Test, track and trace – this is the new formula to contain this and future pandemics. How will it be done and what will be the consequences? Has Big Brother got a mandate to watch over us indefinitely? Victor Hill makes another entry in his plague journal.
“Most things never happen: this one will”
-Philip Larkin (1922-85), Aubade (1977)
The fear of a second wave
There are important lessons to be learnt from the last significant global pandemic – namely that of the “Spanish Flu” which raged from 1918-20, killing between 50 and 100 million people. (By contrast COVID-19 has killed just over 265,000 people as I write on Thursday). The science writer Laura Spinney has written an important book about that pandemic – Pale Rider: The Spanish Flu of 1918 and How it Changed the World – published two years ago.
Despite its name the virus in question was probably first brought to Europe by US troops arriving at the front line after America joined the Allies in April 1917. Ms Spinney explains that, after a relatively mild first wave in the northern hemisphere spring of 1918, the virus receded before returning with renewed force in August that year – and spread in the closing months of World War I over much of the Earth. This second wave was far more deadly than the first, accounting for most of the fatalities. Then there was a third wave in the early months of 1919 which was intermediate in severity between the first two.
Contemporary virologists believe that the virus responsible for Spanish Flu mutated between the first and second waves, becoming much more contagious. COVID-19 is highly contagious because people are at the most infectious while they are still asymptomatic; so the chance that COVID-19 will mutate into something even more contagious is mercifully thought to be unlikely. (Though, any future mutations will make the search for a vaccine more problematic).
Lockdowns in many countries are now being relaxed before the virus has been eliminated completely, while a reliable, proven vaccine is still at least 18 months away. As UK PM Boris Johnson has stated, any premature relaxation of the lockdowns could cause the R-value (the rate at which the virus is able to reproduce itself) to shoot back up and the hospital system could be overwhelmed again.
But we have access to technology that was not available to our forebears one hundred years ago. We have sophisticated testing kits and we have smartphones. If we could identify clusters of infection and isolate the sufferers swiftly then we might be able to contain and finally eliminate COVID-19 without shutting down much of the economy. This is the principle behind the roll-out of the test-track-trace policy that is likely to become, in one form or another, a global standard for the foreseeable future.
Please may I go out now?
As I wrote last week, South Korea has been using smartphone apps to identify infection clusters since the end of January. On Tuesday (05 May) the UK government made a tracing app available – initially to the people of the Isle of Wight, an island with a population of 140,000 people. Although the island comes under the English county of Hampshire it has its own health authority and it will be relatively easy to evaluate the efficacy of the system in short order.
But the UK’s NHS has a long history of failed IT project management. When the NHS was hit by the WannaCry ransomware cyber-attack in May 2017 it turned out that most NHS computers were running on MS Windows 95. The NHS tracing app already faces a possible legal challenge and there are concerns about interoperability – for example, whether it would work outside the UK.
The basic architecture of tracing apps is much the same everywhere. Whenever two people carrying smartphones are in close proximity for a certain amount of time, low-powered Bluetooth signals on their phones exchange a digital handshake. If someone subsequently tests positive for the virus – or in the case of the NHS app, reports symptoms – they then report it to the app which immediately pings an alert to all other people with whom they have been in close proximity in the preceding two weeks – instructing them to get tested ASAP. If such people then test positive they will be required to self-isolate. The technology will need to be supported by an army of human contact-tracers.
While Google and Apple’s solution ensures that contact tracing logs are anonymous and stored on the smartphones themselves, the version developed in the UK by the NHS stores that data on a central server. France and Norway have opted for similar centralised apps. This makes the data vulnerable to hackers. The NHS claims that its app wakes up if it detects that another device is trying to run it. That is good news, if true; but it has a cost in terms of the phone’s battery life.
I’ll wager that the tech giants – particularly Apple (NADAQ:AAPL), Google (NASDAQ: GOOGL) and Facebook (NASDAQ:FB) – will come out of this with their dominance entrenched as they become critical tools of public healthcare. I’ll explore that idea further shortly.
Not all measures required to reduce the risk of a second wave are medical or even technical in nature. Researchers at the University of Cambridge have identified 275 non-pharmaceutical approaches to reducing transmission, from virtual schools to online queues telling people when to go to a shop or surgery, and banning background music in public places so that people don’t have to get too close to speak to one other.
WHO, exactly, is “Ted”?
People (like Gordon Brown) who believe that all problems can be solved by international cooperation believe that there should be a global coordinated response to the pandemic – essentially coordinated by the World Health Organisation (WHO). On 14 April, the WHO published a playbook for countries to use as a guide when easing lockdown. David Nabarro, a WHO Director-General and others have called for a Pandemic Emergency Coordination Council that would unite the heads of the United Nations, WHO, the IMF and the World Bank, to provide the authority that the WHO alone lacks. The problem is that the loyalties of the WHO are suspect.
On 14 April President Trump, having previously been occasionally rude about the WHO, announced that the USA would no longer pay its dues. For his detractors, this confirms all their prejudices about Mr Trump – a man who deprives doctors of resources during a global pandemic, just as he cut funding for some of America’s key medical research institutions previously. But for those who see Mr Trump as in the vanguard of a new type of politics this is a harbinger of what the post-pandemic world will look like. The key is that China should no longer have things all her own way.
Does Mr Trump have a case? Last year the USA contributed $550 million to the WHO – about one tenth of its total funding. Shouldn’t the WHO have been orchestrating the development of vaccines and anti-viral medications in anticipation of this pandemic? Or would that be to expect too much?
Dr Tedros Adhanom Ghebreyesus has been the Director General of the World Health Organisation (WHO) since 2017. For the sake of brevity, I call just him Ted. Ted was the Foreign Minister of Ethiopia who invited the Chinese into the country by signing up to their Belt & Road initiative. When he was health minister in that poverty-stricken country (2005-12) he resisted calls to record several cholera epidemics (2006, 2009 and 2011). Even when he became chief of the WHO, Ted refused to record a cholera epidemic in Sudan
Ted is now given to writing jointly signed articles with Kristalina Georgieva, the Bulgarian Managing Director of the IMF in which they declare that protecting public health and putting people back to work go hand-in-hand. Since the pandemic first became manifest in late February, 85 countries have requested emergency finance from the IMF to the tune of up to $50 billion.
But, as Matt (Lord) Ridley has argued, the WHO has questions to answer.
First, why did it do so little since the SARS (2002-03), MERS (2012-present) and Ebola (2013-16) epidemics to prepare the world for a new pandemic of this kind? Certainly, some countries, such as South Korea and Singapore were much better prepared than others because of their previous response to SARS. But, as we know to our cost, even the most advanced economies in the world had not war-gamed national lockdowns: and the extent of the mayhem in developing countries is only just beginning to become evident.
Second, when the epidemic first appeared in Wuhan, the WHO downplayed its significance. As late as 14 January it posted that “Preliminary investigations by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel coronavirus”. Yet strong evidence had already been submitted that the virus was transmissible. Instead, Ted chose to heap praise on China, saying “China is setting a new standard for outbreak response”. Then he said China’s lockdown strategy “had brought time for the world”.
We now strongly suspect that China massaged the figures from an early stage. As I write, China is reporting just 82,881 cases – a figure that has hardly changed for weeks, as against about 1.26 million in the USA. A report by the University of Southampton has suggested that, had China acted three weeks earlier, the global pandemic could have been averted altogether.
Third, when in April 2014 the French charity Médecins sans Frontières declared that the Ebola epidemic was out of control in West Africa it was ignored. Instead, the WHO proclaimed that the defining issue of the 21st century was climate change. It was not until August 2014 that the WHO recognised the gravity of the situation.
Ted is also a bit of a publicity-seeker. In 2018 he wrote an article for The Guardian about suicide with that well-known medical scientist, Lady Gaga. Yet he did not act on the appeal of conservationists to condemn outright “wet” markets (that is to say markets where wild animals are sold alive to be slain and eaten).
China is a major funder of the WHO and as a result, Taiwan (which is one of the real exemplars in how to handle a modern pandemic) is excluded from membership. Ted is a Chinese client. Why did the WHO stall until 11 March before declaring a pandemic? In fact, the WHO has been amenable to doing China’s bidding all along.
The high degree of mistrust of China now makes a global coordinated response all but impossible. The idea that from hereon in America and her allies must “reset” relations with China is now entrenched.
Epidemiology, as I think we all now understand, is an inexact science. There are even factions amongst epidemiologists – we now know that Imperial College London and the Epidemiology Department at Oxford have been engaged in a long-term feud. There are also reports that pop up regularly with quite surprising angles on what is really going on.
Professor Isaac Ben-Israel of Tel Aviv University claims that all efforts to contain the disease will lead to the same result because the disease is self-limiting and burns itself out within 70 days – lockdowns or not. He thinks that shutting down major economies has had devastating consequences for little ultimate gain. However, the idea that all mitigation methods are pointless is considered highly eccentric by mainstream scientists.
The eminent German epidemiologist Professor Alexander Kekulé thinks that the young should be allowed to get the virus while the elderly must remain isolated. Lord Blunkett thinks that is ageist.
The revenge of the BBC
The Remainer mainstream media are enjoying an opportunity to excoriate the Brexiteer government which – if you follow Labour’s line – have, by their insouciance and incompetence, visited the highest mortality rate in Europe on the UK. Except that most British people don’t believe that. Rather, with some qualms, they think the government is trustworthy, if challenged.
What is unfolding is a classic autochthonous struggle. The BBC elite think that the Johnson government is out to destroy them (by abolishing a compulsory license fee) because they tried to undo Brexit – in alliance, of course, with a wing of the Tory Party which has now itself been destroyed. So, the BBC elite have decided that, in order for it to survive, it must destroy the Johnson government. Kill-or-be-killed. It’s entirely understandable in a dystopian, Darwinian context.
I suspect either one or the other will be with us in five years’ time – but not both.
Remembering Daniel Defoe
efoe’s Journal of the Plague Year followed on two years later from his enduring masterpiece, Robinson Crusoe, published in 1719. To this day this is the most successful book of fiction ever, having been translated into every written language on Earth. 300 years after it was first printed it is still selling. Only the Bible has sold more copies. One might have thought therefore that Defoe would be a very wealthy man, the 18th century equivalent of the creator of the Harry Potter franchise, who is a billionaire. And, pace Ms Rowling, the Potter phenomenon will probably prove to be much less enduring that the tale of the shipwrecked mariner.
But not a bit of it. He was permanently hard-up and on the run from his many creditors. Indeed he was in and out of debtors’ prison, rubbing shoulders with out-of-pocket minor nobility, gamblers, louche ruffians and impoverished gentlefolk – all mingling in a kind of genteel squalor. He died in poverty and was only saved from a pauper’s grave by the intervention of benefactors.
I find it endlessly fascinating to reflect on why some writers make money – but most don’t. My own most recent book received good reviews but my latest royalty cheque just managed to finance a trolley-full in Waitrose…
Defoe lies at rest in Bunhill Fields cemetery – just round the corner from the Design Centre, Islington, where Master Investor holds its annual show (next scheduled for 05 December – please note). John Bunyan (Pilgrim’s Progress), the mystic poet William Blake and the Rev. Thomas Bayes (creator of Bayesian logic on which modern computer security relies) rest there too. Well worth a visit when this interminable lockdown ends.
Life continues on schedule
May. The apogee of spring. And, bang on cue, last Sunday night the swifts arrived from Africa. They have colonised the ancient belfry of the locked-up church – just like in previous years, but with no human interference now. So that was the tapping I heard from the loft early this morning. Tonight they are wheeling and diving like manic sky-struck acrobats…Mother Nature always wins in the end.