Travel and the virus. Ministers face some of the hardest decisions yet as they plot UK’s next course.

25 Jan

Tomorrow, the Government faces an extraordinarily difficult decision: what does it do about international arrivals, given the increasing threat of new Coronavirus strains?

Since the “UK” and “South Africa” variants were discovered, ministers are understandably fearful about other mutations getting into the country, which could undermine progress – and, even worse, prove resistant to the current vaccines.

This is why the Government has already taken the bold step of banning travel from South America, Portugal and many African countries, due to concerns over new and potentially more infectious variants.

But there are bigger questions for the Cabinet’s Covid operations committee, tasked with deciding the future travel policy, which will meet on Tuesday.

For instance, does the Government go ahead and stop all travel, as Israel has recently done? The idea once seemed unthinkable, but on Friday George Eustice, the Environment Secretary, said the possibility of a full UK border closure had been “considered”, and it’s understood that this will be tabled tomorrow.

A more likely eventuality, however, is that international arrivals have to quarantine at hotels, organised by the Government but paid for by themselves – which has been the case in Australia, New Zealand and Thailand.

The detail missing is who this measure applies to, with Matt Hancock and Priti Patel reportedly wanting all arrivals to quarantine – whereas Grant Shapps and Rishi Sunak are apparently pushing for a more selective policy, only applied to high-risk countries.

Given that Patel recently said she had argued for closing the border in March – an idea that now has considerable endorsement – she may find herself winning this argument.

A widespread quarantine policy does mean, at least, that all countries are treated as potential threats, in terms of having mutant strains of Coronavirus, which is better detected by those with more advanced levels of genomic sequencing. 

As we’ve seen before in the crisis, Coronavirus can come from regions that are least expected (in the first wave, many worried about China, whereas it was travel from Italy, Spain and France that had the most impact). 

However, as Sebastian Payne points out in the useful thread below, quarantine for every traveller would also be a huge logistical challenge for the Government, whose plan ultimately relies on the number of people coming to the UK reducing, as they’re put off by the cost and effort of self-isolation. (And if that does not happen, matters will become even more complicated).

Furthermore, some say it’s simply too late to put in this measure, especially with travel at its current level. All it takes is one person to spread a new variant – already there are 77 cases of the “South Africa” Coronavirus variant in the UK, for instance. That’s before we get to risk from goods being transported in and out of the country (is it a coincidence that the UK variant emerged in a county with a major port?).

All of these areas will enter the decision-making process tomorrow, much of which is a sad paradox of the UK’s success as an international travel hub – and in essence a trade-off.

If the Government does too little it may find itself dealing with a mutant strain that’s more damaging than the immediate economic hit of banning travel, or using the hotel policy.

Too much, and the Government may find it has destroyed an industry – while being unable to trap new variants.

It is worth saying, however, that when the Government has stepped up its measures in the past, they have aged well. As I wrote last year, in July there was huge uproar about its 14-day quarantine rule – which now seems completely accepted.

Either way, no one can envy the choices that have to be made.

Garvan Walshe: This week’s Israel-Morocco deal. A consolation gift for Trump…and a strategic win for China.

17 Dec

Garvan Walshe is a former national and international security policy adviser to the British Conservative Party. He runs TRD Policy

Since the Second World War, the revision of frontiers, overriding the wishes both of the people who lived in the territories adjusted and their officially recognised governments has been frowned upon, for obvious reasons – as Saddam Hussein found out to his cost in 1991 when he invaded Kuwait (and as he also found out to his cost in 2003 – because revision of leaders could still happen, as long as frontiers were not disturbed).

Like all international norms, this non-revision of borders wasn’t universally upheld. Yet even when Russia annexed parts of Georgia or Ukraine, it went through the motions of holding sham elections to legitimate its land grab. The Trump Administration doesn’t feel the need to be bound by such hypocrisy – which Benjamin Netanyahu has tried, but never quite managed, to exploit fully.

His latest qualified victory has come in the form of Israel’s normalisation this week of relations with Morocco. Morocco has great cities, a large diaspora, one of the world’s major Jewish communities; it also controls territory significantly beyond its internationally recognised borders, and protects itself from insurgents by means of an long separation barrier.

Morocco’s king, Mohammed VI, has now won this land for himself – in exchange for the diplomatic gesture of recognising Israel, something he probably wanted to do anyway, so as not to be left behind by the United Arab Emirates and Saudi Arabia.

The territory in question is Western Sahara. It had been a Spanish colony for almost 90 years until the decaying Franco regime (which owes its origins to a military putsch that began in Spanish Morocco) decided it could no longer hold on, and offered the Saharawis a plebiscite.

As Franco lay dying in hospital, the then King of Morocco, King Hassan II, forced a Spanish regime that was now confronting a succession crisis to hand the territory over. The last thing Francoists wanted was to have the best units of their army occupied fighting a colonial war to defend territory they wanted to leave anyway, when these troops might be needed to quell an uprising in Spain.

The insurgency in question is led by the Polisario movement, originally backed by Algeria, which operates from the inland desert. The separation barrier referred to above has been constructed to prevent them infiltrating guerillas into the territory Morocco controls.

Morocco and Israel have pulled off a notable diplomatic coup in the Trump Administration’s twilight. Israel gets diplomatic recognition from another Arab country, and access to an important destination for foreign investment. Morocco gets recognition of territory, and Israel’s support in seeking to prevent an future American administration from changing its mind. There are legal consequences too: it should be easier to have Saharawi insurgents designated as terrorists, making it harder for them to raise funds.

This mutual recognition comes, however, with wider diplomatic costs. The West is now divided on Moroccan sovereignty over Western Sahara. The EU and UK (not to mention the UN) are opposed. So it is not obvious that Morocco, for whom relations with the nearby EU are far more important than with Israel or the United States, has made the best use of its diplomatic capital. That the agreement was made with a lame duck Trump administration won’t help win over a Biden team bent on restoring the international order.

This trade gives off the whiff of a nineteenth century-style carve-up. Other territories denied international recognition will have been made distinctly more nervous. Perhaps the most important of these is Taiwan. Though Trump will have been booted out of office before he can trade away American protection of Taiwan, Taipei is now a little less secure than it was.

Morocco did extremely well out of this Mohammed-Trump-Netanyahu deal. And Israel got something out of it. But the biggest long term winner will be Beijing, whose diplomats are doubtless already working to turn this egregious lame-duckery into a precedent for the next stage in China’s “peaceful rise.”

Garvan Walshe: Gloomy Sturgeon projects competence. The Government doesn’t – and the Union may be the price it pays.

19 Nov

Garvan Walshe is a former National and International Security Policy Adviser to the Conservative Party. He runs TRD Policy.

The Prime Minister’s reset has had immediate effects on Scotland. Out with “devolution is a disaster”, in with a “Union task force” (£). And in the Financial Times to boot, no longer boycotted by the No 10 media operation, but graced by a Prime Ministerial op-ed.

Details about the task force, which is to include English, Welsh and Scottish Tory MPs, are scarce. As the party with no Northern Irish MPs, it would be wise to add a Northern Irish peer, and David Trimble is an obvious candidate. Its mission to make the emotional and cultural case for the Union is welcome. Merely pointing to the fiscal benefits of Scottish membership of the Union is too easily spun as “we pay for you, so shut up” (a problem that scuppered Arthur Balfour’s unsuccessful “killing home rule with kindness” in relation to Ireland at the turn of the century).

The Scottish experience in the Union in the 100 years before the independence push has been a good deal better than the Irish (it’s only a decade since the last Scottish Prime Minister), but that hasn’t stopped the SNP dominating Scottish politics as Charles Stewart Parnell and John Redmond dominated the Irish scene.

Unlike Redmond and Parnell, the SNP doesn’t hold the balance of power at Westminster, but it has, because of the devolution, a platform to show how it would govern an independent Scotland.

Though it might irk unionists, who can point at failures in education, a self-inflicted wound over trans self-ID, the grubby mess involving Alex Salmond’s trial, and cruelty of anti-Covid measures applied to Scottish students, it’s a platform the SNP has made good use of.

It took maximum advantage of two events — Brexit and the Covid pandemic — to switch the balance of risk away from independence and convince Scots that leaving the Union had become the safer option. Brexit moved public opinion to give independence a slight edge. Covid has turned that slender lead into a solid advantage of around ten points.

The effect of Brexit will not be possible to address in the short term. There’s simply a difference of belief between the Government, which was elected to get Brexit done, after all, and Scottish public opinion, which is strongly against it, but safety and predictability are things the Government should, in principle, be able to get a handle on.

Number 10 has come in for heavy criticism for its management of the pandemic, which, however true it may be in an absolute sense, feels distinctly unfair when compared to Scotland.

England’s record has not been particularly good, but then neither has that of France, Spain, Belgium, Sweden, the United States, or most pointedly Scotland. All have had high death rates, found their test and trace systems overwhelmed, and struggled to gain acceptance for public health restrictions. These serious problems are common to almost all Western countries. An independent Scotland is just as likely to suffer from them.

What the SNP has been able to do has been to communicate stability (something that comes more naturally to Sturgeon than the bombastic Salmond). Unlike the Government in London, which has veered between seriousness and hope, Sturgeon has been consistently sober and gloomy. She has avoided overpromising on test and trace, and did not convert useful rapid antigen testing into a grossly over-the-top operation moonshot. This has allowed her to be perceived as far more competent despite having the same Western Standard Average performance in managing the disease.

There is, however, a useful lesson to be drawn from this. Projecting competence does not require achieving excellence. The public will react positively to a government that provides a realistic assessment of the difficulties faced. They understand that governing a country isn’t like pitching for investment in a start up, and would prefer a tolerably realistic assessment of the difficulties ahead then to endure an emotional rollercoaster of hopes raised only to be dashed.

This is not to rule out inspiration as a part of political rhetoric, but it is best for mobilising support for very long-term struggles, like the fight against climate change.

Scots go to the polls next May, and whether the SNP can get an overall majority at Holyrood will be a key test of their movement. Douglas Ross has an uphill battle to stop them, but reset towards realism from the Government could just convince wavering Scots that it’s safe to stay in.

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.

Bernard Jenkin: A herd immunity policy would mean hundreds of thousands dead. If that’s what’s meant by a Swedish option, forget it.

28 Sep

Bernard Jenkin MP is Chair of the Liaison Committee, and MP for Harwich and North Essex.

Some suggest that latest renewal of some restrictions to reverse the resurgence of Covid19 is over-reaction or shows the Government to be preoccupied with the wrong risks. And insist that Sweden is the example that we should now follow.

This denies some basic facts of viral spread. If R-number remains above one, then matters will continue to get worse. The timescale may be hard to predict, but eventually hospital beds would fill up and far more people would die or be permanently damaged by the illness. If R is brought below one, life can return to nearer normal again.

People who invoke ‘herd immunity’ must be honest about what they want, and prepared to defend the likely outcomes of this policy.

The Office for National Statistics estimate is that fewer than eight per cent of people in the United Kingdom have coronavirus antibodies. Given the official death toll of around 40,000 people so far, this is in line with what we would expect from a disease with a mortality rate of slightly under one in every hundred.

This means that, in order to reach general population immunity without a vaccine, at least a further half of the population would have to contract Covid-19 – approximately 30 million people. Given that tens of thousands have died so far, it is not an exaggeration to say that infecting this many would be likely to result in hundreds of thousands of further deaths.

As millions fell ill, they would require hospitalisation, overwhelming the hospitals – even the Nightingale hospitals. While advances in treatment and medicines can reduce the lethality of this disease and the length of a hospital stay, they cannot prevent a patient needing a hospital bed in the first place.

As we ran out of bed space, many would be unable to access basic care. We know that this is likely, not because of any predictions, but because it very nearly happened in the spring.

During the two weeks from the 25th of March, the proportion of English ICU beds occupied by Covid-19 patients trebled – from 20 per cent to almost 60 per cent. A reminder: this test to hospital capacity was caused by fewer than one in ten people in the UK contracting Covid-19, not half the population.

These are verified, confirmed facts about the spread of the disease in the UK. To claim that these facts are incorrect would require an explanation of why the NHS recorded tens of thousands of deaths and hospitalisations from Covid-19, or of why the ONS has not seen tens of millions of people with coronavirus antibodies.

In the absence of a credible explanation for this, we are left with the simple fact that more than 90 per cent of the UK has yet to be exposed to a disease far more virulent than seasonal ‘flu.

Yes, Sweden appears to have avoided the wave of deaths of countries such as the UK and France, while also managing to avoid the draconian spring lockdowns and, so far, the rising second wave of the oncoming winter. So why can’t we mirror its success?

The populations of the United Kingdom and Sweden differ significantly. Moreover, the absence of a national lockdown in Sweden does not mean that the government of Sweden did nothing at all.

First, the population of Sweden is healthier than in the UK. About 20 per cent of Swedes is obese: the UK’s figure is 27 per cent. The average Briton smokes more than 100 more cigarettes per year than the average Swede. This means that, for the average Swede, Covid-19 is a less deadly disease.

Second, Swedish people are more dispersed than in the UK. Sweden has 25 people per square kilometre: the UK has 275. In the UK where the most common household type is a family home with children, but in Sweden more than 50 per cent of people live alone.

So the Coronavirus is far less likely to spread between people in Sweden, because they are less likely to live with someone they could infect. This lower rate of spread means that it is easier for testing, tracking and tracing to suppress the virus. When people already live alone, and far away from other people, they are less likely to have spread the disease to others, lowering the burden on a national track and trace system.

Finally, Sweden may not have imposed a national lockdown, but people there are following social distancing guidelines. According to data seen by the BBC, the average Swede has fewer than one third of the social contacts they had before the pandemic, and surveys from August suggest that almost 90 per cent of people in Sweden are continuing to follow the government’s advice on distancing from other people.

Studies also suggest that far from everyone in Sweden having been infected with Coronavirus (‘herd immunity’), rates of cumulative infection range from six per cent to 30 per cent – but all estimates still leave millions of people still vulnerable to the disease.

Taking all these facts into account, what has happened in Sweden is not a quick rush to mass exposure, followed by population immunity. As before, there is very little evidence that Sweden has seen levels of Coronavirus exposure to put them on the brink of reaching herd immunity. Proponents of this theory require a serious account of how multiple studies have missed millions of infections and recoveries.

Indeed, were Sweden to have achieved herd immunity, the second spikes being seen in Spain and other European countries should not be taking place. This is because, extrapolating backwards from the number of Coronavirus deaths in these countries, they would have already reached a similar level of infection as Sweden.

The more plausible explanation is that the government of Sweden has used social distancing, extensive testing and an effective track and trace system to systematically monitor the pandemic.

This path, in principle, is available to the United Kingdom, but it requires a far more testing and contact tracing than we currently have – which is why military planners and commanders should be brought in to help scale up this part of the response. The current level of social mixing and trace-based isolation is allowing thousands of new cases per day, and this number is growing. Until a vaccine is developed, massively increased test, track and trace is the only way forward. More restrictions are a poor substitute.

To be clear: mass exposure is indeed one way out of the crisis. But those advocating it must be utterly clear that this extraordinary human cost is something that they are willing to have others pay.

David Gauke: Johnson’s Covid policy – and why it’s opening up a rift between him and his traditional Tory supporters

26 Sep

David Gauke is a former Justice Secretary, and was an independent candidate in South-West Hertfordshire at last year’s general election.

For an amendment of no legal force that may not even be called, Graham Brady’s proposal that there should approve in advance any Covid-19 restrictions is of real significance.

On the face of it, it is an amendment that is more about process than substance – the extent to which Parliament, rather than just the executive, has a say on future restrictions. But in reality, it also exposes the divide between the position of the Government – and the Prime Minister in particular – and many of his Parliamentary colleagues on how far we should go in attempting to stop the spread of the virus. For the first time in many years, Boris Johnson’s position puts him at odds with the instincts of many on the right of the Conservative Party. What is more, his position appears to put him at odds with his own instincts.

The Coronavirus crisis has been immensely difficult for the Prime Minister. In part, that has been due to his own ill-health that took him out of action at the peak of the virus, and from which he has made a slow and painful recovery (although, from what I hear, he is now physically in good shape).

t has also been a crisis that has exposed his longstanding inability to grasp detail. A Prime Minister was needed to get Whitehall focused on the virus in February, identify and prioritise testing and tracing and spot that the Department for Education was heading for a fall with its approach to exam results. On all these issues, he appears to have been absent.

However, I suspect that the most challenging aspect of recent months for Johnson is that he has felt compelled to do things that alien to his normal approach to life. By restricting the freedoms of his fellow citizens, he is not acting like the great admirer of Mayor of Amity Island, the foe of the doomsters and gloomsters, the critic of pettifogging bureaucrats, the ‘freedom-loving, twinkly-eyed, Rabelaisian character’ for whom Toby Young – and many others – voted.

Why has this happened? His own experience of the virus may be a factor, but one can only conclude that he has been convinced that there is a real risk that, without further action, the virus will spread more widely – including to the vulnerable, and that this will result in very large numbers of deaths. Given the widely-held view that we locked down too late in March, this would not just be a health disaster but a political one as well.

His libertarian critics argue that these measures are panicked and unnecessary. There is anger over the projections of a weekly doubling of cases (a much worse trajectory than France and Spain have followed). Some point to Sweden or Brazil – countries that have been hit hard, but now have falling or stable levels of infection – to argue that herd immunity comes quicker than we previously thought, perhaps because of T cell immunity.

Maybe these critics are right; I certainly hope that they are. There are reputable scientists who are making the case, and we all want to believe those that are telling us that it is all going to be alright. But there are also reputable scientists who are making the opposite case, who are arguing that we should be tightening up further and faster (a view, incidentally, that has a lot of public support).

This is where the job of Prime Minister is a difficult and lonely one. I think we all know where Johnson would stand on this issue if he were still a Daily Telegraph columnist. We can also take a good guess as to his approach if someone else was Prime Minister, and he was an ambitious backbencher with a desire to free the ball from the back of the scrum.

But he is not a columnist nor a backbencher but the person who has t person who has to make the decision. And unlike some decisions that a Prime Minister might make, if he gets it wrong the consequences will be both enormous and very quickly apparent to all.

So when faced with advice that the virus was now spreading strongly and that, without intervention, deaths would soon rise substantially, Johnson acted in much the same way as any recent Prime Minister would have done. Maybe his libertarian instincts softened some of the new restrictions, but essentially he has made a decision to be risk averse; to be conventional.

This is not the first time during the pandemic that he has reached that conclusion. But it has also been obvious that this sits uneasily with him. He does not like restricting people’s liberties (not a bad quality, by and large) and he likes to tell people good news. He has promised we would have this licked by July and then by Christmas. He has urged us back to our offices when it was predictable (indeed, predicted  that he would soon have to reverse that advice. Even on Tuesday, he seemed to consider it a matter of national pride that we, as a great freedom-loving people, have not been following the rules. The old Johnsom instinct is hard to suppress.

The consequence of this internal conflict is inconsistency and muddled messages. His natural supporters – those who value freedom and independence from the State and are most sceptical about the advice of experts – are in revolt. This has manifested itself in signatures for the Brady amendment. There are signatories from across the Conservative Party spectrum, but they notably include big Brexiteer beasts such as David Davis, Iain Duncan Smith, Steve Baker and Bernard Jenkin. These could be dangerous opponents.

Of course, Covid is not the only issue where the Prime Minister is going to have to make a big choice in the next few weeks. Does he make the necessary concessions in order to conclude a Free Trade Agreement with the EU before the end of the transition period? Yesterday, James Forsyth suggested that a deal was close and that the UK might take a more flexible approach to the negotiations, choosing to fight some battles in the future (‘you have to make it through the short term to get to the long term’ says James, using language that will sound very familiar to anyone who served in Cabinet with Michael Gove in 2018-19).

The piece suggests that the Prime Minister is ‘totally focused on Covid’. But he will soon have to make a choice. On the one hand, he will be receiving advice from officials that the adverse consequences of No Deal are very significant, especially for a fragile economy. On the other hand, his instincts presumably tell him that this is all over-stated gloomsterism.

The Prime Minister knows that the instinct to take a risk, to chance it, to tell the experts to go to hell, is very strong both within himself and amongst many of his Parliamentary colleagues. He is already defying those instincts on one issue. If he is to take the necessary steps to get a Brexit deal (and I hope he does), he is going to have to defy those instincts on a second issue, too. Given that he is already in danger of losing his hold over his traditional allies, it is not obvious that he will.

Dying by numbers

24 Sep

Covid-19 can cast a “long shadow”.  Its aftermath effects include “fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain”.

One study suggests that the proportion of those who first catch the virus and then develop such persistent symptoms is about 15 per cent.  But there’s still much we don’t know about it and evidence is hard to come by.  Nonetheless, it is clearly wrong to claim that the Coronavirus is no worse than flu.

The long shadow effect is also a reminder that one doesn’t either get Covid-19 and end up in hospital, or else not get it at all.  However, the UK, like other countries, would not be responding to the virus with a mix of shutdowns, new laws, voluntary action and testing were the Coronavirus not a killer.

As this site explained yesterday, we believe that a choice between more mass lockdowns and a Swedish option would be the wrong one: the best policy to counter Covid-19 is mass testing.  But successful testing will inevitably be go hand in hand with social distancing and other preventative action.  And the scale, duration and sweep of all anti-virus measures will ultimately be shaped not by the long shadow, but by death numbers.

These are notoriously hard to calculate, both here and abroad.  The NHS in England has changed the way in which they are assessed at least twice: in April and August.  The daily figures “do not include deaths outside hospital, such as those in care homes”, and each daily release is always lagging, since “reporting in central figures can take up to several days”.

Furthermore, there is over-counting, because the figures include cases in which Covid-19 was mentioned on the death certificate, which doesn’t necessary mean that it was the main cause of the death, and under-counting, because the figures can’t catch every single case. Those that follow are therefore heavily caveated.

Two similar peaks are recorded as having being reached: 1,152 deaths on April 9 and 1,172 on April 20.  Were England to suffer, say, eleven hundred Covid deaths a day for a whole year, that would be some 369,600 deaths in all, plus more in the rest of the UK.

But nothing like that, of course, has actually happened.  Writing on ConservativeHome, Raghib Ali says that “we now have good evidence from death certificates that Covid-19 was the underlying cause of death in about 50,000 people”.  Still, that’s about 30,000 more than the 20,000 that Patrick Vallance said would be “a good outcome”.

Those recorded deaths began to fall in late April, and the last figure we can find, yesterday’s, was 37.  Since August 8, they have ranged from 55 to zero.  Those inclined to minimise the severity of Coronavirus will quote those low totals, while those disposed to maximise will quote Vallance’s figure, from his presentation earlier this week, of some 200 deaths a day by November – some 5,600 that month.  Or point out that it could be higher.

Replicated each day for a year, that would suggest about 67,000 deaths.  But that’s based on cases doubling every seven days, as at present – with no change.  Vallance himself conceded that such an assumption is “quite a big if” – which raises the question of whether he should therefore have raised it at all, or at least clearly put it in a more rounded context.

Which would include looking at what’s happening in two other European countries whose increase in numbers we seem to be following: France and Spain.  (As last spring, the figures suggest that the UK is treading in the footsteps of some other European countries.)

If 50,000 cases in mid-October were to be followed by 200 deaths a day by November (“the Vallance model”) 10,000 cases a day (“the French/Spanish model”) would be followed by 40 deaths a day.  If we play the same game of replicated that number each day for a year, we get 13,440 deaths.

That would be lower than annual flu death totals in England during recent years. Public Health England estimates that on average 17,000 people died from flu in England annually between 2014/15 and 2018/19.

But whether the number of deaths each day by November is 200, more than 200, or 40 (or fewer), there is no reason to believe that a rise from present levels would be sustained.

Ali says that “deaths should also be significantly lower due to the lower age profile of cases…better shielding of those at highest risk and possibly a lower viral load  due to social distancing and masks. We are also now much better at managing the disease with more effective treatments.”

Were we to follow Spain and France after all, and if test and trace doesn’t show clear signs of improvement, the mood on the Conservative backbenches is likely to shift away from Government policy, which is ultimately based on state-enforced lockdowns, and towards Sweden’s, and mass voluntary action.

Belgium hasn’t “flattened the curve” – and should not be used to justify UK curfews

11 Sep

During the Government’s press conference on Wednesday, Chris Whitty explained that the latest lockdown rules, which mean it’s now illegal for over six people to socialise indoors or outdoors from Monday, had been inspired by Belgium.

On July 29, the country introduced similar guidelines, reducing the number of people who are allowed to socialise together from 15 to five, as well as enforcing a 10pm national curfew (which, depressingly, has been applied to bars and restaurants in Bolton – and could be extended to other parts of the UK).

Speaking about Belgium, Whitty said it had been a “clear indication that if you act rapidly and decisively when these changes (rises in cases) are happening, there is a reasonable or good chance of bringing the rates back down under control”.

Newspapers were quick to praise the country. The Daily Mail suggested that it had been “able to curtail a second wave of coronavirus”, and The Evening Standard even referred to Belgium as a “success“.

On the other hand, Spain and France, which have both seen cases rise rapidly, have been portrayed unfavourably. In the press conference, Whitty used this dramatic graph (below) to highlight their situation.

The conclusion is clear: the UK now needs to “act decisively” – aka apply similar measures to Belgium’s – to save it from a similar fate.

Matt Hancock, too, echoed Whitty’s sentiments. “If you look at what’s happened in Belgium, they saw an increase and then they’ve brought it down, whereas in France and Spain that just hasn’t happened”, he said.

Yet, in the last few days the idea that Belgium is a “success” look rather dubious (to say the least).

Indeed, as The Brussels Times points out, the country has recorded a rapid rise in the number of new Coronavirus infections. According to the latest figures by Sciensano (the Belgian institute for health), an average of 547.4 people per day tested positive for Covid-19 in the country during the last week, with new infections per day rising by 22 per cent over the seven-day period (from September 1 to 7).

It’s the sixth day in the row that the average number of new confirmed Covid-19 infections in Belgium has risen again.

Furthermore, while the Government’s graph was plotted from the European Centre for Disease Prevention and Control, others look less flattering. Take the site Worldometer, as an alternative source, which released these yesterday:

Although it’s worth pointing out that Belgium did experience a slight dip in the number of new infections in August, the trend clearly hasn’t been sustained as people return to work and school. And on a more contentious note, it’s not obvious whether the dip was due to the interventions (limiting parties to five and curfews) or something else. There is still much that we do not know about the virus, and why it moves through countries at different rates.

Another question to ask is what hospitalisations look like in all this; from September 4 to 10, there has been an average of 22 new hospital admissions per day in Belgium – an increase on the previous week (15.7). Compared to cases, these figures are relatively low, and another reminder that scientists still don’t understand how cases translate to hospitalisations and deaths (partly because no one knows what cases were at the beginning of the outbreak).

Already there’s been talk of whether Britain could copy Belgium more in its approach, with a troubling YouGov poll showing that 62 per cent of the public would support a 10pm to 5am curfew.

But any moves must be made on more clear-cut data. By all indications, the latest figures are not that.

What is the current status of Europe’s situation with Covid-19?

20 Aug

Yesterday, ConservativeHome updated readers on the current status of the UK’s situation with Coronavirus (today there are 1,182 new cases and six deaths recorded within 28 days of a positive test). The next question is, of course, how this compares to Europe.

There are a number of different sources offering information on European rates, some of which contradict each other, due to when the data was collected and uploaded onto sites. For the purpose of consistency, we have gone with John Hopkins University of Medicine’s Coronavirus Resource Centre, and have chosen a selection of countries that are often compared to the UK.

Belgium

There have been 582 new cases and 10 new deaths in the past day; the record high being 2,454 on April 15 and 496 on April 10, respectively.

France

France’s data hasn’t been uploaded yet, but over the past week it has had 12,446 new cases and 59 new deaths.

Germany

1,586 new cases and eight new deaths in the past day; the record high being 6,933 on March 27 and 510 on April 15, respectively.

Greece

212 new cases and three new deaths in the past day; the record high being 251 on August 14 and 10 on April 3, respectively.

Italy

642 new cases and seven new deaths in the past day; the record high being 6,557 on March 21 and 919 on March 27, respectively.

Spain

6,671 new cases and 127 new deaths in the past day; the record high being 16,269 on August 17 and and 1,179 on June 19, respectively.

Sweden

192 new cases and 12 new deaths in the past day; the record high being 2,530 on June 29 and 185 on April 21, respectively.

United Kingdom

When measured in the same timeframe, it has 831 new cases and 17 new deaths; the record high being 5,505 on April 22 and 1,224 on April 21.

Some conclusions

Looking at these statistics, it’s clear that trying to compare countries in terms of their fight against Covid-19 is far more complicated than it seems.

While there has been concern about about rising cases in the UK, it is by no means the worst affected in this respect (take Spain). Also it is interesting that Sweden, having received huge criticism for its approach, now only has 192 new cases, and a rapidly declining death rate. The fact that it has “flattened the curve” without enforcing a full lockdown raises many questions about how much of Covid-19’s decline can be attributed to the intervention (versus a natural decline).

Another interesting pattern to observe is that having a high number of cases, relative to other countries, cannot be taken alone as measure of how successfully it has fought Covid-19. Germany, for instance, has much more new cases than Sweden, but it has less deaths, indicating that – as has been remarked on before – its healthcare system is much better equipped than others’.

It’s also worth looking at some of the curves for different countries, which can be seen on Google (if you search for a country’s name and “Covid cases/deaths”).

In terms of deaths, most countries display the same pattern – one peak and then a gradual decline – albeit on different timelines. Even Greece, which has one of the lowest death rates, has a noticeable peak in April (nine deaths).

Perhaps the biggest outlier in terms of the curve, both for deaths and cases, is Spain. It has a clear peak in deaths in March (929 deaths) then another higher one in June (997) – although it does seem to have trailed off. Cases have recently been on the rise again, hence why politicians have been concerned about the possibility of a second wave in the country. But it’s worth remembering that the detection of cases is also a paradox of improvements in testing regimes.

As another thesis, it may be the case that countries that went into lockdown fastest will see harsher spikes as the economy reopens again, as opposed to Sweden which lived with the virus. It has been hypothesised that Covid-19 has a u-shaped curve, regardless of intervention, but if an intervention is applied, it may distort the pattern of Covid-19 on a graph. There will be spikes and the appearance of the second wave (when it may be the first one still coming through). In Greece, which was one of the fastest to lockdown, this could potentially happen.

Overall, while there has been concern about cases across the continent – with France planning to make masks compulsory across all workplaces – it’s clear that deaths have fallen rapidly. When making sense of these figures, politicians and journalists should use as many as possible in conjunction to assess the situation with Coronavirus. They should look at the big differences between cases and deaths per day, compared to what they were at the peak.

By all indications, there is reason to be optimistic that the most dangerous statistics are coming under control.