Tuesday, February 16, 2021

When should the current Lockdown finish? How about 3rd April

All the previous charts have simply taken the England in-hospital death rates and plotted them. I have then postulated what the charts might look like if the peaks were reached sooner. Nothing more, nothing less. The following chart depends on two assumptions:

1. The peak of new-infections is 13 days prior to the peak in deaths.

2. The IMR was 0.7% in the spring and 0.4% in the autumn. 

If you want to model all this out properly it would be simply a matter of plotting several charts with different input values and seeing what the charts look like. I have no doubt that part of the expert advice to the government is to run these kinds of numbers and therefore generating a range of potential dates to relax the Lockdown.


(Click on the image to see a bigger version).

There is without a doubt a temporal relationship between new infections and deaths. The exact nature of this relationship is not known for sure but 13 days is a reasonable estimate. It is based simply on the time from initiation of lockdown to peak of deaths (on average). Thus this figure will be reasonable accurate.

The IFR is the Infection Fatality Rate put simply that is the number of people who die as a proportion of the total number who get infected. In principle, it is possible to measure this number directly. In practice that is extremely difficult. In order to do so, you either need to be testing (accurately) the whole population and thus you know the total number of infections (the total number of deaths being a robust figure as well) - or you need a representative cohort that can be followed prospectively to see how many of those who are infected (not necessarily symptomatic) end up dying from Covid-19.

I took the IFR's that I used to generate this chart from here: https://www.cebm.net/covid-19/estimating-the-infection-fatality-ratio-in-england/

This is one of several estimates around. There are lots of caveats with this data. The one thing that is clear (although we'll have to wait for detailed publications on this point) is that,  of those who present with Covid-19, fewer people are dying. We seem to have made several incremental improvements in supportative care such that the mortality from Covid-19 is lower. This is really good news. 

However, in terms of tracking the pandemic, it makes things more complex. If the mortality rate is fixed then using the death rate to track the pandemic is easy. The number of new infections is simply derrived accurately by multiplying the number of deaths by the IFR. If the IFR estimate is wrong it doesn't matter for our purposes here as the key to understanding the pandemic (and how we respond, to this is the timing of the peak. It doesn't directly matter here whether the IFR is 2% or 1% or 0.5% or 0.1% the peak will still correspond to the peak in deaths - just ~ 2 weeks earlier. I.e. if the IFR is constant it changes the numbers but allows east comparison between spring and autumn. If it's not, then an adjustment is needed.

To point of a lockdown is to reduce new infections. (Unless you are able to test everyone or at least a representative cohort then the best way to track new infections is to track back from the death rate. In the Spring of 2020, the only accurate figure we had was the daily death rate). However we know that the IFR is different between the spring and the autumn we just don't know for sure how different.

All I have done here is to use these two figures to estimate infection rates based on the known death rates. The point here is that because the IFR is different the number of infections implied by a death rate of x in May 2020 would be less that the number implied the the same deathrate of x in January 2021.

What I am getting at is that if we assume the relaxation on 30th May 2020 makes sense, then we need to acheive the same level of infection in the community in Feb-April 2021 to relax the current lockdown. The number of daily deaths in Jan '21 appears to be about the same as April '20 but because the IFR is now lower (again this is good news!) it does reflect a much higher infection rate in the community and thus we have further to go to be in a position to relax lockdown.

This is just one chart. There are other ways to derive these estimates and the potential that the estimate of the IFR being wrong is important as that will change the graph and move the target level of ~8000 infections a day to a different point in time and thus change when is the right time to relax the Lockdown.

Two more things need to be said though. Firstly I think ~8000/day is still too high a level to be relaxing. We need to be at a point where the numbers are low enough that Track & Trace can work. So maybe, we need to wait a bit longer?

The other unknown here is the effect of vaccination. The vaccines were passed as safe and effective based on the trials that showed they reduced the risk of people getting ill. That's not the same as saying they stop people from passing the virus on (whilst remaining well themselves). Increasingly we are seeing early evidence that the vaccines are also effective at stopping the spread. As more people are vaccinated, it does become easier to relax restrictions.⁰

Lots of unknowns but based on what we have so far; beginning - middle of April would be my target. If I find more data on IFR estimates which enable me to refine this further and/or fixed estimate on time from infection to death I will modify the chart accordingly.

AFZ


Sunday, February 14, 2021

The Night is Dark but the Dawn is Coming...

 Here's an update as to where we are as of 14th February 2021. (See previous posts for details of the methodology).



The horizontal line represents the death rate (and thus by inference a proxy for infection prevalence) when the Lockdown was relaxed in May 2020. This is the earliest it would be safe to relax this Lockdown (I would argue for another week beyond this point). There is one caveat to this that the inferred infection rate may be different in March '21 compared with May '20 as the Case Fatality Rate is lower and thus the death rate corresponds to a higher infection level. Conversely large sections of the population will be vaccinated so it's not clear what the correct point is. However, as always in this pandemic, erring on the side of caution seems very wise.


AFZ


Thursday, February 04, 2021

Covid-19 and How Johnson's Government has failed totally and completely.


And thousands have died unnecessarily as a consequence.

 

This post builds on these two previous ones:

http://alienfromzog.blogspot.com/2021/01/covid-data-january-2021.html

http://alienfromzog.blogspot.com/2020/09/covid-19-and-why-timing-of-lockdown.html

In the previous posts I have laid out the caveats that exist around these charts. This is a simple method of estimating the effect of the timings of key decisions but 1) it is in line with much more complex modelling (reference in first post) and 2) it is intuitive and easy to understand: When you lockdown, around 2 weeks later you will see death rates start to fall. Because the growth rates are exponential a week's difference in timing makes a huge difference in the total number of deaths.

In this post I am going to lay out three scenarios. None of which support the government's managment of this crisis. They have failed. Many thousands more people died than needed to. That is the inescapable conclusion of all this. 

Firstly, I will lay out the effect in the Autumn of not learning the lessons of the Spring. This was the major thrust of my post in September - by refusing to acknowledge the mistakes of the past - the government doomed us to the consequences of making the same mistakes again. That is exactly what happened.

Secondly I want to show the effect of acting sooner in the spring - there was a point in mid-march when it was inescapable that prompt and drastic action was needed. It is probably unfair to blame the government for what went before then (in terms of the Lockdown decision-making, although not in terms of PPE planning or other decisions but I am not going to write about that here).

And thirdly I will look at a 'perfect' response. The point here is that the government has claimed - and continues to do so - that the UK government has done an amazing job responding to this 'unprecedented crisis.' In this section I will hold the government to their own standard - this is what was possible if things had been done right from the very beginning. 

For me, the second scenario is, I think, fair criticism. Any government can make honest mistakes and that is a good arugment for using my second model rather than the third as a true comparitor with the sad reality we are living. However, when the government claims to be 'World-beating' or 'proud' of their response, then the honest mistake arugment runs into trouble. The on-going issue is an absolute and total refusal by the government to admit mistakes were made. Without accepting that mistakes were made, it is impossible to learn from them. And the consequence of that is measured in thousands of lives.

Friday, January 29, 2021

Covid Data - January 2021

In September I wrote about the timings of lockdowns. That is this post here. In that post I discussed the various measures of mortality and what they mean. Put simply, the best measure of the overall effect of the pandemic is the excess mortality and the best way of tracking the pandemic in real time is with the daily in-hospital deaths published by NHS England here.

When I wrote in September, I was simply exploring the first wave from the Spring. The assumption that underlies all of this is that the lockdowns work. There is a lot of international data to support this assumption; and it is very reproducible. Basically the peak of deaths occurs around 2 weeks after lockdowns are instituted. Hence the arugment is very simple - if you change the time of the lockdown you change the time when the peak is reached. Because of exponetional growth of the virus, moving this peak has very large effects on the overall death toll.

Here is the figures plotted from 1st March 2020 to 1st March 2021:

This graph shows the daily in-hospital deaths in England for each individual day. The blue line is the daily deaths. The red line is a seven-day rolling average. The reasons for using that figure is that is smooths out the natural daily variation. The shaded areas show the three national lockdowns. The darker shading is the time from initiation of lockdown to the peak (the ligher shade being the rest of the lockdown).

It is important to note that by using death figures the peak is behind the peak of infections. (I discussed perviously why this is the best measure but it is important to realise this time delay is implicit in the data).

One thing that is very noteworthy here is the timing from lockdown to peak of deaths. The first lockdown was 23rd March; the peak of deaths was 8th April (16 days later). The second lockdown was on 5th November; the peak was 25th November (20 days). Third lockdown, 5th January; peak 19th January - 15 days.

There is a lot of work to do studying these; it is known (although the data is imcomplete) that survival rates have improved in the second wave as we have better treatment protocols from lessons learnt from the first wave. It is also true that the accelaration phase of the waves was slower in the second and third waves than in the first. In the first, the number of deaths per day increased from 159 on the day of lockdown to 900 at the peak in 16 days; that an increase in the death rate of 46/day. In the second lockdown the rise was 5.4/day and in the third 16/day. These differences may be simply a feature of the phase of the exponetial rise when the lockdowns were instituted or may reflect that prior to the 2nd and 3rd lockdowns, various restrictions were still in place. Or there may be a different explanation such as better medical care.

Anyway, the whole point of my previous post was that earlier lockdowns have big effects. One of the implications of this chart is simply that the relaxation of the lockdown from 5th November after only 4 weeks was far too early. But I also want to ask the question, what would have happened if the Autumn lock-down had been two weeks earlier? 

Here's what that looks like:

As I discussed before, the only assumtion I am making here is that the lockdown would cause cases to fall at the same time interval; i.e. if lockdown occurred two weeks earlier, the peak would be two weeks earlier. 

The pink shading is the actual 4 week lockdown that we had. The green shaded area is a lockdown started on 22nd October and running until the death rate was the same as when the spring lockdown was relaxed.

The dotted lines show the expected death rates going forward, if the pandemic follows the same sort of trajectory as it has done previously. I will post in the future, a comparison between these predicted figures as the real ones.

So if a lockdown had been instituted on 22nd October 2020 and it had been as effective as expected what effect would that have of the death rates?

Well: Currently the number of in-hospital deaths in England is around 69,000 (upto 24th January 2021). If the lockdown had been instituted on 22nd October and worked as this graph suggests then that total would be 41,000. That's 40% fewer deaths.

The official UK deathtoll from Covid-19 is currently 106,000. As I discussed before, the excess death figure is the best one to use but if we simply take that figure at reduce it by 40% then we are talking about OVER 42,0000 fewer deaths if we had acted sooner in the Autumn.

In my next post I will discuss a bit more the issues around politics and decision-making and how I think this mistake in the Autumn a gross error of government with the cost being massively high.

AFZ




Wednesday, September 16, 2020

Covid-19 and why timing of Lockdown makes a HUGE difference

It is fair to say that the coronavirus pandemic has had a dramatic and profound affect on all of us. No one is to blame for the disease happening but I do think there is significant responsibility with governments and policy-makers in terms of how they responded and continue to respond to this public health emergency. This post is about the effect of lockdowns and the timing of a lockdown. I will leave you to draw your own conclusions on the decisions made and the decision-makers.

There is some serious mathematics and epidemiology that underpins this. I will link to some of the publications at the end. However what I hope to do here is show the principle and how it intuitively makes sense that small time differences in actions have very large effects. This is because epidemics like this (with a very highly infectious disease) grow exponentially. This is very much a back-of-an-envelope type of calculation but the charts make the concept clear and the estimates that I end up with are completely in line with (although not as precise as) those generated by using formal complex modeling.

Here's a very silly example. If you place 1p on the first square of a chess board and then 2p on the next, 4p on the third and 8p on the fourth, then 16p, then 32p, then 64p and £1.28 on the last one of that row; your first row only adds up to £2.55. But if you keep going like that the total value you end up with at the 64th square is an astounding One hundred and eighty thousand, trillion pounds! Obviously, the biggest problem with this thought experiment is that you very quickly run out of physical space on each square of the board. Exponential growth is difficult to imagine but quite easy to model mathematically.

We see exponential growth in epidemics because generally speaking, each person who gets infected, infects in-turn, two or three or more other people. And thus the total number of people affected doubles and doubles and doubles again very quickly.

At the height of the pandemic, official estimates had UK case numbers doubling every 2 days.

So, let us have a look at the UK death figures.

There's a few things to consider here. Firstly the most reliable estimate of deaths from Covid-19 are the excess death figures. However, the best day-to-day dataset is the in-hospital deaths in people who tested positive for Covid-19. In the next paragraph I will explain the differences between these data and the importance of each. However, the short version is that for this calculation and demonstration I will use the hospital-deaths in England figures. The fact that these are incomplete does not matter for this example as it's all about the proportions. What we do need though is day-to-day tallys in order to do the calculations and thus these data are best for this.These day-to-day totals track the pandemic. The death figures are approximately two weeks behind the infection rates (which were not measured accurately at this point).

With Covid-19 there are three categories of mortality to consider. Covid-19 kills (primarily) vulnerable people. By-definition, vulnerable people have a high mortality anyway. That's what vulnerable means. If you take the entire population of the UK that is over 80 years old, approximately 15% of them will die in the next twelve months (without a Covid pandemic). For those aged 20-29 the same figure would be less than 1%. If someone has heart-failure and contracts Covid-19 then they are quite likely to die from it. However, they are quite likely to die anyway. So, in one-sense the Covid-19 is purely the terminal event and it would be more precise perhaps to attribute the death to heart failure. On the individual level it is impossible to untangle these things but on a population level, it is possible to see these effects. If we go back to our over-80s population then only 85% would be expected to be alive in 12 months' time. If Covid hitting this population means that when we look a year later only 55% are still alive then we could easily argue that 15% would have died anyway, but 30% wouldn't. Thus we could infer that 2/3rds of the deaths (30% out of 45%) were due to Covid. This is important because in the real world some people die from Covid-19 without being tested. Conversely some people who test positive for Covid-19 actually died from something else. And sometimes it's really hard to tell. There is also another thing to consider and that is the knock-on-effects of the pandemic. People presented less to hospital because they were worried about the risk of contracting Covid-19 in hospital (an appropriate fear) and thus it is likely that deaths from heart attacks and strokes may have been higher than normal. Not to mention delays in cancer care etc. It is correct to attribute these deaths to the pandemic because it is the effect of the disease on society that causes these changes in behaviour. Similarly, it would not be surprising if the extreme stretch in hospital resources meant that care was not quite as good as normal. Again on the individual level it would be difficult to unravel this but a spike in other causes of death would reflect this. What I mean is, if you take 100 people who have a heart attack, normally you would expect 75 of them to survive. If you found that during Covid times only 70 out of 100 survived that is a measurable effect but on the individual level it would be very difficult to precisely determine which of the thirty deaths would have happened anyway (25) and which of them would have survived in normal times(5). So the three categories are:

  1. Those that would have died in a 3-6 month period but Covid-19 was the terminal event
  2. Those that had a normal life expectency but died directly from Covid-19
  3. Those who died from some other cause but would not have done so in non-pandemic times.

There is a fourth category that has the opposite effect on total mortality. That is that reduced activity (particularly the massive drop in traffic numbers) probably resulted in a reduced death rate from road-traffic accidents directly and asthma (and other respiratory diseases) indirectly due to improved air quality.

The bottom line here is that the only way to understand the total number of deaths due to the Covid-19 pandemic is to look at the excess mortality over the whole time period. In the UK excess mortality is simply calculated by looking at the average death rates over 5 years (for the week/month/whole year) and comparing that with the same time period in 2020. (Different countries calculate this by slightly different methods but the principle is the same).

The major strength of this approach is that it will encapsulate all of the categories I've described and will also capture the large numbers who died from Covid-19 without being tested. However, excess mortality can only be done retrospectively and is entirely useless for tracking the progress of the pandemic and thus determining the effect of the lockdown. However with the daily death totals we can estimate the effect of lockdowns as a proportion of total deaths and thus apply that to the excess mortality figures to estimate how many deaths might have been prevented by an earlier lockdown.

I just want to pause here and note that each excess death is a real person and real tragedy for them and their loved ones. The question is to what extent some of these deaths might have been avoided.

 

This is the NHS England official daily deaths, available from here (data used covers up to 14th September):



The grey box indicates the time from initiation of lockdown to the peak of death rates. This delay reflects the incubation period of the virus and the clinical progress from displaying symptoms to death. This time-frame will vary between patients but overall will average out the same. Thus we can estimate what the curve would look like if we move the time point at which lockdown is introduced.

For example, this is what the chart looks like if we hadn't locked down on 23rd March but waited a week:



The principle here is that the number of people infected (and thus the number of deaths which is a proportion of this) will keep on growing until something changes. That 'something' could be that there are no-more people left in the population who are susceptible to the virus or it could be that people's behaviour changes profoundly and thus infection rates drop off. The former would happen eventually but even at the peak of the infection, probably the number of people infected was measured in the hundreds of thousands out of a population of 60 million. Thus there was still plenty more people for the virus to infect. Thus, in this example, the infection rate carries on growing exponentially for a further week, and therefore the peak is later by a week and much higher. In this model, the total death toll is more than doubled. If there was no government intervention (and no effective treatment etc.) eventually the death rate will plateau as the number of susceptible people in the population falls (as those left have been exposed to the virus and not become ill) or because people's behaviour has dramatically changed anyway. This is what happened with bubonic plague - civil society broke down and thus people stopped mingling and eventually the plagues died out.

Conversely, intervening with shutdown earlier has profound positive effects:



If Lockdown had been introduced a week earlier then the peak would only have been ~650 deaths/day and ~250/day if it had been two weeks. What this adds up to is a 55% reduction or and 80% reduction in the total death-toll.

Our final chart highlights that earlier lockdowns also mean shorted lockdowns. If we assume the easing of some restrictions on 10th May was appropriate - i.e.the circulating levels of the virus was low enough to make this safe then we can estimate when the same level would have been achieved with the potential earlier lockdowns.

The grey box indicates the real Lockdown that happened (23rd March to 10th May). The green boxes represent the Lockdown times that would have been needed to achieve the same low level of new cases. Note how these time periods are significantly shorter.

I just want to reiterate here that these charts are produced by a very quick-and-dirty method but I hope they show intuitively why when you have a death rate growing exponentially, small differences in timing of actions have very large effects. This is particularly obvious in the last chart. Having said that, the figures I have produced by this are in line with the estimates produced by sophisticated modeling by epidemiologists and mathematicians who are expert at this. Therefore I feel confident that these charts are a good approximation and demonstrate the concepts very well.

So the conclusion of this is that locking down a week earlier results in 55% less deaths and two weeks, 80%. These are estimates and if we calculated the confidence intervals they would be wide but let's take those estimates and apply them to the excess mortality data described earlier.

This is a recent publication in the British Medical Journal which examines excess death rates. Using a similar method the Financial Times puts the UK death-toll (based on excess mortality) at 65,700 (upto 11th September 2020). By combining these two sets of data we can postulate that introducing the lockdown a week earlier would have led to 36,000 fewer deaths and if we'd done it two weeks earlier, 52,000 fewer.

As I said, this is a crude methodology and those figures are not precise estimates. However it is still accurate to say that locking down, even 1 week earlier would have meant tens of thousands fewer deaths as well as a much smaller economic cost as the lockdown would also have been shorter.

Saturday, April 18, 2020

Wednesday, December 11, 2019

Getting Brexit Done or Getting Boris Done?

(Or both?)

Two and half years ago, I wrote this: Is this election May's Waterloo? Looking back, it's one of my better pieces of political analysis. The only part I got wrong was how long May's fall from power would take. I am a little annoyed about that - but I think, in retrospect, the 2 years it took for May to actually leave office was predictable once you appreciate various factors that I didn't think about back then. But that's for another time.

What do I think on the eve of this election? I have hopes and dreads and find objectivity very difficult. But it should be, because I am not - nor can I be - a disinterested observer. The stakes are too high.

So, If Johnson wins a majority the following will happen: the Withdrawal Bill will pass, the UK will leave the EU on January 31st 2020 and almost certainly we will end the transition period in December 2020 with no deal. Boris might deliver Brexit but he won't get it done and it will certainly do for him in the end.

On the other hand, if he loses then these will be important factors:
  • Johnson is a terrible campaigner (he always has been)
  • Johnson cannot withstand any scrutiny
  • Tactical voting
  • The effect of Election law on the reporting of Jeremy Corbyn
  • Youth turnout
I can see various narratives of this election emerging but the one(s) that will be told will be decided by the outcome - because far too many commentators retro-fit their explanations with hindsight. This is intellectually dishonest and often results in people drawing the wrong conclusions from the evidence.

Here's the thing: Whilst polling points to a Conservative win; the evidence on the ground - such as how Johnson is booed and protested against, and Corbyn can draw a huge crowd in Bristol - points to Conservative support falling significantly. If Tory voter turnout falls (and predicted wins harm turnout if there's another factor, like say December weather), there is a lot of scope for a different result than what many expect.

None of this is certain. I think anyone who makes any prediction with certainty is fooling themselves. If they happen to get it right, this most basic of lessons will be lost and they'll claim superhuman wisdom or that it was blatantly obvious to everyone. This is just an example of confirmational bias.

What is certain however is that we are a very divided nation. This division is what allows such a failed and failing government to have any chance of re-election. The other key lesson is that lies (more than ever before) win votes. The staggering level of dishonesty and out-right fraud carried out (almost entirely) by one political party is a great danger to our democracy. This is not news; it's just the Leave Campaign in different clothes. In the long-term though, this is deeply, deeply worrying.

So, I do think that the 2017's election was May's Waterloo. For Johnson, this election was a strategy designed to win by dividing his opposition and continuing the big lies about what Brexit actually is. It might well work. If it does fail though, it will be because, since 2016, Leave have over-reached. A sensible (ish) Brexit has always been achievable but the unreasonableness of the extreme right-wing of the Tory party has always demanded more and more with no concession possibly being good enough. It's a classic revolution where the early leaders are denounced as traitors to the cause by those that follow.

So May's Waterloo - choosing to offer battle because of an erroneous belief that the enemy cannot unite and thus being caught fully engaged when it's too late to retreat. Johnson's over-reach - shooting for the moon because he believed his own propaganda and thought he really could build a rocket in his back garden? In a day or so, we will find out.

If Johnson loses, we can begin rebuilding our country. If he wins, the rebuild will be delayed and the starting point will be a lot worse.

AFZ

Wednesday, October 23, 2019

Writing to My MP...

I have just written the following to my MP with respect to the Government's attempt to force the Withdrawal Act Bill (which is the necessary legislation to allow the UK to leave the European Union) through the commons in record time.

My MP is very much in favour of leaving the European Union - potentially on so-called No Deal terms.

Saturday, June 01, 2019

More thinking Right (and Left)

It is commonly held that as one gets older, one becomes more right wing. I don't know if it's just because I am contrary, but my experience has been the exact opposite. Whilst I have always been a lefty, I am become more so as I age. It is only just recently that my age begins with a '4' and coincidentally I now have become a father and thus, no doubt I should be becoming a deeper blue, but I am really not.

My most recent reflections have been driven by reading this excellent book: The Secret Barrister, Stories of the Law and How it's Broken. The author beautifully outlines our criminal justice system and all that it can and should be. He also tells the truth about how it is crumbling and falling apart. The truth is that no system is perfect but chronic underfunding will always risk systemic failure. The problem is that the system was chronically underfunded until 2010. Since 2010 it has faced literally massive cuts. The political expediency of this is obvious; it goes largely unseen by the public-at-large but the real world consequences are terrible.

I find myself intrigued and dismayed by the banality of evil. This is not a novel observation but I do think it a crucial one. My favourite best/worst example of this comes from Apartheid South Africa.

The mind-boggling level of bureucratic racism meant that even prisoners' diet was determined by their skin colour. The picture below comes from my visit to Robben Island 15 years ago. This is a blown up ration card showing the allocations to 'coloured' prisoners and black inmates. Somehow the system had decided that the racial differences meant that the nutritional needs of non-whites were by gradations less that the white man's and hence by the simple banality of this pseudo-science, Black prisoners faced malnourishment.

In a similar way, I think it entirely accurate to describe the cuts to the criminal justice system since 2010 as evil. I do not use that word lightly nor do I wish to accuse or decry individuals whose politics I profoundly disagree with. What I am driving at here is the disconnect from the thought of 'we need to save the taxpayer some money and not spend as much on legal aid or Crown Court proceedings. which in and of itself is quite inoffensive but the huge consequences to real people at the sharp-end of these decisions are terrible.

I just want to note here, the vital truth that austerity was always terrible economic policy and has completely failed in its own terms. The notion that these cuts were anything but a choice is actually as ridiculous as it is commonly believed.

In my own area of healthcare, I so often see the effects of constant scrimping and the myth of efficiencies that will somehow ensure that we can continue to do more and more with less and less. Just to deal with the strawman here - of course all systems have efficiency issues and I have no problem with honest drives to improve things. However what I have seen in my professional life is that ultimately it is the quality of care that suffers from inadequate resources; all healthcare professionals I know would tell you that they are not delivering the level of care that they want to or think they should because it is simply impossible with the resources we have. There is also a point where certain kinds of cuts and 'savings' end up costing more. The simplest example of this (that I have seen countless times) is due to the fact that hospitals have no spare capacity. Bed occupancy rates are too high in winter, and as a consequence there are no beds for elective surgical patients. So the cost saving is in not having the number of nursing staff needed to have more beds. But the cost is often that an operating theatre goes unused for half a day or more. That's usually two surgeons, an anaesthetist or two, a scrub team and an anaesthetic nurse who cannot do the work they're paid for. Between 6 and 10 people who are being paid to drink coffee and generally be annoyed that they can't just do their jobs.

There is no doubt that cuts to legal aid often have similar effects. There are plenty of tales of Crown Court workings grinding to a halt because of the huge issues caused by a defendant with no legal experience defending themselves because they cannot afford legal representation.

What the Secret Barrister tells is the real life consequences of how an under-resourced system fails victims of crime in a myriad of ways. It is also a system that fails the accused. The state has a duty of care to the guilty which it is nowhere near meeting. And the creaky system definitely risks failing the innocent defendant.

Which brings me back to my point about the banality of evil. This creaking system is a machine that chews up and spits out real people - often the most vulnerable of our society. The cost is measured in the damage to people's lives. The political decision to save what actually amounts to quite small amounts of money for a nation state has implications for real people at the sharp end that are literally life-changing and unjust.

This is why for me, politics is always, inescapably, a moral pursuit. I do not claim to have all the answers or even some of them, to be honest, but I am very suspicious of a political philosophy that is so careless of the consequences.

Why am I becoming more left-wing? Well, when you look at where right-of-centre thinking is at right now, it is failing of every front: Economically, austerity is not just wrong, it was - and is - the opposite of good policy; on health, our NHS has rarely faced more challenging times whilst a look at the US shows the dangers of abandoning this system; endless attacks on 'red-tape' led to Grenfell; Punitive strategies for immigration caused Windrush. I could go on and on but the truth is the same. All political questions are moral ones. The consequences of decisions are lived out in real people's lives and subsuming the interests of individuals to a political philosophy that leaves a trail of destruction makes me ever more convinced that the right-of-centre framework is inherently flawed. That's not to say that left-of-centre is blameless or flawless but as I outlined here, there is a reason why I hold to this worldview and how my main question with any policy position is 'what is the real-world effect?'

The Secret Barrister has simply outlined how in the area of Criminal Justice this kind of approach that knows the cost of everything but the value of nothing - that seeks to do everything on the cheap - leaves us with a Criminal Justice System that is certainly not just and only barely meets the definition of a 'system.' Thus what you're left with is simply criminal.

AFZ

Monday, January 14, 2019

Sound bites sound good but usually have a hidden bite.

How's that for a soundbite? It's not bad is it? But is it true?

I have spent a lot of time over the past couple of years thinking about how poor public debate so often is. Simplistic soundbites trump complex truths. This is especially true with respect to Brexit but it applies to all areas. It is so easy to 'win' an argument with a simple phrase but when you dig, just a little deeper you find out that that simple phrase is simply not true.

A good example of that is the argument around 'austerity.' It was very fashionable half a decade ago to compare the national economy to a household budget. Phrases like 'we have to pay our way' or 'maxing out the nation's credit card' or 'not running up debts for our children to pay off' carried the day. Each is deeply misleading. This is an interesting post, but if you want to understand why all of these austerity soundbites are untrue, Mark Blyth's Austerity, the History of a Dangerous Idea is a really good and accessible book.

Here's one of my favourite examples from over a decade ago: The M4 Bus Lane.

Sound ridiculous doesn't it? A Bus Lane on a motorway. Seriously? I have to admit that when I heard about it, I was very sceptical. I filed it in the mental bin marked 'not this thing.' What I mean is that I broadly supported the government of the day but there were some policies that I wouldn't defend.

Then I discovered that it worked. And that intrigued me. The point about the M4 Bus Lane is that is was never about buses. It was never about encouraging public transport. It was all about smoothing traffic flow.

There is a small elevated section at the end of the M4 that is 2 lanes. That is never going to change in the medium term. To make it three would be hugely expensive and involve demolishing a lot of nearby homes. The transition from 3 lanes to 2 with the well-understood behaviours of drivers is responsible for worsening the congestion at busy times. As it's not possible to make it 3 lanes, what can be done? Well, because of where the traffic is joining and leaving, it was thought that moving the 3 to 2 lane reduction back to Heathrow might ease the flows. The idea was that having the reduction at a point where there was less traffic would more than compensate for the loss of capacity. Basically there was a short stretch of tarmac that needed to be closed to make this work.

How do we know if it worked or not? Well, the Department for Transport did the studies before and after and indeed the average travel times for cars got better. (And got worse again when the lane was removed). It would have been achieved simply by closing that lane but as the lump of tarmac is there, why not use it for something? Like Buses. Even if it didn't work, it would still be a reasonable policy to try out.

But here's the problem: How long does it take to unpack why it's a sensible idea and to go looking for the data to see if it worked as intended? And how long does it take to utter the soundbite We're removing the M4 Bus Lane as we're ending the War on Motorists...?

Sound bites win arguments. Arguments that should fail.

Hey, that's a good sound bite too...

I don't really know what the answer is, especially in a age of mass and instant media but I do know that our democracy is under threat from people who deliberately obfuscate and mislead with cute phrases.


AFZ




Thursday, July 19, 2018

Anti-semitism and the Labour Party - some complex thoughts...



I should probably begin by stating that I am a member of the Labour party. My reasons for joining were a little convoluted. I do think that part of being a citizen is to be politically engaged. It depresses me and worries me that many people aren’t. So many things that affect all our lives go unnoticed or unchallenged for this reason. As the West Wing noted, decisions are made by those that show up.

I must confess though that I am one of those odd people who is inherently interested in politics. I really care about policies and outcomes but I am also interested in the process. So in one sense, it’s easy for me to be engaged. Despite this, I was not a member of a political party until quite recently. It was David Cameron who inspired me to join the Labour party. As I have mentioned, I do have an interest, and I tend to watch the party conferences’ leaders’ speeches. I was so incensed by Cameron that I joined the Labour party. I got involved. Only in a small way but I did. Having said that, I am not significantly involved in the party – I have never been to a meeting or canvased doorsteps. I do read the members’ emails, and I have voted in leadership elections, but that’s it.

Antisemitism has become headline news – specifically in the Labour party, the following is my analysis of where we are at. I really want people who disagree with me to try to convince me, I want discussion. I want to be persuaded of a different view, if my understanding is wrong.

It is impossible to talk constructively about antisemitism without first acknowledging the long and horrific history of Jewish oppression. The Holocaust looms very large over the 20th century, but that was not a new phenomena. It was new in extent but not in terms of how Jewish people have been maligned, mistreated, oppressed and ultimately murdered. We know that Shakespeare wrote about it, we know how in mediaeval times in much of Europe, Jews were despised. You can go back to the third century AD when Rome converted to Christianity and Christendom was born and Jews were cast as ‘Christ-killers’ (which is appallingly bad theology, by the way). You can go even further back to ancient Babylon when the Jews were a mistrusted and persecuted minority. So there is 2500 years of history here.

Given the two-and-a-half millennia of history it is not surprising that Jewish people have a kind of 'paranoia.' I don’t even think ‘paranoia’ is the right word. Most commonly we use that word when there is no actual threat, when it is a perception that everyone is out to get you – what is the word when they actually are? Even after the Second World War with the establishment of the State of Israel, the surrounding Arab nations vowed to destroy the state and drive all Jews into the sea. It is not true to characterise antisemitism as a thing of the past – it is very much a thing of the present. From the desecration of Jewish graves to personal violence to simple discrimination, it has not gone away. 

Given all of this and the true horrors in living memory, Jews have an absolutely justified sensitivity (if that’s the right word?) and antisemitism should never, ever be remotely tolerated. I think it is hard for non-Jews to understand, to inhabit this. But the horrors of the all-too-recent past are very real. However, I am not yet convinced that antisemitism therefore should command a special status above other forms of racism. More of that later.

The State of Israel has an ignoble history but it is a complex one. The above description of centuries of abuse and discrimination that in some senses culminated in the Nazi atrocities gives the psychological backdrop to Israel. Added to that is a genuine military existential threat and so I do not think anyone can be surprised that a siege mentality exists for the Israeli State. In fact, it is almost the defining characteristic of the country.

This is where it all gets a lot more complicated. In order to establish the State of Israel, the Palestinian people were displaced and they have for seven decades now lived in what is essentially a massive refugee camp. The Israeli state is able to cut off access, cut off power and generally ensure appalling conditions for those who live there.  And in this particular battle, the Israelis are the ones with all the power. In this article in the Guardian, it is argued that it is inherently antisemitic to compare Israel to Nazi Germany. I disagree. It is both potentially deeply insensitive and very offensive but the Israeli state very much have the whip-hand and some comparison with the way the Palestinian people are treated could be factual accurate. If that is true, not withstanding the circumstances I have just described, why would it be wrong to say so? Arguably, given the history of Israel, the charge of becoming like one's oppressors is an important one to lay if the facts support it.

It is true, that extremist groups target Israeli civilians and that is pure evil. It is also true that the Israeli forces when attacking legitimate targets are incredibly careless of the so-called collateral damage -  as well as being guilty of criminal over-reaction: responding to stone-throwing with live ammunition. Make no mistake, there is a lot of blood of everybody’s hands but the State of Israel, for all its totally legitimate security concerns, is guilty of horrendous crimes.

There is a part of UK left-wing politics that has a strong affinity for the Palestinian cause.  Ultimately, this in an oppressed – and often murdered – people. Where we run into trouble is the conflating of righteous criticism of the actions of the State of Israel and an attack on all Jewish people. And it happens both ways.

There are, undoubtedly, people who take criticism of Israeli actions and turn it into an attack on Jews. And that is antisemitism. There is no way around it. The historic tropes about Jewish people are so often heard when criticisng Israeli actions. It is also true that apologists for Israel will use the word ‘antisemitism’ as a shield to hide behind – as if any criticism of the actions of the Israeli state are automatically dismissible. Herein lies the problem – genuine antisemitism is real in UK left of centre politics (although very much a minority) and the accusation of antisemitism is used to avoid fair scrutiny and challenge to horrific actions. 

I do not think it possible to have a meaningful discussion of the issue without understanding and acknowledging that these two situations co-exist.

So, what of the UK Labour party; does it have an antisemitism problem? My answer to that is yes and no. And I will insist that it really is both yes and no.

There is clearly a sub-group of left-of-centre thinkers who cannot separate the wrong actions of Israel from Jewish people (or do not want to) and some who take it further and believe in odd world-wide Jewish conspiracies. This does exist, and some of these people are Labour members.

For what it’s worth, I have never seen this within the Labour party. But, as I have already said, my day-to-day participation is minimal, so I could just not be in a position to see it. What I do know, is that whenever an allegation has come forward, the party has investigated and suspended or expelled members found to have crossed this line.

Antisemitism is never acceptable. In the light of the 20th century it is particularly abhorrent, and should never, ever be tolerated. But here is the first however. I do not think it remotely accurate to say that the Labour party does tolerate it. I think the investigations and expulsions show that the party does not. Furthermore the evidence from actual research on the matter shows that antisemitic views are prevalent in society – but less so among Labour supporters. Moreover as the Parliamentary report in 2016 stated, It should be emphasised that the majority of antisemitic abuse and crime has historically been, and continues to be, committed by individuals associated with (or motivated by) far-rightwing parties and political activity. So, here’s where it gets really sticky. There are anti-Semites within Labour’s ranks, but the characterisation of the situation by the media is also deeply misleading. So I believe the following to be true:
  1.  Labour is striving to deal with the issue
  2.  The prevalence of antisemitism is not higher in the Labour party than elsewhere in society
  3.  Newspapers are being selective and misleading in their reportage.
I will concede that, given all that the Labour party stands for (or claims to), the presence of antisemitism within its ranks is deeply disappointing. It is also the case that there is a particular flavour of ‘leftie’ antisemitism which is different to the kind of prejudice and racism you see from right-wing parties. However, this leads me into point 3. I do not want to fall into the trap of whataboutery. I will not defend antisemitism by saying it’s everywhere or that other parties are guilty of racism. What I am driving at here is that the Labour problem is not as huge as some want you to believe and is being confronted by the party. To give the counter example; the Conservative Party has a much larger Islamaphobia problem that gets a fraction of the coverage. This is what I mean by the selective and misleading reportage. By the way, it’s not just me that thinks the Conservatives have an Islamophobia problem – former party chairman Baroness Wasi (with whom, I disagree on almost everything) says so. But more to the point, in the Mayoral election, Zac Goldsmith ran a deliberately racist campaign against Sadiq Khan. Not only did the party leadership take no action against Mr Goldsmith, they sanctioned this campaign and supported it. To be absolutely clear here: my argument is not that 'Labour may be antisimetic but that's ok because the Tories are Islamophobic.' That is as ridiculous as it is ethically wrong. My argument is that the media reporting bias makes the Labour antisemtic issue look bigger that it really is. And that is also morally unacceptable. As I hope I have made clear, I consider antisemitism deeply evil, but it is also wrong to use antisemitism for one's own ends.

Whilst, I disagree with those who think the antisemitism in Labour story is just a media-creation, I can understand where they are coming from. This incredible inconsistency feeds into that understanding very easily. Labour must continue to fight and root out all forms of racism wherever they are found within the party. And antisemitism does deserve special attention and at the same time, the projection that some want you to believe that Labour is inherently antisemitic is both unfair and misleading. It does become something of a nuanced argument after a while. Whilst the evil of antisemitism is very much black and white, the wider story really isn’t in this case.

Part of what I am reaching for here is the notion that something is not necessarily antisemitic because a Jewish person says so. Clearly, the voices of Jewish people should be the first we hear from but this argument is what allows people to defend the hideous actions of the Israeli state by claiming any criticism is antisemitic. There must be some objectivity possible here.

So, how do I sum all this up? Firstly I am not convinced that antisemitism is categorically different to other forms of racism. (If the argument is the Holocaust, then the Roma people of Europe have a strong case too). If you disagree, please convince me otherwise, I really want to hear what you think. Secondly, the conflation of legitimate criticisms of the actions of the State of Israel with animosity of all Jews is both a hallmark of antisemitism and a very convenient shield to the evil argument that Israel can do no wrong. Thirdly, the Labour party must strive to confront this. Fourthly the party has taken actions. Fifthly, there is no doubt is my mind that parts of the media are playing this story as a way to attack the party (and particularly the leader) with significant bias and deliberate myopia.

Ultimately, I do not think the Labour party is inherently anti-Semitic. You may say that I would say that as I’m a member. I profoundly disagree; if I thought the party was anti-Semitic, I would leave immediately. If you disagree, show me why I am wrong. I am listening.

AFZ