The Government is up against the clock to justify its next set of restrictions – as the Covid Recovery Group grows

17 Nov

Will they or won’t they? Is the question being asked of MPs in regards to whether they will extend the current lockdown restrictions in England. Although these measures are due to expire on December 2, at yesterday’s press conference, Matt Hancock told the nation that it was “too early to know” if they had worked.

The Government’s post-lockdown plan is to return to the tiered system of lockdown. But even that could shift. At the same press conference as Hancock, Susan Hopkins of Public Health England, threw a spanner in the works when she said there had been “little effect from Tier 1”, and that the Government might have to “think about strengthening” tiers “to get us through the winter months until the vaccine is available for everyone.”

Despite some encouraging statistics about the nation’s battle with Covid – intensive care admissions have fallen, and hospitals are running at “normal capacity”, according to Carl Heneghan, a professor director of evidence-based medicine at Oxford University – there are signs the Government will play it safe when it comes to imposing more restrictions.

There was the fact that Rishi Sunak recently expanded the furlough scheme so that it will last until March. More recently, a newspaper printed emails from George Pascoe-Watson, Chairman of Portland Communications, who had been advising Dido Harding and James Bethell on strategy and communications, revealing he had been “been privately advised that tier 2 restrictions will be imposed on London until at least the spring of next year.” 

In short, it wouldn’t be unreasonable to make the following prediction (contingent on hospitalisations being at a manageable level): the Government will phase out the lockdown (thereby keeping its promise and avoiding the difficulties of an extension being approved) but then move parts of the country into Tier 2, 3 or 4 (as has just been imposed on 11 local authorities in Scotland) – with the measures in place until spring. Therefore, many will be left feeling that they are in de facto lockdown. 

One reason the Government might feel emboldened to keep restrictions going is the news of two vaccines, as well as the knowledge that mass testing is being rapidly developed. It’s far easier to ask people to “sit tight” if they know an exit strategy is on its way.

But one group that is going to present a big headache for the Government is the anti-lockdown Covid Recovery Group (CRG), whose members will vote on the next set of restrictions. The CRG has been steadily growing in numbers, now standing at around 70 members, according to reports. Depending on how much bigger this figure gets, and what restrictions the Government next wants to impose, it may have to increasingly call on Labour to get the voting numbers.

And it’s not only the idea of a national lockdown that the CRG is opposed to. Its members are also sceptical of softer restrictions; or, at least, they want them to be justified. Mark Harper, CRG chairman, has called some of the previous Covid-19 measures “arbitrary”, and the group is unlikely to ease off the pressure because of a vaccine. Steve Baker, its deputy chairman, has said that “we must find a more sustainable way of leading our lives until a vaccine is rolled out”. As far as the CRG is concerned, days, weeks and months are too long in terms of waiting for Pfizer to come to the rescue.

The group’s main demand is that the Government is more transparent with information on the cost of lockdown. It wants a full-cost benefit analysis of restrictions on a regional basis, and for the Government to publish the models that inform policies – so that members of the public can make up their own mind. In short, the CRG is trying to place the burden of proof onto the Government to explain why it’s imposing any restrictions – as opposed to MPs having to argue for them to come off.

As Harper tells me: “When the Government brings forward its proposals for what follows the lockdown, it’s incumbent on it to show that for every restriction it wants to put in place, the good done by the restriction outweighs the harm, both from a health perspective and an economic perspective.”

Given that December 2 is approaching the Christmas period, the pressure will be all the greater for the Government to explain the rationale for each set of restrictions, as even more closures for shops could signal their end. MPs will also be after more information for how the Government’s mass testing programmes are coming along – one of the main ways it can reopen the economy until the vaccine arrives.

Interestingly, the Government could be about to run into difficulties not so disimilar from the ones Angela Merkel has experienced in Germany. Merkel had wanted to tighten Germany’s restrictions, but failed to win the support of the country’s state leaders. Thus she has had to postpone decision making in this regard. In essence, just as the public support for lockdown might be tiring, so is MPs’.

Either way, the next couple of weeks will be interesting to say the least.

Elsewhere:

Bob Seely: Lessons from the Cummings era about leadership, decentralisation, localism – and making more use of MPs

15 Nov

Bob Seely is the MP for the Isle of Wight.

Dominic Cummings has gone, but his strengths – and weaknesses – have lessons for us, and his departure still leaves Britain’s government in need of reform.

First, in fairness to Cummings, we need creative thinkers in politics, and he was clearly is as allergic to waffle as he was to a decent dress sense. However, being a free thinker is not the same as being a leader. Every organisation needs genuinely creative thinkers like Cummings to challenge group-think and, as the cliché puts it, think outside the box.

You do not, however, put them in charge because, unless they are there to drive a single issue for a specific amount of time, chaos ensues. Iconocasts question and challenge – and sometimes trash things – but they rarely build.

Cummings’ ability to diagnosis a problem was impressive, but his ability to drive solutions was flawed.

Two Armed Forces comparisons here are useful.

Cummings saw through the chaff to a single core idea. Broadly speaking, in military theory this is called “understanding the centre of gravity”. It’s rare to see it convincingly reduced to a single idea, without the laziness of adding the ballast of supporting points. The Brexit referendum, the levelling up agenda, the need to use data better, all showed that Cummings had the ability to understand clearly a problem: revolutionaries often do.

But whilst Cummings had a rare clarity of thinking, the evidence suggests he wasn’t so good at implementing it. I wonder if that was difficulty in delegating, and a need to keep control – if so, this issue goes much wider than Cummings.

The trend towards centralisation is actively damaging Government. Add our growing culture of risk-aversion, as well as the human rights legal industry, and you have some understanding why centralised Government is slow and cumbersome and its reform is difficult.

Compare this situation with best practise decision-making in the Armed Forces – which is called “mission command”.

Mission command is the combining of centralised intent with decentralised command; it’s when generals give orders to achieve an objective, but the responsibility for delivering that intent is pushed as far down the command chain as possible.

It is the system which gives young men and woman significant responsibility very early in the military careers, and is perhaps the key reason why they stand out so much from their civilian peers. They have responsibly forced on them.

We need such a culture of decentralised responsibility in the civil service and in local government. In which central government sets a broad agenda, but the responsibility for delivering it is pushed down to the lowest possible level, with freedoms to experiment to provide the best way forward.

Revolutionaries want centralised states because they want to drive change, but this is rarely successful. In non-democracies, many centralised revolutions produced catastrophic consequences in the twentieth century. And in democracies, over-centralisation has inhibited reform and good government.

For example, Labour’s obsessions with a top-down, targets-driven culture resulted in NHS managers prioritising treatment based on targets, not need: people died as a result. Another example – Germany’s decentralised health and public health system has coped with Covid-19 much better than ours.

In Westminster, the recent sucking-away of political influence from MPs has caused friction and frustration. Disdain has been accompanied by mistakes: not a good combination. Downing Street now has a chance to reset relationship with MPs who feel marginalised over a variety of issues, including the disastrous housing algorithm and the potentially destructive planning changes. MPs need to be able to contribute to policy. Ministers need to have power and agency in their own right, not just be cyphers.

However, for successful reform to happen, we need a change of culture, not just a change of names. Second, ‘taking back control’ must now mean finding ways to decentralise decision-making from Whitehall and Westminster. Government, working with MPs must drive the intent, but decentralised command must give more power and flexibility for local leaders and local councils to drive local initiatives, the best of which we could all learn from.

Liam Fox: How MPs can better hold Ministers to account over their handling of the Coronavirus

11 Nov

Liam Fox is a former Secretary of State for International Trade, and is MP for North Somerset.

One of the most quoted maxims in medicine is “first, do no harm”. In effect, it means that the patient should not be left in a worse condition following treatment than they would have been if there had been no treatment at all. For all sorts of reasons, are clear echoes of this in our approach to Covid-19.

As we deal with the consequences of the pandemic, we must ensure that the measures we are introducing do not inflict more damage on our long-term well-being than the virus itself. All around the world, governments are struggling to maintain balance as they walk the policy tight rope, with public health pulling in one direction and economic necessity pulling in the other. All of them find themselves confronted with a series of options but no clear solutions.

Our own Government is no different, as it tries to limit the damage to the health of the population and the NHS with the current lockdown – before moving back to the tier system on 2nd December, whilst trying to keep enough of the economy going to fund vital public services and infrastructure for the future.

In many ways, it is a “no win” for the Government, with calls for both stricter lockdown and greater civil liberties being made with equal ferocity. The latest opinion poll shows that 20 per cent of the population believe that the Government has overreacted to the Covid19 emergency, 43 per cent that it has underreacted and that 31 per cent believe that the response has been proportionate.

Problems with track and trace are cited by those who are determined to show that policy has been inadequate, while conveniently overlooking the fact that, across the channel, the French had to introduce a new track and trace system because of the failure of their initial model.  Meanwhile, in Germany, track and trace efforts had become completely swamped, leaving the origin of three quarters of infections a mystery.

Others point to the mistaken use (or misuse) of NHS data as evidence of their assertion that the threat to healthcare capacity has been overblown to justify a second national lockdown. If the public’s confusion is understandable, what clarification is Parliament able to give through its powers of scrutiny?

The answer is that it is limited and, I believe, inadequate. At the moment, Parliament is unable to hold the Government properly to account, because it is unable to access the full range of data on which decisions by the executive are made.

Despite the best efforts of the Speaker and his team, the House of Commons cannot possibly discharge its role of scrutiny by a series of question and answer sessions on ministerial statements that lack the rigour which comes with proper parliamentary debate.

To properly assess the overall response to the pandemic, we need to ensure that we are able to monitor the “treatment” that the UK is receiving, looking across the whole range of issues from public health to social well-being to economic viability. Our current select committee structure allows proper interrogation of the response at departmental level but lacks the crosscutting oversight necessary.

In response to the UK banking scandal in 2012, the government established The Parliamentary Commission on Banking Standards.  It was, in David Cameron’s words, “a full parliamentary committee of inquiry involving both Houses”, with a clear mandate, a senior and experienced membership and cross-party support it was, and was seen to be, rigorous and independent. We should follow that example now.

There are other reasons why such a structure is necessary. The first is that the credibility of the government’s assertion that it is basing its response on “the science” is wearing thin to many and will be sorely tested if the situation continues, or worsens, through the winter and into 2021.

This particular difficulty is exacerbated by the over-exuberance generated in some quarters, where news of progress with a vaccine has been wrongly interpreted to mean that an end to the coronavirus is nigh. The Prime Minister was exactly right to try to dampen this down immediately as it is likely to create an increased risk appetite to the virus, without justification, in an understandably frustrated public. It would be to everyone’s advantage (including the government) if it was clear to the British people that not only “the science” but all other relevant information sets were being independently assessed.

The second reason why such a structure is important is that this will not be the last pandemic that we face. They are the rule in human history not the exception. In recent years, we saw the coronavirus manifest itself in SARS and MERS which, thankfully, were relatively limited and short lived. Covid19 is widespread but not particularly lethal in the history of human pandemics.

In an era of globalisation, where widespread human interaction is necessary (and where before the outbreak around 700,000 passengers were in the air around the world at any one moment) the likelihood is that we could potentially face worst scenarios. We need to be prepared with a blueprint that can be put into effect quickly and to develop global protocols to prevent the piecemeal, delayed and sometimes shambolic global response that we have witnessed on this occasion.

At home, we need our Parliament to be able to credibly assert that it has examined all the evidence, medical and economic, on which policy is being determined. This is crucial in maintaining the political consensus and public confidence needed to see off the naysayers, the cynics, and the political opportunists. To do no harm we need more information, more transparency and more scrutiny. And we need it urgently.

Robert Halfon: This time round, let’s keep the schools open – and not risk an epidemic of education poverty

4 Nov

Now is the time to back Boris Johnson

However reluctantly, we need to back Boris on the lockdown.

Regular readers of my column will know that I have been no shrinking violet when it comes to recommending changes to Government policy. But on Covid, I think we have no option but to support the Prime Minister.

When the Chief Medical Officer (CMO), the Chief Scientific Adviser, Public Health England and independent modelling all suggest a huge rise in deaths and an overwhelmed NHS on the current national trajectory, what Government wouldn’t listen to that advice?

As we learned from the comfort of our sofas on Saturday evening, we could see, without action, up to twice as many deaths over the winter as we saw in the first wave – exceeding as many as 4,000 deaths per day.

In September, critics hounded Sir Patrick Vallance for saying that there could be 200 deaths a day from Covid by mid-November. In fact, we reached that figure much sooner, in late October, rising to 326 by 31 October.

Even if some predictions seem wildly high, would the leader of our country really be willing to risk it? Death cannot be reversed.

For those who question the statistics, read my colleague Neil O’Brien’s article on this site and his numerous tweets, explaining the data behind the decisions that are being made.

Of course, there are differing views about the science from the professionals involved – there always will be. But, at the end of the day, if you ignore advice from the top medical and science advisers appointed by the State to look after our health, what is the point in having such appointments in the first place?

Moreover, it is not as if Britain is unique in all this. Belgium, Italy, France and Germany faced a similar fate and have imposed tougher restrictions and lockdowns. Are the Government’s medical advisers in these countries, who are also dealing with a second wave, all wrong?

I just don’t think as a country we can afford to take the view that this is just the sniffles, as the Brazillian President has suggested. As for the comparisons with flu, we have an annual vaccine and significant herd immunity.

Don’t get me wrong, I would have preferred to keep the traffic light tier system as a compromise. I still think we should return to this system in a months’ time. There is real demand for the Government to publish much more data behind its decisions to close certain venues, alongside the impact of lockdown on the economy, livelihoods, poverty, mental and physical health. Apparent anomalies like not allowing pubs to serve takeaway drinks need to be answered.

In press conferences, the Government should do more to emphasise understanding of the devastation these decisions are causing small business owners, their employees and their families, and then set out (in good time) policies to mitigate against these consequences. The Prime Minister’s statement in the Commons on Monday, announcing additional support for businesses and the self-employed through November, was enormously welcome.

However, given that I am not a scientist nor an epidemiologist, if the CMO says that the situation is rapidly becoming much worse, and urgent action is needed, who am I to argue? I certainly don’t think I am an idiot for listening to what they have to say.

So we need to back Johnson at this time. The Government is walking a tightrope between destitution and death. Opposition to what the Prime Minister is doing in a national emergency sows confusion in the eyes of the public. It gives succour to political enemies – who can shout the loudest, without having to take life or death decisions.

Keep the schools open

Of course, more than ever, schools need to be safe for teachers, support staff, children and parents. It is absolutely right that teachers and support staff who are at risk – those who are vulnerable, or need to self-isolate – should be able to stay at home.

However, thank goodness the Chief Medical Officer and others have said that, even with the new restrictions, it is safe to keep schools open and vital for children, pupils and students.

Pointing to the “extensive evidence”, the Chief and Deputy Medical Officers across the UK reached the consensus that “there is an exceptionally small risk of children of primary or secondary school age dying from Covid-19” – with the fatality rate being lower than seasonal flu. In their joint statement, they noted schools are also “not a common route of transmission”. Data from the ONS also suggests teachers are not at increased risk of dying from Covid-19 compared to the general working-age population.

During the last lockdown, around 2.3 million children did no home learning (or less than one hour per day), according to the UCL Institute of Education.

The Education Endowment Foundation estimated that the disadvantage attainment gap could widen by as much as 75 per cent due to school closures.

And just last week, a study reported in Schools Week found that Year Seven pupils are 22 months behind expectations in their writing ability. Disadvantaged students have inevitably suffered the greatest.

Scientific research has shown that it is safe to keep the schools open and that closing them would exacerbate issues relating to children’s mental health and wellbeing, safeguarding and academic attainment.

Throughout this pandemic, the Children’s Commissioner, Anne Longfield, has been a powerful advocate for keeping children in school – not only for their education, but mental health and safeguarding. In advance of the lockdown announcement she tweeted, “We’ve always said that schools should be the last to shut and first to open. It would be a disaster for children’s well-being and education if they were to close”. I doubt that the Children’s Commissioner would make such a statement if she thought there was significant risk to those in schools.

Even the Labour Leader, Keir Starmer, told Andrew Marr on Sunday that schools should remain open as we go into a second national lockdown, recognising that, “the harm caused to children by not being in school is huge”.

The Head of the Association of School and College Leaders, Geoff Barton, issued a response to the Prime Minister’s statement, saying: “It is right that keeping schools open should be the priority in the new national lockdown… Children only get one chance at education, and we have to do everything possible to provide continuity of learning.”

As Serge Cefai, Headteacher of the Sacred Heart Catholic School in Camberwell, told BBC Radio 4’s World at One on Monday: “Good schools and good teachers will always prioritise the needs of the children. And, of course, it’s a balancing act, but we need to understand that the harm in keeping children at home is huge… The idea that sending children home will stop the transmission is absolute nonsense”.

Daniel Moynihan, CEO of the Harris Federation – London’s biggest academy chain of 50 schools – said: “Young people have already lost a large chunk of their education and disadvantaged children have been damaged most. Aside from the loss of education, there is rising evidence of mental health and child protection issues under lockdown. The closure of schools would inflict more, probably irreparable, damage to those who can afford it least”.

So many heads, teachers and support staff are working day and night to keep our schools open. I’ve seen the extraordinary work they do in my own constituency of Harlow.

Other European countries imposing lockdowns have also decided to keep schools and colleges open. In Germany, for example, a conference of Ministers in October stressed that children’s right to an education is best served in the classroom, arguing: “This must take highest priority in making all decisions about restrictive measures that need to be taken”.

The Prime Minister has said that the Government is ramping up testing. Capacity is now at close to 520,000 tests per day. Schools have access to the Department for Education and Public Health England for sound advice and guidance.

To put it mildly, it is disappointing that the National Education Union would rather risk an epidemic of education poverty, rather than doing everything possible to keep our children learning.

From Disraeli to Johnson, the Left has never understood the Right, and Fawcett shows us why

31 Oct

Conservatism: The Fight for a Tradition by Edmund Fawcett

Edmund Fawcett, “a left-wing liberal” (his term), here performs, with grace, acuity and good humour, a signal service for conservatives. He introduces us to each other.

Reading his book is like being at a vast family party, where as one glances round the marquee one is struck by the affinities between people who have never met, but have much in common.

Here one encounters cousins of whom one may, perhaps, have heard, but about whom one knows next to nothing.

In one of the most delightful parts of his book, published as Appendix C, Fawcett in under 40 pages gives us brief lives of over 200 conservative politicians and thinkers, drawn from Britain, France, Germany and the United States, all of whom have attained some degree of eminence since the French Revolution.

This brevity is wonderful. It is not difficult to find a long book about any of these people. To find a dozen lines that are worth reading can be almost impossible.

And conservatism is itself an almost impossible subject. As Fawcett remarks in his preface, “A chaos of voices has often made it hard to say what, if anything, conservatives stand for.”

He notes a paradox:

“Puzzling as it sounds, conservatives have largely created and learned to dominate a liberal modern world in which they cannot feel at home.”

He remarks that he is not writing solely or even primarily for the benefit of conservatives:

“Readers on the Left will get a view of their opponent’s position, which they are prone, like rash chess players, to ignore.”

And he adds a pointed question for his companions on the Left:

“if we’re so smart, how come we’re not in charge?”

Part of the answer to that question is that the Left often fails to take the Right seriously. Moral condemnation forestalls understanding.

Another part of the answer is that the Right does take the Left seriously, is indeed terrified of the damage it can do. Fawcett begins with two conservative opponents of the French Revolution, Edmund Burke and Joseph de Maistre.

Burke is for British and American conservatives a marvellous source of wisdom, endlessly invigorating and enjoyable. Few of us have ever felt at ease with Maistre’s savagery, but Fawcett insists that although “Maistre was never going to sit well in conservatism’s front parlour”, he “belongs in the household as much as Burke”.

We are happier to be told that Friedrich von Gentz (1764-1832), a Prussian who studied under Kant, worked for the Austrians and took a retainer from the British, translated Burke’s Reflections on the French Revolution into German, “teasing out Burke’s thought in long footnotes that tidied up the argument in rationalist spirit”.

Gentz, Fawcett suggests,

“was an early model of a familiar present-day figure, the clever policy intellectual with top degrees circulating between right-wing think tanks, conservative magazines, and political leaders’ private offices.”

And Gentz in his essay “On the Balance of Power”, published in 1806, developed the ideas which would guide the post-Napoleonic settlement, upholding peace between nations while retarding not just revolution but democracy.

Fawcett is excellent at giving us a feeling for his conservatives by quoting remarks which a less worldly Lefty would not find funny, and might therefore be inclined to censor.

So at a dinner at the Congress of Aix in 1818 we get Gentz telling Robert Owen, pioneer of utopian socialism and of the co-operative movement:

“We do not want the mass to become wealthy and independent of us. How could we govern them if they were?”

But Gentz was not some blinkered reactionary, who supposed the ruling classes could restore to themselves the privileges they had enjoyed before 1789:

“Revolution had to be fought, Gentz insisted, not with nostalgia but with modernity’s own weapons.”

Here is another part of the explanation for conservative incomprehensibility. Intelligent conservatives are at once more attached to the past than their opponents, and more anxious to understand what will work in the future.

This mixture of mixture of emotion and pragmatism cannot be reduced to an ideology – the very thing that leftish commentators consider it a mortal weakness not to possess.

Fawcett’s book is brilliantly organised, so one can without difficulty find what conservatives in Britain, France, Germany and the United States were saying and doing in any particular period.

He himself worked for The Economist as its chief correspondent in Washington, Paris, Berlin and Brussels, and also as its European and literary editor.

As in that magazine, his eye for what is happening overseas is very good, but the texture of British politics is sometimes smoothed away in order to make it fit some editorial analysis.

Fawcett does not get Benjamin Disraeli. Few historians of ideas do, for by the time the butterfly has been pinned to the page, he is dead.

Millions of voters did get Disraeli, loved his patriotism and felt exhilarated by his impudence. He is the only Prime Minister who has inspired the creation of a posthumous cult: the Primrose League.

When he comes to Stanley Baldwin, Fawcett attributes his description of the new Conservative MPs elected in 1918 as “a lot of hard-faced men who look as if they had done very well out of the war” to Lloyd George, as if only a Liberal could see how repulsive the Tories were.

Baldwin succeeded in part because he well understood how repulsive the Tories might seem, and took enormous pains to create a more favourable impression.

In 1980, Fawcett introduces us to “the hard right”. It is an unsatisfactory label, for the word “hard” makes it sound more defined, and less yielding, than it really is.

Fawcett knows the term is not satisfactory, for he keeps worrying away at it, and trying to justify it. In the course of a passage about Donald Trump, he writes:

“The hard right, in sum, was not weird or extreme. It was popular and normal. Indeed, it was alarming because it was popular and normal.

“Lest the term ‘hard right’ here sound loaded, and the account of events overdrawn, the passion and dismay with which mainstream conservatives themselves reacted needs recalling. They did not, in detached spirit, dwell confidently on the hard right’s visible weaknesses and incompatibilities. They did not ask if there was here a pantomime villain got up by the liberal left.”

Trump was and is an opportunist, a huckster who has belonged to three different political parties, and who seeks, as American presidential candidates since Andrew Jackson have sought, to get himself elected by expressing the anger of poor white voters who loathe the condescension of the East Coast establishment.

When he comes to consider Boris Johnson, Fawcett quotes The Economist‘s description of him as “indifferent to the truth”, and its advice to voters last December to vote Liberal Democrat – a way, perhaps, of feeling virtuous, but also of opting out of the choice actually facing the country.

Fawcett goes on to attribute a “forceful hard-right style” to Johnson, and a “disregard for familiar liberal-democratic norms”. The author is worried, for as he declares in his preface:

“To survive, let alone flourish, liberal democracy needs the right’s support… When, as now, the right hesitates or denies its support, liberal democracy’s health is at risk.”

The conservative family is in danger of going to the bad. This is true, but has always been true, and sometimes the warnings have turned out to be exaggerated.

Johnson enjoys teasing liberals, but has lived much among them, craves their approval and himself possesses many liberal characteristics.

Fawcett will know this, for he is the Prime Minister’s uncle: a brother of Johnson’s mother Charlotte.

The near impossibility of defining Johnson, something of which his critics complain, could even be a sign that he is a conservative.

These quibbles about the last part of the book in no way diminish admiration for it as an astonishingly accomplished survey of the last two centuries of conservative thought.

Iain Dale: Stop this utter selfishness and pathetic whinging about not having a normal Christmas to look forward to

30 Oct

Iain Dale presents the evening show on LBC Radio and the For the Many podcast with Jacqui Smith.

Again, it feels like the calm before the Covid storm, doesn’t it?

As more and more swathes of the country go into Tier Three lockdown, it’s clear that, by this time next week, most of the north and parts of the Midlands will have joined Merseyside, Greater Manchester, West Yorkshire and Nottinghamshire in that tier. It’s only a matter of time before London does too, I suspect.

This week, even Germany has gone back into a partial lockdown.  Spain has declared a state of emergency.  France has announced a further draconian lockdown – and Coronavirus in Belgium is seemingly out of control.

At some point in the next two or three weeks, the Government will be forced to take a very difficult decision. No one wants a second national lockdown, but I’m afraid it is looking all but inevitable.

We could of course, take a different pah, ignore the scientific consensus and let the virus take its course – or let it rip, might be a more accurate way of putting it. I cannot see any responsible Government taking that course of action.

In the end, we are going to have to learn to live with this virus. But until our test and trace system is worthy of the name, or a vaccine becomes available, it’s very difficult to see any degree of normality returning to our lives in the next six months – or maybe for longer.

– – – – – – – – – –

After the political debacle about the provision of free school meals, and yet again being comprehensively outplayed by a young Premier League footballer, the next challenge for the Government is how to counter the pathetic accusations about the government ‘cancelling’ Christmas.

Those who make the accusation claim to be those who don’t have a Scooby Doo about what Christmas is all about. It’s not some quasi-materialistic present giving binge; it is a religious festival that celebrates the birth of Jesus of Nazareth.

There is nothing the Government can do or will do that could cancelsthat celebration. Yes, it may mean that family gatherings are more limited in number. Yes, it may mean that we don’t do as much present-buying as we have done in the past. Yes, it will be different.

But for God’s sake, if people don’t understand the seriousness of the situation the country may be in by Christmas, then there is nothing anyone can say or do which will shake people out of their utter selfishness and pathetic whinging.

I can say that. The Government can’t. But somehow, they will need to take on the view that somehow we should all be given a free pass on Christmas Day to let the virus rip.

– – – – – – – – – –

Arzoo Raja is 13 years old. She lived in Italy with her Christian parents. She too was brought up as a Christian. On October 13, she was abducted from outside her house. A few days, later the Italian Police said they had received marriage papers, which stated she was 18.

Her new “husband” was 44 year old Ali Azhar, who also stated Arzoo had converted to Islam, and her new name was Arzoo Faatima.

Her parents provided her birth certificate to the Italian and Pakistani authorities to prove that she was 13. This cut no ice with the Sindh High Court in Karachi, which ruled that she had converted of her own volition, and that she had entered into the marriage of her own free will. The court even criticised the Pakistani police for “harassing” Arzoo after her abduction.

In effect, the court has validated both forced marriage and rape. There have been protests on the streets of Lahore and Karachi.

Countries like the UK cannot stand by, and trot out the well-worn narrative that we can’t interfere with the judiciary of a sovereign nation.

No, but we can turn off the aid tap. We can call in the Pakistani High Commissioner for an interview without coffee. We and other countries have both the power and influence to stop this.

Imran Khan, the Pakistani Prime Minister, has a daughter called Tyrian. He should think how he would have felt if his daughter had been abducted like this when she was 13.

Just for reporting this news on Twitter I have been accused of being islamophobic and “not understanding” the culture. Utter tosh. If we are meant to keep quiet about child abduction and forced marriage, we have come to a pretty pass. I, for one, will continue to speak out, no matter what the backlash.

– – – – – – – – – –

On Thursday morning we all woke up to yet another terror attack in France, with two people being beheaded and another murdered in the name of “the religion of peace”.

Apparently, it is politically incorrect to point out that while the barbarous acts were taking place, the perpetrators were joyfully shouting ‘Allahu Akbar’.

Muslims quite rightly point out that these acts are ‘not in my name’, but the uncomfortable fact is that this is not the view of the terrorists.

In his autobiography, David Cameron says he regrets maintaining that these kind of terror attacks were nothing to do with Islam. He argues that adherents of mainstream Islam have tried to disassociate themselves from the attacks without ever really understanding what has driven the terrorists to assert that they do their dastardly deeds in the name of their religion. He is right.

Stephen Booth: The Brexit trade talks, the romance and realities of fishing, and its crucial importance for Scotland

29 Oct

Stephen Booth is Head of the Britain in the World Project at Policy Exchange.

UK and EU negotiators are now targeting a mid-November deadline to reach a trade agreement. This would give the European Parliament enough time to consider the treaty and hold a vote on it in the last session of the year, due in the week of December 14 – only two weeks before the Brexit transition period ends.

A fortnight ago, a public row erupted due to the apparent suggestion from EU leaders that further compromises all had to come from the UK side and that this was a precondition for “intensified” negotiations. After Downing Street declared the talks “over”, some on the EU side, including Angela Merkel, the German Chancellor, and Mark Rutte, Dutch Prime Minister, sought to immediately defuse the situation, saying the bloc was also willing to make concessions. Ultimately, it took Michel Barnier’s speech to the European Parliament, in which he said it was his intention to “seek the necessary compromises on both sides”, to get the UK to confirm that talks were back on track.

After these theatrics, the EU does appear to have dropped its insistence that the most difficult areas must be settled before progress can be made on lower hanging fruit. The Financial Times reports that much of the talks this week have been engaged with the technical process of agreeing common legal text in areas where there is already considerable agreement, including many of the rules for trade in goods and services, with a mixture of EU and UK drafts being used to reach a consolidated text.

The fact that very little has leaked out of this week’s round of talks is a positive sign that these negotiations are now serious and, indeed, “intensive”. Simon Coveney, the Irish Foreign Minister, this week stated optimistically that: “We’re likely to get a deal, but it won’t be easy.” Charles Michel, the EU Council President, was more equivocal, noting that the two sides have yet to overcome their differences on “level playing field” guarantees, fishing, and the deal’s enforcement.

As I noted in my previous column, the differences over subsidies seem to be narrowing and fishing is increasingly emerging as the major sticking point.

Fishing’s political symbolism is outsized compared to its economic importance to either side. The industry is not significant across the UK – it makes up only around 0.1 per cent of gross value added. The economic contribution is similar in Spain, Denmark and France, which together account for over half the total EU catch.

On the UK side, we know that the Common Fisheries Policy was long viewed as one of the major inequities of British membership and fishing communities were among the most vocal supporters of Leave in the EU referendum. In 2017, around 35 per cent of fish landed by EU vessels from the north Atlantic came from UK waters. By contrast, only 13 per cent of fish landed by UK vessels came from EU waters.

There is a certain romance that an island nation attaches to the sea-faring industry. But cold, hard political realities also explain the significance of fishing in this negotiation. Although not a major national employer, the industry is of course very important to particular communities – often remote, such as along the west coast of Scotland, in Wales and Northern Ireland, with limited other employment opportunities – and, ultimately, the negotiation is a zero-sum game for both sides. More fishing quota for the UK means less for the EU.

For a Conservative Government with increasing reason to be concerned about the state of the Union, there is obvious political benefit to ensuring a better settlement. According to the Government’s statistics, the UK’s largest and most valuable fish landings are in the north-east of Scotland, where larger trawlers tend to operate. 40 per cent of fishers working on UK boats are on Scottish boats. Should the UK gain extra quota, this region is likely to benefit the most. A Brexit dividend for Scotland would be an important win.

The EU knows that the UK has leverage when it comes to fishing access. A failure to reach a deal would mean the UK was under no obligation to provide access to foreign boats at all. Brussels had therefore wanted a deal on fishing rights settled in July, well before the final horse-trading of end-game negotiations.

Nevertheless, a wider trade deal – if it includes a better quota share – is also in the interests of the UK fishing industry. The UK imports most of the fish British consumers want to eat but exports most of the fish UK vessels catch. The EU is by far the biggest market for UK exports. It should also be noted that the wider fish processing industry is a larger, although less vocal, employer than the catch sector. Failure to reach a trade deal would increase costs for UK exports and the processing industry via new trade barriers.

Brussels’ starting position – described as “maximalist” by Barnier – was essentially that its fishing rights in UK waters should not change after the transition period. The EU has so far turned down the UK’s request to move to a new regime of annual quota negotiations – a model the UK recently agreed with Norway.

A possible compromise is likely to rest on establishing a process under which EU fleets’ catch would be phased down over a number of years. The UK would regain a much greater share of future catch opportunities but EU fishing communities would be assured of their rights over the medium-term. How the 100 or so stocks that are up for discussion might be apportioned could also present opportunities to ensure certain political constituencies are prioritised.

So far, Emmanuel Macron, the French President, has been steadfast in his belief that the EU should stand firm on fishing access, vowing to scupper any Brexit deal that “sacrifices” French fishermen. He is aware of a potential political backlash in coastal and rural areas.

However, despite the rhetoric, reports suggest that in private, at least, the French government is preparing the industry for a compromise. It should be noted that Macron is also effectively negotiating with the rest of the EU about how much of the residual quota France will get in the future.

Given the wider economic and political issues at stake, it still seems unlikely that fishing will be the deal-breaker. Macron is likely to come under increasing pressure from member states most exposed to no deal – Ireland, Belgium, the Netherlands and Germany – to moderate his position. However, it is clear that the political choreography of reaching a deal on this issue is vitally important on both sides of the table.

Tobias Ellwood: The Government has helped to let Iran, a rogue state, off the leash. It’s time to rein it back in.

28 Oct

Tobias Ellwood is Chair of the Defence Select Committee, and is MP for Bournemouth East.

Javad Zarif, Iran’s Foreign Minister, was in a celebratory mood last weekend, as the United Nations’ long-standing arms embargo quietly expired. The occasion, in accordance with the Joint Comprehensive Plan of Action (JCPOA) nuclear deal, was deceitfully proclaimed as a “win for…peace and security in our region”. This could not be further from the truth.

In reality, Iran is now unencumbered in its ability to purchase advanced weaponry to strengthen itself and its terror proxies, including Russia’s game-changing S-400 missile defence systems, and upgrading its outdated air force. Such systems would provide Iran’s nuclear programme with invaluable strategic protection.

It is for this reason that I have joined over 80 of my Conservative parliamentary colleagues in signing a letter outlining our concerns to the Prime Minister, coordinated by Conservative Friends of Israel.

The strength of feeling among the Conservative ranks is clear to see. There has long been widespread concern about Iran’s malign activities throughout the region, but it has become increasingly apparent that the UK’s response has failed to adequately meet the challenge.

The signatories were united in their view that the United Kingdom should have supported the efforts of the United States to secure an extension to the conventional arms embargo at the United Nations in August.

While recognising the political balancing act necessitated by ongoing Brexit trade negotiations, I fear that the UK’s abstention alongside France and Germany has regrettably facilitated the Chinese and Russians in their quest to sell advanced weaponry to Tehran’s fundamentalist regime. China has reportedly agreed a 25-year $400 billion defence deal with Tehran.

There are major questions hanging over the UK’s strategy towards Iran moving forward. While the EU arms embargo regime on Iran remains in place (until 2023), this will not prevent other actors from selling weapons. Certainly, existing UN resolutions haven’t deterred Iran from supplying arms to its terror proxies, and the UK now needs to work urgently with its allies to enforce existing resolutions more rigorously.

Iran’s support for terrorism has left a trail of destruction and death across the world. From Buenos Aires to Jerusalem and Bulgaria to Yemen, Iran-backed terrorists have killed untold numbers. Iran is not just a threat to Britain’s allies and international peace and stability – it has been linked to the deaths of dozens of British service personnel in Iraq.

Looking ahead, there needs to be a clear-sighted approach to Iran from the Government.

From continuing to enrich uranium closer to weapons grade above the JCPOA limit and increasing its stockpile of low-enriched uranium to ten times higher than permitted, Iran’s flagrant breaches of its commitments under the JCPOA has confirmed that the deal is not fit for purpose.

Time and again, Iran has chosen the path of a rogue state. At the time of the JCPOA’s signing, British officials spoke of an opportunity to reset relations. Iran had no such intentions, as most dramatically illustrated by the detention of our Ambassador for attending a memorial to the victims – including Britons – of a Ukrainian passenger jet in January. Not to speak of the continued imprisonment of British nationals on spurious and indefensible grounds.

Iran’s leadership has not earned the benefit of the doubt. The UK’s ongoing efforts to keep the JCPOA on life-support since triggering the Dispute Resolution Mechanism is not a sustainable strategy, just as the UK’s INSTEX mechanism to facilitate trade by circumventing US sanctions has essentially rewarded Iranian non-compliance.

Our Prime Minister was right when he said in January that the JCPOA has “many, many faults”, and called for a replacement deal. So, too, was the Foreign Secretary right to describe the nuclear deal as a “hollow shell”. Now is the time for UK policy to align with these statements of reality.

The UK is well placed to bridge the US with the EU and push for a new, broad framework. The framework must provide unprecedented regulation of Iran’s nuclear activities, an end to Iran’s support for terrorism and its ballistic missile programme – the primary means for delivering a nuclear warhead.

How do we ensure Iran returns to the table? It is an unavoidable reality that Iran was compelled to the negotiating table for the JCPOA process as a result of one of the most comprehensive sanctions regimes in history. The UK has introduced a welcome set of sanctions against Iranians linked to the Islamic Revolutionary Guard Corps, but has desisted from the US ‘maximum pressure’ sanctions campaign.

Sanctions work, and it is time for the UK to consider further ones it can target against the regime, while making abundantly clear that these do not apply to legitimate humanitarian aid. Snapback of pre-JCPOA sanctions ought to be under consideration and would be in full accordance with United Nations Security Council Resolution 2231, as necessitated by Iran’s “significant non-performance”.

The continued resuscitation of the JCPOA despite Iran’s clear non-compliance is not only short-termist in thinking, it is fundamentally ill-considered. The framework has been fatally damaged for some time and the focus must now be on diplomatic efforts to secure a strengthened, broad deal.

Iran’s defiant advancement of its nuclear programme now risks proliferation across the Arab world, at a time where hitherto unthinkable peace deals are being agreed between Israel and Arab states.

We are at the beginning of a new chapter for the region – one based on prosperity, shared interests and peace. But unless the UK readjusts its current thinking that chapter may never get written.

The Government’s Integrated Review is about re-establishing our post-Brexit global credentials and our desire to help shape the world as a force for good. This must include greater strategic engagement in the Middle East and standing up to the destabilising actions of the Iranian regime.

David Davis: My prescription for a Covid Plan B? A strategic dose of vitamin D.

26 Oct

David Davis is a former Secretary of State for Exiting the European Union, and is MP for Haltemprice and Howden.

Remdesivir, the much-touted anti-Covid drug, has failed its tests, and has been shown not to prevent any deaths. Vaccines, touted for September, are now delayed at least until the second half of the winter, will be rationed, and are expected to be only partially effective.

Meanwhile, the various lockdown strategies tried by the government are of variable effectiveness, somewhere between partial and zero in their impact. The Government’s scientific advisers are recommending temporary lockdowns without hard evidence of their effectiveness. Only last week they admitted that the evidence base for the so called non-pharmaceutical strategies are “weak”, but that urgency requires their use.

Lockdowns have enormous economic cost, and have deadly side effects on the general health of the nation. Indeed if the lockdown strategy were a drug, it would have failed to meet the criteria that have now led to the rejection of remdesivir, hydrochlorquine, and countless other more or less promising medicines.

And the trouble with the “temporary” lockdown is that, without a very fast and effective test, track and trace system, backed up by a rapid isolation strategy, the lockdown will go on for months. The harm to lives and livelihoods will be enormous.

So what now? Is there an escape from this nightmare? Is there a game changer available to us that will allow us to create an effective plan B? I believe that there is.

In early May, I wrote to the Health Secretary pointing to two studies showing a strong association between the incidence and severity of Covid-19 with vitamin D deficiencies in the patients.

Vadim Backman, one of the authors of one of those studies, said about healthy levels of vitamin D that “Our analysis shows that it might be as high as cutting the mortality rate in half”.

Now I am a sceptic when it comes to vitamins and supplements. The supplements industry has a few too many salesmen too willing to make bogus or overblown claims for products that have are mostly harmless – but also mostly useless.

But this was a little different. The claims were, and are, coming from highly respected scientists, the vast majority of whom had no commercial interest. And the arguments were scientifically plausible.

Most of us learned in our GCSE science courses that vitamin D was important to calcium uptake for building healthy bones. Deficiency led to rickets and other bone diseases.

But less well known is that since the mid 1980s there have been a series of scientific discoveries that showed that the the role of vitamin D was massively greater than had previously been understood. Every cell in the body had a vitamin D receptor. At sufficient concentrations, the vitamin switches on thousands of genes.

In particular the immune system seemed to be hugely dependent on the availability of the vitamin. It enhances both innate immunity – the original primitive immune system that is the primary defence of young children – and adaptive immunity, the system that creates antibodies to kill pathogens.

Every year that passes sees more and more scientific insight into the role of vitamin D in resisting disease and controlling inflammation. There is hard evidence in particular in the role of vitamin D supplementation in resisting respiratory diseases. It can help suppress colds, influenza and pneumonia, which fact I also highlighted in my letter to Matt Hancock.

When the Secretary of State referred my letter to NICE, the Government’s body that assesses drug effectiveness, they essentially rejected it on the grounds of insufficient evidence. The evidence was, of course, stronger than for there so called “non-pharmaceutical strategies”, but that was not a matter for NICE. And since then, there has been a non-stop stream of supportive evidence.

Before we get to the hard science, there is already a vast amount of circumstantial evidence. Everyone is well aware that the risk of dying from Covid-19 is significantly increased if you are elderly, obese, come from a black or minority ethnic background or have a pre-existing health conditions such as diabetes.

A very large proportion of all those groups are people with Vitamin D deficiency. Of itself, that implies that vitamin D deficiency may be the common cause.

There are clear correlations with latitude and seasonality in the severity of the disease. Basically, the more sunshine, the more vitamin D, the fewer deaths. The exceptions are countries like Spain and Italy, whose cultural traditions (of covering up) lead to very low vitamin D levels, and to higher death rates. The example the other way is the Nordic countries, who are very northerly, but whose diet is either naturally or artificially rich in vitamin D.

So the physiology and biochemistry implies that there is an immunological effect. The evidence all around us implies that there is an effect. But for the scientists we need hard data.

When I wrote to the Health Secretary, I laid out observational studies that had shown a significant reduction in infections, and a dramatic drop in the death rate above a certain blood level of vitamin D.

Since then, the evidence showing that vitamin D might help prevent Covid turning serious in some people continues to grow.

The gold standard of medical research is the randomised control trial. At the start of the pandemic we did not have such evidence, and NICE highlighted this in their June review.

However, since the review, researchers in Spain have published the results of the world’s first randomised control trial on vitamin D and Covid.

The results are startling and clear-cut.

The trial, which took place at the Reina Sofía University Hospital in Cordoba, involved 76 patients suffering from Covid-19. 50 of those patients were given vitamin D. The remaining 26 were not. Half of those not given Vitamin D became so sick that they needed to be put on intensive care. By comparison, only one person who was given Vitamin D requiring ICU admission.

To put it another way, the use of Vitamin D reduced a patient’s risk of needing intensive care 25-fold.

Two patients who did not receive Vitamin D died. None of those on vitamin D died. While the sample size is too small to conclude that Vitamin D abolishes the risk of death in Covid patients, it is nonetheless an astonishing result. Again, it is consistent with earlier studies showing large reductions in mortality.

This is just one element of the growing body of evidence showing a link between Vitamin D and Covid-19 outcomes. Recent analysis by Ben Gurion University suggests supplementation can cut the risk of infection from Covid-19 in half in some of the most at-risk groups. This 1.3 million person study backed up the conclusions of a previous 190,000 person research project in America. The mass of evidence is building and building.

Thankfully, the Government at last appears to be acting on this.

Last week, the Health Secretary confirmed his Department would be looking again at the evidence. He also confirmed that the Government would be increasing the public messaging around Vitamin D supplements. Crucially, he confirmed there are no downsides to taking supplements.

The vitamin D levels in the blood of the British population halve over the winter, which is one reason we catch so many colds then. They started going down in September. So this announcement is long overdue. Nevertheless we still have just enough time to act on this.

Vitamin D is readily available and – at a penny per pill – it is incredibly cheap. Providing supplements to those at risk due to pre-existing conductions, such as diabetes, would cost £45 million: to these, plus to every ethnic minority citizen, about £200 million.

For a little more, we could do what the Nordic countries do, and fortify some basic foods with vitamin D. And for tiny amounts of money, we could repeat the Spanish experiment in every British hospital, elevating vitamin D levels in Covid patients on arrival, cutting down the demand for ICU treatments.

These expenditures are trivial amounts compared to the £12 billion spent on test and trace and the billions being pumped into the NHS to help it through the crisis.

Furthermore, providing supplements for those at most risk would also help reduce other pressures on the NHS through the winter months, as we know Vitamin D can reduce the likelihood and severity of other acute respiratory illnesses, which flare up annually around this time. Imagine the thousands of lives that could be saved even if we just made prescription mandatory for care homes?

If we were really ambitious, we could fortify our food with it. Sweden puts it in milk as a matter of course, as do some of their Nordic neighbours.

In summary, correcting vitamin D deficiency could halve the infection rates in vulnerable groups: in addition it could more than halve the death rate for those who do get infected. At a time when we are considering yet another lockdown, with all the damage that that could cause, this could be a game changer.

Add this to the better techniques in medical handling of serious cases, and the availability of dexamethasone for the most severe. These are already cutting death rates in ICU from about 50 per cent to nearer 30 per cent. Combine it with the better organisation of hospital care which is now underway, and perhaps reinforce that with use of the Nightingales to isolate more infected people (rather than just as overspill capacity).

The pandemic mortality rate, properly managed, would begin to approach the severity of a serious flu outbreak. At that level, we would no longer need the massive economic self harm of national lockdowns. And as that pressure comes off, there may be a chance of the track and trace getting ahead of the disease, and controlling it further with a hyper-localised strategy, similar to the successful German and South Korean ones.

So while the review of the evidence is underway the Government must take the first step towards addressing the issue.

The Government must at very least provide free supplementation to the at-risk groups. This will no doubt save thousands of lives across the winter months and, in Matt Hancock’s own words, supplementation has “no downsides”. The odds of success are seriously better than the government’s existing strategy. Accordingly, the precautionary principle makes this a no-brainer.

Raghib Ali: The Government needs a Plan B for Covid-19, lives and livelihoods. Here’s how one would work.

22 Oct

Dr Raghib Ali is an Honorary Consultant in Acute Medicine at the Oxford University Hospitals NHS Trust, and a Visiting Research Fellow of the Department of Population Health, University of Oxford.

Last month, I described on this site what I expected the likely trajectory of the second wave to be; explained why a certain level of suppression was needed to enable the NHS to keep running all services running to prevent non-COVID health harms; and why that should not be achieved through more lockdowns, since the Government’s own cost benefit analysis showed it caused greater overall long-term health harm.

Since then, there have been increasingly pubic divisions between both scientists and politicians as to the best way forward over the coming months with opposing declarations and memorandums.  Some say current restrictions go too far, others not far enough – with the Government left in an almost impossible position of choosing the least worst option.

Today, I will briefly review the main strategies that have been proposed – herd immunity/focused protection (Great Barrington Declaration, GBD); further suppression/test & trace (John Snow Memorandum, JSM); the current tier system with targeted restrictions; and a potential alternative way forward.

In my last article, I outlined three criteria that any strategy / intervention should be judged by:

i) the evidence for effectiveness,

ii) whether a mandatory approach produces better outcomes than a voluntary one, and

iii) most importantly, that they produce less overall harm.

And today, I add a fourth – compliance – because all measures are only effective if a high enough proportion of people comply with them.

The Great Barrington Declaration

Having consistently highlighted the health harms of lockdown since May, I did of course welcome the GBD’s emphasis on the many harms of lockdown – particularly in developing countries without welfare states – where lockdowns are even more likely to cause overall health harm.

However, a declaration is not a policy and there are still too many unanswered / unanswerable questions which have been highlighted by many others.

Although I fully agree on the need to focus protection on care homes & hospitals, I am not yet convinced that it is feasible to shield the very large numbers of vulnerable people in the community while Covid-19 transmission is high (especially for those who live in multigenerational households).

Also, the number of ‘non-vulnerable’ who would be symptomatic and hospitalised in the coming three to six months (about 50 per cent of COVID admissions are currently aged 18- 64) would make it very difficult to maintain all NHS services – there is simply not enough spare capacity (particularly of staff.) And no country has successfully followed a herd immunity strategy.

It also does not currently have public support (more than 2:1 oppose it) which would be essential in maintaining compliance with shielding for the vulnerable; and in persuading the less-vulnerable to be exposed by returning to normal life.

Finally, its advocates have not shown that it will cause less overall harm which is, of course, the key overall metric it should be judged by.

The John Snow memorandum

In response to the GBD, the JSM was released. I understand the rationale of those who advocate a second (so-called ‘circuit-breaker’) national lockdown who believe that is better to have a shorter lockdown now than a longer one later – which may well be true – but this is not the key question, which should be: is it less harmful than not having one at all?

The limitations and harms of lockdowns have been well documented and I will only add a few points.

There is insufficient evidence that a two week lockdown will achieve its aims (Israel’s second lockdown has already lasted four weeks) and it may not be possible to lift it after two weeks if cases are still rising. And this strategy may just lead to a cycle of lockdowns which is not sustainable.

Lockdowns are only effective if they are complied with (Israel had much lowers levels of compliance in their second lockdown) and, even with current restrictions in the UK, compliance is lower than it was during lockdown and there is no guarantee it will be high enough to be effective.

The models only show that a lockdown may reduce Covid-19 deaths, but these have not modelled the number of non-Covid lives that will be lost or adverse health effects from other causes.

Although the intention of the circuit breaker is to buy time to get Test &Trace (T&T) back on track and ensure the NHS is prepared, it is hard to see how two weeks would make much difference when the NHS has had months to prepare.

T&T is of course an essential part of the solution but, again, there is insufficient evidence that we will ever be able to control the virus through T&T – we tried this over the summer when virus levels were almost zero after one of the longest lockdowns in Europe and it hasn’t worked here – or in the majority of countries in Europe.

It is also not true to say that ‘the only thing that works is lockdowns’ – social distancing and sel -isolation before lockdown here was bringing R down, and Sweden has showed it is possible to overcome a first wave without one – which I will return to later.

Finally, although public support for a two week lockdown is currently high, this would change if it was made clear that it could be 4 or 6 weeks or that it may well cause more long term health harm than benefit.

I know and respect many of the scientists supporting both positions and know they genuinely believe their strategy will cause the least overall harm, but I have not signed either the GBD or JSM. Neither adequately acknowledges the limitations and harms of their approaches or the uncertainties of the evidence – and both are overly confident in their assessment of their effectiveness.

The Government’s three-tier system

I still think the current gGvernment strategy of suppression to keep cases low enough to maintain all NHS services and minimise non-Covid health harms while trying to protect education and jobs is a reasonable compromise. Furthermore, if virus levels get too high, fear increases and people don’t come to hospital, don’t go out and the economy suffers, etc.

I certainly support the targeting restrictions based on the local level of cases as opposed to blanket national ones. I find it hard to understand how it can be possibly be fairer to destroy jobs and businesses all over the country including in areas where hospitalisations are extremely low than to target restrictions on those areas where they are highest and the NHS is under pressure. This should not be a political issue, or North vs. South – it’s just common sense.

We can only get through this crisis by supporting each other, and by keeping the economy open in as many places as possible, we can help fund businesses and jobs in those areas that are forced to temporarily close until the pressure on the NHS subsides.

There is also evidence that the current measures are working – R is stabilising (or even falling) in most regions at about half the level of the first wave, and the NHS is not being overwhelmed. However, they have not yet bought R down below one, and hospitalisations and deaths are still  rising.

The key problem appears to be compliance, and we need to focus more on how we can improve compliance with existing restrictions rather than increasing restrictions. After all, the purpose of restrictions (& lockdowns) is purely to enforce social distancing. We urgently need to analyse levels of compliance by local area and to understand what is driving lack of compliance.

For example, despite good intentions, only 20 per cent of those required to self-isolate are doing so, and it may be that financial incentives may be more effective in sustaining compliance with testing and self-isolation (e.g. paying people to self-isolate, as in Germany and Sweden).

Some people also think the measures aren’t working and so say, ‘What’s the point?”, but this is not true, which needs to be stressed.

So think it is reasonable for the Government to maintain its current strategy for three more weeks to see the effectiveness of the Tier Two and Three restrictions and devolved nations ‘circuit-breakers’.

A potential Plan B

However, we also need a Plan B to get us to Spring – and potentially longer if vaccines / treatments / mass testing are not as effective as hoped.

I would therefore ask the Government to consider an alternative strategy which may cause less overall harm based on the Swedish approach, but with much better protection of the vulnerable, especially in care homes. This is now much more achievable than in the first wave – because cases are lower, testing and PPE are more available. Individual risk calculators will now also  enable, smarter, voluntary shielding of the community vulnerable.

The key point is that Sweden has shown that it is possible to suppress the virus and get over their first wave (and so far control their second wave) without a national lockdown; without reaching herd immunity and without an effective T&T system. And while keeping schools and businesses open – and so reducing overall harms.

The Swedish approach has been widely misunderstood – the official government strategy is ‘to limit the spread of infection in the country and by doing so, to relieve pressure on the health care system and protect people’s lives, health and jobs.’

And as its Chief Epidemiologist, Dr Anders Tegnell, has said, Sweden is not trying to reach herd immunity (and has not achieved it) and it did not encourage the non-vulnerable to return to normal life. Indeed, its government is strongly encouraged social distancing, reducing social contacts, plus th use of public transport and working from home).

It has also introduce many other measures (i.e: closing universities, table-service only in restaurants, limited gatherings to 50 people.Tegnell has described the policy as a ‘voluntary lockdown’ – and generally the levels of compliance have been very high.

The Government has stressed personal responsibility and trusting the public with simple, consistent, public health messaging and tried to build public consensus and trust.

Of course, there are differences between Sweden and the UK, and there is no guarantee that its approach would work here, but the principles are still valid. The Sweden model is also not a cost-free option – and may lead to more Covid-19 deaths in the short term than would otherwise have been the case – but that is not the key metric, which is whether the strategy will lead to the least overall health harm in the long term.

The key to any successful strategy is sustainable compliance – and it must therefore have public trust and confidence. Open debate is important but, as I wrote in June, ongoing divisions lead to both fear and complacency, undermine public confidence and compliance – and can cost lives and livelihoods.

We therefore need doctors, scientists, and politicians to get behind the same overall strategy and I think this will only be possible if we can show which one causes the least overall harm.

The Government should therefore immediately bring together doctors, scientists and economists to conduct a comprehensive cost-benefit analysis of these four options (similar to the one they have already conducted) and come to a consensus – which should then be shared with the public and other scientists.

I have made my own assessment, but I neither have access to all the data nor a monopoly on wisdom and so am happy to accept whichever option comes out best – and hope others will do the same.

I end with the same conclusion as in June: ‘Finally, of course we are not primarily ‘pro- or anti- lockdowners’ – we are all ‘pro-protecting lives and livelihoods’ and wanting to recover from this crisis as quickly as possible. And so, we must put aside our differences, compromise and come together in the national interest. ‘A house divided against itself cannot stand.’