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?

We need a plan for when lockdown ends or there won't be an economy to reopen

Our latest paper, written by Dr Eamonn Butler and Matthew Lesh looks at the economic urgency growing for a plan to reopen the economy at the end of the lockdown once medics say it is safe to do so. Without one, too many firms are stuck in limbo and are running out of cash. Each one that folds creates issues for others in their supply chains, for their shareholders and their customers. With half of British firms thinking they’ll run periliously close to running out of cash in the next three months we need the UK government to explain how it’ll reopen the economy and allow the private sector to start raising revenue again. If they don’t, there’s a possibility that there won’t even be an economy to reopen at the end of this.

Time to get rid of the idea of cultural appropriation and other Marxist identity claptrap

When the pandemic is over, it’s possible that a few things that once seemed important to some people might leave with it. This could include some of the more arcane elements of what constituted the “Woke” culture. For example, some people used to fret about what they called “cultural appropriation,” castigating people from Western white cultures who adopted practices from other cultures. Justin Bieber was slated for wearing his hair in blond dreadlocks, and university students were derided for holding costume parties themed on countries such as Mexico or Japan. 

It’s nonsense, or course. When we take on board things done by other cultures, more often than not it’s cultural appreciation rather than appropriation. The walls of my house feature paintings done by a Western artist in the Chinese style, but this is a tribute to Chinese culture rather than the theft of it. I love Chinese cuisine, and I don’t mind in the slightest if some of it is prepared by non-Chinese chefs. Indeed, I sometimes cook in that style myself, as I do in the style of many countries. When I dress, as I often do, in clothes that echo the fashions of Eastern countries, it is because I admire that style.

At the heart of this absurd idea lies the notion that we should all live in boxes with labels on them. Western Europeans are supposed to live like stereotypical Europeans, without enriching their culture with outside influences. It would be a duller and poorer world if we did this. We’ve always taken outside ideas and influences, usually because we admire them. When the Pope and his predecessor wore sombreros on visiting Mexico, they were honouring Mexican culture, not mocking it.

It is identity politics gone mad to define us and limit us to one narrow culture. People are too complex, too diverse, and too multi-faceted to be confined like this. We express our own independent ideas, rather than simply giving expression to what someone else thinks is our class interest. We need to be treated as individuals, not dealt with merely as members of the groups that others want to define us by. 

There are people who prefer to dismiss our ideas as the mere expression of our group interest and identity. It saves them from having to listen to those ideas, or to consider them, or to argue with them. They claim that people in one box have nothing to say about those in other boxes, and no value to draw from them into their own lives. Fortunately, people are bigger than this, and the idea that they should be limited in this way will almost certainly have a short shelf life when the current pandemic is over.

Thanks very much, but we’ve had quite enough confinement of late, and when it’s ended, we’re not about to let a few obsessives continue to confine us culturally or intellectually.

What is this rise in child poverty being claimed?

We are being told that the recession is going to cause a significant rise in child poverty. By the method that this is normally measured we can’t see it ourselves:

Coronavirus will cause child poverty to soar. So what can we do about it?

We agree that this recession - and it’s a proper doozy of a recession too - is going to lead to a decrease in the economic resources available to many to most of the population. We’re entirely happy with calling that an increase in poverty. But that’s not actually how poverty is measured these days. Instead we use a relative definition, poverty is having less than others not less in toto.

That is, the current measure of child poverty - living in a household with less than 60% of median income - is a measure of inequality, not poverty. And here’s the thing about recessions, inequality falls in them. At first blush this should mean a reduction in child poverty. And, in fact, given that relative measure, that’s what does happen in a recession.

We can go into slightly more detail. Median income is clearly going to fall when GDP does by 25 or 30%. But the incomes of the poor are somewhat to largely to completely made up of welfare and benefits, none of which are going to fall in these difficult times. We’re going to see a compression of incomes at the low end that is. Top end incomes will fall, largely based upon profits as they are, middling incomes and the median will fall, bottom end incomes will be static. Because inequality falls then so does poverty given the way we measure that poverty.

We entirely agree that we shouldn’t be measuring this way - falling incomes will indeed cause more poverty sensibly defined. But that also means that in more normal times we shouldn’t be measuring poverty this way either.

We can go a step further. In the good times inequality expands because that’s just what happens. At which point the call is for more taxation and more redistribution to curb the rise in child poverty. In these bad times our commentators are insisting that the same cure must be applied - more taxes, more benefits, to curb the increase in child poverty. But if both good and bad times increase that child poverty then there’s something wrong with the measure of the poverty we’re using, isn’t there? And something very definitely wrong with the proposed cure if that remains the same whatever else is happening.

We’re as with medieval doctors and leeches. An entirely sensible cure for a limited set of problems but their application to every problem is closer to religion than sensible disease management. So too with this treatment of child poverty. If the answer is always the leech then we’re asking the wrong question.

Critical supply chains and the lesson of I Pencil

Given the interruptions to international trade as a result of the coronavirus there’s a series of calls that we must bring closer to home, somehow control, supply chains of what might be called “critical” items.

As Don Boudreaux points out there’s a certain difficulty with that:

Instead of a collection of distinct supply chains, our modern economy is a single globe-spanning web of interconnectedness. Within this web every output is the product of countless inputs and each kind of input typically is used to produce countless different kinds of outputs. This web of interconnectedness – the complexity of which is beyond human comprehension – is indispensable for our modern mass prosperity. Yet its existence – its ‘everything-is-connected-in-some-way-to-everything-else’ reality – means that there are no objective and clear lines separating “critical supplies” from “uncritical” ones.

We can reach the same conclusion by re-reading I Pencil. No one does actually know how to make a pencil because the supply chain to do so is that entire global economy. Therefore we can’t in fact build supply chains that are transparent to our concerns about a pandemic.

But the lesson goes further than that. We also can’t build supply chains that are transparent to any other concern that we might have. Those insistences on fair wages say, or certain environmental practices, or blood minerals, whatever will be next in the list of fashionable concerns. The full supply chain for anything at all is the entire global economy. As it’s not possible to track all of that then it’s not possible to track the absence of those agreed and admitted evils from a specific supply chain. The adventure is simply impossible from the start.

It’s not even possible for us to know the supply chain let alone manage it.

Genetically Modified Organisms take the fight to the coronavirus

Some things will change after the pandemic, and one of the likely ones is that opposition to genetically modified organisms will be much diminished. We’ve been using genetic modification since our ancestors first domesticated grains and farm animals about 12,000 years ago, but in the slow way, by cross-breeding and selection. 

When we found how to do it faster by inserting useful traits from one organism into another, some environmental lobby groups discovered they could attract funding by running scare campaigns against it. They coined terms like “Frankenfoods” to imply that GMOs were laboratory monsters that would run amok. 

Since the technology was developed, none of their dire predictions has come about. Americans have been eating GM foods for most of this century with no ill effects at all, and several useful organisms have been developed to help solve some of our problems. A modified enzyme has been developed to eat up waste plastic, and another organism has been tweaked to gobble up oil spills. 

Most of the teams racing to develop vaccines that protect against Covid-19 are using genetically modified organisms to produce effective ones, and the world will be thankful when they succeed. There’s a Canadian company genetically modifying tobacco plants to grow proteins for use in a potential vaccine that would normally be done in eggs, taking longer and at higher cost.

The argument about GMOs is that they should be banned until they are “proven safe.” This is absurd, because nothing can be “proven safe.” It’s more valid to ask if they present a greater or less risk than their traditional, non-modified, rivals. This can, and has been, established in trials. But the anti-GMO lobby opposes even trails, and has systematically tried to sabotage them by destroying crops. No evidence has emerged that GMOs pose greater risk. On the contrary, many of them offer huge benefits.

One of the greatest benefits is offered by golden rice, modified to incorporate vitamin A, whose absence in the diet of poorer countries leads to malnutrition, blindness and death, especially among children. The NGO campaigns against it have prevented its use, and a Johns Hopkins study published late last year puts the death toll caused by their actions at several million lives. The variety has been made open source and non-profit to farmers in needy countries, but has been opposed as a “Trojan horse” that threatens to break a blanket ban.

It does, it should, and it will, and more countries are now beginning to approve its use. After the pandemic has been defeated, helped by organisms genetically modified to fight it, countries will look more objectively at the benefits GMOs offer, and those who accept those benefits will prosper more than those who continue to resist them. 

A very Protestant view of the world

Perhaps not Protestant but Calvinist. That it is work which is the thing that must be done. We must work, that is, for the good of our souls:

Unleash us from the “tyranny” of work and we are likely to feel the tyranny of inactivity more heavily. When the coal-mining and fishing industries collapsed the loss went far beyond financial pain; whole communities were denuded of identity and purpose. As Musk has admitted of technological unemployment and the limitations of UBI, “If there’s no need for your labour, what’s your meaning? Do you feel useless? That’s a much harder problem to deal with.”

Can you feel it? That burn as the absence of wage slavery diminishes our sense of self worth? It’s being put forward as the reason why we shouldn’t have a universal basic income. About which there are a couple of possible comments.

The first and most obvious being that it’s an idea being put forward, often enough, by those who do not need to work by hand or brow to put the calories on the dinner table. Who have, themselves, found something to occupy their time even as the essential basics are paid for in other ways. That is, those who do not have to work for a basic income are postulating that if other people didn’t have to then, well, they’d not be like those who currently don’t have to. Oi, the polloi won’t do like what we do sort of thing.

The second and rather more important being that we’ve already got a basic income guarantee in this country. It’s called the welfare state. Whether you bother to work or not there will be education for the kids, health care for everyone, a roof over the head (absent those mental health and addiction problems that so plague the rough sleepers at least) and so on. There will even be some modest amount of cash to aid in moving life along. It might not be all that much but it is there.

If you like, we’ve already sold the pass that there is that basic income. Now we’re only arguing about the form of it. The current system is conditional which has its inefficiencies, not least the immense tax and benefit withdrawal rate faced by those just climbing up out of poverty. The universal basic income rather neatly solves that. It is more efficient that is.

We like economic efficiency around here because it means that, by definition, we’re richer in aggregate by doing things that efficient way. This over and above our refusal to believe that work is what defines us. To insist so is, clearly, most illiberal for it implies that the dunnykin diver is of less moral worth than the nurse, or the newspaper columnist, which isn’t part of our vision of the good society at all.

Let’s plan before we need the plan

Even Baldrick knew that you actually had to have a cunning plan before you could action it. 

On 10th April, Matt Hancock announced his distribution plan for Personal Protective Equipment (PPE). It involved guidance on what and how much to use, a website to order it and fulfilment. Nothing wrong with the plan — apart from it being several weeks too late.

It is too soon to know when the lockdown exit strategy should be triggered but we have reached the point where we all need to know what it might be so that we can prepare for when it is actioned. If the form so far is anything to go by, the exit strategy will only be announced after it should have been implemented. And neither that, nor alternative strategies, will have been exposed to the sunlight of debate and improvement.

The lack of planning

Here are some more examples of this not-in-time Covid-19 planning. The government announced the emergency on 30th January but it was not until mid-March that briefings began. We were told there would be stages of restriction in order to spread the load on the NHS, but there was no plan for the specifics; it would be “steered by the science” coming mainly from the Scientific Advisory Group for Emergencies (SAGE). But SAGE provides only scenarios and opinions, not actual science nor proposals for government action. Being “guided by science” looks like a smokescreen to conceal the lack of in-time planning.

To be fair, government has well planned the provision of additional hospital beds and intensive care. The arithmetic was suspect but the 50, 000 extra beds (15K from ejecting bed-blockers, 15K from the private sector and 20K from Nightingales) looks, so far at least, enough. But the plan to increase bed capacity should have led immediately to plans for manufacturing and distribution of PPE, ventilators, oxygen and relevant medicines. 

The lack of timely planning is most conspicuous in the case of antigen test kits. Prompt action (and results) in South Korea in February indicated their critical importance. On 2nd April, in response to criticism that UK testing was too little and too slow, Matt Hancock announced a goal of 100,000 tests a day by month end, up from 10,000 a day at that time. Since then, reporters have pressed him for the plans for reaching that ambitious target, but none have been forthcoming. 

The need for a future plan

For the future, the government needs public acceptance of whatever the lockdown exit programme turns out to be. Only two trends matter: hospitalisations and deaths, which will peak at different times, and sooner in some regions than others. The number of Covid-19 infections not requiring hospitalisation should not affect the exit programme or the trigger date for starting it: they do not drain NHS resources.

We also know that the lockdown exit programme can begin sometime (hopefully soon) after those peaks are apparent. For that, the public needs to see decent tracking curves, nationally and by region, for Covid-19 hospitalisations and deaths. Figures need to be accurately allocated to the right days; it is not apparent that they are now. 

The programme will almost certainly proceed by stages, e.g. age groups, regions of the country and types of congregation and commercial activity. For example, it seems likely that schools should open first followed by wage-earners with seniors last. We need to know what other countries have done and what those experiences appear to be. Denmark, for example, has opened its golf courses, but not clubhouses, to two-ball games. Germany has kept DIY stores open. 

Whatever solution is adopted, there is an urgent need for transparency and debate so that the public can support whatever is decided and help carry it out.