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Once More Unto the Breach, Dear Friends. Covid 19, Part II.
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After a brief summer, in which we dared to hope that we could eventually go to the pub without booking a table, and without choosing our food in advance, the darling buds of May have given way to the surly scowls of September, and we are down in the dumps again.

This pandemic is testing our intelligence: it makes us assess personal risk, alter our behaviour, and do our best to understand the advice we are given. Our doctors, scientists and politicians are all facing tough tests of problem-solving ability. There are precedents, principles, methods, and a large dollop of uncertainty, so no shortage of options.

This week began with the nation’s chief science and health spokesmen telling us that cases were increasing fast, and if they continued to do so exponentially (the big IF, they conceded) then deaths would follow. It was not a prediction, they said, but I judged it was the key slide they wanted to show.

To the dismay of any data scientist, France and Spain were given as examples, rather than the two experts showing us a range of countries in Europe and elsewhere, and discussing the different trajectories. Sweden and Germany also have their stories to tell. Unless you have a strong justification in terms of matching, you should not cherry pick countries.

They explained that the case increase was not down to testing: repeated testing of care home residents showed a real increase as autumn approached. They also said that an individual’s attitude to risk was not just a matter for them, because risky behaviour by one person can lead to the virus being spread to others. Public health depends on public behaviour: risk taking individuals can be super-spreaders. The tragedy of the commons is that viruses jump from one person to the other by propinquity, not according to our personal politics.

Antibody tests suggested only 8% had formed them, but it was left unclear whether exposure to previous coronaviruses would confer any degree of general protection, even though that may be the case.

Government policy, as explained the next day by the Prime Minister, is that “a stitch in time saves nine”. I like the rhyme, but am not entirely sure of the reason. The policy has sought to be proportional to the threat. Those who can work from home, but had been encouraged to come out to eat in previous weeks, have been told to work from home again. Pubs, bars and restaurants have been told to provide table service only and, in a new departure, to close by 10 pm. One wag grimly noted that middle-aged people had been observing that practice for decades.

Face coverings, also known as masks, had to be worn in shops and all indoor hospitality settings. Covid guidelines were now legal obligations. The recently introduced “Rule of 6” (no more than 6 persons to a social group, rather than government by 6 persons, though the latter may be closer to the mark) had been “strengthened” in the following way: there could be no more than 15 persons at a wedding, but 30 at a funeral. This last injunction has caused some bemusement. I presume people are more likely to sing, dance, embrace and form new intimate relationships at a wedding than a funeral. They should have spelled out why they had chosen those different numbers.

I think that public health is better served by giving good explanations and stressing general principles. Only then should you go to specific prohibitions. The advising experts never said:

Don’t inhale other people’s exhalations.

They never set out a range of activities, rated by risk.

They never mentioned the advantages of dilution of exhalations in moving air as opposed to their concentration in enclosed, stagnant air, and what that meant in terms of prudent behaviour.

In short, they did not spell out a general principle which people could use to guide them in ambiguous settings. Specific examples without general principles are a hostage to fortune. Studies of compliance with medical advice stress that patients need to understand why they are being asked to follow certain procedures. Absent a good explanation, patients are likely to stray from strict observance.

Also, and this is a minor point, but I am a minor person, the official slides were not always self-explanatory, which is a great problem when they are being used to justify policy decisions. For example, have a look at this one.

It is very hard to see what point they are making, given that the slide was not up for long. They make the usual error of “explaining” the age groups by reference to a legend on the right which has only partly discriminable colours, and a sequence of ages which does not match the order of ages shown on the graph. How long did it take you to find which age band was rising most? Furthermore, why not use 20-year age bands, which make the general point more clearly, reducing the number of lines which need to be displayed? Also, how do they suggest that the most-highly-rising age group be managed? Are they the pub-goers?

Here is another messy one, or two messes in one slide.

How can anyone read this, and why should they? The virus is not driven by the wind, nor does it arise from the soil. Why show maps? Why not list the 10 towns of greatest concern, from highest to lowest, and say whether they were “High Rate” or “High Rising” or both? Job done. It would also identify for everyone some places to avoid.

The day after the Science and Medicine spokesmen did their double act (adroitly allowed to say their piece on their own, so it was clear that they were providing Science, not politics) the Prime Minister did his political balancing act, announcing his slight changes, with the clear implication that more will follow if the populace keeps giving the virus an easy ride.

A YouGov survey on 23 September suggests that 67% of people feel the pub curfew will not be effective, but 71% agree that a second lockdown would be effective.

I was in favour of the initial lockdown. Though implemented a bit late, it gave us all a chance to reduce the spread of the virus, manage the clinical load in hospitals, and generally buy time to find out what treatments worked, and which vaccines were worth developing. It was high cost, possibly even in terms of unintended health costs, but understandable in the circumstances. If the supreme function of statesmanship is to provide against preventable evils, then the Government tried to do that. Better safe than sorry. Dead relatives will be remembered more fiercely than national debts, and governments suffer if they don’t manage blame cleverly.

Now we are in a time of uncertainty, and the advice and exhortations are likely to change every couple of weeks. Adults should understand that we are titrating our responses to a hazard, and that even though case increases are probably not exponential, they are on an upward path. That said, it is hard to obtain commitment when the rules vary so much. Insurrection seems unlikely, but actual non-compliance will probably increase.

Hopes, once raised, are cruelly dashed, and will be hard to raise again.

 
• Category: Science • Tags: Britain, Coronavirus, Disease 
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