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.

1. Learning the Lessons of the Spring and Acting on Them in the Autumn

In July 2020, The Prime Minister, Mr Boris Johnson declared that it was not the time for an enquiry into the government's response to the Covid-19 crisis.

“I do not believe now, in the middle of combating the pandemic, is the right moment to devote huge amounts of official time to an inquiry"

[https://www.bmj.com/content/370/bmj.m2869]

The logic is quite appealing isn't it? We are still in a crisis therefore it would be waste of resources to look at things in too much detail now. 

However, the truth is very different; the mistakes of the spring were repeated in the Autumn with devasting consequences.

The data from the Spring in the UK is very clear; if we had Locked-down earlier, many fewer people would have died. The problem is that the government has refused to acknowledge that mistakes were made and thus were not in a position to make better decisions when the moment came.

If we allow that things were difficult in the spring and that mistakes were honest and difficult to avoid then the Autumn cannot be taken in the same context. Twenty-twenty hindsight is often misleading. It is not always possible in the centre of a crisis to see with clarity that which is obvious with hindsight. It is not always possible to know the effects of certain decisions. Therefore hindsight criticisms may not be fair.

However, if we allow that the Spring was a new situation, the Autumn is very different. By early-/mid- October it was clear that things were escalating and the experience of the Spring demonstated unequivocally the cost (measured in number of deaths) of acting too late.

This chart takes the first-wave from the spring as a given but by October 2020, the number of deaths was rising. The slope there is a lot less steep than in the Spring but still rising rapidly. The argument here is simply that action should have been taken sooner. Quite possibly the various 'tiers' and other measures slowed the progression but not sufficiently. This graph postulates what would have happened with lockdown on 22nd October.

The double-peak that we saw in reality is not seen here because it suggests that by the beginning of December numbers were down enough to relax lockdown as was the case in May. (For the record, I still think that was too early but it is not unreasonable to expect the rate of decay in cases to follow the same trend in December as it did in June).

The dotting lines are a good test of the modelling I've done here. Put simply, this is what I expect the figures to be going forward. I will provide an update around the beginning of March to see how accurate my prediction for the next 4 weeks has been.

Anyway, if we take the number of deaths to date and then assume this trend continues as plotted that takes us to around 80,000 deaths in the 12 months 1/3/20 to 1/3/21. That is in-hospital Covid deaths in England. The earlier lockdown (assuming the double peak was avoided in Dec/January, which is should have been because rates would have been much lower) gives an estimate of 41,500 deaths. That's a 48% reduction overall.

It is so high because the second wave has been bigger and more deadly than the first (despite improvements in the case-mortalty rate).

In the whole of 2020 (and therefore not included Jan '21), there were around 80,000 excess deaths in England and Wales (and around 10,000 in Scotland and Northern Ireland). As I discussed before, the excess death figure is the more important one for understanding the total effect of the pandemic but it takes longer to compile and we don't yet know what it is for January 2021 or what it will be in the next few months. The official estimate of Covid Deaths now stands at over 108,000. [Worldometer as of 3/2/21]. If this simple modelling is correct then the effect of getting the response wrong is the Autumn amounts to either 48% of 90,000 or 48% of 108,000 (so far). Or to put it another way somewhere between 43,000 and 52,000 people have died who would not have done if our response to the second wave had been more effective. (These figures will increase as more data comes out). 

Given what happened in the first half of 2020, I do not think the response in September/October is remotely justifiable. There was within very recently memory a clear and obvious illustration of what would happen if we didn't act fast enough. And the effect of that mistake is 50,000 more deaths. 

 2. Getting is Right from the Beginning 

In the autumn there is no excuse. However, in March of 2020, there was also a missed opportunity. We had the clear example of Spain and Italy to see what was coming. Most damning of all was the 10 days that were lost from March 13th to March 23rd.

On March 12th 2020, Public Health England stopped contact tracing of known cases of Covid-19 because the vast number of cases overwhelmed capacity. This was the final warning sign. This was the key indicator that a lockdown in the UK was going to be needed. At this point the UK had community transmission. Now we were on the verge of losing control.

On 11th March the Director-General of the World Health Organisation issued a statement; this is an exert from it

We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic.

<snip>

Even those countries with community transmission or large clusters can turn the tide on this virus. 

Several countries have demonstrated that this virus can be suppressed and controlled.

There is no justification for the delay from 12th March to 23rd. Lockdown should have followed on 13th March; once it was clear that containment had failed it was time to act differently. So the following chart is modelling a Lockdown a week earlier in the Spring.

One of the unknowable consequences of this is what effect this would have on the occurrence of our second wave. It is certainly possible that if the control of the first wave had been effective enough then a second wave may have been avoided. Especially if the lockdown was held in place long enough to get infection levels down to a low enough level to allow track-and-trace to be effective. This, coupled with a working track-and-trace system could have stopped a second wave before it got started. However, the odds of that are difficult to evaluate so for the purpose of this chart, all I am postulating is a prompt lockdown in the spring 1 week earlier (i.e. 16th March) and a timely lockdown in the autumn (22nd October). 16th March is 4 days after it became clear that a change of strategy was needed. Four days is plenty of time to pass the necessarily legislation in Parliament, it is plenty of time to get the logistics sorted, it may have been challenging to lockdown on 13th March but it was definitely possible to do so by 16th. If there was the political will to do so. This is another key decision that the government got very wrong.

So what do 16th March and 22nd October lockdowns look like? Well, this:

Whilst not perfect, a government who's record looked like this would be fully justified in saying they had done a good job, saved lives and achieved a good outcome in the face of a major Public Health challenged.

As I said, the red line represents what actually has happened in England and the total to-date is 69,000. (projected to reach 80,000 by 1/3/21). By using this method we can estimate that a lockdown 1 week earlier in the spring and 2 weeks earlier in the autumn results in a total in-hospital death toll of 28,500 (in England) a drop of 59%.

The point of all this is that I do believe the government is culpable for the majority of deaths. Basic, good governance would have reduced our death rate by nearly 60%. Nothing heroic, just making the right calls when it was obvious they were needed.

The other thing that is clear here is that if you lockdown earlier, lockdowns end up being much shorter. This is important because lockdowns are not without consequences on our wellbeing and this should not be overlooked. Moreover there is no trade-off between health and the economy. Prioritise saving lives and you minimise the economic harm.

3. What World Beating Really Looks Like

 

Once again, the assumption here is that the second wave would still have happened. With an early lockdown in the spring, and thus lower infections levels, it might have been avoided. Although it is very difficult to put a probability on this.

English In-hospital deaths to date:  68720. Estimated by 1/3/21: 79987

Early lockdowns in both waves: 15919. Estimated 1/3/21: 16309

A reduction of 76.8%

But how about if we add-in an effective test-and-trace system. How about if we have appropriate bio-security at our borders, what then? Then we can consider the possibility of no second wave. If infection levels remained low enough then the total number of deaths falls again. If we postulate that then the total deaths would be 5695 (a 93% reduction!).

It is possibly unfair to judge the government against this standard; even in the best of all worlds, achieving this kind of control over the virus would also depend on the assumption that virus suppression was sufficient to prevent the second wave.

However, this is the government that has repeatedly boasted about being 'world-beating.' This is what world-beating really looks like: Less than 6000 deaths (as opposed to our at least 108,000!).

I want to stress that for the vast majority of the people of this country, we should be going about our business as usual.

[Prime Minister Johnson March 3rd 2020]

We have so far succeeded in the first and most important task we set ourselves as a nation to avoid the tragedy that engulfed other parts of the world. 

[Prime Minister Johnson April 30th 2020]

 

We have growing confidence that we will have a test, track and test operation that will be world-beating and yes it will be in place by June 1

[Prime Minister Johnson May 20th 2020]

 

If you look at what we are doing, actually I think it certainly does fit the description of  'World-beating'

[Prime Minister Johnson, August 6th 2020]

 

I have not even got into the issues around PPE provision, management of our borders and international travel in to and out of the UK, the stresses placed on NHS staff etc. etc.

Often international comparisons are criticised because many other factors effect the pandemic - especially demographics and population density. However, the point of all these charts is to simply compare the UK with the UK. I can never prove the counter-factual, of course that's not possible but the relationship between the introduction of extreme restrictions (a lockdown) and the reaching of the peak of deaths is clear and consistent both in these data and internationally. Therefore, I am simply arguing that the data implies quite simply that the government has failed us all repeatedly.

This is very tragic. Even single number I've thrown around here represents a mother, father, wife, husband, daughter, grandmother, friend, colleague and the pain and sorrow for all their loved ones. If we were truly world-beating, then we would be talking about 6000 tragedies. As it is, we are talking about well over 100,000.

What more is there to say?

AFZ