Saturday, April 25, 2020
Suppose the right-wing headbangers in the Tory party get their way, and Westminster eases the lockdown before it is safe to do so. Suppose Nicola Sturgeon, after consulting with her advisers, reaches the honest conclusion that the only way to avoid a totally unacceptable loss of life is for Scotland to maintain its own lockdown, and thus protect the public to a greater extent than is happening elsewhere in the UK. Would Jackson Carlaw really suggest that she should not do that? Remarkably, his answer is "yes". He's made abundantly clear that he thinks Scotland should just blindly follow whatever decision is made in London, in order to avoid "confusion" and to ensure that the UK is moving "together" - although of course we all know that only the latter reason really matters to him. It's no secret that the Scottish Tories always put British uniformity ahead of virtually every other consideration, but it's still quite startling to discover that they even put it ahead of the preservation of life.
The Scottish Labour position is even more incomprehensible. They are, after all, the self-styled "party of devolution", and must surely accept that there was little point in the Blair government devolving health to the Scottish Parliament if every single decision made in London was to be simply copied-and-pasted and implemented here. Labour are also supposed to be opponents of the Tory party and to have severe misgivings about the way the Tory government has handled this crisis. Every piece of logic therefore suggests they should want the Scottish Government to use the powers of devolution to do better than the London Tories. Instead, for some reason, they demand that Scotland must lower itself to the Tory level at all times. Well, I say "for some reason", but the reason is clear enough - dogmatic British nationalism.
And after last night's appalling revelations about Dominic Cummings' involvement in the SAGE scientific advisory group, let's not hear any more of the pretty fiction about a joint decision-making process in which the "Four Nations" all have parity of esteem. The fabled "science" that originally led to the catastrophic herd immunity policy was hopelessly tainted by political interference from the UK government's Prince of Darkness, and there was no equivalent input from Scotland, Wales or Northern Ireland. According to the Guardian report, the Scottish and Welsh Chief Medical Officers were not even permitted to ask questions in SAGE meetings, while the non-scientist Cummings had free rein.
Thursday, April 23, 2020
Scottish Government document decisively repudiates the catastrophic 'herd immunity' approach that the whole UK was following only six weeks ago
"Our objective is to contain and suppress the virus in order to minimise the harm it can do."
"As and when we lift restrictions, we will need to put in place public health measures to stop cases becoming clusters, clusters becoming outbreaks, and outbreaks becoming an uncontrolled peak..."
The use of the word 'suppress' is significant, because a suppression strategy is the opposite of the previous 'herd immunity' strategy that applied UK-wide until March, and that the Scottish Government's own Jason Leitch evangelised for during his infamous tour of the TV studios, and that would have deliberately allowed 60%+ of the population to be infected. But the use of the word 'contain' is arguably even more significant, because the UK explicitly abandoned containment efforts in mid-March on the grounds that containment of the virus was literally impossible, in spite of experience in China and South Korea suggesting that was not true. At least as far as Scotland is concerned, that stance has now been fully reversed and containment is regarded as both achievable and desirable.
"We are clear that an assumption that there is a proportion or section of the population that it is safe or acceptable to allow to be infected forms no part of the Scottish Government's policy or approach."
Again, those words are an unmistakeable repudiation of the discarded 'herd immunity' approach, which only sought to shield a relatively small percentage of the population from the virus. The vast majority of people under the age of 70 and without known underlying health issues would have been allowed to be infected, precisely because of an outrageous assumption that it was "safe and acceptable" for that to happen.
"To contain the virus we must keep the R number below 1, and this means minimising the risk of spreading the virus at every turn."
"Suppress the virus through compliance with physical distancing and hygiene measures, ensuring that the reproduction number remains below 1..."
"The World Health Organisation has stated that before any decision is made to lift restrictions, transmission of COVID-19 must be controlled. That means that we must see R stabilise below 1.0 and ensure that the impact of any decision to ease restrictions must maintain R below 1.0."
This is absolutely vital, because keeping the reproduction rate below 1 ensures that the epidemic is always in retreat. That effectively 'locks in' the suppression strategy and makes the pursuit of herd immunity through mass infection impossible.
"If we see evidence of outbreaks of the disease we will need to be ready to act decisively to suppress them and so prevent wider transmission. This will require both a very high degree of virus-aware public behaviour along with enhanced public health services. These services would come in five stages."
Those five stages are the 'test, trace, isolate' approach that the World Health Organization have been urging all along, but that the UK has been so resistant to. The Scottish Government have now - albeit belatedly - accepted the need for it completely.
The only caveat that has to be placed on this good news story is that the document reiterates that Scotland is committed to the '4 Nations' collective decision-making process, and suggests there will only be a departure from this at the margins, for example on "optimal timings". Given that it appears the UK government advisers are still split on whether or not to attempt the type of full-on suppression strategy that the Scottish Government are now committed to, what happens if Westminster shoots off in completely the wrong direction and lifts the lockdown without 'test, trace, isolate' in place? How can Scotland follow a completely different strategy with only small discretionary differences in the measures that are enforced?
That would be a difficult circle to square. But the hope must be that the Scottish Government have laid down a strong marker today that will ensure any collective UK approach that sidelines contact tracing and that doesn't attempt to fully suppress the virus is a non-starter.
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.
We're in limbo. The SAGE is split and the CMO's office is not behind the Minister. It's a recipe for confusion and many further deaths. Are we trying to crush the virus or let it spread? We need to know. The SAGE members must speak out now. @richardhorton1 @devisridhar (22)— Anthony Costello (@globalhlthtwit) April 22, 2020
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.
If it's true that @MattHancock is serious about contact tracing and Chris Whitty is trying to put him off the idea, then for the love of God, Matt, face Whitty down. Whitty and Vallance led this country to catastrophe once, don't let them do it a second time.— James Kelly (@JamesKelly) April 22, 2020
If ever there was a case to show that making bespoke choices best servs the common good it’s right now. It’s time the Scottish Government firmly abandons the UK 4 nations approach, otherwise we are doomed to be handcuffed to the worst handling of Covid-19 in the world.— 🏴CHRISTOPHER McEleny (@SNPChris) April 22, 2020
It would be interesting to know the real reason for the attachment to the '4 Nations' approach. On the face of it, it suggests an 'internationalism ends at Dover' mindset, which is associated more with Labour. Perhaps the civil service pushed it?https://t.co/K80sbr1kWN— James Kelly (@JamesKelly) April 22, 2020
In the UK we have taken the triple hit of terrible death toll, high economic costs, and awful social consequences bc govt allowed virus to spread at the start, then had to reverse and take harsh lockdown. A true lose-lose for everyone. And economy = lives also.— Devi Sridhar (@devisridhar) April 22, 2020
If we mobilise our national public health + primary care teams NOW for test, trace, isolate, with support from volunteers and communities, we can suppress this virus like S Korea. (17)— Anthony Costello (@globalhlthtwit) April 22, 2020
So look again at the Table. The advantage of speed of action is clear. Korea’s test and trace policy brought their epidemic under control within 3 weeks, with just 238 deaths. Greece imposed a national lockdown before their first death and have had only 121 deaths.(19) pic.twitter.com/BauZpmTkMr— Anthony Costello (@globalhlthtwit) April 22, 2020
"If you're hiding up a tree from a lion, you don't come back down because you've got uncomfortable, you wait to be sure that the lion is completely gone."— Helena Humphrey (@helenachumphrey) April 22, 2020
MP @Dr_PhilippaW speaking to me earlier today on why easing of lockdown must be carefully done.
I don't believe this. If 'every life is precious', why does this video end with basically the same 'reducing the peak' graphic that Leitch was touting during the herd immunity episode? Is this his doing or is it still Scottish Government policy? https://t.co/sIAHJF2OKw— James Kelly (@JamesKelly) April 22, 2020
I'm trying not to cry at night with worry that she's going to cave in to Westminster and not re-institute our test and trace operation before relaxing the lockdown. Lives are at stake. This is more important than not having a confrontation with WM.— Morag (@DrMoragKerr) April 22, 2020
Dear COBRA - We are seriously worried that the advice you are receiving is not considering evidence from non-UK scientists who have very clear messages on how to exit lockdown safely. Please would you meet with us as a matter of urgency. @globalhlthtwit @devisridhar— richard horton (@richardhorton1) April 22, 2020
Tuesday, April 21, 2020
* * *
Buck-passing, obviously, but there's no doubt that Whitty amd Vallance must accept a large share of the blame for this catastrophe. Their advice was based on the bogus assumption this was a mild infection, even when there was clear evidence it wasn't.https://t.co/fV7Hz5zSFw— James Kelly (@JamesKelly) April 19, 2020
Oh, so now there's "no single science". But in February, the words "the science" were spoken in a hushed, reverential tone and were synonymous with "Whitty and Vallance's opinion". It was the one true path. No-one could question it, not even *the WHO*.https://t.co/fV7Hz5zSFw— James Kelly (@JamesKelly) April 19, 2020
I cannot believe what I am hearing at the press conference. Deputy CMO Jenny Harries still believes that testing policy in the UK has been correct. And she doesn't understand links between tests and #COVID death rates. Is this #CMO policy? If so, they should resign.— Anthony Costello (@globalhlthtwit) April 19, 2020
The key lesson to learn is that after our lockdown suppresses virus transmission (8-10 weeks?) we must find, test, trace and isolate all cases and contacts in every street, village and town across the UK. A new normal of snuffing out outbreaks will allow us to wait for a vaccine.— Anthony Costello (@globalhlthtwit) April 19, 2020
Pity I missed this, because the question I would have asked Leitch is: "Knowing what you know now, would you still have gone to a concert on the 14th/15th March, and if so, what would you say to the loved ones of those who might have died as a result?"https://t.co/yPa0g0F7fs— James Kelly (@JamesKelly) April 19, 2020
It strikes me that if Whitty, Vallance, Harries etc were Cabinet ministers, the media would have scented blood, forced them to resign, and we'd have started afresh. Instead we have the absurd spectacle of Harries pretending the original plan was fine and we're still following it.— James Kelly (@JamesKelly) April 19, 2020
Thank heavens Jenny Harries is here to explain what the WHO's comments really mean, because otherwise there'd be major misunderstandings. Some naive souls would assume "all countries must test, test, test" means "all countries must test, test, test".https://t.co/0ZBjidkKE1— James Kelly (@JamesKelly) April 19, 2020
When you see supposedly independent medical advisors to government tell what are manifest untruths to shore up a political regime whose credibility is rapidly collapsing, you have to say that those advisors have lost their integrity and our trust.— richard horton (@richardhorton1) April 19, 2020
"We're following the science" is the new "Jesus told me to do it".https://t.co/6QmSQgSlO7— James Kelly (@JamesKelly) April 20, 2020
NZ has less than 20 deaths. Strong leadership with: aggressive containment of virus (test, trace, isolate), early border closure, early lockdown & widespread trust that @jacindaardern's government is looking out for best interests of NZ people. https://t.co/ZlJ8HcWYUx— Devi Sridhar (@devisridhar) April 20, 2020
I'm really glad @joannaccherry has raised the issue of airport checks, because the UK has got to break out of this silly trance of "airport checks make no difference". That's what we were previously told about mass gatherings, and testing, and contact tracing, and face-masks.— James Kelly (@JamesKelly) April 20, 2020
The Department of Health were caught out running fake accounts astroturfing for 'herd immunity' and later for 'opening up the country'. Anyone who points this fact out is being greeted with the creepy reply below, worthy of a communist dictatorship.https://t.co/yH7BDBPAqK— James Kelly (@JamesKelly) April 20, 2020
BBC on the government's fake NHS accounts: "Until there is any evidence to suggest these allegations are true...it is unhelpful to re-share them."— James Kelly (@JamesKelly) April 21, 2020
Hmmm. My own view is that it is 'unhelpful' of an alleged news outlet to issue paternalistic instructions on behalf of the state.
That’s a joke! The amount of times the media quote “sources”, or that general “claims” have been made, without actually providing any evidence.— Fuzzballjunior (@fuzzballjunior) April 21, 2020
"So-called lockdowns can help to take the heat out of a country’s epidemic, but they cannot end it alone.— World Health Organization (WHO) (@WHO) April 20, 2020
Countries must now ensure they can detect, test, isolate and care for every case, and trace every contact"-@DrTedros #COVID19
It's high time we started following WHO guidance to isolate for *14 days* after symptoms *end*. Words like "probable" and "unlikely" inspire little confidence, given that the laxer UK guidelines were set during the disgraceful 'herd immunity' episode.https://t.co/b8I2B5oCWm— James Kelly (@JamesKelly) April 21, 2020
Monday, April 20, 2020
The "British family coming together" has directly led to Scotland being part of (probably) the worst death toll in Europe - and that in itself makes a powerful new case for independence
1) Part of the process of "the British family coming together" involved the three devolved administrations - ironically including nationalist parties in both Scotland and Northern Ireland - remaining in lockstep with London during the catastrophic 'herd immunity' episode. That meant, for example, that we totally disregarded WHO guidance by abandoning contact tracing at exactly the same time as England. We did, to our credit, stop large gatherings and announce the closure of schools slightly earlier than England, but nowhere near early enough, and of course we had the grotesque spectacle of Jason Leitch openly encouraging people to go to large concerts on the weekend of the 14/15th March, and saying that he would have gone himself. That was at a time when the UK epidemic was taking off in a really significant way. People have almost certainly died in recent weeks as an indirect (and perhaps even direct) consequence of infections that occurred at mass gatherings that weekend.
When the crisis is finally over, there'll inevitably be a number of inquiries into the unmitigated disaster of Britain ending up with probably the worst death toll in Europe, and Scotland being part of that. One conclusion that will be absolutely inescapable is that Scotland would have suffered fewer deaths - and probably far fewer - if it had departed much earlier and more dramatically from the common UK position. The SNP's eventual justification for failing to protect lives during those crucial days in mid-March may be that it was never realistic for the Scottish strategy to differ significantly from the UK's, due to the structural limitations of devolution. If so, that in itself will make a compelling new case for Scotland becoming an independent country.
2) There has already been a full-scale Scottish opinion poll during the crisis, and it shows the Yes vote holding up remarkably well at just a smidgeon below 50%. OK, that was in late March when normal life was still a relatively recent memory, but nevertheless it's what we have to go on at the moment, and unionists would be foolish to lightly dismiss it.
3) Regardless of whether the effect of the crisis on support for independence is neutral or negative, there's pretty strong evidence that the 'rally round the flag' effect is in Scotland primarily benefiting the SNP and Nicola Sturgeon. We've seen very strong numbers for the SNP in both the full-scale Panelbase poll, and in Scottish subsamples of GB-wide polls. There was nothing inevitable about that, because in Wales the devolved Labour government is not the beneficiary - instead voters are flocking to the Tories. The bottom line is that to make independence go away, the unionists will have to get the SNP out of power or at least bring an end to the pro-indy majority at Holyrood - and at the moment it appears that the crisis has weakened their chances of doing that.
4) It may not be an exaggeration to say that the crisis has kept Nicola Sturgeon in office as First Minister and leader of the SNP. Some people genuinely think she'd have been forced to resign at the end of the Alex Salmond trial if coronavirus hadn't been preoccupying the nation. Now, I know there's a point of view that the chances of independence would actually have increased if Ms Sturgeon had departed, because she's failed to produce a credible roadmap for circumventing the Westminster veto of a Section 30. But the counterargument is that anyone who replaced her as leader would not be as charismatic or as effective a communicator as she is. In general the public will be more receptive to the message of independence if the messenger is convincing, and it does appear that the crisis has further increased the public's trust in Ms Sturgeon.
5) One of the weaknesses of the Yes movement over the last few years has been that the public simply haven't had a break from the constitutional debate since 2011. That's what has given the Tory line of "give it a rest Nicola" some traction. But a side-effect of the crisis is that the public won't be subjected to any talk about independence for a prolonged period (notwithstanding the odd spasm from the likes of Deerin), and that means they'll eventually be hearing the case with fresh ears.
6) The crisis has resolved - at least temporarily - a strategic divide within the SNP between those of us who wanted the mandate for a pre-2021 indyref to be honoured, and those like Pete Wishart and Andrew Wilson who wanted a lengthy delay. The completely random factor of the worst pandemic for a century means that we're all now united in accepting that a referendum cannot realistically be held until 2022 at the earliest (unless a vaccine becomes available sooner than expected). Whatever the frustrations of a delay, the end of the arguments over timing may help the Yes movement to go forward with renewed purpose.
Just by chance, I've discussed some of these issues in my column for next month's edition of iScot - a terrific magazine that is well worth buying either digitally or by print subsciption.