Science should determine the weight of the pig

The government claims that lockdown exit will be triggered only by science. Science today gets the reverence that the middle ages accorded to religion. We need to look more closely. The experience of other countries leaving lockdown will be truly valuable. We must learn from Italy, Denmark and Germany and also Sweden which has had no lockdown at all.  

The government’s chief scientific adviser, Sir Patrick Vallance, has pinned his colours to the R mast: on 1st April, he stated we must get and keep “R, which is the average infection rate per person, below one.”  R, the reproduction number, “is an indication of how much an infectious virus will spread in a population, and various things impact that value,” said Jonathan Ball, professor of molecular virology at the University of Nottingham. “The susceptibility, size and density of the population that the infection is introduced into matters, as well as the infectiousness of the virus itself.”

Estimates of R across Europe vary, not least because, as Imperial College modelling concedes, no one has any idea how many Covid-19 infections there have been. Their report, with over 50 authors, estimates R to have been about 3.87 before lockdowns.  Following lockdowns and other interventions, they estimated a 62% fall to 1.43. As an example of facts not being allowed to get in the way of a good theory, the 30th March their report stated (p.6): “The estimated reproduction number for Sweden is higher, not because the mortality trends are significantly different from any other country, but as an artefact of our model, which assumes a smaller reduction in Rt [reproduction number at time t] because no full lockdown has been ordered so far.”

By contrast, on 1st April the London School of Hygiene and Tropical Medicine, also part of the government’s scientific advisory team, estimated pre-intervention R0 to be around 2.1 and a 70% reduction to 0.62 would result from lockdown and other interventions, e.g. social distancing. They asked 1,300 individuals in lockdown to list their contacts for the previous day and compared the results with an unrelated study in 2006.  The research is not peer-reviewed and a number of caveats will be apparent but at least an effort was made to anchor it in reality.

In short, science is widely divided on pre-intervention reproduction numbers: on 13th March, the Journal of Travel Medicine reported “Our review found the average R0 to be 3.28 and median to be 2.79, which exceed WHO estimates from 1.4 to 2.5.”

Bandying R about is scientificating a simple measurement of whether the number of cases is increasing or decreasing and, if so, at what speed. Is infection accelerating or decelerating and by how much? It has nothing to do with the rate of deaths nor with prediction. And it is undermined by not knowing how many cases there are.  As Jeremy Hunt in The Times on 21st April, has rightly pointed out, contact tracing is critical. That, as the Lancet on 28th February confirms, would also provide the necessary data for estimating, via sampling, and controlling total infections. It is odd that there has been little or no mention of contact tracing from the government or its scientific advisers.

We do not need to track R, just the number of cases.  Whatever the ideal, we must use the numbers we have. Deaths, sad and important though they be, are not relevant for our purpose. Non-hospitalised cases are not known and, again, do not impinge since those infected can recover at home as they do for common colds or flu. Remember that the object of lockdowns and other interventions is to moderate the effect on the NHS.  Hospitalisations, or the “cases” numbers published, are the only leading indicator we have. Monitoring that needs no more than a simple graph, viz.;

The big bogey is the second wave. It is foolish to suggest that can be avoided, or even should be avoided.  Minimising, or at least moderating, it is what matters. Whenever the lockdown exit begins, and contacts increase, a wave of some kind will follow.  The issue is not when exit begins but how it is managed. It is extraordinary that such a simple distinction escapes the government’s scientific advisers.  Furthermore, exit management needs to focus, for the reasons above, on the number of hospitalisations, or the closest proxy available. As that trails infections by between a week and 10 days, the exit should be in fortnightly steps to allow response to significant changes in trend.

Advice from the scientists has been questionable all along. On 20th March, the Scientific Advisory Group for Emergencies (SAGE) stated: “In fast moving situations, transparency should be at the heart of what the government does. We have therefore published the statements and the accompanying evidence to demonstrate how our understanding of COVID-19 has continued to evolve as new data emerges, and how SAGE’s advice has quickly adapted to new findings that reflect a changing situation.”

They then went on to say that the modelling could not be published as the modellers may wish to do so later in academic journals.  Secondly, the site does show SAGE’s current understanding of the situation, but not its evolution. Thirdly, they present possible (guessed) scenarios but neither science nor proposals for government action. Their estimates of public compliance proved wildly wrong and even their estimate that 75% of 80+ year olds would not go to work or attend schools were, surprising as it may seem, low.

All this is reminiscent of the time the Ministry of Agriculture decided that too much guesswork was involved in estimating the weight of pigs.  A committee of science professors from obscure universities was formed. After deliberation, they recommended the acquisition of a plank with the pig tied to one end and a basket to the other.  The plank should be carefully placed with the mid-point on a low wall and the basket gradually filled with stones.  When the plank is balanced, the farmer should guess the weight of the stones.

Private benefit is a public good

I’m often asked how bad the impending recession is going to be. The answer is that nobody has the faintest idea. If they say they do, then they’re either lying or mistaken. 

We’ve had a whole range of figures from the forecaster. From a 5% decline to a 35% decline this year. With things changing so fast, it’s impossible even to guess. 

We might be able to get a clue from the Spanish flu of 1918-9 which was actually far more lethal than Covid-19. US industrial production then  fell by 25% but it had mostly recovered within a year. I don’t expect a quick bounce back this time. 

In previous recessions, business has at least kept going. This time we have closed it down. And our economy is much more integrated than it used to be. Rupture any bit of it and you dislocate the whole. 

Government can help the recovery of course, mostly by getting out of the way: cutting regulations like the land planning rules and taxes like VAT and the taxes on capital and investment: the factory tax. 

Some people might worry about the loss in government revenue doing that but unless we encourage new businesses to spring up and replace the old ones that have been killed by the recession then there won’t be any government revenues anyway. And what does that mean for the funding of welfare benefits and indeed the healthcare system. 

Fortunately most people agree. In polling commissioned by the Adam Smith Institute and conducted by Survation under BPC rules, 72% of people say that they’re supportive of tax cuts designed to boost the economy and jobs after lockdown ends. The largest cohort of support came from the youngest in society. We’re going to need the private sector to survive and thrive if we’re to have a prosperous future, that means reducing the cost of government.

Perhaps Sadiq Khan should have a chat with Trevor Phillips?

Sadiq Khan wants to know why BAME folk are being hit by the coronavirus rather worse than non-BAME in our fair and pleasant land. We’d offer the simple observation that pandemics tend to hit concentrations of population, the BAME population is largely in the big cities and that’s at least a reasonable start to the answer:

It’s by no means a revelation that there’s a link between health and socioeconomic inequalities – certainly not for those who live these lives, or for all the charities, campaigners and organisations, including City Hall, that have been fighting these injustices for years. But one of the unexpected consequences of this crisis is that the depth of these inequalities is being laid bare in such a stark fashion.

Mr. Khan is a politician on the stump and so we get structural problems, inequality, racism - Vote For Meee!

As it happens, Trevor Phillips, who is not a politician with an election all too soon, has also been looking into the same matter:

Concern about this known unknown was etched on the face of the chief medical officer as he addressed the issue at the weekend; factors like genetics, culture, language and religion could be quietly undermining scientists’ attempt to predict the spread of infection. Public Health England has rightly begun an inquiry. But however hard they try, scientists can’t keep pace with the rumour mill and must ensure the emerging conspiracy theories and knee-jerk victimhood do not go unchallenged.

That seems a reasonable point to us.

The pattern isn’t easy to explain. Assumptions about racial biology are unlikely to hold good across a range of non-white groups who are in most ways more unlike each other than they are different from whites. As for poverty, the list of the seventeen most afflicted local authorities includes low-income Brent, but also features multi-ethnic Wandsworth, where median weekly earnings, at £720, are 50 per cent above the national average. And of the virus hotspots, only two appear in the list of England’s ten most overcrowded boroughs. The most significant hotspots outside the capital, Liverpool and Sheffield, are 35th and 107th respectively out of 126 boroughs in order of population density.

That would be both Mr. Khan’s and our own suggestion dealt with then.

One puzzling finding in our report concerns not who is being infected, but is who is not. Were poverty the key determinant, we would expect the virus to be running rampant among Britain’s Pakistani and Bangladeshi Muslim communities. Yet they are conspicuous by their absence in the list of hotspots — no Blackburn or Bradford, no Rotherham, Rochdale or Luton. The London borough of Tower Hamlets is more than a third Muslim — the highest density of any in England — and is sandwiched between two Covid-19 hotspots, Newham and Southwark, both home to substantial non-Muslim minority communities. Yet Tower Hamlets lies in the bottom third of the capital’s infection list: 22nd out of the 32 boroughs.

The surmise that the religious ritual of washing immediately before the five times a day prayers might have something to do with it seems reasonable to us.

The surface point here being that perhaps Mr. Khan would like to have a word with Mr. Phillips - the latter does seem to be doing the research that the former desires, even if the results aren’t quite the electoral gold dust first thought of. This does presuppose that Mr. Phillips could bring himself to converse with Mr. Khan of course but where there is hope and all that.

The deeper point is that a politician on the stump doesn’t appear to be all that good a place to go looking for solutions or even reasoned analysis. Which does rather mean that politics itself isn’t, doesn’t it?

SAGE advice from some economists might help

As the government has said, its strategy on COVID-19 has been driven by the science. Specifically, it has been informed by SAGE, the Scientific Advisory Group for Emergencies.

SAGE comprises a number of very distinguished epidemiologists and physicians. And the same is true of the three other committees that feed them.

These experts supported the economic lockdown—and its extension—as a way of flattening the infection curve, preventing an unmanageable surge in critical cases and deaths. And most of us have gone along with that.

But we are starting to realise that locking down an economy for three weeks is very damaging. Locking it down for six weeks is disastrous. Each business that closes spreads trouble to many more. And they in turn to many more others. So, the failures and unemployment multiply, like a virus ripping through our productive network.

Given the enormity of that, you might think that economists would be involved in the lockdown decisions. But no: there are no economists on SAGE, nor the committees that feed into it. No Roger Bootle, Mervyn King, Paul Ormerod, John Vickers, Patrick Minford nor others who could explain the cost of lockdown and how best to unwind it.

Advice that has such serious economic impact should not be decided by physicians alone but by economists too.

Lockdown and the size of British housing

The man has a point here:

Tom Wall highlights one of the great problems in our housing, lack of space, which is exacerbated by the Covid-19 pandemic (“Two adults, five children, one room: ‘It’s really scary but what can I do?’”, News). We have a confusion of “overcrowding” standards in housing law and even the latest minimum standards for licensing of houses in multiple occupation originated in the 1930s – is 10.22 square metres really adequate for two people to live and sleep in as their permanent home? We need an overhaul of these standards that must recognise the adverse health effects of lack of space and crowding, including the spread of infectious diseases, unintentional injuries and mental ill health.

Prof Gabriel Scally, quoted in the article, is right: the housing market has led to the modern equivalent of the Victorian slums that the new diseases will just love. At the same time, we build the smallest new homes in Europe, so we are storing up problems for the future.

Dr Stephen Battersby

Britain does build the smallest new housing in Europe. The bit that the Good Doctor gets wrong being “the housing market has led to…” the problem in fact being an absence of market, not existence. For planning laws only allow permission to be granted for projects of minimum density - it is this which leads to 30 to 35 dwellings per hectare. Given the cultural preference for a des res with a garden this and this alone explains the less than 80 m2 rabbit hutches now built as new housing.

Back before we had such a prescriptive planning system speculative builders used to throw up those 30s semis and detacheds that people now fight to be allowed to buy. One solution is therefore our oft suggested blowing up of the Town and Country Planning Act 1947 and successors.

Another possibility is that we just insist upon those in the planning system - from the MPs who vote on it, the civil servants who administer, the local councillors who approve and the planning officers who examine - live, en famille, in the estates of shoe boxes they allow. As we are rather sure very few to none of them do now. At which point we can just leave it to public choice economics, that insistence that public servants are subject to the same economic incentives as the rest of us, to return us to a system of new dwellings being houses that people would like to live in being built in places that people would like to live.

That or the blowing up, either would work.

For once we're going to take The Guardian's advice

The Guardian tells us that the current troubles mean we should think about food, where it comes from, how, what we might do about all of that:

The Guardian view on the future of farming: let’s think about food

Editorial

The British food system, as well as individuals’ diets, needs to be balanced. Price is not the only factor

Entirely true that price is not the only factor, it never is and never has been. The aim of having an economy at all, let alone an economic policy, is to maximise human utility. Price will of course be an influence here, possibly a dominant one, but never the only.

As it happens the same edition of the same newspaper warns that the country might be running out of tinned tomatoes:

Suppliers ration stocks of tinned tomatoes after surge in demand

“Ration” is a bit extreme as a description, warn that the supply is not infinite perhaps:

Italian tomatoes make up about three-quarters of UK stocks, according to the Grocer trade journal, and are canned between June and September.

Diego Pariotti, the head of export at Conserve Italia, which owns the Cirio tinned tomato brand, said it could meet usual order levels but not “crazy demand”. He added they had told customers: “If you don’t start calming the fever we won’t get to the next crop.”

....

McDiarmid said: “It’s a seasonal crop. It’s finite. What was picked last year is what was picked and that’s all there is until 2020 harvest. We can’t bring forward the harvest.”

Which is a useful education in how things used to be. The Hungry Times were not in winter, they were in June and July. It is just before the next harvest that the supplies from the year before are in danger of running out. It is the weeks just before the fleets of combine harvesters sweep through the fields of golden grain that bread is in short supply.

With tomatoes there is added detail. It’s possible to hothouse them in the UK but as Adam Smith said about wine in Scotland it’s easier - consumes fewer resources - to get the product shipped in from where it grows freely under the Sun. Spain - largely employing a different cultivar - ships us fresh tomatoes, Italy these canned being talked about.

So, thinking about farming and food, what should we do about this? Clearly, we should be maximising the number of different harvests that we gain our supplies from. The best method of gaining copious year round edibles being to ship in from places that pick and process across the calendar rather than being reliant upon just the one event a year. Southern Hemisphere farms, for example, might well be canning tomatoes in the January to March window to match that July to September in Italy. Which would neatly cover any possible shortages in May and June, wouldn’t it?

We have indeed done what The Guardian advises, thought about food and farming. We desire more globalisation and free trade in food. Not that we expect The Guardian to come to the same conclusion, despite its origin as a paper campaigning against the Corn Laws, but we can hope, right?

We're against the idea of salary caps

We have entire think tanks - the High Pay Centre for example - dedicated to the idea that some people earn, or are paid, too much. Thus, perhaps, there should be limits, salary caps, on how much people may earn. We are against this, yea even in association football:

Tony Bloom, the Brighton & Hove Albion chairman, suggested that it may be necessary to introduce a salary cap for top-flight players as a depressing picture started to emerge yesterday of the financial predicament Premier League clubs are in.

The reason for our opposition is that this is a distinctly pro-capitalist move.

Bloom, while seeing the problems with introducing a salary cap, was not averse to the idea. “If it’s going to work, it needs to be worldwide — certainly Europe-wide — and I see big difficulties with that,” he said.

“But something, I think, does need to change. Otherwise, salaries, player salaries, will always increase far too much and it becomes unaffordable for clubs. Certainly, I think something like that will be talked about. I see it being very difficult to come to fruition, though.”

Markets work best when they’re allowed to work. An outcome of this being that the money flows to whoever has the scarce resource. Being able to play professional sport at the top level is a scarce talent - certainly more scarce than the possession of a ground to play it upon, the ability to design and or buy a strip or the possession of a brand name. Thus all and more of the money in sport flows through to the players, none to a negative amount sticks to the hands of the capitalists.

We’re entirely happy about this.

It’s notable that American sports teams are generally profitable. They are also all a cartel - there’s no promotion up or down into and out of the professional leagues, making the team itself the scarce item - and have strict salary caps. It is these two things that limit the portion of the overall cashflow heading toward players and thus make them profitable. European sports near all have that promotion up and down. In association football a club can move from only just above amateur to the very top rank in mere years as both Rangers and the old Wimbledon and now again the new one have shown.

This does mean that we’re against UEFA’s financial fair play rules as well, which are a lighter version of the same restriction upon player incomes.

This is all most apparent in sports, where the scarcity of the talent is most obviously pronounced. But it is the same in any arena where salaries are restricted - it’s all a manner of increasing the incomes of the capitalists.

We should point out that we’re entirely happy with capitalists earning, just as we are with labour however talented or not. It’s just that to us financial fair play means the outcome achieved by a free market, not a set of rules designed to favour one side or the other. And the truth is that salary caps, as with other earnings restrictions, favour the capitalists, not labour. Our opposition is to the thumb on the scale, not the measurement itself.

Start scaling back the lockdown today

We all agree that lockdown should only be eased once we have passed the peak.  But what peak? There are three possible: infections, hospital admissions and deaths. The numbers in hospital or in intensive care will also peak, or have done so, but, if they are collected at all, they are not reported. The original strategy, and it was right, was to spread the emergency so that the NHS could handle it. Those who are infected but stay at home are little, if any, burden on the NHS.  In any case the Department of Health and Social Care (DHSC) do not have the slightest idea how many non-hospitalised cases there are in the community. They are not tested (unlike Germany) and not sampled. 

So far as deaths are concerned, the DHSC only tracks English deaths in hospitals.  For the saddest of reasons, deaths actually reduce the load on the NHS. The DHSC has very little idea of how many Covid-19 deaths occur in care homes or domestically.  The number of deaths is compiled from certificates completed by GPs visiting, online or in person, corpses who tend to be unresponsive as to their symptoms. The GP has to guess or take the opinion of the unqualified carer or leave it to a coroner weeks later. The weekly estimates by the National Statistics Office are not reconciled with the daily estimates by Public Health England (PHE).

In short, the only peak that matters, for lockdown exit purposes, is that for hospitalisations.

So how does that analysis compare with the “five conditions” announced for starting exit yesterday: “They are: ensuring that the NHS can cope across Britain; a sustained and consistent fall in the daily death rate; evidence that the rate of infection is decreasing to “manageable levels”; enough testing and protective equipment to meet demand; and no risk of a second peak large enough to overwhelm the NHS”?

Firstly, Downing Street has no mandate on health matters for Britain, only for England.  Secondly the DHSC has no reliable figures for deaths and hospitalisations is a better measure for NHS coping.  Thirdly, the DHSC has no measures of infections. Fourthly the government claims we already have enough protective equipment even if the front line does not agree.  Once hospitalisations are falling and now that local suppliers are filling the gaps, we can begin. 

He is, however, right that caution should be exercised. Returning too quickly to normal too soon might precipitate a major second wave of hospitalisations. But that is a matter of how the exit proceeds, not when. Whether it is at the end of April or June, the second wave problem remains the same.  And we certainly cannot wait for the entire population being vaccinated in two years’ time. For a discussion of the urgency of leaving lockdown see yesterday’s paper “Reopening Britain” by Eamonn Butler and Matthew Lesh. Being later in the pandemic experience than our largest European comparators, notably Italy, Germany, France and Spain, allows the UK some evidence of other lockdown exit experiences.

PHE reports Covid-19 tests, both positive and negative, and deaths, daily and cumulatively.  No comparative data or trends are shown and there is some misreporting as past data are amended, making the figures exceedingly difficult to track.  Frankly, the data for the latest day should be disregarded. The figures for positive Covid-19 tests are reported now as “cases” but the cumulative discrepancy for the UK (between the total and four nations’ figures) was 7,151 (7%) on 15th April which may be explained by Pillar 2 swab testing for key workers and their households. PHE’s elucidation “cases in people who have not been tested are not included in the confirmed case counts” is textbook Zen Buddhism.  We have to take these “cases” as proxies for Covid-19 hospitalisations.  Obviously, there are quite a few patients thought to have Covid-19 who turn out not to have, quite a few who test positive but wrongly and some who test positively but do not need hospitalisation.  As the trend lines compare like with like, such problems probably do not matter.

The trend on hospitalisations looks like this:

It would appear from the above graph that hospitalisations have peaked but even if not, a cautious and gradual relaxation of lockdown should now be put in hand.  It can always be frozen or reversed if cases turn upward again. The more serious matter is that no lockdown exit strategy has yet been announced. Perhaps the DHSC and Public Health England have yet to give that matter any thought.  As discussed in an earlier blog, it would not be surprising if that were the case.  We need urgently to know what it is, to shine sunlight upon it, to debate it and, hopefully, for us all to support and implement it.

Marci Shore's "The Taste of Ashes"

The Berlin wall fell in November 1991, marking the beginning of the end for  Communism in Europe and the reopening of the Eastern bloc. In reality the spectre of communism continued to haunt those who had lived under totalitarianism. The Taste of Ashes is a beautiful yet sad recollection of the author’s, Marci Shore, an associate professor of intellectual history at Yale, travels throughout the old eastern bloc in the 1990s. Part history and part travel writing, it retells the memories and stories of individuals as they fit into the history of the regimes they lived in. 

The most obvious memories of communism in Western popular culture are the police state and informant neighbours. Recent stories of curtain-twitching neighbours reporting on each other to the authorities during the coronavirus crisis for going out twice in a day pale into comparison as banal mundanity of the everyday to the betrayals from friends and families under regimes in Eastern Europe. How easy it is to slip into that mindset though. How cheaply our integrity sells. 

In the novel The Joke by Czech author Milan Kundera the committed Communist party member and university student Ludvik writes a joke about Trotsky on a postcard to his girlfriend. For this, he is expelled and sent to work in the mines where he often looks back on the moment of his expulsion — his professors and closest friends raising a hand to cast him out. 

“Since then, whenever I make new acquaintances, men or women with the potential of becoming friends or lovers, I project them back into that time, that hall, and ask myself whether they would have raised their hands; no one has ever passed the test: every one of them has raised his hand in the same way my former friends and colleagues (willingly or not, out of conviction or fear) raised theirs. You must admit: it’s hard to live with people willing to send you to exile or death, it’s hard to become intimate with them, it’s hard to love them.” 

A sense of suspicion can survive long after the fall of the regime. This was especially felt in Czechoslovakia, as it entered the painful period of “Lustration” (a Roman purification ceremony) which revealed the extent to which so much of the population were informants. The exciting new world was intercut with revelations of betrayals of the old. Shore describes how even some of those most admired were exposed for cooperating in some way, shaking the confidence even in some of the resistance leaders that had helped bring about this new free political order. 

Speaking to the father of one of her students at the school she taught at in Czechoslovakia, Shore recounts how far the culture of informing and spying spread. 

“His family did not go to May Day parades; every year he and his wife asked that their children be excused because the family would be away in the countryside. One year the teacher appointed one of his son’s classmates to spy on them: she had suspected they had not really left town.” 

It is a reminder that it was not only the state spying on its citizens but its ideology permeates so deep that many normal people are turned into curtain-twitchers, poking their noses into the lives of others.

In the same conversation, he narrates about the stagnation under communism. Shore writes, ‘around 1970 time had stopped; afterward there was no movement, only stagnation. He had never believed he would live to see a way out.’ Instead of innovation and progress, there was only bureaucracy and management. 

Attitudes and culture survive years after the systems that created them disappear. It is no surprise that a country that had banned entrepreneurism for years, found itself with a lack of entrepreneurial, or can-do spirit, in the population at large. The ‘computer says no’ attitude of bureaucracy was not immediately replaced by the initiative and hustle of capitalism. 

“The realm of the not possible was expansive: it included the new, the uncommon, the difficult, as well as the vaguely inconvenient, the previously unconsidered, that which someone was not in the mood to do at the moment. And nothing could be done without the proper rubber stamp. To acquire the proper stamp, it was usually necessary to acquire a series of them, each a prerequisite for the next. A given stamp was generally in the hands of a single person, a local bureaucrat who had been made inordinately powerful by such a possession and who might prove to be capricious, or greedy, or resentful – or simply absentminded, or ill, or lazy, or indefinitely on vacation.” 

Among the students she taught briefly in Czechoslovakia, Shore noted:

“My students were bright – they had been accepted to the only university preparatory school in their region – but they were also passive, in some sense deadened at sixteen or seventeen. They preferred memorization and rarely expressed any opinion. Communist content had been purged from that school, but a certain totalitarian for – or rather an acute sense of the world’s restrictiveness – lingered.”  

Shore’s work is remarkably easy to read, and adept at portraying the wide range of emotions felt by the people she met. From the apathy of many, to the sorrow of many of the Jews visiting the countries of their parents, to the anger of those Jews left behind in what others see as simply a graveyard country. A generational divide in attitudes is also observed with the excitement of the young at new opportunities and an almost romantic view of the old for some of the security of the old regime, especially after their pensions became quickly eroded by the inflation of the 1990s.

Also interesting is the nervousness of a return to fascism, especially relevant by what we are currently seeing in Hungary but also seen by how the far right in Germany (the NPD) have historically been more successful in the east of the country. In many of the countries she travels through there is a struggle to come to terms not only with the faults of communist regimes but also with those of many of their predecessors as well. 

Marci Shore’s book is an excellent lockdown read, and a healthy reminder of what impact the sort of society we are just having a glimpse at — but which became all too miserably the norm for those in Eastern Europe under the oppression of socialism.

We think we might have discovered the problem with the coronavirus public health response

There are tales of horror from the public health world concerning the coronavirus. CDC and the FDA in the US combined - presumably on the grounds that no bureaucracy likes to see other people doing its job - to prevent testing for the virus. Even, at one point, banning home testing kits. Here in the UK Public Health England has not exactly covered itself in glory despite that £4 billion and change a year they get. Even when people try to defend the World Health Organisation they do so by harking back to the half a century ago eradication of smallpox, not by reference to anything being done right now.

We think we’ve found the one little detail, the perfect exemplar, of what has gone wrong. Writing in The Guardian a professor of public health, at Imperial no less, tells us of her work:

Mathematical models are being refined to predict the extent and speed of spread and estimate the impact of control methods. My own group is studying the response of communities, showing how the epidemic is amplifying existing social inequalities.

We’re in the middle of a pandemic, exactly when we’d like to know interesting things from the public health wallahs, they’re still off treating the subject as a branch of grievance studies. They’re not even being coy about it, the evidence is being proudly presented as with a two year old showing off the new potty training skills. We would, professor, rather prefer to know how not to kill people while still preserving civilisation and some semblance of an economy. Rather than, say, how disease perpetuates the inequities of a patriarchal and neoliberal capitalism or whatever it is you think you might be able to show.

That is, the problem with the public health response to the coronavirus is that public health isn’t about public health any more. So, perhaps we should stop exalting the subject - or even looking to it for advice?