UKH

The conclusions of the inquiry into the government's handling of the pandemic could hardly have been more damning. That's old news of course, on the subject of which there have probably been previous UKC threads?

My reason for starting this one is to turn the spotlight on the so-called scientific advice given to the government by the likes of Patrick Vallance, Chief Scientific Adviser to the UK government since 2018. Boris Johnson's defence against criticism of the government's delay in implementing the first national lockdown was that they were "led by science". What Johnson should have said was that the government was "led by its Chief Scientific Adviser", which is true. My contention here is that these two propositions are not the same claim and, as it happens, have different truth-values.

Vallance's response to Johnson's claim (that the government was led by science) was to say that science "informs" but "it doesn't lead the way". That strikes me as lame, to put it mildly. Note he doesn't deny that the government followed his advice. The job of the Chief Scientific Adviser is to provide the government with scientific advice. Advice, not just information. In a pandemic, the government should be following that advice, which is what it did. The problem was that the advice was not scientific, and here's why.

Vallance's advice was to delay a national lockdown. Why? Because he thought the great British public might not tolerate being locked down for more than two or three weeks. So, where was the scientific data behind that judgement about what the British public would or would not tolerate? Clearly, there wasn't any. Vallance was no more qualified to make such a judgement than you or I. Yet that's what passed for "scientific advice", which the government duly followed. That's pretty scary, isn't it?

I'd say that's bang on the money. Whether to lockdown or not is a political decision, it might be informed by the science but the science isn't the only factor.

I think in the case of the pandemic, deciding the correct policy was an objective, scientific decision. As much as we've all been told that there were different competing priorities to be balanced, I don't think that's true.

Many other circumstances are different, because different policies have diverse effects which might do more harm to some or have more benefits for others; or no one can reliably say what policy is results in the best outcomes because it's simply impossible to calculate and instead we have to go with the waffle of political decisions based on "values". But here we simply faced the question of "what policy will lead to the least harm". The worse the pandemic got, the more the economy suffered, so there was no trade-off to consider, despite what we were told.

A number of different policy options should have been formulated and worked through for their consequences, and it should have been obvious that a hard, fast lockdown would at the very least buy time to work out what to do next. Which would depend on what was happening globally, but opening up the economy slowly with minimal contacts and contact tracing would be the likely course of action. Any other option just allowed the virus to spread everywhere, and from that point everything would be f*cked. Which of course it was. I don't think there's any room there for political differences, it was an objective question with one simple answer: let the virus spread everywhere and the whole country will be f*cked - the economy, civil liberties, education, you name it, if you don't lock down now, you'll lose it.

The scientists got it wrong initially, and those in charge wouldn't have listened to the correct advice if they'd had it, because they don't have the country's interests at heart and frothing ideological lunatics were pulling the strings. We couldn't have done worse had we tried.

Maybe it should have been that but it wasn't because all sorts of other stuff got in the way and that's politics!

I’m waiting for the right time to post to this thread.

Should be in about 3 weeks or so.

Yes. No one had worked out that if the virus spread everywhere then the whole country would be f*cked. The scientists and the government miscalculated that there were different options and a political decision was needed - this way of looking at the situation was conceptually wrong at the most fundamental level. If they'd realised that allowing the virus to spread would ruin everything, and that because we're an island we could stop it spreading, things would look very different.

There was a massive range of options, by Feb/Mar 20 the stable doors were wide open, the options just varied the death toll, economic damage and impact on non covid health (yet to be realised), plus a vaccine was a distant hope. But, that's the joys of power, take the advice and make a decision, then lead.

Ps. I still think they made many dire decisions, often the worst of both worlds and the best of none. 

What amazes me is that our government  more than once repeated the same mistake of leaving imposition of restrictions far too late and didn't appeared to learn. Presumably a main reason for the UK having a higher death rate per head of population than comparable countries. I hope this isn't happening again.

I don't understand what you're saying. 

Are you saying that there was an option with low covid deaths but high economic impact; another one with high covid deaths but a better economic outcome, etc?

What we found out was that all the variables worth caring about were tied together. Do you think something different?

You're talking about March 2020, right? Have you read Jeremy Farrar's book 'Spike'? Farrar, who as Director of the Wellcome Trust was very much in the know and attended several SAGE meetings, says that the "public would not tolerate" view didn't come from SAGE and may have been direct advice to the PM from the Downing Street Behavioral Insights Unit (Cameron's "nudge" outfit).

Said it before, instead of listening to behavioural scientists saying the public wouldn't tolerate a lockdown, they should have employed Saatchi & Saatchi to convince the public of its wisdom.

Ridiculous idea that behavioural nudges are the solution to a pandemic that's already evidenced as tearing the arse out of a nearby country.  What next, applying the concept of consent to an inbound nuclear weapon?  

The scientists didn't get it wrong.  The scientists in China were bang on the money, most of the advisors in the EU got it right, most of the Asian countries got it right,  Trump got some good advice in the US and ignored it, New Zeeland and Australia got it right.

The scientists employed by the UK government got it wrong - or they were too passive in asserting differences of opinion with their Tory masters.   Part of the story is the SE England, Oxford/Cambridge old boys network which dominates the Tories and UK civil service. 

At the point where China clearly had the outbreak in Wuhan under control with a hard lockdown there was no longer any doubt what the correct policy should be.   The Tories and any adviser who was still prattling on about herd immunity after that point should be held accountable.

That's what I meant, yes. 

Without a counterfactual, this is meaningless.

Agreed. 

In the UK, our politicians are given advice by officials (from a number of quarters) who then act on it, or not.  They are free to go further than said advice or ignore it. In this case, the best approach appears to be to look what other countries were doing and go beyond the advice given.  The downside is you have no one to hide behind when it goes pear shaped.  

If they ever find themselves in such a situation, let us hope they show accountability and don’t hit on the idea of gaslighting an entire nation.

This.

I'll never forget those press conferences every night with Valance and Whitty absolutely terrified of saying something which might upset or contradict Johnson who was standing between them.

E

I think they were more frightened for the country than individually frightened of Boris. I will be buying their memoirs with a keen eye on their explanation of why one of them at least didn't resign each in September 2020 and in December 2020, when Boris explicitly went against the scientific advice. I'd add that even when they followed science in March 2020 that was the output of a SAGE membership that must have been heavily influenced by Whitty and Vallance, with too many modellers and too few with scientific expertise in fighting outbreaks (most of those said they were pushing for an earlier lockdown).

What I always find really interesting is “why was the default plan herd immunity by infection?”.

Clearly this must have been modelled countless times before by both civilian and military planners. In every scenario I assume they reached the conclusion that hospital capacity was breached, but that this was still the best solution to the problem.

What we’re they missing in their assumptions? The rapid development of highly effective vaccines? A lack of lockdown fatigue?

They must have modelled alternatives such as lockdowns/ quarantines. Why were these dismissed in planning?

I made a point to wintertree on the plotting thread that arguably we were one of the best prepared in the run up to the pandemic. Why did we get it so wrong?

Yeah... if we'd had a government that was actually governing, instead of being fixated by one ideological obsession, they might have questioned the scientific advice, asked why the advice they were giving was at odds with that internationally.

Anyway, September 2020 demonstrated that even if they'd had better advice the government would still have delayed lockdown till too late.

I think there are one or two legal exemptions to that. From my understanding they are legally obligied to follow the recommendations of the JCVI for example.

But you are correct, its advice only.That is because there maybe other interests- economic or security for example.

Its ultimatley a political decision .

In a democracy, that is what we have to live with.

While I agree with your outlook re the UK response, I think it's worth pointing out that hard lockdowns seen in France, Spain & the UK were essentially a sign of failure. In much of central and Northern Europe there were much more pragmatic restrictions e.g. no bans on meeting anyone from other households, no bans on outdoor activity. Obviously the ship had sailed on that by the time we got any significant government action and we'd have needed far more competence in terms of quarantine, testing, tracing etc at a much earlier stage... Probably beyond the capabilities of Matt Hand/cock and his mates.

I remember this interview (10mins onwards) with Tomas Pueyo and Prof John Edmunds.

https://www.youtube.com/watch?v=C98FmoZVbjs&t=446s

Edmunds was obviously unhappy at having a blogger criticise him, but I remember thinking at the time, Tomas did seem to be taking the international anecdotal evidence seriously, which at the time was all we had to go on. Edmunds is very confident in his assertions, some amounting to behavioural science, others about the rate of transmission..... none of which were actually knowable at the time. Pueyo did start to get theatrical in his responses, which is a shame as his main point, lock down fast and hard to get it under control, then manage it, was correct. Edmunds didn't really tackle it, just waffled on about herd immunity. 

Contrast with Edmunds a few month later

https://www.bbc.co.uk/news/uk-politics-52955034

Caused I think in no small part by the formalisation of career progression in to a form filling, box ticking exercise based on selling ones own merit through evidencing various indicators of esteem, many of those themselves amenable to people gaming the systems.  

The best people rise based on their achievements, more recognise this for the box ticking, game playing nonsense that it is, and some end up coming to define themselves in terms of these things and forget that they have risen up the ranks through game playing far more than competence at the basics.  I think various ideological shifts being pushed in to the sector from different angles by the last couple of governments have made this worse in so many different ways.

I certainly think membership of big name advisory bodies should not be admissible evidence in any promotions process, to remove any game playing mindset from motivating someone to be on any such committee.  

I've known enough professors where my take in a crisis would be to ask them for a suggestion and then do the exact opposite...  I think a lot of people aren't aware that that UK academia is a self-regulating game without any accredited professional standards (*) or any sector-wide code of conduct, and think Professor conveys far more weight than it should.  

(*) Excluding various sub-fields that typically overlap with human health etc.

Having said that, there are a lot of exceptional people in UK academia, and a lot of exceptional achievements if you compare on metrics normalising outputs to the money spent.  Which raises the question of how we can fail so badly with so much stacked in our favour.  Structural problems abound.

As Jon Stewart has said, in a pandemic the science is far and away the most important factor because everything, including the economy, depends on controlling the spread of the virus. There isn't a "balance" to be struck between competing interests.

The point I was trying to make was that, even if Vallance's statement ("science informs, it doesn't lead the way") is true, it is disingenuous as a response to Johnson's defence that the government was led by science, because it evades the fact that the government was not led by science. Vallance is of course motivated in his evasiveness because the government did follow his advice, which ought to have been based on science, but actually wasn't.

That's a dishonest position. Vallance has to fully support government or resign.

Has to fully support or resign seems a bit OTT - surely there must be some room for disagreeing but following the line?

That's what Whitty and Vallance did as they couldn't publicly criticise the official government line. I'm pretty sure they were very robust in private but what do you do when Boris invites Heneghan and co to No10 (and believes those idiots over SAGE) as happened in September 2020.

The latest news illustrates this point well:

https://www.theguardian.com/world/2021/nov/02/jeremy-farrar-sage-scientist-...

I would be very interested to see the "models" that were used to underpin any of the response planning implemented in the UK. Its not exactly like the civil service and the military are known for their cutting edge infrastructure. If public health england is anything like some of the departments within DEFRA they will still be using absolute dinosaurs of IT infrastructure and software. I find it unsurprising that things like track and trace were just absolute failures and never properly pursued. 

Are you serious?.... the models were generally multi-institutional academic led. In March the key problem was they were modelling based on flu, yet Ferguson in particular was key in getting a government U-turn to lockdown, when models didn't match reality. In September and December 2020 the models were right and Boris messed up by ignoring them... in September that was partly based on voodoo 'science' from the likes of Heneghan who claimed herd immunity was in place.

I'd agree that that is very true.

If policy was led solely by science with a rider of saving lives/reducing hospitalisations, a number of things that cause great harm would be banned outright, such as tobacco, alcohol and private motor vehicles.  And we'd lock down for flu every year.

Weren't PHE and local authorities also modelling local areas based on positive case numbers when they introduced the local lockdowns across England? From what I've seen reported this was made almost impossible by the use of the old Excel formats they saved the results data in?

I disagree.  It is much more finely balanced than that, in particular because entirely eliminating the virus is close to impossible (this has been achieved precisely once with this sort of virus - smallpox - and even China which was willing to nail infected people in their apartments and leave them to starve hasn't achieved that), so it's all about how you manage the transition from novel to endemic without too many people dying but also without destroying education and business.

Even ignoring the UK's poor performance, there is certainly a political decision to be taken between the Western European approach of "keep it down to reasonable levels" and the New Zealand approach of "keep it down to basically nothing" pending vaccinations becoming available.  The former is I think the policy I would favour; the latter had benefits but also big downsides.

The UK should have had an advantage following Brexit as an island in that they had taken back control ( of their borders and whatever else). They could have locked down NZ style, but I guess the economy was prioritised. 

It's very difficult to compare countries as they all have different age/ health demographics, and ways of measuring infections and deaths but it's fairly clear the US, uk, and western Europe have struggled. 

The fact that most of the cabinet seemed to catch it in the 1st few months seemed to indicate how seriously our leadership took it. 

The UK could have never locked down NZ style.

NZ is in the middle of nowhere and all of its goods come in via containers.

In the UK you can see mainland France from the Kent coast in a clear day and all of our food comes in via the back of a lorry.

We would have starved to death before we eliminated Covid we’d gone for NZ style controls.

Feel free to link evidence of any major impact that excel based data collection (it certainly wasn't modelling) in local Public Health departments had on lockdown. The government decisions in March 2020 were based on SAGE modelling.

Local Public Health was good in the UK a decade ago, but this position has been trashed in England since the Lansley 'reforms' moved the departments into cash strapped local councils.

That's my favourite hyperbolic post of yours yet on UKC. Starved to death?  If we imposed appropriate controls it wouldn't have impacted freight in the slightest but might have inconvenienced middle class holidayers returning infected from Italian ski resorts. That could have given us more time to spot the flu models were wrong. Stricter border controls at airports then could have saved thousands of lives.

30% of our food comes from the EU (https://www.google.com/amp/s/www.bbc.co.uk/news/business-55408788.amp).

If we had the same NZ border controls none of this would get through. You can see the impact from relatively light touch post-Brexit checks.

Could we survive with 30% less food on the shelves? My guess is no.

I guess we might find out in more details how all the data base procurement issues effected the implementation of the local and later lockdowns in the public enquiry.

I fail to see how the events such as this (https://foreignpolicy.com/2020/10/08/uk-coronavirus-covid-spreadsheet-excel...) Wouldn't have effected the information available for informing the strategy being used. it's a prime example of the kinds of IT failings that plague most big organisations with stupidly complex procurement processes. I doubt this was the only such issue effecting test results.

I dont disagree, this situation doesn't seem to be improving either and more cuts to goverment departments are almost certain. To me this has looked like a perfect storm of events: drastically diminished public health capabilities, a goverment that seemed indifferent to a pandemic that is still killing 100s of people per day and in some instances poor data collection/handling practices.

That link is an outsourced track and trace failure that has nothing to do with Public Health departments.

Were they not the ones in receipt of the results from that company? I think PHE would take a dim view on a water company making a similar failing with a water quality incident.

Yes but that mess was in October, not March.

The now defunct national body PHE (replaced by the NIHP) is not the same as local Public Health departments.

https://www.gov.uk/government/publications/the-future-of-public-health-the-...

That's scary coming from you....

Don't we throw 30% of our food away? 

There were two earlier SARS outbreaks that were stopped and there's been several outbreaks of diseases like Ebola stopped before becoming pandemics.

If everyone had learned from China's response in Wuhan as soon as it was clear what they were doing was working there's a good chance this one could have been snuffed out before going full pandemic, or at least confined as a disease of poorer countries with quarantines at frontiers.   Johnson, Trump and Bolsonaro bear as much responsibility as China for Covid becoming endemic.

There's also a more basic complaint about the UK government response which is more about engineering and common sense than science.  When you are faced with a new threat and you have an option which slows things down and allows you to learn more before making serious decisions that is the way to go.  There's no reason to rush to assume letting everyone catch it to obtain 'herd immunity' or similar dangerous strategies are necessary.  Maybe you will get to the point but you don't start out from that assumption.   

Do we know (i.e. are there any peer reviewed papers on) how SARS-1 was stopped?  Did it for example evolve into something less harmful?

What sort of R did it have?  (Notably lockdowns have not eliminated flu nor the common cold despite these having a much lower R than the Delta variant).

Standard lockdown and hospital infection control measures stopped SARS 1 (albeit lab accidents led to some later cases)

https://en.wikipedia.org/wiki/2002%E2%80%932004_SARS_outbreak

MERS is still with us

https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome

I don't pretend to know any more about this than anyone else, & less than many who post here I am sure, but sat in HK where the local administration is now desperately trying to develop ever more stringent measures (when they are already some of the most stringent in the world) in order to open the land border to mainland China the political dimensions of public health policy are very clear.

China acted hard & fast to control the spread of infection.  They have advantages in this - 70 years of controlling the population & information.  The economic model (& long-term economic goals, like slowing unsustainable rates of growth & moving from an export-led to an internal consumer-driven economy) has probably helped.  However, even by admitted standards, they have under-reported infections &, as pointed out above, there are continuing indications of local outbreaks, so "zero-covid" looks to be as unrealistic a goal there as anywhere else.

The upshot of these policies is something close to 100% normality locally, at the cost (if you see it as such) of severing your ties with the rest of the world.

The point in my original post is what might have happened if the whole world had followed China's lead on suppression as soon as it was clear that it worked.  That's a different scenario because there would be less re-importation into China if its trading partners had Covid suppressed.  

Although zero-Covid is unrealistic now, maybe it wouldn't have been if countries like the US and UK had not f*cked up so badly early in the pandemic.

I wonder. I am sceptical about re-importation into China.  There were outbreaks in HK that were very probably the result of permitted exemptions to quarantine over the land border

Thanks, I had confused SARS and MERS.

There was more chance of stopping the outbreak earlier in China, if they had alerted the world's health experts to what they faced instead of initiating a state cover-up. Better early communication certainly would have reduced the awful world death toll in the first wave

I think the chance of worldwide collaboration, particularly in countries that couldn't afford that, was so close to zero that that was really a fantasy.

I'd disagree.

If Obama or Biden had been president in the US and responded intelligently and aggressively by very strong leadership and backing of organisations like the WHO to drive lockdown/quarantine responses early on we would be in a much better situation.  It's not impossible we'd have managed to suppress it.  We would have been dealing with the initial variant, not the more infectious ones which developed from it.

One of the reasons Covid got so bad is because both the US and the UK were being lead by total dickheads.

Obama might have managed a better outcome but developing countries would have still harboured it.

Biden is an utter chocolate teapot.

There are many diseases in developing countries which advanced ones manage to isolate themselves from quite effectively.

Also the worldwide vaccination program is actually doing pretty OK,  7.83 billion doses so far.  A lot of that is down to China.  The rich countries would only have needed to shut down travel for non-vaccinated people to developing countries for maybe 3 years and there wouldn't be a hell of a lot of business travel to the poorest countries anyway.

https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distributio...

I'm not sure.  He's clearly old and it shows its effects and he isn't as good a media communicator as Obama.  But he is a Senate veteran and he may be more effective behind the scenes.   My reading is that Biden's primary focus at the moment isn't influencing people outside the US or even the US electorate it is getting key bills through the Senate.  If he manages it the money which flows will start influencing voters and changing the direction of the country.

They tend to be diseases with very different properties from Covid though.

I think your point about things being better under different leadership is a bit simplistic. Better leadership might have lead to fewer deaths which would have been great but to suggest that suppression was possible under other leaders is mostly wishful thinking and pointless speculation.

It may be speculation - like any other prediction - but it is not pointless.  The people who f*cked up have a vested interest in the narrative that it was inevitable and it is lazy and counterproductive to assume that is true.  We should try and understand what was possible for competent leaders as a measure to evaluate the performance of our leaders against.

Two key points: 

a. we were not dealing with the Kent or the Delta variant.  The initial variant was less infectious and clearly could be suppressed with lockdowns because China did so.  The logical reaction to the success of lockdowns in Wuhan should not have been 'oh f*ck this is impossible lets just all catch it' it should have been 'what they did only more'. 

b. There were two previous SARS outbreaks which were suppressed - that's why China was set up to do it. Several countries had it pretty much suppressed.  New Zealand being an obvious one but even Scotland had a period where there were no deaths after a lockdown.  It was the countries like England, the US and Brazil that refused to try and make suppression work that f*cked it up for everyone by ensuring there would be continuous reseeding.

To be clear Tom, I argued vociferously (behind the scenes through routes available to me before ranting / venting on UKC) that we should have gone harder and sooner on Covid; I doubt we could have achieved zero Covid in the way a couple of places did, but trying and failing could still have been far better for every measurable outcome (lives lost, health damage, net duration and effects of lockdown) than the absolute mess that we had.

I have not minced my words over the failure of the intersection of institutional (academic and industrial) science and the government in early 2020.  I'm appalled by it.

Let's look at two comments from you today:

Two days ago you accused me of bias for not having enough "respect" for China or the US [1], yet here you are a couple of days later on the same subject blaming the US.

You seem confused.  Which is it Tom, are they to blame or are we to blame for not following their example?  Why did you think I need more respect for them with regards to Covid?  A perusal of the news shows chaos and disarray with vaccines, masks and other control measures being weaponised into their party political culture war right up to the level of a state governor (lining up to go for president) punishing schools with mask mandates by withdrawing their funding.

Pardon me if I continue to struggle to respect a nation that is willing to intern half a million of its citizens and subject them the atrocities widely publicised on an apparent pathway to effective genocide [2, 3].

Two days ago, you argued that we can't compare nations with large populations to nations with small populations [4], and a couple of weeks before that you were making the point that population normalised rates are the unbiassed way of comparing these measures [5].

Yet here you are comparing nations with large and small populations and using absolute, not relative rates.  You have this knack for cherry picking what ever view of the data supports your pre-conceived world view.  It's impressive.

The death rates in Scotland and England were comparable in the period you note, but because the rates were so low in both countries and Scotland's population was so low, it had an average absolute number of deaths of less than one per day, with statistical noise leading to a couple of 7-day periods with no deaths; but average the data sufficiently to accommodate the extreme shot noise in such low number statistics and it was doing no better than England; possibly a little worse.

I've enjoyed seeing you contradict here the reasons you've used to object to my plots over recent weeks, thank you.

[1] https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_51-...

[2] https://en.wikipedia.org/wiki/Xinjiang_internment_camps

[3] https://www.bbc.co.uk/news/world-asia-china-55794071

[4] https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_51-...

[5] https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_49-...

My argument has been misconstrued here, my fault as I wasn't very clear.

I absolutely maintain that in *in the phase of the pandemic before vaccines were rolled out* there was no political decision to be made, only an objective decision on the best policy to control the virus. As I said, all the measures we care about were yoked together: the worse the spread of the virus got, the more everything else, especially the economy, went to shit too. There were no competing interests for a political decision to be made between.

This doesn't rely on an ability to eliminate the virus. I agree elimination was not realistic in the UK. It's about locking down soon and hard so outbreaks can be effectively managed as they occur when you open up - keeping the thing *under control* instead of the Johnson policy of *let it spread everywhere and allow the whole country to go to shit*. There are NO valid arguments for this policy, of any kind, objective nor political.  There is no measure that is improved under this policy. Noone's interests are served (except for the govt creating a bigger catastrophe than brexit to hide that under - while this might have been done later on, I don't actually believe Johnson's failure to follow a justifiable policy was motivated by this from the start). It was 100% pure incompetence, and not random incompetence either. Incompetence caused by a fundamental absence of moral backbone and contemptible short-term personal self-interest (the nutjobs I installed to support me won't like it if I do what is necessary).

The correct policy, objectively (now we know the consequences of letting the virus spread) was to control the virus with hard, early lockdowns to buy time. Sure, the detail of how that should be done wouldn't really be objective (how coercive/enforced, etc.).

I'm not really convinced that the NZ option was on the table. My guess is it would have turned into a "keep it under control" policy had it been attempted, but at lower levels that Europe what with us being an island and having a bit of warning.

Strawman. I'm arguing that *in the phase of the pandemic before vaccines were rolled out* there was only an objective decision to be made because all the measures we care about were yoked together, I'm not arguing for utilitarian policy across the board.

I pretty much agree with you Jon, as usual, but I do have one disagreement - I think you're looking at this through the lens of a compassionate person who holds their personal interest below society wide suffering.  Try and wear a very different hat, as much as it stinks of the sewer, and look at two of your comments with that hat on.

Are you sure that literally nobody's interests have been served by the consequences of allowing the virus to spread not once, not twice but three times to the point it was quaking universal healthcare?

There are no society wide interests served, no greater good, no net benefit, but this does not preclude some interests being furthered by the long game.

Objectively it seems some people we know about have done rather well out of contracts placed with little to no scrutiny or usual due process, and we don't yet know how the accumulated attrition these last 20 months have worn on the NHS is going to convert to future structural changes to healthcare, nor which interests may get their slice of that pie.

I see what you're saying, but I find it quite difficult to believe that the benefits for the scum of allowing the UK to descend into a quagmire of disease and death were actually what motivated them. I think these were side-benefits which will have influenced their decision making along the way, but it doesn't strike me as credible as an underlying motivation for Johnson. The likes of Swainson and Baker I don't know either (they're most certainly both mad and bad, but I think mad and thick and bad in that order - which given how mad and thick they are still leaves plenty of room for them to be extremely bad).

Johnson is motivated by nothing except his own ego. He's not trying to achieve a libertarian deregulated state without universal healthcare for ideological reasons. He doesn't give a shit either way. I think he would much prefer to have been hailed as a hero for having the best pandemic response on the world stage (i.e. he wanted it turn out that the virus wasn't that deadly and herd immunity allowed us back on our feet in no time). He didn't want to preside over a total failure for the sake of achieving lasting changes to society that benefit his tribe. He has no interest at all in what happens to society, for good or ill, nor anyone in his party or social network. All he cares about is himself.

Can I suggest an alternative viewpoint - something that’s been nagging away at the back of my mind for a while now -which people are welcome to flame away.

The reason that herd immunity through natural infection was the default option for the UK is that in every scenario modelled it resulted in the lowest net loss of quality adjusted life years across the population compared to any alternative (in a reasonable time window - say 20 years). And the decision to lockdown was a political one to avoid the collapse of the government, not a public health one. 

We have spent approximate 67k (400bn / (600k * 10)) per quality adjusted life year saved, compared to the NICE guidance of 20k. There is a reason why expensive drugs are controversial, because whilst they save/ extend the life of one person it causes a net harm to the rest of the population.

Is our debt burden and the pressure placed on the NHS by residual pockets of vulnerable people going to kill more people than were saved from Covid? Fractions of life years lost would swing the balance to the cure being worse than the disease.

I’m sure I’m going to get all the down votes under the sun, but I thought I’d air my view as it’s been nagging away for the last month or so.

I'm not saying that's what motivated Jonson - I agree with your commentary on him and his qualities (for want of a better word).

But, some people do stand to gain.  They have large, well funded, established and connected lobbying organisations, they have put eloquent, professionally titled people in front of Johnson and Trump and they push influence in myriad ways onto the political system.

They do it all in the open, and neither government nor opposition politicians mention it, raise it, suggest maybe it's not the way to do things.

I thought that QALY driven view was wrong in March 2020 and I've not changed my mind since.  

Ample evidence abounds from past pandemics and now from this one that going in harder and earlier leads to less net total lockdown and less net total economic cost, and that the trade you're considering is not realisable.

All the more reason to innovate in drug discovery to lower the cost, and to increase our net productivity and wealth through education, social welfare and technological development so that these costs can be reduced.

What more can a person want than a good life and a good death?  The last 20 months have not been good for either.

Yes, I agree. There are people who gained, and they did influence political decision making for their own ends.

I'd generally support a QALY approach, but I think you're still labouring under the false belief that herd immunity by natural infection was at any stage an option. The people at the helm thought it was at first, they turned out to be wrong. I imagine they did run models that showed it to be a good strategy using a QALY calculation - but those models clearly didn't factor in the real world impact of the virus.

Do we need to go through again what it would have looked like if we'd pursued a herd immunity strategy? The hospitals would have collapsed, then the emergency services, people would then start panic buying for their own self-enforced lockdown, there'd be chaos in every town and city, then army on streets, economic collapse, no herd immunity achieved, just destruction. This was obvious after Italy. The herd immunity idea seems to be that loads of people just die and magically disappear (not needing hospital, mortuary, burial, funeral services etc) while everyone carries on as normal. It's just total garbage once you've seen how much the NHS gets clogged up with covid, and how people respond in their behaviour. People were never going to volunteer to catch a deadly virus and give it to their loved ones for the sake of a better national QALY total in 20 years time. Honestly, they wouldn't have done it. Once things got bad, they'd have just stayed indoors scared shitless of what was going on outside and the first wave of the virus would have peaked with a maximum amount of destruction without getting anywhere near herd immunity.

The UK isn't a herd of cattle. It's too big, and natural infection doesn't give everlasting immunity, and the virus mutates. The idea was a bad one. It didn't work, and it never could have worked. They got it wrong.

This has been explained to you several times before, so are you being stupid, a bad actor or both? Your QALs argument simply doesn't apply in a situation where the entire health system is so at risk of collapse that everyone risks losing QUALs; at the same time that the cost increases as we can't function as a society with no hospitals, so the extra heavy economic costs of hard lockdown are inevitable. Poor covid control costs lives and increases lockdown costs: they correlate, they are not a trade off. There has been no scientific defence of this type from anyone aside from GBD types, who's views have been proven to be both wrong and dangerous. Frankly I think some here are being very kind to you. Tom rightly gets flack for cherry picks and spinning too much on a nationalist line but given previous explanations on QALs you are still spreading plain misinformation. As an aside, most of your strongest critics have publicly said they never down vote.

Some very rich bad actors, financially supported those GBD scientists as well.

My point is a nuanced one. Perhaps someone who’s main hobby seems to be posting links to Indy-Sage or the guardian can’t understand.

And my point is more of an open question. Has the response to Covid (whilst looking okay at the moment) actually killed more people than it has saved in the long run?

It’s very controversial to say this, but I’m wondering if that’s the case (down vote away if you want).

I understand that healthcare collapsing would have a massive impact on health (50k dead losing 30 years of life each?).

Likewise there would be some serious economic damage regardless of the path chosen (100bn to support the economy for 9 months?).

However there must be a reason why the default strategy was herd immunity? Can you explain what years of government and military planning got wrong?

The more I think about it and the further we progress with the pandemic, the more blurred the distinction between the outcomes of lockdown and let it rip seems to be. 

What's the comparison?

They didn't understand what the real world impact of the virus was. They made models based on the wrong input assumptions. When they tried to apply it in the real world, that was made clear - it didn't work!

I honestly can't get my head round how anyone could think that. This belief in herd immunity has become a fundamental for people on the hard right. It doesn't matter how much evidence mounts to show the belief is false, all you get is backfire effect. 

Look around the world, look at the countries that did let it rip, look at the ones who controlled the virus. You're just arguing that the world is flat.

Deaths have generally lagged infection by a about three weeks. That timescale has been known from cases in China in January (ish) 2020 with a progression from infection to symptom (~5 days), hospitalisation (~10 days) & death (~23 days) for fatal cases.

If lockdown caused more deaths than Covid:

1. you would have to explain why deaths correlate with cases rather than lockdown measures
2. you would have explain why deaths lag cases by about 3 weeks rather than lag lockdown measures by some other timescale
3. you would have to explain why the retired and elderly are vastly more vulnerable to lockdown when they don't suffer the economic impact suffered by the working age population

Time for you to stop asking questions and provide answers as to why you think lockdown causes more deaths than Covid. Otherwise I have to conclude you are a bad actor spreading disinformation under the guise of "just asking questions".

Well the comparison would be excess deaths.

My devils advocate position is that the models haven’t broken down. Human behaviour was always factored in (the points you raised) and that there’s a possibility that we ignored the best long term plan.

The point that you’re getting hung up on is that you’re looking at it over the window of the last 18 months and then adding on another 6 months of probably outcomes. The outcome of which I agree has been vastly superior to a let it rip scenario (absolutely no challenge from me their).

My point is:

1) surely the modelling captured human behaviour. Are you really telling me that the government/ military forgot to factor in the fact that people would be scared of a new disease? 

2) over a 20 or 30 year horizon what does the impact of both responses look like?

3) quarantines/ lockdowns must have been considered in the modelling as an alternative. Certainly if the death rate exceeded a certain percentage. Why were these discounted.

Could it be as simple as the impact of vaccines coming on stream as quickly as they did was overlooked?

Lockdown will never cause more death than catching the virus in the short term (hopefully that’s very obvious).

However is 400bn of debt going to cause more than 6m of life years lost of the next 20/30 years?

It’s probably going to be close? 

Without commenting on the merits of applying this type of health economics calculation to the pandemic, it's worth noting the 20k figure is out of date. Treasury guidance from 2018, which the Department for Heath was signifiantly involved in drawing up and agreeing, recomends a value of 60k per QALY be used for appraisals across goverment departments.

That doesn't make any sense. I'm pretty certain that you're contrasting the following two options:

1. The bungled 'let it rip for a few weeks, realise that's insane, then lockdown for ages once everything's gone to shit, rinse and repeat' "strategy" followed by the UK

against a comparison of:

2. 'Let it rip' strategy, and you're implicitly making completely stupid assumptions about what would have happened in this fictional, and impossible case, where herd immunity is achieved and economic support from the govt is minimal. 

The fact that 2. is just a fantasy makes your argument nonsense. Had we tried to pursue 2. we would have had worse economic outcomes and more death and destruction.

I'm saying that they got it wrong. They must have tried to factor in everything they could, but they did not have sufficient information and the assumptions they put in were incorrect.

Since the 'let it rip strategy' has far worse economic outcomes than even 'bungled britain' (1.) then obviously 'bungled britain' is far superior. There is no possible counterfactual where we achieve herd immunity with a minimum of economic support. You're clinging onto that like a belief in god. There is no herd immunity for covid. There is no god. These are false beliefs, held by faith, in the face of overwhelming reasons to let them go.

(Not coincidentally, it's similar to the brexit argument -  "OK, I admit it's a complete car crash now - twice as bad as covid for the economy in fact - you've just got to wait 20 or 30 years and it'll all come up smelling of roses".)

Because according to the assumptions, they'd cause vast economic damage and it seemed like herd immunity was a better option all told. But the assumptions were wrong! Herd immunity didn't work! Italy showed what happened when the virus got out of control and it became obvious that letting it rip wouldn't work. People just started to lock down by themselves when they realised how the serious virus was. 

Look, you're never going to let go of your false belief about herd immunity. For you, the earth is flat, and no one's going to tell you otherwise. This psychology is common - it's how religion works, conspiracy theories, all the rest. You can see a rational path to the things you believe that no one with a grasp on reality can, because you've got certain beliefs that you can't let go of no matter how much evidence shows them to be false.

We certainly don’t all seem to understand how the total overload of healthcare by around a million extra people going to hospital in 3 months would have denied everyone the agency we all normally have over quality of life and healthcare, and the circumstances of many of our deaths.

Preserving healthcare matters far to far more peopl than saving lives from covid, and at this point - with the alternate tragedy having played out live in the media from Brazil and India - it’s facile in the extreme to pretend otherwise.   You can’t protect healthcare without controlling Covid.  

My guess is the deaths and health impact from the debt will overall be similar if not larger than covid deaths but a lot more buried in noise. I suspect it will be an equally major reason scientific experts will look back with regret at the long term consequences of poor public health covid measures in the UK that led to the need for harder longer lockdowns (despite our UK advantages:  we were hit later than some, had island advantages on borders and had run preparatory pandemic exercises, yet we were the hardest hit in western Europe due to some terrible government decisions). After the first wave (that hit an under-prepared Europe), hard lockdowns and their extra debt expense correlate with poor government public health covid control. Your concerns are completely backwards: all the literature consensus says that,, yet you still ignore this and spout misinformation. More death and more lockdown debt arose from poor public health actions on covid: it was never a trade off except in the minds of fools and liars.

I agree - it seems highly likely we had far more net total lockdown that we would have had with a more proactive approach to controlling the virus in the first year.

The harms of lockdown were greatly magnified by misguided, un-evidenced and sometimes counter-factual faith in allowing the virus to spread uncontrollably at various points in time.  

It's only now with a highly effective vaccine roll out and a lot of work on clinical care and therapeutics behind us that it's been possible to allow the virus to spread without quaking healthcare apart or driving us to lockdown.  

Even then, the spread over the last 3 months that appears to be moving England forwards towards the next step out of this mess is I think only possible because of the radical changes to society that came together long after the initial periods of barely controlled spread.  

With the benefit of vaccines, past infections, repurposed and new therapeutics, improved clinical care, a big focus on workplace and school ventilation, a radical shift to working from home and test and trace, we have still only just been able to prevent the virus rising exponentially to the point of quaking healthcare.  

It's terrifying to imagine what would have happened early on without all this with another week or two of growth; I like you think we would have seen a very chaotic individually and locally driven lockdown causing more economic damage, a much worse situation for panic buying and disorder and set us back even further.  

I totally agree with that but still think the UK is 'rushing to an exit' and metaphorically (for now, putting aside the obvious direct effect of covid on people) parts of the NHS are getting trampled in the rush, that would have been in a much better state in a calmer exit based on good clear messaging, on the very clear public health information that the UK government choose to ignore; including limited restrictions that have little or no impact on the economy.

The more I think about this, the more I have an issue with the phrase "scientific advice".  At best, a scientific approach to analysing a complex issue will predict probable outcomes but the predictions will depend greatly on what parameters you include in the model.  So its reasonable to predict, on a statistical basis, what would happen to a disease spread, death rates etc under various social scenarios.

Where predictions break down is when we try to model complex social interaction - it just doesn't work well (all it takes is one newspaper headline to take events down a vastly different path).

So sure, someone can make a judgement on what the scientifically derived models predicts AND on their view on desirable outcomes AND on their expectation of the social behaviours of society and offer advice accordingly - but it is a person's advice not "scientific advice".  "Scientific Advice" is just a buzz phrase to try to add an unjustified veneer of certainty to  a complex and very uncertain situation.

There's a distinction though between an objective decision made on the basis of modelling (which I agree is a push to call "science" once you're in the business of making dodgy predictions about human behaviour), and a political decision based on something like "values". In the former case, there's no dispute over the goal that's being achieved, in the latter, it's a choice of goal.

People upthread were arguing that there was a political decision to be made re. covid strategy at the start, but since there were no competing goals, this is incorrect. Unless people think it could be acceptable for a government to knowingly choose the worst of a number of options (on all reasonable measures) for reasons kept secret from the electorate, for valid political reasons?

I'm not sure that, at the level of decision making faced by the government there can ever be any truly objective decisions.  The politicians have to make a decision based on the modelling (derived largely through scientific methodology, albeit with incomplete input data to start with and generated at breakneck speed) but also, as they would see it, to balance up financial risk/reward, social pressures and to maintain their 'popularity'.

It is a political decision and it does (unfortunately) rely on competent politicians that understand (or at least grasp) what the interactions between these potentially conflicting inputs are.  Which is unfortunate for us.

There's also the choice of what to 'save'; lives or the economy. That's a political decision. I guess that's your 'goal' point. The fact that the 'lockdown or the economy' argument was a bollocks false dichotomy is somewhat incidental...

It's not incidental at all. 

Either

a) there really was a choice of economic or public health costs, with political incentives for the govt going on at the same time - in which case it was a political decision; or

b) the lockdown/health vs. the economy was a bollock false dichotomy (it was), in which case, it was an objective decision. It's objective because the variables we care about (lives, economy and even political favourability) all predictably went in the same direction, as a matter of how the world works. So everyone would have to agree whether the policy was good or bad, because whatever measure you care about gives the same answer. 

The argument I'm making is straightforwardly logical. Either it's correct (all the variables are yoked together) or it's not (there was some choice to be made about which measures would be increased at the expense of others). It's not an opinion! 

I suppose you could ask to what degree they were aware what they were being asked to make was an objective decision, or whether this is only a matter of hindsight. Answer: it was obvious at the time. The whole 'lives vs, livelihoods' was obviously a crock of shit. One that was kept alive in the media because the govt were too shit to operate competently in the crisis.

The reason the government didn't appreciate this was that they were simply too stupid (exhibit A: "lockdowns don't work" - Boris Johnson), and they failed to act in even their own political self-interest (Johnson would be having a better time now had he not failed so hard at managing covid).

There's a new definition of stupidity doing the rounds you might have seen: stupid people make things worth for others while not even making things better for themselves. Other than the brexit distraction and the corrupt contracts, this is exactly how the government acted. They put what the Express would say tomorrow above even the interests of how the electorate would judge them in a few weeks time. It's actually the most stupid thing I've witnessed in my entire life - but it will be trumped when the few surviving mutilated turkeys who by chance didn't get roasted this time vote for Christmas for the second time running. That will really take the f*cking cake.

That's if you're being generous... Other possibilities are available.

As well as being stupid, or perhaps as an example of their stupidity, they are unable to see much past the end of their noses; they think in timescales of a week or two, and can't see the long term picture. That, to some extent, explains why they refused to lock down in a timely manner; they could only see the economic damage it would do tomorrow. Not the damage that would be done in the next few weeks and months, as a result of their short-term thinking.

As for the Express headlines, i see today's is again pretty scathing of Johnson. Do I hear the sound of knives being sharpened...?

Nb. I'm not trying to excuse Johnson et al. I blame them entirely for the covid disaster we suffered (let's not get into the brexit disaster). I'm growing increasingly furious over yesterday's maskless hospital stunt; if I'd been any one of the medical staff he met, I'd have forced him to wear a mask, or f*ck off and take his photo op elsewhere.

There's absolutely no inconsistency in my position.   There is a difference between the US science and technology base including companies like Pfizer and agencies like the CDC and the Trump administration.  Trump was a f*cking clown just like Johnson, they're two cheeks of the same arse with the same money behind them.

Yes there is, you told me "Not enough respect for the US" - you most definitely did not say "not enough respect for the multi-national firm Pfizer".

You also appear to have no conception of the damage that the Trump administration caused to the CDC, here is some suggested reading:

https://arstechnica.com/science/2020/10/how-the-trump-admin-devastated-the-...

https://arstechnica.com/science/2021/01/first-task-for-bidens-cdc-director-...

If it turns out you meant the company Pfizer and not the US, I am at a total loss as to why you think I haven't given them due consideration.

I see you selectively responded to my message and ignored my comments calling out the following inconsistencies from you:

• The inconsistency between you giving absolute numbers in this thread and insisting I was biassed for not considering numbers normalised to population size on another thread - that I referenced.
• The inconsistency between you giving numbers for a low population country here during a short period of time, in order to make comparisons with larger ones, vs you stating on another thread that (that I referenced) it's not valid to compare countries with small and large populations in a short period of time.

There's nothing but inconsistency here.

Actually, I saw it was about a page long and didn't read most of it.

The fact that you spend 10x as much time as anybody else means you are more committed to communicating your point of view, it doesn't mean your point of view is unbiassed.

It's hard to see how you're ever going to reach an understanding of anything if your attention span is limited to tweets.  

It doesn't take me very long at all to knock out a brief message like the one you couldn't be bothered to read.

However, what does take a lot more time and what I consider essential to trying to overcome the innate biasses we all have as well as the bias inducing pratfalls in the data is the act of looking at something from many different angles, finding different ways of examine the data and the context, exploring different perspectives, and identifying how each approach affects or biasses the findings, looking for invariants amongst all this and communicating it.

If one just wants to yammer but doesn't want to put the time in to this, one becomes a slave to their own biasses.

I think the very scary thing is (excluding our political leaders) that 5 or 10 years back we would have been even more stuffed.  I cant imagine vaccine development being anything as rapid.  Getting the virus genome first sequenced, and sequencing of variants would take weeks/months.  Add to the mix, if not the tories, we could have been blessed with JC instead.  
 

As bad as things got, could still get, I still think we’ve been very lucky in some regards.

Incredibly lucky.   On top of the changes to sequencing you note, if this had landed 20 years ago, we wouldn't have had the at-scale technologies needed for the PCR testing, none of the vaccine platforms that have been adapted for Covid would have existed leaving us with just rather ineffective, barely adjuvanted inactivated virus vaccines, the technology and infrastructure wasn't there for most people to work from home or to switch to online shopping. 

The whole thing serves as a much wider warning about how poorly set up governance and society are for unpredictable threats; this time it was a pandemic (and one we had been anticipating and sporadically preparing for for a decade), next time we might not be so lucky.

The lack of self-awareness you exhibit is extraordinary.  On an entirely separate issue, how long do you spend communucating your point of view on the delights of Scotland and the Scottish versus the awfulness of England and the English?  Would you say your point of view might be biased in this respect, rather than based entirely on fact?  Just wondering....

If you knock out all your guff so quickly then exactly how much insight does it really carry?

Both you and your nemesis seem to spend an inordinate amount of time wittering on here.  Not sure how you manage to fit it in with your day jobs.  Perhaps you should get together with TiE and write a time management self-help book. 

There was another pathetic man on Sky News yesterday getting his words mixed up. 

Matthew Taylor from the NHS Confederation said it was "unfortunate" that Prime Minister Boris Johnson was seen without a mask during his visit to a hospital.

What he meant to say was Prime Minister Boris Johnson was an absolute f****** t*** to be seen without a mask during his visit to a hospital.

E

Or the IT infrastructure for remote working and home schooling. Just think of trying to teach a whole class remotely with a dial up internet connection and no smartphones/tablets.

Your reply appears to bear bog all relation to my question!

You didn't ask any specific question; you merely mused that 'maybe...'

If you don’t understand how a comment about a health care system being overloaded to the point of catastrophic collapse relates to agency around “a good life and a good death”, you are probably beyond help.

Pointing out Tom's transparent inconsistencies is a lot easier to knock out quickly than most of the guff I post, so be careful not to over-generalise from what I actually said.

Step 1 - 04:56 is for sleeping, not for posting random snipes to strangers on UKC?  (That being the time of your post).