DO ADVISERS OR GOVERNMENT DECIDE THE STRATEGY?
For any government, dealing with Covid-19 (CV) is like Sisyphus pushing his rock up the mountain only for it to roll back down just as he nears the top.
It is not very long ago that the media and opponents of UK Government (UKGOV) were rightly questioning whether being guided by the science meant that the medical and scientific advisers were in charge and UKGOV had given up leading and making decisions in the round. They were insisting that leadership meant acting in the interests of the UK balancing all factors not just doing what health advisers wanted to stop Covid-19 (CV). It is always important to remember that the scientists know very little and their predictions are notoriously varied: almost any conclusion can be justified with the artificial model to back it up, when it comes to CV and the future. This is perhaps best exemplified by the scenario described by health advisers if draconian measures were not adopted a few weeks ago, stating that by now, mid- October, the UK could be looking at 50,000 cases a day and thousands of unnecessary deaths – of course the reality is nothing like that. These fear tactics damage the credibility of the advisers. But it is very difficult to get their views in perspective.
THE NEW CV TIER SYSTEM AND RESISTANCE
UKGOV just the other day announced a new approach of 3 tiers of restrictions dependent on infection in a region, supported generally by all the political parties and all the UK nations, if not necessarily by all local authorities. The approach is to resist national lockdowns and the catastrophic consequences they may bring as evidenced by the first one. Of course that consequence has yet to be played out – the long term effect on the sick who were not treated and those whose jobs have been lost and other effects remain to be felt. Just after that announcement, SAGE revealed that only 21 days before it had recommended to UKGOV a national lockdown for a few weeks, a circuit breaker, to suppress the virus. It is important to remember that SAGE advice relates only to the way to slow the virus, but is prefaced by a recognition that the decision-maker, UKGOV, may have to consider other factors such as the economic effects, job losses, health damage for other malaises and other consequences for the country, in making a decision. That is a much wider brief than slowing the virus. SAGE it appears does not predict what would happen as a result of a lockdown where UKGOV has to be insurer of last resort. It is also worrying that SAGE members, without imputing a malicious motive, seem to be conducting their own leakings or briefings to journalists, sowing confusion for UKGOV decisions and their basis.
UKGOV balanced the relevant factors and information before it, and judged not to nationally lock down, but to adopt other measures, and did the same a few weeks later with the adoption of the 3 Tier system. Certain SAGE members are reported to have concluded that, without lockdown, by December, there could be 3,000-104,000 avoidable CV deaths: note the use of “could”, because of course anything could happen. And then note the 100,000 margin for error! Is this sort of advice credible and how is it of any use to the public or UKGOV? However, it is fair enough for SAGE to give in good faith the advice it does, and it is inevitably going to take a line which is safest. And its members have always been very clear, and it is reported that their reports state, that the ultimate decision is not for them, as they do not have the job of weighing up the issues which is for politicians. But it is wrong and unbecoming for the members of SAGE then to criticise, expressly or impliedly, a decision which does not entirely accord with their advice. The scientists look frightened and concerned to ensure that they cannot be blamed. What if their remedy of simply slowing down the virus is in fact not the right one? After all, it depends on a vaccine arriving, which is not guaranteed by any means, and, even if it does, suggestions are it may be only 50% effective. What if the herd immunity approach is in fact the best way to go? Are the incumbent health advisers wise enough or do they have the humility or strength of character to move their minds and change advice? Hopefully, yes. Realistically? Or does UKGOV have the wisdom or strength to overrule them: possibly if recent decisions are a precedent.
SHOULD NOT THE MEDIA AND POLITICIANS STOP THE POLITICISATION AND CREATION OF DIVISIONS AROUND CV?
Sadly, the discussion around CV and the best strategy has become deeply politicised, or perhaps it always was. Keir Starmer, Labour leader, had purported through the pandemic to support UKGOV decisions, but always in doing so had described them as inadequate or too slow or late, such as the financial support packages and the medical response. Having supported the 3 Tier approach, he now has come down so categorically in favour of more national lockdown, the circuit breaker, of 2-3 weeks or more if needed, vaunting that he would do as the advisers told UKGOV to do, chastising UKGOV for “ignoring” the scientific advice of SAGE referred to above – as have commentators such as at the BBC. All misleading, as all UKGOV has done is not ignore advice but do what they have been encouraged to do, that is make the decision using that advice and all factors to seek to find a balance. No approach is without risk and the risk taking is the big judgemental effort.
It remains possible, if current strategy does not slow the virus, UKGOV will go for a lockdown as a last resort, and then the words “I told you so” and “U turn” will resound, to create more discord. This has of course been the easy strategy of opponents throughout. There remains a view that under no circumstances should a national lockdown be on the table given the appalling likely consequences which put CV deaths in the shade, and that it harms the many regions and their populace where CV infection is a minor problem. It always must be remembered that CV itself is really the enemy of the old and some others with morbid conditions, not the vast majority. Lockdowns and economic disaster punish the young generations and the least well off in society, not briefly, but perhaps for the rest of their lives. However, there is neither from UKGOV, nor elsewhere, a real analysis of all the consequences of lockdowns and state subsidy; or real analysis of the health and wealth costs of less restriction accompanied by special protection for the old and most vulnerable with problematic conditions.
Now too regional leaders, mayors and others, are rightly mobilised and vocal, fairly arguing that they, not central government , are the best judges of the right measures for their communities, and in many cases that the imposed restrictions are wrong and not shown to be effective. A reasonable position, and their voices must be properly considered. Some it seems at the same time advocate now a circuit breaker national lockdown, a bit inconsistent maybe? Or perhaps they are really saying that in that event UKGOV must subsidise as to almost 100% of loss all employers and employees and self- employed who are affected – whereas in local lockdowns UKGOV is not offering as generous a furlough as before.
Opinion polls suggest that a significant number of people would like tougher CV restrictions. But such polls are not conclusive. They depend on the question asked. A question which were to ask whether a lockdown is a good idea if it means long term reduction in NHS and other public services is very different to one which excludes that second part, and may get a different answer. If lockdowns may cause more early deaths than CV, would people want them?
Most concerning is the divisive forces gathering pace in the UK. Politicians are clearly flexing muscles further promoting a north v south divide. Also, the divide between the better and worse off. Allegations fly that UKGOV is treating Conservative voting constituencies more leniently than Labour ones. The language of Andy Burnham, Manchester Mayor, suggesting UKGOV is using Manchester as an experiment for CV remedies, without care or concern for the region, illustrates real political animosity: he clearly wants UKGOV to shoulder more cost of restrictions but the divisive language is very dangerous. His narrative suggests that he is concerned about the well-being of the Manchester public but UKGOV is not. The BBC commentators are adopting some similar tones. Is it possible too that the ongoing divide of Remainers against pro-Brexit voters continues, some remainers wanting to still punish UKGOV for Brexit , which was supported by the UK electorate, and they see opportunity with the CV division to renew the conflict? And then whatever the motive for disagreement, an even bigger problem is that the only lobbies being heard are those who want to suppress the virus, waiting for the vaccine bail out which may never come. Real strategic alternatives can gain no traction as they get dismissed out of hand by UK health advisers and it seems, as a result, UKGOV.
The GREAT BARRINGTON DECLARATION (GBD) has been thoroughly well suppressed by the ruling medics and the media. It may not be right but debate about its merits has been stifled. The GBD has been signed globally by tens of thousands of scientists, as well as hundreds of thousands of others, it has been reported.It calls on governments to consider focussing less on lockdown remedies. Leading scientists from the UK, including Oxford, and major U.S. Universities promoted it. It theorises that the lockdown remedies lead to devastating effects on general public health and otherwise. The GBD advocates letting people, that is largely the young and those who need to, get on with ordinary living including hospitality and entertainment. It advocates special protection for those most at risk – the very old and those with conditions making them very vulnerable to CV. Since financial resources, now getting scarce, would be less needed to subsidise industry and non- working employees, much more could be spent on looking after those who are CV vulnerable.
Of course, the GBD may not contain the precise magic formula for long term living with CV. But it must be worth a wide debate and real analysis, so that the public and experts can compare the pros and cons of alternative options. Sadly, as advised by SAGE the UKGOV response is to denigrate it as an alternative of letting CV rip. This alternative surely is worthy of analysis beyond unverifiable retorts like “ there would be thousands more deaths” without any real information published to compare options. Are there closed minds in SAGE and the health advisory system which some might refer to as “group think”? Having said that, those advisers moved from the position that face coverings were unjustified to now requiring them widely to reduce CV spread. So maybe they can move their minds, albeit with resulting accusations of U turns, as knowledge develops, or remedies fail. It is noteworthy that the WHO regards lockdowns as a very last resort due to the collateral damage they bring.
Nobody seems to argue that national lockdowns will defeat the virus, but at best it is thought they will defer some deaths and hospitalisations. Local lockdowns face the same problem. Nobody advocates lockdowns unless UKGOV finance them, that is in effect the younger generations pay. Such finance is finite and perhaps is close to a sensible limit. Once a lockdown has reduced the virus, restrictions relax, the virus revives, and lockdown returns, a cycle doomed to eventually drive people into rebellion perhaps. The average age of a person dying from CV is 82. So, the trade- off that always exists in society must be faced, as it is every day. Is there any doubt what the over-80s would say, if you asked them, whether they would prefer to live normally, behaving sensibly and with protection, and risk a bit, and allow the younger to prosper rather than degenerate and lose hope, instead of destroying those futures? The media and politicians surely need to really consider the alternative to more restrictions and lockdowns contemplated above rather than argue about minutiae of behavioural controls.
Perhaps yet again the real reason for all restrictions is , as before, to stop the NHS being overwhelmed. The NHS is in a much stronger position, by its own admission, than in last March. The rate of hospitalisation is much lower than in the first wave. Nightingale provisions can even be used perhaps! With know-how improving all the time, CV deaths can be reduced considerably. UKGOV may have to take a position which defies the popular option in the long- term interests of the UK. So few commentators show any sympathy to the dreadful dilemma confronting decision makers, which is doubly unedifying as those commentators mostly have no experience of doing anything in practice except express opinions about others, or having any decision making responsibility: most sit back and toss out their whimsy as if they have experience, for example, of supply chains or balancing billions of pounds in expense and job losses against deaths of the very old. Of course, nor do many of those elected to govern: but what they decide matters and they should be given at least a little respect for their efforts, and be presumed to act in good faith, even though the couch decriers may disagree with their decisions.