This particular article in the Spectator (which we still haven’t managed to restore to the sidebar) best reflects my own view of the current situation, which is that no-one can yet tell whether Lockdown is the most or the least effective strategy for dealing with the pandemic. The best or the worst. The wisest or the stupidest. I’ve said this before and I’ll say it again - the jury’s still out.
We cannot yet know whether the economic fallout from Lockdown will turn out to be a bigger calamity than the imminent prospect of a few million more premature deaths from Covid, and no amount of logic and reasoning can provide a definitive answer till the fat lady sings; and not even then. In the absence of a reliable, robust, retrospective tally, our polarised attitudes and prescriptions can only be ’visceral’, instinctive and speculative, and I daresay, dependent, at least in part, upon whether we’ve got vulnerable and very precious loved-ones to worry about.
It seems to me that in a no-win scenario like this, any strategy is risky; but since we voted for the present government, and Lockdown is the strategy they’re betting the farm on, it’s wiser to cooperate than to dissent, because the chosen strategy is heavily dependent on our cooperation.
If Brendan O’Neill thinks it’s the wrong strategy and Peter Hitchens says dissent is our moral duty, it’s not so much that I disagree with their arguments - they may well be right - but at the moment it’s extremely premature to be certain of anything, and in my opinion, it’s unwise to insist you can be.
No outcome I can think of is likely to give us a definitive answer anytimesoon. Perhaps if the pandemic rapidly dies out and the economy bounces back double-tout-suite, we can pretend we knew it all along. Not very likely though, is it? Even with the benefit of hindsight, we’ll probably still be left with a bunch of ‘what ifs’ that we can argue over forever and a day.
I just think this piece by Professor Michael Baum details the uncertainties that make me quite sure that we can’t be sure. There’s even a reference to TV journalists in there, so no-one can accuse me of going completely off-topic.
“We now have a rich and varied amount of data on coronavirus that is global and increasing by the day. As you would expect, in the face of uncertainty, opinions in the scientific community are diverse. Now is not the time for point-scoring and facile comparisons, but for global collaboration.
Ultimately this lockdown period will come to an end, we will develop herd immunity, produce antibody tests that work and vaccines to protect the vulnerable. We will win against this virus and our children will ask, ‘What did you do in the great corona war of 2020?’.
The best answers will come from those currently caring for the sick or who work in our science and mathematical laboratories. But if you are a whinging TV journalist demanding, ‘Something must be done’, or an armchair epidemiologist who has no doubt that ‘rhubarb’ is the answer to our problems, you may have to keep quiet and change the subject.
Please disagree in an orderly fashion. It’s our blog and we. can. exterminate.
Rest assured that in the world of the BBC that the current policy will be found to be the wrong policy, or if the right policy, not to have been adopted soon enough.
ReplyDeleteShould the government adopt a different policy then that will be a 'U-Turn', proving that they had previously adopted the wrong policy and were now far to slow in adopting the right policy.
Whichever policy is adopted, as long as at least one BBC journalist survives, they will be able to find an expert, dead or alive, that clearly knew that the government had adopted the wrong policy/policies all along.
In an uncertain world we hang on to these certainties!
Lol, very well put and close to the truth...
DeleteTo examine the points he raises:
ReplyDelete"1. Population density
The population density of New Zealand is 18/square Km whilst the population density of England is 430/ square Km. This will obviously affect the spread of the disease."
It's not entirely clear that there's anything "obvious" about this. The USA's population density has always been far, far lower than the UK's and is currently 36 per Sq Km. Nevertheless it is suffering a serious outbreak of Covid-19 and lost up to 850,000 people to Spanish Flu in 1918/1919 when its population density was even lower.
Accommodation density is probably a more important factor than population density, given the ubiquity of travel by jet and car.
"2. National demographics including incidence of co-morbidity.
Some minority groups in rich countries will have more co-morbidities such as diabetes, hypertension and obesity. While in India, Pakistan, Bangladesh and Sub-Saharan Africa, malnutrition and infectious diseases are rife."
The guy is showing his ignorance. Diabetes is rife in Pakistan. Easily found on the web:
"Pakistan. LAHORE: The Diabetes Prevalence Survey of Pakistan has revealed staggering 16.98 percent prevalence of diabetes as 35.3 million people among the adult population are found diabetic in Pakistan." 16.98% and 35 million!!!
"3. A single or multiple epicentres for the start of the epidemic
South Korea seems to be an exemplar. Yet the country mainly had a single cluster of the disease in a church with a full register of members. Health authorities also had warrantless access to the credit card and phone data of its citizens, including location data. So what we might regard as breaches of civil rights are part of the country’s success story."
I would agree the South Korea "success story" has been oversold. But then, why hasn't there been a much bigger outbreak in S Korea?
"4. Recording of incidence of infection
The more tests for the virus that are conducted, the higher the incidence of the virus appears. Yet some of the apparent differences in the number of deaths worldwide could be related to the type of antigen test used in each country. There are many tests available but there has been no transparency in reporting their sensitivity and specificity. In other words, the tests with the lowest sensitivity (leading to more false negatives) would reduce the number of deaths (suggesting a better outcome for each country), while the more accurate tests would increase the number of apparent deaths caused by coronavirus."
Rather sloppy use of the word "deaths" as opposed to "death rate". I think everyone is aware of this issue - it's really the number of tests undertaken which is the key variable, which differs by factors of ten or more between countries.
(...continued)
Delete"5. Recording cause specific or all cause deaths
The way deaths are recorded greatly varies between countries. Many deaths, for example, will be in care homes or in people’s homes in quarantine a long way from hospital, and so won’t be recorded. Even if we only measured deaths in the ICU in hospitals to compare different countries, this would be insufficient to accurately quantify the death rates from the coronavirus because many deaths outside this will be wrongly attributed to co-morbidities that make the patient vulnerable to the virus. The Office for National Statistics (ONS) is considered one of the best in the world, so in this respect we are victims of our own success. This view is vindicated by reports today that show an alarming increase in deaths from 'other causes' that match the peak in deaths from the coronavirus in the last few weeks."
True, which is why excess mortality is the best guide. Just look at the most recent ONS figures, there is no denying the impact of Covid-19 in terms of excess mortality for Week 14.
"6. Deaths from the collateral fall-out of the draconian measures taken so far
As the chief medical officer (CMO) keeps warning, there will be collateral deaths as a result of the measures used to contain the virus. For example, deaths from cancer might be a consequence of redistribution of NHS resources, and deaths from suicide might be the consequences of social isolation. Yet we shouldn’t forget collateral non-deaths, because of the decrease in road traffic accidents, for example. A paradox of this crisis is that our A&E departments are almost empty."
Well yes, indeed. We don't know what the impact of the Lockdown is or will be, now or in 3 months' time or a year's time. Anecdotally it's not good.
Overall, I found the article a bit sloppy - could do better Professor Emeritus!
In terms of comparing between countries, while you can't make meaninful comparisons at a one or two per cent level, when there is such a huge difference between say Italy and Spain at over 400 deaths per million and Greece at 10 - one 40th - then clearly there is something crying out for an explanation.
The presitigious John Hopkins University in the USA has identified a strong correlation between BCG national vaccination programmes and low death rates for Covid-19. This isn't even mentioned in the article.
Calm down dear.
DeleteSorry Monkey Brains, but I find your assertive tone quite intimidating.
Disagree with me as much as you like, but please be considerate. Others might be deterred from offering an opinion that might differ from yours.
Not guilty!
DeleteI was tackling the article, not your comments Sue. I don't think I referred once to your comments. It's not my fault if the Prof hasn't familiarised himself with the huge extent of diabetes in Pakistan - but he should have, shouldn't he? - given his area of "expertise".
The Prof was being pretty assertive there - and wrong. Not my fault.
Indeed, when it comes to "assertiveness" there could be nothing more relentlessly assertive than the constant propaganda barrage we are living under:
1. Lockdowns save lives.
2. Only nations that adopt the total lockdown solution are safe from the virus.
3. NHS is perfect.
4. All NHS workers are saints and angels.
5. We are facing an unprecedented epidemic.
I think when you are subjected to this sort of relentless (and mostly false) propaganda 24/7 day in day out you have a natural Orwell-approved right to resist with equal pressure.
Remember this isn't some game we are playing. The OBR tells us the economy is going to shrink by 30% this quarter. Increasingly economists say there will be lasting damage - the economy will not bounce back, now the Government has scared everyone witless and created a paranoid anti-contact culture. This attack on our prosperity will have huge negative consequences for our health and well being and the futures of all our children.
No one has a crystal ball but we can see that Sweden, S Korea, Japan, Taiwan and Singapore have all NOT adopted total lockdowns. But they haven't suffered far worse Covid-19 death rates. Quite the contrary: they've all done much better. And we also know that countries like Russia, China, Greece, Croatia, Poland and Nigeria all have incredibly low rates of deaths per million. Why? OK some of those countries might not be the most reliable in terms of accurate reporting but Poland, Croatia and Greece? Why are they so low?
I have never heard a government scientist or any Lockdown Cultist address that point.
It is a Cult, because it simply refuses to address anomalous evidence that doesn't support its cultish beliefs.
Agree with every sentiment you express, MB.
DeleteI would not characterise MB’s comments as intimidating (I was surprised by the use of the word). I found the comments informative, objective and evidence-based.
DeleteTalking of "certainties", I really cannot understand the theoretical basis for claiming as Policy Exchange do that (a) the Lockdown has brought the virus "under control" and (b) within a couple of weeks we can safely relax controls subject to people maintaining helpful "behaviours".
ReplyDeleteThe point about a supposedly successful Lockdown is that it stops or slows down greatly the spread of the virus. We are told however that only about 15% max of the population have been infected. That means 85% haven't! We are also told the virus is highly infectious and that something like 15-25% of the infected are aysmptomatic.
In those circumstances how on earth can you relax controls? Surely with 56 million people not yet infected, then the virus will start to spread again, through asymptomatic individuals who have the virus and are merrily turning up for work, travelling on the underground, kissing partners etc etc
But it won't will it? - well not so strongly as before. Why? That's not been explained by the "experts".
The reality I think is that it is indeed the most vulnerable people who are cut down in the first wave.
Meanwhile the experts need to explain why Belgium after 4 weeks plus of total lockdown is experiencing a huge spike in cases and in deaths, so that it now has the highest deaths per million population rate in the whole world (bar San Marino)...The median infection onset is 5 days after exposure. Any total lockdown should lead to strong reduction in numbers of cases after 10 days and in deaths within 20 days. That this hasn't been happening is very instructive.
There's a lot of "magical thinking" going on in the science community.
I’ll flesh out my response then. Headers and text are Professor Michael Baum’s; MB’s critique is in italics; my responses appear below.
ReplyDelete"1. Population density
The population density of New Zealand is 18/square Km whilst the population density of England is 430/ square Km. This will obviously affect the spread of the disease."
It's not entirely clear that there's anything "obvious" about this. The USA's population density has always been far, far lower than the UK's and is currently 36 per Sq Km. Nevertheless it is suffering a serious outbreak of Covid-19 and lost up to 850,000 people to Spanish Flu in 1918/1919 when its population density was even lower.
Accommodation density is probably a more important factor than population density, given the ubiquity of travel by jet and car.
1) Whatever category of density (be it ‘population density’ as in U.K. v N.Z., or simply ‘clusters of people in close proximity', as in the U.S.) it is ‘obvious’ that proximity is a factor in the spread of the disease.
"2. National demographics including incidence of co-morbidity.
Some minority groups in rich countries will have more co-morbidities such as diabetes, hypertension and obesity. While in India, Pakistan, Bangladesh and Sub-Saharan Africa, malnutrition and infectious diseases are rife."
The guy is showing his ignorance. Diabetes is rife in Pakistan. Easily found on the web:
"Pakistan. LAHORE: The Diabetes Prevalence Survey of Pakistan has revealed staggering 16.98 percent prevalence of diabetes as 35.3 million people among the adult population are found diabetic in Pakistan." 16.98% and 35 million!!!
2. Nothing wrong with that. It doesn’t show any ignorance at all. Diabetes may well be rife in Pakistan. - obesity is rife in Gaza for that matter - but that doesn’t nullify the malnutrition and infectious diseases in the countries he cites, nor make them any less significant.
"3. A single or multiple epicentres for the start of the epidemic
South Korea seems to be an exemplar. Yet the country mainly had a single cluster of the disease in a church with a full register of members. Health authorities also had warrantless access to the credit card and phone data of its citizens, including location data. So what we might regard as breaches of civil rights are part of the country’s success story."
I would agree the South Korea "success story" has been oversold. But then, why hasn't there been a much bigger outbreak in S Korea?
3 But he’s not saying Korea’s ‘success story has been oversold’. He’s asking whether ‘breaches of civil rights’ are justifiable.
(...continued.)
ReplyDelete4. Recording of incidence of infection
The more tests for the virus that are conducted, the higher the incidence of the virus appears. Yet some of the apparent differences in the number of deaths worldwide could be related to the type of antigen test used in each country. There are many tests available but there has been no transparency in reporting their sensitivity and specificity. In other words, the tests with the lowest sensitivity (leading to more false negatives) would reduce the number of deaths (suggesting a better outcome for each country), while the more accurate tests would increase the number of apparent deaths caused by coronavirus.
Rather sloppy use of the word "deaths" as opposed to "death rate". I think everyone is aware of this issue - it's really the number of tests undertaken which is the key variable, which differs by factors of ten or more between countries.
5. Recording cause specific or all cause deaths
The way deaths are recorded greatly varies between countries. Many deaths, for example, will be in care homes or in people’s homes in quarantine a long way from hospital, and so won’t be recorded. Even if we only measured deaths in the ICU in hospitals to compare different countries, this would be insufficient to accurately quantify the death rates from the coronavirus because many deaths outside this will be wrongly attributed to co-morbidities that make the patient vulnerable to the virus. The Office for National Statistics (ONS) is considered one of the best in the world, so in this respect we are victims of our own success. This view is vindicated by reports today that show an alarming increase in deaths from 'other causes' that match the peak in deaths from the coronavirus in the last few weeks.
True, which is why excess mortality is the best guide. Just look at the most recent ONS figures, there is no denying the impact of Covid-19 in terms of excess mortality for Week 14.
"6. Deaths from the collateral fall-out of the draconian measures taken so far.
As the chief medical officer (CMO) keeps warning, there will be collateral deaths as a result of the measures used to contain the virus. For example, deaths from cancer might be a consequence of redistribution of NHS resources, and deaths from suicide might be the consequences of social isolation. Yet we shouldn’t forget collateral non-deaths, because of the decrease in road traffic accidents, for example. A paradox of this crisis is that our A&E departments are almost empty."
Well yes, indeed. We don't know what the impact of the Lockdown is or will be, now or in 3 months' time or a year's time. Anecdotally it's not good.
4 Paras 4 5 and 6 highlight the incompleteness/unreliability of the currently available statistics, which was the gist of my post, (which you haven’t ‘referred to')
Here’s the thing though. The way it usually works is that the blogger/site owner (Craig or me) posts something, and the ‘commentariat’ (you) responds if they wish to, and it’s customary to at least pay lip service to the original post, even if it’s not the primary focus of your response.
(...continued)
ReplyDeleteOverall, I found the article a bit sloppy - could do better Professor Emeritus!
In terms of comparing between countries, while you can't make meaninful comparisons at a one or two per cent level, when there is such a huge difference between say Italy and Spain at over 400 deaths per million and Greece at 10 - one 40th - then clearly there is something crying out for an explanation.
Here you seem to be agreeing with me that it’s too soon to tell. Which was the gist of my original post.
The presitigious John Hopkins University in the USA has identified a strong correlation between BCG national vaccination programmes and low death rates for Covid-19. This isn't even mentioned in the article.
Perhaps he didn’t find it relevant?
Your points about propaganda are fair enough, but look. You may disagree that this is an unprecedented crisis, but many think it is and see it in terms of ‘war’. In war, propaganda can act as a sort of ‘rallying cry’, and it encourages society to sacrifice some of their liberties for the greater good. Again, my argument is that it’s too soon to make arguments as you do so dogmatically and with such certainty.
Sue,
ReplyDeleteI don't particularly like to disagree with the Blog's owners, since there is far more we agree on than disagree looking at the big picture.
My impression was that you were saying everything was too uncertain for anyone to reach any judgements. That seems to rather leave the field open to anyone who wishes to push their beliefs without evidence, as far as I am concerned. You must realise that your position - that the evidence on Lockdown effectiveness is not yet clear one way or the other - is opposed by just about every MP, every TV reporter and virtually all NHS doctors and spokespeople. They all think the evidence shows Lockdowns are effective. You are just as much in a minority as I am.
I take it you do understand that for the Lockdown theory to be correct it should work within at most 10 days because the median incubation period is 5 days. By that point there should be a significant reduction in cases. That should be followed within 15 days (the median period from onset to death in fatal cases is 10 days) by significant reductions in cases of death per day.
This has not been happening. So Lockdown supporters have kept shifting the goalposts on this and issuing misleading statements. Now we see a country like Belgium which has been in Lockdown for over a month suddenly recording significant increases in cases and deaths, and suddenly making it the country with the highest number of deaths per million - why? - any interest from the media? No.
Regarding your comments on Baum:
1. If Baum doesn't understand the difference between population density and urban density within a country that's his problem not mine.
The largest city in New Zealand, Auckland, has a population of 1.65 million. I am not sure what point he was trying to make. There aren't many countries that don't have large urban centres where Covid-19 can thrive due to "proximity".
2. Baum specifically referenced an alleged contrast between Western countries with diseases like diabetes and countries like Pakistan with infectious diseases. Pakistan has more people with diabetes than we do (16.5% against our 10%)! I don't see why you want to defend Baum's inaccurate portrayal of health stats. He specifically claimed there were more co-morbidities of these type in the UK than in Pakistan. He's just plain wrong.
(...continued)
Delete3. He appeared to be implying that the S Korean "contact tracing and treat" approach had been oversold as a success story by coupling a "seems" (to be a success) with a "yet" (they basically had only to go after one Church congregation). I was saying that I agreed the success had been oversold (but for more reasons than he gives, I should perhaps have added).
My point would be that given the disease is asymptomatic in a large proportion of cases (WHO says about 25%)and is also highly infectious, is it really credible that any state's contact tracing policies could really protect it? If the answer is truly yes, well that's great because South Korea certainly doesn't have a total lockdown, which we are told is necessary to prevent the disease spreading.
4. I was confused by the point he was trying to make here. He is specifically referring to antigen tests. Reading up on this, it seems he is referring to the PCR tests - apparently they test for viral RNA not antigens but are sometimes loosely referred to as antigen tests...(so I read). These are the nasal-throat swabs as opposed to the antibody blood tests.
Yes, false negatives can be a problem - up to 30% apparently, but (a) I don't think hospitals confine themselves to doing one test. I am sure if someone looks like they have Covid, they will do a second test if the first comes back negative (b) unless you think some countries are particularly poor at PCR testing, then it is unlikely to make a huge difference. If false negatives are up to 30% (as I read) most countries are going to fall in the 10-20% range perhaps and multiple testing will reduce the risk of false negatives. This gives good background on testing:
https://www.sciencemediacentre.org/expert-comment-on-different-types-of-testing-for-covid-19/
There is no way poor PCR testing would account for differences of some 400 plus deaths per million between Greece and Italy.
5. Baum doesn't seem to acknowledge that you can quickly identify if Covid deaths are being missed by looking at excess mortality, specifically for pneumonia and flu. There is no evidence I can see in the ONS stats that there has been a huge rise in "other deaths". I doubt more than 400 Covid deaths were missed in Week 14:
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/weekending3april2020
6. I don't agree the figures from democratic countries with rule of law (most of Europe, USA and a large chunk of the rest of the world) are particularly unreliable or incomplete. I think they are broadly comparable - probably within a range of 25% certainly. There is certainly nothing in such variations to explain how Italy's figures are some 4000% higher than Greece's.