15 March the story from the government is that they are going to do something ‘when they get round to it’.

http://northernvoicesmag.blogspot.com/2020/03/we-have-cunning-plan.html

Gove is trying to fool us into thinking that he can shift the blame for the shambolic situation with regard to personal protective equipment for NHS workers, the lack of testing for infection, the lack of critical care beds and shortage of ventilators, away from the government.  We all know that China initially suppressed news of the seriousness of the disease inside the country, but as we see above cases were reported to the WHO from 31 December 2019 onwards.

It beggars belief that Public Health England and the Chief Medical Officer were not monitoring the Situation Reports from the WHO and passing on to government ministers advice as to how this infection could spread in the UK. The inaction after the first of these on 21 January is down to political decisions taken by this government. 

***************************** 

Johnson And The Guinea Pigs

by Les May

EARLIER this afternoon I watched the Minister for Care, Helen Whately, trying to give a reassuring message that the government had an effective strategy for dealing with the SARS-02 virus which when it infects humans causes the disease now known as Covid19.  What she did not explain is why the UK is following a strategy which differs from that being followed in Spain and Ireland, recommended as good practice by the World Health Organisation (WHO) and vigorously pursued by China.  That it works is evidenced by the massive decline in new cases in China in recent days and the fact that the it is now advising Italy about the measures to be taken to defeat the outbreak.

Following WHO guidance other countries affected by the disease are pursuing a policy of ‘contain the disease and eliminate the virus’.  That’s not easy and it is expensive.  As well as hospitalising and treating those who are suffering from the disease you have to find the people they have been in contact with and isolate them until they either show signs of the disease or you can be sure that the incubation period is over.

Boris Johnson and his government prefer the cheapskate option of letting the virus infect at least 60% of the us so that the survivors will no longer be at risk from infection and so transmission of the virus will come to an end and it will disappear. It has the grandiose title of ‘herd immunity’ which makes it sound a medically respectable strategy.

A more honest appraisal of it is that Johnson and his government are proposing to use the UK population as guinea pigs and are quite prepared to see a lot of people die as ‘collateral damage’. This is a purely political decision. If it really is ‘science based’ as is claimed then that evidence needs to be placed in the public domain so that it can be independently evaluated by people who are less close to government than Chief Scientific Adviser, Sir Patrick Valance and Chief Medical Officer, Professor Chris Whitty. These two seem happy to provide cover for the political decisions being made by Johnson.

As I pointed out in an earlier article if 60% of a UK population of 60 million people become infected with the virus causing the disease Covid19 that is 36 million people. The mortality rate for those infected is 1%, that translates to 360,000 deaths. Not everyone infected with the virus will show symptoms, but as the mortality rate for those who do show symptoms is about 4% we can estimate that the total number of people who will be infected and show symptoms, will be about 9 million people. Of these 80% will recover without hospitalisation, 15% will require oxygen and 5% will require to be artificially ventilated. In other words 1.8 million of those 36 million it is assumed will be infected, will need hospitalisation.

If we assume that the virus is with us for 18 weeks of the summer and the infection curve is fairly flat that means there will be a requirement for space for a 100,000 patients of which 75,000 will need oxygen and 25,000 will need to be artificially ventilated EACH WEEK. If the infection curve is not flat and is sharply peaked these figures will be much higher for a short time.

I have based these figures on the information provided by the WHO and UK government assumptions about the proportion of the population who need to be infected to produce ‘herd immunity’. If you don’t like the message don’t shoot the messenger.

If you are sceptical about whether the NHS will be able to cope with 100,000 high maintenance patients a week for much of the summer you are not alone.

When the weekly death toll starts to move into four figures Tory MPs will get jittery: when granny and grandad die gasping for breath, Johnson’s ‘Red Wall’ will be rubble.

************************

We Are Following The Science! Oh Really?

by Les May

DURING the Apollo 8 mission to the moon one of the crew, Jim Lovell, pressed the wrong button on the flight computer.  That cleared the memory which held the data about the exact position and orientation of the command module.  As a result the flight computer ‘thought’  it was still on the launch pad so instead of the nose pointing forward along the flight path, it pointed more or less at right angles.  Using the astro-sextant to make sightings on various stars the crew were able to give the computer enough data to allow it to figure out the orientation of the module.

Getting back to Earth safely wasn’t magic or good luck, it followed from the fact that the physics of space flight is an exact science obeying the laws of motion formulated by Sir Isaac Newton in the seventeenth century.   Knowing the mass, velocity and the forces acting on an object we can predict exactly where it will be at any time in the future.

Like ecology, economics, politics and sociology, epidemiology is not an exact science. It uses the tools of science to analyse its data, presents its findings in numerical form and runs computer simulations, but unlike physics, it is not an exact science. Its predictions are ‘educated guesses’ based upon the collective experiences of it’s practitioners.  Those experiences come from investigating past outbreaks of some pestilence.  The educated guesses are in the form of ‘this is what happened last time with a similar disease’.

The UK government could truthfully say it was being ‘led by the science’ so long as we were in the ‘containment phase’ of dealing with the spread of SARS-CoV-2, the name of the virus which causes the disease COVID-19.  Containment worked with the original outbreak of the first human transmissable SARS virus which was eventually brought under control in July 2003, following a policy of isolating people suspected of carrying it and screening all passengers travelling by air from affected countries for signs of the infection.  It has also worked with outbreaks of Ebola, so it is a tried and tested method.  That phase is passed. From now on the decisions are political ones.

As I understand the situation the government is assuming that about 60% to 70% of the UK population will become infected with SARS-CoV-2 and suffer from COVID-19, and that those that recover will resist further infection so the virus will die out, an assumption based upon the concept of ‘herd immunity’.

Now lets put some figures to this. The present population of the UK is about 60 millions. If we take the conservative estimate of a 60% infection rate that means that some 36 million people will be infected.  According to the World Health Organisation (WHO) the crude mortality rate (the number of reported deaths divided by the number of reported cases) is between 3-4%, (the Chinese experience suggests 3.9%), but the infection mortality rate (the number of reported deaths divided by the number of infections) will be lower.  Assuming that it is in the regions of 1% that suggests 360,000 deaths can be expected in the the UK in the space of a few months.

What I find remarkable is that the UK government seems so complacent about the spread of the virus. Compare this with the situation in China where there have so far been 82,000 cases reported and 3,200 deaths in a population of 1.4 billion people. (Figures correct at 13 March 2020)

Just because the UK government has decided that the spread of the virus can no longer be contained does not mean that we as individuals have to fall in with this view.  Older people in particular can to a large extent avoid placing themselves in a position where they might become infected, by avoiding meeting groups of people in confined spaces. This isn’t ‘panic’ it is rational behaviour.

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200313-sitrep-53-covid-19.pdf?sfvrsn=adb3f72_2

https://en.wikipedia.org/wiki/Herd_immunity

***********************