Thursday, April 23, 2020

The Scottish Government must overcome or override Chris Whitty's obstructionism. We must at long last accept the WHO's guidance, and proceed with a contact tracing operation to suppress the epidemic.



If the above assessment from Professor Anthony Costello is to be believed, the Health Secretary Matt Hancock is serious about belatedly bringing the UK into line with the WHO's recommendations and with international best practice by using mass testing and contact tracing to suppress the virus, but the Chief Medical Officer and the Deputy Chief Medical Officer are perversely undermining him and instead want to persevere with the British exceptionalism that has already cost tens of thousands of lives. The broader advisory body SAGE are split on the subject - which is not a major surprise, because Professor Neil Ferguson has been regularly making sensible on-the-record comments about using contact tracing to keep the number of new cases persistently low after the lockdown is eased, while on the other extreme Graham Medley made horrific remarks to The Times a couple of weeks ago about allowing the virus to spread widely and effectively sacrificing the old to benefit the young.

So what are the likes of Medley and Chris Whitty (the Chief Medical Officer) playing at? As I've said before, in Whitty's case I'm convinced this is largely psychological. He and Patrick Vallance were the authors of the discredited 'herd immunity' strategy, and they based it on a number of highly dubious judgement calls - most of which have proved to be hopelessly wrong as the weeks have passed...

* Whitty insisted that the extraordinary success of China and South Korea in suppressing the virus by means of testing and contact tracing was an illusion, and that those countries would soon be overwhelmed by a massive second wave. There was no need to wait and see if he was right about that - he was right, and that's all there was to it, and contact tracing in the UK could therefore be abandoned.

In fact, the Chinese and South Korean success has continued in the six weeks since the UK abandoned contact tracing. South Korea recorded just eleven new cases on Tuesday - the third-lowest figure since mid-February. It's impossible to say for certain that Whitty won't still be proved right at some point in the future, but the chances of that happening have receded with every passing day.

* Whitty claimed it was futile to attempt to stop the virus from sweeping across the UK, because you only needed to "look at the map" to see that it was absolutely everywhere else in the world.

This was plainly sophistry even at the moment he said it, because the virus is not capable of crossing the English Channel on its own propulsion. If an island nation keeps its own numbers low, and prevents the importation of cases by means of border controls and appropriate quarantining arrangements, it is self-evidently possible to avoid a mass epidemic no matter what is happening elsewhere in the world. But just in case there was any doubt about that point, the success of New Zealand's elimination strategy in recent weeks has helpfully driven it home.

* Whitty repeatedly characterised the infection as "mild". He speculated implausibly that the outbreak in Wuhan had not been brought under control by the lockdown, or by testing and contact tracing, but instead by a vast, hidden epidemic of asymptomatic cases that generated herd immunity. He therefore concluded that the mortality rate was likely to be much lower than estimated by China or the WHO, and that we shouldn't regard the prospect of a mass epidemic in the UK as any more alarming than a bad flu season.

In reality, early serological studies in Europe have suggested that infection rates so far are low. If that's right, the high absolute number of deaths so far would point to a relatively high mortality rate, and a potentially biblical death toll if the virus is allowed to spread widely in the UK.

Given that the whole basis for his advice to the government between January and March now lies in tatters, it's arguable that Whitty feels that whatever is left of his professional reputation will hinge upon his apparent rearguard attempts to prevent a successful testing-and-tracing operation in the UK. Why? Because if the UK manages to suppress the virus in exactly the same way that China and South Korea have done, he knows it will prove beyond a shadow of doubt that the decision - on his advice - to abandon contact tracing in mid-March (along with the unforgivable delays in implementing social distancing measures) led directly to many thousands of needless deaths. He'll inevitably and deservedly be left carrying the can in the subsequent inquiries.

The grotesque irony is, of course, that if he succeeds in frustrating a successful contact tracing operation, he'll simply be causing even more thousands of needless and avoidable deaths. So to cover himself, he's trying to reframe the debate as one that is largely about the extent of the social distancing that should remain in place. He's tacitly arguing for a relaxation by arguing there is a "trade-off" between the harm caused by the virus and the harm caused by lockdown. The big question is whether he'd be willing to relax the measures even at the expense of the reproduction rate of the virus going back above 1 - because if he is, that would be tantamount to a reversion to the herd immunity strategy, with the likelihood of hundreds of thousands of deaths needlessly occurring over the course of a stop-go epidemic.

In truth, what he talks about as a trade-off is actually a lose/lose, because if the virus is allowed to spread widely, all of the harms caused by lockdown will be magnified rather than reduced. A second much longer and harsher lockdown will be inevitable once we lose control of the situation yet again, with all of the implications for mental health and domestic violence. And even before the second lockdown is announced, people with other health conditions will be unable to access the help they need because the NHS will be completely overwhelmed by a resurgent epidemic.

Luckily, there's a way of breaking out of that vicious circle, even if Whitty himself can't bear to entertain it. The countries that are currently moving quickest away from the harms of lockdown, while at the same time minimising the number of deaths caused by the virus itself, are the ones that were most successful in getting on top of the epidemic with strategies that prioritised contact tracing - for example Germany and New Zealand. That's undoubtedly the path that the UK must follow. It's backed by hard evidence and it's backed by the WHO. Whitty and his fellow travellers must quite simply be faced down.

The Scottish Government potentially have a decisive role to play in this, because by all accounts Boris Johnson has placed a premium throughout the crisis on maintaining a common UK front on strategy. Nicola Sturgeon originally signed off on the herd immunity strategy authored by Whitty, perhaps not realising how totally at odds it was with the gold standard international science of the WHO. We've since seen the cost in human lives, and that mistake must not be repeated. Ms Sturgeon must insist that the UK lockdown is not lifted until a credible 'test, trace and isolate' operation is in place. If the UK government 'call her bluff', she must demonstrate that she wasn't bluffing and make clear that the Scottish lockdown will remain in force even if England's own lockdown is lifted prematurely. The extra time that buys must then be used to set up a distinctively Scottish contact tracing operation.

Will she do that? There are mixed signals. Her own language has been very encouraging in recent days - she's talked of the need to "continue suppressing" the virus after lockdown is lifted, and of "keeping the virus at the lowest level possible", and specifically about "test, trace and isolate" as a key component of the post-lockdown strategy. All of that is irreconcilable with Whitty's covert herd immunity approach. But on the other hand, the Scottish Government today published a Jason Leitch video on social media which uses exactly the same "reduce the peak" graphic that Leitch was touting in the TV studios when he was openly an evangelist for herd immunity. The implication is that the purpose of lockdown is simply to spread out a huge number of infections over a longer period of time, rather than to radically reduce their number. That's herd immunity in a nutshell. The hope must be that Leitch inserted the graphic on his own private initiative and that his political masters didn't grasp the abhorrent implications of what they were signing off on.




















19 comments:

  1. Looks like political crunch time on this crisis may be approaching for the uk. It looks complicated on the surface but in the end it boils down to the old, old choice - people or profit ?

    If a few leading tories are willing to break their programming and come on to the people first side then, for the time being, that should be welcomed. Weed out the determined arse coverers first and help to get us on track to beat this scourge humanely. Lives first, second and third on the priority list.

    Well done again James.

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  2. I see Leopold puts the union before lives.

    https://twitter.com/LabourRichard/status/1252876257080995847

    It's utterly mad to suggest Scotland should end lockdown simply because England did. That could kill thousands.

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  3. I know testing centres are being set up. Last I heard Inverness was in trials for NHS personel by appointment. I have just seen a tweet that a Glasgoe centre is up and running.

    Don't know where the rest are.

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    1. Tents have been erected in the car park at Borders General Hospital. I believe these are to be testing stations.

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  4. The increasing number of unionists attacking the idea of cross border differences in strategy does suggest a significant further departure by Scotland is imminent.

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    1. And given that health is a devolved matter, then when common sense dictates, we must seize the benefit of ‘difference’ in healthcare, and just take the accruing political benefits.

      I’ve been puzzled as to why scot gov have not done a simple thing - create gateways at airports and impose quarantine.
      Transport Scotland could assist by decreeing that only certain vehicles for certain purposes are allowed to enter Scotland’s road network. Policing would be a bonkers thing but the message would be clear.

      I’m already having conversations with people in England who are talking about summer holidays in the Highlsnds’ on the basis that ‘as long as I drive I should be ok’
      Retorting back about vulnerable communities and exceptionalist travel decisions doesn’t really seem to dent the aspirations, as they have no real care for other communities (as in ‘careless’ rather than ‘callous’)

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    2. When the Scottish government's Chief Medical Officer thinks that it is OK to drive around the country with her family, it's undoubtedly OK to drive around the country with your family. She was one of the best informed people in the country, and she thought it was fine. So, it is.

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    3. She was shown the door for that (admittedly after the customary faffing). So it's probably not.

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    4. She didn't leave the country either.

      Taking your infection to another country to burden their health system particularly serious.

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    5. But free speech doesn't apply to personal spaces such as homes, blogs etc. Only to public spaces.

      If you don't let assholes shout crap at you in your own home / blog, that isn't stopping free speech. It's your home / blog. You a get to decide who visits.

      Stopping free speech would be James blocking comments on other people's blogs, or trying to shut these down.

      You are free to disagree with everything james says on your own blog, and James isn't trying to stop you, so he's respecting free speech.

      I'd have though this obvious to anyone with a couple of brain cells. It's primary school stuff.

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  5. Perhaps we should be questioning why uk government are encouraging known coronaviras patients to placed in care homes that were in lock down.
    Why would you want to spread the disease to the vunerable that had been protecting them selves.
    There have been five coronaviras patients placed in the care home near us where we have relatives, and yet relatives have been told not to visit their own relatives,
    Why would Prince Charles visit Scotland when he had coronaviras and Prince William give out The Edinburgh awards.
    There are coronaviras issues not being spoken about in the media

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  6. If the UK government decides to relax lockdown significantly and couples that with a consumerate decrease in access to furlough funding, then scottish businesses will not be able to maintain lockdown, no matter Scot Gov's feelings on the matter.

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    1. It's not a question of 'feelings'. The Scottish Government has the legal power to maintain the lockdown.

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    2. But how would it fund furlough? That's a UK government scheme.

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    3. The protection of lives comes first.

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  7. Not wrong about test and trace it seems. See S. Korea vs UK. UK is still on course to overtake Spain for death rate, making it the worst in Europe. https://www.newstatesman.com/2020/03/live-data-coronavirus-crisis-all-you-need-know

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  8. Madame Skier may elucidate the finer points of this:

    https://www.hug-ge.ch/medias/communique-presse/seroprevalence-covid-19-premiere-estimation

    5.5% Covid antibody prevalence in Geneva

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  9. I would recommend the video of the press conference, called by doctors Dan Erickson and Artin Massihi, who run a clinic in Bakersfield, California, to release the results of their Covid19 testing program. Youtube took it down after it went viral, but you can still see it on the OffGuardian site. The main message is : “the greater the prevalence, the lower the death rate.” Widespread testing has shown that covid19 affects the same proportion of people as seasonal flu. It has a case fatality rate similar to seasonal flu. 92 per cent of people infected recover without any consequences. (Remember that the British government, guided as always by solid logic, decided on March 16th, shortly before Britain was shut down, that covid19 was not after all a “high consequence infectious disease” or HCID.) People should be out and about boosting their immune systems rather than hiding away like fragile newborn babies. The doctors have been accused of being “attention seakers.” That is not how they seem to me. These are doctors who deal with patients, not scientists working with mathematical models. I urge everyone to watch the video.

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