Bipartisan politics is admirable but will cost lives

Dear Keir Starmer and Nicola Sturgeon

Both of you have been rightly praised for your refusal to play politics during the current crisis. Both of you have made it clear that the national interest must come first and for that reason you will leave criticism of the Government’s record until later. But are you right to adopt this approach?

 Let’s take a hard look at the facts.

Projections of future hospital-based deaths from Covid-19

On April 30^th Boris Johnson announced that “the peak has passed. We are now on the downward slope”. What he didn’t say is that the slope has a very shallow gradient. 

The figure below shows the actual number of hospital deaths since 24^th March compared with the theoretical number based on the Imperial College model. Since the peak of hospital deaths on or about April 10^th there has been a fairly close fit between theoretical and actual outcomes. If the number of deaths continues to follow the theoretical model trend then three months after lockdown they will be at approximately the same level as when the lockdown began.

 This will have been reported to the Government by SAGE but clearly the public are not to be trusted with the information.

Broadly speaking, the theoretical model demonstrates that, whilst the growth in the number of cases increases exponentially until the peak, decline from the peak will be likely to follow a trend which is much shallower; currently the decline is less than 10% every seven days. 

By omitting to emphasise the shallowness of the actual decline gradient, the Government is raising false expectations about how quickly we can emerge from lockdown.

Projections of all deaths

The evidence for ONS suggests that, whereas at the time of lockdown most deaths would have occurred in hospital, an increasing proportion is now taking place in care homes and the community. Hence,  if, as Boris Johnson claims, the peak has now been reached, that peak must be well in excess of the 850 or so hospital deaths which occurred around April 10^th. The date by which total deaths returns to the same level as at lockdown could therefore be considerably later than June 24th.

Number of cases

The number of cases being reported each day is only a fraction of the true number of cases. On the conservative estimate that deaths occur in 1% of cases the number of new cases UK-wide must now be around 70,000 a day. The equivalent figure for Scotland would be about 7000 new cases a day. The new cases represent the pool of infection which would need to be tackled by contact tracing.

Contact Tracing and Testing

The UK Government announced there would be “18000 contact tracers” – presumably for England. This was subsequently clarified as 3000 contact tracers and 15000 people in call centres. There has been no announcement that current policy will be reversed and people encouraged to ring in to report symptoms.

If there are 70,000 new cases a day, and people are encouraged to ring in to report symptoms, then, given that there will be many calls from people who subsequently are found  to be asymptomatic, the 15,000 people in dedicated call centres might well be appropriate. But what would 3000 contact tracers achieve?

In Michigan it is estimated that one contact tracer is required for each confirmed case. By contrast others have estimated that 3 contact tracers are required for every case. Despite the wide variation, (probably due to differences in what is meant by “contact tracing”), it makes little difference. On current trends 3000 contact tracers would only scratch the surface.

An essential feature of contact tracing is targeted testing. The key is to test all people exhibiting symptoms to determine who should be followed up by contact tracing.  Currently, the testing regimen appears to be focussed on achieving a big number (the by now infamous 100,000) rather than targeting those with symptoms. 

Personal Protection Equipment (PPE)

Everyone is horrified that all hospital staff do not have PPE and many  deaths have come about  as a result of this neglect. What seems to receive less attention is that many of these deaths have occurred amongst care staff who are not working directly in coronavirus treatment areas of the hospital. To these must be added the many deaths of other care workers and key workers in the community.

This scandal has another important aspect often overlooked. Under lockdown, key workers will inevitably be an important vector of the virus. PPE is needed not only to protect the heroic people who provide care and other services but also those  with whom the key workers are in contact. The failure to provide PPE will have resulted in many thousands of deaths.

International Comparisons

ONS data on ‘excess’ deaths suggests that the number of deaths from coronavirus must be much greater than the 27000 or so which is the current reported figure. Some “conservative” estimates have put the true figure as being in excess of 47000.

If these estimates are correct, then the UK, which once led the world in public health medicine, is likely to have the worst mortality record in Europe. 

The Five Key Tests

On April 28^th the Government offered a “clarification” of one of its five key tests for easing or lifting the lockdown. The wording was changed to state that the easing of lockdown must not result in a second peak of infections which overwhelms the NHS.

This “clarification” has important implications. The experience since lockdown is that the NHS can cope with a level of infection which results in, say, 800 deaths in hospital a day. This in practice will be much higher because of the deaths which occur outside hospitals. Lockdown has provided evidence of the level of infection and death which can be sustained without the NHS going into meltdown.

The Effect Of Bipartisan Politics

The proponents of “herd immunity” haven’t gone away. They have just undertaken a tactical retreat. Those in the Cabinet who are in favour, in Michael Gove’s words, of “running it hot” will have been closely monitoring public reaction to the appalling death figures in the UK. The absence of criticism will give them the evidence they need to suggest that the British public will tolerate without protest a sustained level of deaths from the virus. The only difference from the previous herd immunity strategy will be that the tens of thousands of deaths predicted in the Imperial College “mitigation” model will be stretched out over many months.

If some important restrictions were lifted, perhaps in the third week of May, the number of deaths in hospital would be perhaps 300 per day. The level of infection that this represents would not “overwhelm” the NHS. Would this be an amount of death that people would tolerate for an extended period? 

By refusing to criticise the government’s appalling record on dealing with the virus, proponents of bipartisan politics risk allowing a sustained level of deaths to become the accepted norm. The critical question is: how many deaths does the government think are acceptable?

So to return to the original question: Are you right to limit your criticism of the UK Government’s current policies? Surely now is the time for you both to follow the example set by Jacinda Ardern:  

“We never EVER considered herd immunity – it would have meant many tens of thousands dying and I simply wouldn’t tolerate that.”

A Critical Manifesto – Five new tests 

• Setting an immediate objective to urgently reduce the death rate to a level below that which obtained when we first entered lockdown and then  seeking to reduce that rate to as near zero as possible
• Providing all key workers with PPE sufficient both to protect them and to inhibit spread of the virus in the general population
• Reversing existing policy and encouraging  people to self-report coronavirus symptoms to dedicated call centres
• Creating testing capacity sufficiently large to allow testing of anyone reporting likely coronavirus symptoms
• Acknowledging that previous neglect has created a formidable requirement for contact tracing and that very large locally managed contact tracing teams will be required to have a meaningful impact on the spread of the disease 

Featured image: Nicola Sturgeon at April 30 via Scottish Government Flickr CC BY-NC 2.0; Photo of Keir Starmer via Rwendland Wikimedia Commons CC BY-SA 4.0; Tracing via Wikimedia Commons: Ferretti, Luca; Wymant, Chris; Kendall, Michelle; Zhao, Lele; Nurtay, Anel; Abeler-Dörner, Lucie; Parker, Michael; Bonsall, David; Fraser, Christophe / CC BY-SA 4.0 International