Liam Fox: Are we really going to close down the global economy every time a new virus emerges?

24 Jan

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

Over 71,000 more people died in 2020 than would have been expected in a normal year. Apart from a deluded and dangerous minority whose addiction to conspiracy theories leave them in denial about the impact (or even the existence) of Covid-19, most people recognise that these excess deaths are due directly or indirectly to the pandemic.

The UK has been recognised as one of the world leaders in the vaccination programme. Britain has made £548 million available to the Covid-19 Vaccines Global Access facility (COVAX), to support equitable and affordable access to new coronavirus vaccines and treatments around the world.

The rollout of the vaccine to the UK population has also been impressive, although there is growing concern about the decision to extend the period between doses of the Pfizer (but not the Oxford AstraZeneca) vaccine.

If we are to continue to lead globally on the issue – and this year’s G7 summit gives us an ideal opportunity to do so – we must be clear about the reality in which we find ourselves, and recognise that the data systems we currently have will be inadequate to deal with the challenges of global pandemic.

We need to understanding that, contrary to a great deal of assertion, this is unlikely to be a “once in a generation” event.

The first major, and deadly, coronavirus outbreak of the 21st century was SARS in 2002.  The second was MERS in 2012. So we are now in the third major global coronavirus outbreak in 20 years.

While the first two had higher death rates than Covid-19, it is the transmissibility of the latest viral variant that has caused such damage. There is, however, no guarantee that we will not get both a more deadly and more transmissible outbreak in the future.  It is likely that Coronavirus is here to stay, and that we will have to deal with potential new variants emerging from time to time around the world.  To have any chance of dealing with this effectively, we need to develop international protocols, and this means having standardised recording of data.

In the UK, there is no single measure to calculate the mortality rate for Covid-19 accurately . We use inferences from total excess death rates, the number of people who have died within 28 days of a positive Covid-19 test, and those who have had Covid-19 mentioned as a contributory cause on their death certificate.

None of these on their own can give us a truly accurate picture about the cost in lives of the virus.  There are three different types of patients who may fall within the excess mortality figures.

The first group is those who have died of Covid, i.e: where this was the main cause of death.

The Coronavirus Act 2020 made changes to death certification which may cloud the waters in this regard. While it is still intended that the doctor who attended the deceased during their last illness should, where possible, complete the death certificate, the Act also allows this to be completed if a patient was not seen by any medical practitioner during their last illness.

If that happens, a doctor would need to state to the best of their knowledge and belief the cause of death.  Covid-19 is now an acceptable ‘direct’ or ‘underlying’ cause of death for the purposes of the certificate but, although it is a notifiable disease, this does not mean that deaths from it must be reported to the coroner.

This may well result in fewer post-mortems being conducted, and a valuable source of data missed.  Some autopsy studies of patients who died of “influenza” during the 1918 Spanish flu pandemic showed that, while almost all patients had evidence of bacterial pneumonia, fewer than 50 per cent tested positive for influenza viral antigens or viral RNA. In other words, there was a significant overestimate of the numbers who had actually died of influenza itself.

The second group is those who died with Covid19, that is, those who had been diagnosed with a positive test ,but who may have died of other, unrelated causes.

It seems strange to many that someone who tested positive for the virus but was hit by a bus within a month is counted as a Covid-19 death.

The third group is those who have died as a consequence of Covid-19, including those who did not access medical care because of lockdown, or those who were unable to access the appropriate care because hospitals were overwhelmed with Covid-19 patients.

This will be of importance in determining how we run our healthcare services, especially if pandemic is likely to occur more frequently.  It has long been the practice in the NHS to run at very high bed occupancy rates.

We have to ask, if pandemic is going to be potentially a more frequent event, whether this is tilting the balance between efficiency and resilience in the wrong direction.  Given that we have spent billions of pounds trying to stop the capacity of our healthcare system being overwhelmed, would it not be more sensible (and potentially more financially prudent) in future to run the system with many more beds available than we expect to need at any one time?

Given the overall cost to our economy and the impact on the future of our public finances, perhaps we need to re-visit some of the assumptions that have underpinned policy under governments of all political colours. ,

Britain has a real opportunity to lead the global debate and the government can lead the way with the shakeup of Public Health England and the Resilience Unit within the Cabinet Office, both of which should have been better prepared for any pandemic.

I have supported the Government in all the lockdown measures they have taken in relation to Covid-19 but, in future, are we really going to close down the global economy every time a new virus emerges?

If not, what are the international protocols that we will need to develop as a global community and what are the metrics that we will require to make them work? Without proper information, how will we be able to determine the case fatality rate (the deaths from a disease compared to the total number of people diagnosed in a particular period) which will be one of the key measures that we will have to make in the event of a new outbreak?

We will also need enforceable global rules around transparency and notification. As we head for the G7, there can be no better example of “Global Britain” than for Britain to take a lead in pandemic preparedness and work towards global definitions that will enable us to avoid the uncoordinated global response that we have seen during Covid19.

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.

Hunter DuBose: Why Sweden is leading the way out of the pandemic

29 Sep

Hunter DuBose is the Managing Partner of Spitfire Capital Advisors.  He also conceived and produced Brexit: The Movie.

In his ConservativeHome article yesterday, Bernard Jenkin derided Sweden’s light-touch strategy in response to Covid-19, and mounted a staunch defence of the Government’s ongoing policy of unprecedented and draconian restrictions on our daily lives in its effort to suppress the transmission of the disease.

He is wrong.

It is becoming increasingly evident that Sweden not only got it right, but that the human cost of the UK’s onerous Covid-19 policies will be significantly worse than Covid-19 ever would have been.

Covid-19 has now virtually disappeared in Sweden. The country had among the worst rates of Covid-19 fatalities in the world in April. Now, it’s among the lowest, having fallen over 99 per cent, and with an average of just one death per day over the past week.

What has Sweden done to achieve this? Almost nothing. And that’s the point.

The Swedish government never imposed any lockdowns. Nor has it required the wearing of face masks (and only two per cent of Swedes have worn masks voluntarily, according to a survey published in the New York Times). Offices, schools, restaurants, bars, shops, salons, gyms, and tourist attractions have remained open throughout. Contrary to enkin’s suggestion, Sweden did not bring Covid-19 under control using a track and trace system, having abandoned such plans in early March.

The Swedish government did require tables to be spaced farther apart in restaurants and bars, banned public gatherings in excess of 50 people (now relaxed to 500), restricted travel from areas outside of Europe, and shifted colleges and universities to distance learning. It also recommended – but never mandated – that Swedes observe social distancing and minimise domestic travel, and that over-70s should stay at home as much as possible.

Sweden, then, is the closest we have to a control group for light-touch mitigation rather than the UK’s draconian suppression of Covid-19.

And, as the extraordinary reduction in daily deaths there reveals, the virus has now all but burnt itself out naturally. The empirical evidence points exceptionally-strongly to the establishment of herd immunity there. While the UK frets about the potential for a second wave of Covid-19, all indications are that Sweden can now move on and get back to life as normal and business as usual.

But what has been the human cost to Sweden of letting Covid-19 run its course naturally and without significant intervention?

This year’s all-cause mortality rate in Sweden is on track to be the 13th worst of the past 40 years, according to Statistics Sweden (their version of the ONS). In other words, Sweden has experienced a worse death toll every three years, on average. Every individual death – from any cause – is excruciatingly sad. But Covid-19 has had an entirely-unexceptional effect on Sweden’s annual death rate.

Notably, Sweden does not appear to have experienced a significant increase in excess mortality for conditions entirely unrelated to Covid-19 such as cancer, stroke, heart disease and suicide. There have been an estimated 15,000 – 25,000 such deaths in the UK so far, with lockdowns and re-prioritisation of NHS resources cutting off access to urgent, life-saving treatment. A recently-leaked SAGE report predicts up to 75,000 such deaths over the next five years due to delayed treatments and diagnoses. That’s almost twice the current UK Covid-19 death toll.

But, “Aha!” Bernard Jenkin says: the Swedish population is much healthier and sparser than the UK’s and, therefore, the bar for achieving herd immunity is significantly lower there. Many hundreds of thousands of Britons would have to die in order to achieve the same outcome, he claims.

On this point, again, Jenkin is wrong. And gratuitously so.

The UK is a nation of fatties, he tells us, with 27 per cent of us obese compared to only 20 per cent in super-svelte Sweden, making us more susceptible to the ravages of Covid-19. However, according to ONS data, only 0.9 per cent of Covid-19 mortalities in England and Wales in March and April – when the vast majority of Covid-19 deaths occurred – cited obesity as the main pre-existing condition. Only 1.3 per cent cited obesity as a pre-existing condition at all.

He also claims the higher rate of smoking in the UK, makes us more susceptible to Covid-19. However, the available scientific evidence does not identify smoking as a significant risk factor for Covid-19 and, in fact, suggests that smokers may actually face a lower mortality risk from the disease.

Jenkin simplistically divides population by land mass to conclude, erroneously, that the UK is 11 times more crowded than Sweden, making it significantly easier for the virus to spread from person to person. However, the majority of Sweden is completely empty, with 85 per cent of its population living in dense urban areas. Sweden’s population-weighted density – which adjusts for this – is actually among the highest in Europe and 25 per cent higher than the UK’s, according to a 2015 EU Commission report, with urban areas 60 per cent more dense than the UK’s. (For this same reason, comparisons between Sweden and other, legitimately-sparse Nordic countries are inept).

Jenkin contends that, according to antibody testing by the ONS, fewer than eight per cent of Britons have contracted Covid-19, thus far, and that a further 50 per cent of the UK population would need to become infected in order to establish herd immunity here.

However, recent scientific research from Oxford University, Karolinska Institutet, Duke-NUS Medical School, and La Jolla Institute for Immunology, among others, demonstrates that the prevailing technology for SARS-CoV-2 serology tests provides a wholly incomplete and unreliable picture of the degree of immunity to the virus in the population at large.

This is because they don’t test at all for the presence of the IgA variant of antibodies or of the killer T-cells that, according to the research, play vital roles in the human body’s repertoire of weapons to eradicate the virus.

Indeed, several of these studies indicate that up to 50 per cent of the population already possessed SARS-CoV-2 cross-reactive T-cells – and presumed immunity to Covid-19 – prior to any exposure to the virus, most likely due to previous infection by other coronaviruses, such as those that cause SARS, MERS and variants of the common cold.

Tellingly, a recent analysis by Werlabs in Sweden found that only 14 per cent of a sample population there was positive for SARS-CoV-2 antibodies. If Sweden has achieved herd immunity with only 14 per cent of its population testing positive for antibodies, can the UK really be that far behind?

By any reasonable standard, given the available evidence, the Swedish model has achieved vastly superior results and at a significantly lower cost in human lives. The British government should take heed.

Luke Evans: We must protect our shop workers from violent crime. Not ask them to police the wearing of face masks.

15 Jul

Dr Luke Evans is a member of the Health Select Committee, and is MP for Bosworth.

Last Friday, a shop worker in my constituency was walking across the car park of the Co-op branch where he works after taking his break. The employee at the Markfield store saw a man acting suspiciously in the car park so asked if he could help him?

At that point the man became ‘very angry and verbally aggressive’ and started shouting abuse at the employee.

Without any provocation, the individual in question physically assaulted the shop worker knocking him unconscious, and subsequently rolled him on to his side stealing the employee’s phone, before climbing into his car and making his escape.

The Central England Co-operative Society have rightly decided to take a firm stance in respect of the incident, they are seeking both to ensure that their employee recovers from the ordeal, but are also doing everything in their power to ensure the perpetrator is tracked down and prosecuted to the full extent of the law.

The details of this incident are shocking, they are also – sadly – not particularly surprising.

The latest edition of the British Retail Consortium Retail Crime Survey reveals that there are 424 violent or abusive incidents against retail employees every day – an increase of nine per cent on the previous year; the use of knives is becoming an increasingly concerning factor; and over 70 per cent of respondents described the police response to retail crime as ‘poor’ or ‘very poor’.

It’s very easy to forget all of the events of Covid-19 pandemic, especially the astonishing contribution made to the national effort made by shop workers.

In the early days as most of us were advised to stay at home, we have to remember that, alongside NHS and care workers, it was shop assistants who continued to go to work, putting their own lives at risk, to ensure we could all continue to put food on the table.

In a very real sense, our shop workers have been the unsung heroes of the pandemic.

Incidents like the one which happened last week in my constituency should not happen. I’m supportive of the principle behind Alex Norris’ Private Member’s Bill calling upon certain offences against retail workers in the course of their employment, such as malicious wounding, to be classed as aggravated offences.

But I would suggest that those protections are needed now more than ever.

This virus has a habit of exploiting weaknesses in our society, and I am about to use it to highlight another.

For not only do we have the year on year increasing level of aggression against shopworkers we also now have their potential role in enforcing the mandatory and controversial wearing of face coverings in shops and supermarkets from 24 July.

In the same way as we must now wear face coverings on public transport, it is the police who will be able to enforce non-compliance in shops. But whilst we have to make clear that protecting our shop assistants is a priority, demanding that they act as quasi-police officers themselves never should be.

Shop assistants asking customers to put on a face covering will unavoidably put themselves at greater risk of being attacked.

With what is very clear legislation we must expect local police forces to act quickly and robustly in order to educate, change behaviour but most importantly protect those shop workers who were prepared to place everything on the line for us just four short months ago.

There is an ongoing debate about enforcing mask wearing, and I see both sides.

The mandatory wearing of face coverings isn’t primarily about protecting yourself, but about protecting others, and shop workers must be included at the very top of that list. It’s quite possible that there will be a second wave of coronavirus infections. I have heard multiple witnesses from Asia, in my role on the Health Select Committee, stating that one of the reasons countries in Asia have fared better is due to the culture adaption of virus reducing behaviour, learned through SARS, MERS and now Covid-19 – and mask wearing is an important part of that.

I see mask-wearing as a symptom, a time-limited intervention to deal with a specific problem. What we mustn’t forget however is those who will suffer because of this introduction; the deaf who lip read and possibly the high street as the advent of masks may deter shoppers.

But the wider point is simply this: frontline workers deserve to be protected, be it from assault or a virus – and we shouldn’t forget or negate that.