From the very start of the pandemic, modelling projections and empirical data have been twisted to suit different agendas. Fanatics on both sides of the debate have cherry-picked data — whether those demanding tougher restrictions or those on the other side who believe that the virus is harmless and that this is all big fuss over nothing. Cold, detached analysis was an early victim of Covid-19.
And so it proved yet again after the Prime Minister’s press conference last Saturday, during which a number of projections were presented showing how the Covid-19 death toll could proceed in the coming weeks. A number of models were used to justify placing England into a second lockdown. One, in particular (produced by the University of Cambridge and Public Health England), however, set a hare running across the media and enraged libertarian MPs, eager to believe we’re being hoodwinked into an unnecessary lockdown. Undoubtedly, it was a huge presentational error that needlessly ruined the government’s messaging. The UK Statistics Authority has issued a warning, saying the graph had ‘potential to confuse the public and undermine confidence in the statistics’. But for lockdown sceptics, however, it was manna from heaven; they were gifted fresh ammunition.
The fuss over the differing models concealed their basic common denominator: that the conclusions of all of them were dire, it was just that some were more dire than others.
We know that the ‘reasonable worst-case scenario’, which the government uses to plan its responses to the pandemic, has already been met in terms of the number of Covid deaths and has been breached in terms of the hospital admissions. Unfortunately, what this worst-case scenario means, in reality, remains opaque; the government won’t tell us. But leaked documents published in The Spectator show Sage’s worst-case scenario points to 85,000 deaths by the end of March. In this scenario we would expect daily deaths over the last week to be around the 80 mark; in reality, the figure is closer to 300. This is the stark truth. Don’t be fooled into thinking this worst-case scenario is the same thing as the Cambridge-PHE model. To pretend otherwise is intellectually dishonest.
It is similarly dishonest to disparage the motives of those burdened with the responsibility of governing: the idea that Boris Johnson, his cabinet, Patrick Vallance and Chris Whitty have no regard for economic and social consequences — or that they simply want to treat the population like lab rats in some social experiment — is ridiculous. It is a classic example of playing the man not the ball. They have a responsibility to protect the economy and society. But they must also ensure that if you have a heart attack or are run over by a bus, you are not turned away at the door of Accident and Emergency because coronavirus has been allowed to run riot. There are currently more than 11,000 patients in hospital with coronavirus, the equivalent of 22 full hospitals, up from 500 at the beginning of September and 2,000 at the start of October. ‘Today's infection is the ICU order book for a fortnight's time’, NHS chief executive Sir Simon Stevens said at his press conference on Thursday. Forget the debacle over the 4,000 figure, where do people seriously think this is heading? We have barely even entered the winter period; flu season is most pronounced in February. We are heading towards a really difficult period. A failure to respond would be terribly irresponsible.
What we’re experiencing now is the absolute antithesis of what the PM really wants to do with the country. Of all our politicians, Boris Johnson is one of the least likely to harbour secret desires to behave in the manner of a Cromwellian killjoy. He is in a horrible bind: action against Covid-19 is needed when it appears unnecessary — and therefore appears an act of madness or wanton vandalism. But leave things too late, and the action needed will be more severe and thus more costly — economically, socially and in the lives lost. The tardy response in March was largely responsible for the UK’s poor pandemic performance. We could well be sleepwalking into the same trap.
A sense of British exceptionalism seems to have taken hold, fostered by misplaced boasts of leadership in vaccine development, world-beating contact tracing, and mass testing moonshots. Most people are not following the detail or nuance of what is being said; all this froth engenders a misplaced belief that it will all be alright and that any concerns and need for action are exaggerated. But look at the deteriorating situations in Belgium, France or Lombardy. For instance, at the time of writing the rolling seven-day average death toll in France stands at 410 and Paris is facing a tightened lockdown because people are flouting the rules. Even Sweden, so beloved by lockdown sceptics, is imposing greater restrictions following a huge spike in infections. Despite all the huffing and puffing about herd immunity, it’s still not riding to the rescue as predicted by its advocates. Covid-19 has already taken a heavy toll on the British people once, it can do so again.
Ever since March when it became clear that the pandemic was going to inflict serious economic damage, a long chorus line of detractors has formed from our commentariat, business community and politicians. Half-baked opinions have been pumped out furiously — from vaccines and treatments (one Tory MP cluelessly reporting on a successful ‘trial’ of a vitamin supplement is a particular favourite), via ad hominem attacks on the credentials of government advisors, to baseless forecasts about herd immunity. Now, earlier I criticised those playing the man, not the ball: reading this piece, you might conclude that I’m doing something similar, but I’m engaging with what’s proposed by others rather than focusing on what best suits my argument.
Why are some people so desperate to argue that the virus is not that bad and to play down the state we find ourselves in? There are probably multiple reasons and without writing a psychology PhD it would be hard to cover them all. One obvious one, however, is that of corporate interests. Remember, for instance, the absurd worried exhortations and crocodile tears in the summer that people needed to stop working from home to keep sandwich sellers in business? Was this really about protecting Pret’s workers and because offices are great bastions of happiness? Or was it more likely a desire to keep the commercial property bubble inflated and to protect corporate investments? Indeed, does anyone recall similar levels of concern from the same quarters about the decline of Britain’s car, steel or coal industries, or was that just market forces? Clearly motivation is separate from a particular argument’s truthfulness — but it is a context that needs examining. The government, for all its many faults, is motivated by a desire to save lives while balancing that against the effects on people’s livelihoods. Are those who put forward lockdown sceptic arguments purely driven by the same motivation?
Why does this matter? Because the confected outrage at the inappropriate use of one graph in a government briefing comes largely from the same quarters that have argued against any restrictions from the very beginning of the pandemic. Back in September, Whitty and Vallance held a widely derided press conference where they announced that if the virus doubled every seven days, by mid-October there could be 50,000 infections per day and that there could be 200 deaths per day by mid-November.
Well, despite the furore, their warnings were realised weeks earlier than predicted. The numbers of new community infections in England averaged 51,900 per day in the week from 17 to 23 October, with the prediction on fatalities breached that same week (20 October). At this rate, we could easily exceed 400 deaths per day by the middle of November. This correlates with the models from the University of Warwick and London School of Hygiene and Tropical Medicine, which were presented alongside the Cambridge-PHE model in last week’s government briefing. This is being conveniently ignored, with the focus instead on projections which have not come to pass.
There are many very grave matters that require serious analysis and sensible discussion — from the effects of lockdown on mental health to the economy and what our exit strategy should be. But instead of having grown-up conversations about these very real issues, we are instead engaged in a repetitive political parlour game where presentational mistakes made by the government are used to question its motives. And, what’s more, instead of constructively engaging with the process, some commentators have descended into pretentious academic onanism, screeching loudly and inaccurately about being lied to. Like any good pseudo-intellectual, they have done their own research and fallen in love with a band of contrarian medics and scientists who, having been plucked out of obscurity and the dusty confines of academia, are only too happy to have an audience.
Professor Carl Heneghan, who first made waves when he rightly revealed that Covid death numbers were being over-recorded. He then moved onto questioning the PCR test used to diagnose infection. Heneghan’s thesis was that the lack of hospital admissions in the summer was explained by the fact that many of the positive tests were people who were not contagious; that they merely had the remnants of dead virus. Now, of course, he was entirely justified to probe this important issue. But, his work on the subject risked giving people false confidence that the virus was burning out.
Let me explain. When the proportion of tests that are positive is low, those that are falsely positive may make up a significant proportion. However, they are more like a fixed number rather than a set proportion. Therefore, as the proportion of tests that come back that are positive grows, those that are falsely positive decreases as a proportion.
Imagine a test that returns a false positive every one in 100 times it’s used — false positives will account for 1 per cent of all tests. For every 100 tests carried out, one test will likely return a positive result even if none of the subjects has the virus. Now, suppose four of those 100 people do actually have coronavirus. The test will return four true positive results and one false positive. That means the proportion of false positives is 20 per cent. But now suppose that 49 people have the virus while 1 per cent of all tests still come back as false positives. That means that the test will return 49 genuine positive results while also returning one false-positive result. So then, false positives account for just 2 per cent of the overall positive results. The point is that the problem that leads to the false-positive lies in the test itself rather than in the number of people being tested.
You should view the false positive as one in every 100 tests conducted, not one in every five positive results. So the only way the number of false positives can grow is by doing more tests, not finding more instances of coronavirus. If you were to double the number of tests conducted to 200, you’d likely get two false positives.
Heneghan’s concern that the diagnoses grew because of false positives was amplified across the media, giving people the false impression that the rise in infection rates was grossly magnified. This was a terrible mistake, not that he has since publicly corrected this perception. Depressingly, it is still a theory widely shared online — often by people who should know better.
When he was questioned this week on the Today programme about the steep rise in Covid-19 hospital admissions, Heneghan responded by talking about total in-patient numbers, pointing out that these were going down. Well, of course they were: for weeks hospitals have been clearing the decks by cancelling operations and discharging elderly patients into care homes again. This is not a declining problem, the government’s whole strategy is geared towards stopping Covid-19 from destroying the ability of the NHS to respond to emergencies and those numbers, as Simon Stevens pointed out, are definitely increasing.
Scepticism is vital in science, but questioning and doubt must be applied with equal rigour to all theories, regardless of how palatable we might find them. Science is about observing nature, it is not about fitting things into political narratives. It is often said that politics is show business for ugly people — frankly the same could be said of some scientists and medics involved in the Covid debate today.
The pandemic will, unfortunately, be with us for some time and will develop in ways we cannot yet know. We are not going to find our way out of it by denying the scale of the problem because we may not like the solution; that way lies failure. Nobody will care about fancy models or the clever use of statistics when our hospitals are on the brink, stuffed full of patients choking to death. Make no mistake, a Covid death is lonely and bleak. Nor will people remember Vallance’s graph in a couple of months, if we exceed the death toll of the first peak. Scepticism ensures that ideas are properly kicked around before becoming accepted. But if a contrarian frame of mind means that uncomfortable truths are shunned, then really that’s a scepticism that only goes in one direction.