Every week of pandemic that goes by we are learning new lessons – but some nations are learning faster than others. The key question for all is when can the lockdowns be safely fully relaxed – if ever? Victor Hill is on the case.
Good news, bad news
The good news is that as the US and Europe enter their second month of lockdown, they are working in so far as the number of new confirmed cases of Covid-19 may already have peaked – which means that fatalities are likely to peak during the last 10 days of April.
The bad news is that the exit from the lockdowns will not be accomplished overnight. In fact, it is going to take months rather than weeks to return to post-normality. As a result, in most major economies activity will remain at levels significantly below normal until well into Q3 if not Q4 2020. And that means there ain’t gonna be no V-shaped rebound.
Nearing the peak?
Last week I asked how we would know that we had reached the peak in the number of new cases of Covid-19 unless we tested everybody – which is clearly not going to happen. However, I now concede that the number of new cases emerging as patients with severe symptoms present themselves at hospitals could represent a sample of the population as a whole, many of whom will have been infected, yet remain asymptomatic. In the same way that we can predict election results with reasonable accuracy by polling a small sample of the total electorate, so we can estimate the broad spread of the infection from the number of people who have fallen ill.
Last weekend I was sent an analysis of the data by a brilliant young economist. What he has done is “to smoothen” the data by computing the ratio of the 5-day rolling daily case figures to new cases reported on a daily basis. As this ratio approaches 1.0, we can suppose that we have reached, or even passed, peak cases – at least of the first wave of the pandemic. That is because this number approximates the R0 value of the virus (i.e. how contagious it is). Why a rolling 5-day period? Because, early on, my economist noticed a surge in daily cases every 4-6 days or so and this corresponded to the incubation period data from China: that is the period that infected people are most contagious and are most likely to spread the disease.
The Chief Medical Officer for England, Chris Whitty, stated that there is roughly an 11-day time lag between infection and testing. If that is correct then here in the UK we passed peak cases about two weeks ago. This is based on two main assumptions. The first is that the virus transmits from one infected case to another in 5-day bursts. This is the length of time from infection to symptoms presenting – when victims isolate themselves, and thus end their own transmission line. The second assumption is that we can observe how infectious the virus is, or make a crude approximation of the R0 value, by computing the ratio of new cases 5 days ago to those recorded today. When the 5-day cases ratio – or approximate R0 – goes below 1.0, each case spreads to less than one other person and the virus starts to burn out as it is transmitted in ever decreasing amounts.
NB: This has not been peer-reviewed.
The trend line here suggests that the number of new cases recorded will reduce to zero in about eight days after this goes to press – so around 02 May – which is clearly unrealistically optimistic. But it does endorse the case that the lockdown has worked – even if it was arguably imposed too late. Other nations are recording similar results.
Professor Carl Heneghan of the Centre for Evidence-Based Medicine at Oxford University has calculated that the UK peak occurred as early as 08 April. One problem is that not only do practices relating to recording deaths from Covid-19 vary from country to country, but the figures issued by Public Health England do not tally with those published by the ONS because the former only records deaths from the virus in hospitals.
Relaxing the lockdowns
This week Germany, Denmark and Austria announced limited relaxations of their lockdowns to be phased in between now and the beginning of May. There were long queues of shoppers outside DIY stores as Austria. Spain, France and Greece plan to limit their isolation measures over the next three weeks. Italy, perhaps the worst affected European country, plans a gradual re-opening from 04 May.
In the US, where Covid-19 is now among the top three causes of daily deaths along with cancer and heart disease, a similar trajectory is envisaged. Most states remain under stay-at-home orders until the end of April. The reopening guidelines announced by the White House last Thursday (16 April) are vague and offer latitude to individual states. Sparsely populated states with a relatively modest disease burden so far could well start reopening in early May.
What has surprised most governments is how amenable citizens are to the curtailment of their civil liberties. That is largely explained by the principle of self-preservation – though there is a significant minority of people across the world who just don’t get it. Generally, people fear dying unpleasantly more than losing their incomes temporarily.
The Chinese experience – even though the Chinese figures are questionable – remains our only template for the efficacy of a protracted lockdown. The Wuhan lockdown began on 23 January and lasted for over 70 days. It is not well understood how or why the virus did not reach the big population centres of Beijing or Shanghai; nor how China has managed to keep its ruling class apparently uninfected. The French virologist and Nobel laureate, Luc Montagnier thinks that the virus was man-made, and that it probably accidentally escaped from a laboratory in Wuhan. If evidence accumulates for that explanation then the consequences – economic and geopolitical – will be huge.
The problem is that nobody knows for sure if the virus might spring back or not in a second or even a third wave. The data coming from Milan this week is concerning – the number of new cases is rising again. The news coming out of South Korea – a country that is a model of pandemic management – is not re-assuring either. Some survivors have succumbed to a second round of infection.
If the policy is to protect the NHS then any potential upswing in infections must necessarily close down the economy again. Even though the real scandal in the UK is that possibly most of the victims of this pestilence died not in Nightingale Emergency Hospitals but in care homes with DNR (Do Not Resuscitate) notices strapped to their bedsteads.
Learning lessons
The historian Niall Ferguson (not be confused with the epidemiologist Professor Neal Ferguson of Imperial College London) wrote recently[i] that plagues tend to be bad news for big empires with porous frontiers; while city states which can close their gates have fared much better throughout history. And in this current coronavirus pandemic small, nimble nations seem to have fared better than large populous ones.
Israel, Taiwan and New Zealand will be regarded after this is all over as case studies in pandemic containment. Sparsely populated countries have an advantage over densely populated ones and rural areas are less prone to infection than urban ones. For example, the Republic of Ireland, which really has only one large metropolis – Dublin, with about 560,000 people – has a fatality rate per thousand people of about half that of the UK. And New Zealand, an English-speaking country of about five million people with a very similar social and political culture to that of the UK is worthy of analysis.
The New Zealand government under Jacinda Ardern decided to impose a tight lockdown very early on in the progression of the virus in the country. All New Zealanders have been sent a comprehensive risk assessment which outlines what is expected of them across four Alert levels. These are: Level 1 – Prepare; Level 2 – Reduce; Level 3 – Restrict; Level 4 – Eliminate. The country was placed immediately on a Level 4 lockdown on the understanding that it would be relaxed gradually over time in accordance with the success in containing the disease.
I had a Zoom session with a cousin in Auckland over the weekend and he understands precisely what the exit strategy is. The literature the NZ government has disseminated to its people is clear and precise – much more impressive that the letter we received from our PM. NZ has had thus far (Thursday afternoon) 1,451 confirmed cases and just 16 fatalities.
New Zealand banned visitors from China in early February even before it had a single case of the virus. Australia has closed its borders completely. In contrast, the UK refused to close its borders – flights have been arriving at Heathrow and elsewhere from China, Iran, Italy and other Covid-19 hotspots every single day this year. Their passenger-loads then travel to central London on Mr Khan’s crippled, incubatory tube lines.
Since March, New Zealand has been unique in seeking not just to flatten the curve of coronavirus cases, as most other countries have aimed to do, but to eliminate the virus altogether. Covid-19 testing is widespread. Supermarket shoppers are even being tested randomly and, if positive, their contacts traced. The health system has not been overloaded. New cases peaked in early April.
This is not rocket science – it’s largely common sense.
The tyranny of “experts”
In an obnoxious article for the New Statesman last week, Caelainn Hogan quoted an unnamed Irish researcher to the effect that First of all, they [the British] told us during Brexit not to listen to experts…Now they will try to shift the blame to the scientific community…
There will be plenty of time for recrimination and blame after the virus is beaten. For now, I note that, in reality, the UK political class has treated the scientific community with a fawning reverence which it does not deserve. What nobody seems brave enough to say is that “experts” have inherent cognitive biases even if they are not aware of them. This was the subject of Daniel Kahneman’s Thinking Fast and Slow, one of the most influential books on behavioural economics of recent years.
The psychologist Paul Slovic, who greatly influenced Kahneman, found that an affect heuristic leads people to “let their likes and dislikes determine their beliefs about the world.” If you are biased towards strong government action to combat the coronavirus, you will believe that the benefits of lockdowns are substantial and their costs manageable.
The American economist Barry Brownstein wrote last week that media coverage of the impact of the coronavirus is biased towards novelty and poignancy. The resulting emotional reaction shapes our estimates of the risks, which include the health risks determined by the lockdowns – such as cancelled treatment for cancer sufferers, which will certainly lead to increased mortality.
The quantification of risk is not objective; and experts have exactly the same cognitive biases as non-experts. What’s more, experts are always overconfident in their own assumptions because they are constantly told that they are experts– in effect, magi. Moreover, put two experts together and they are susceptible to group think. The popular wisdom is that groups are smarter than individuals; but there is a lot of psychological evidence that groups can be stupid because they are guilty of confirmation bias. That is, they unconsciously seek information which confirms their underlying intuitions. The upshot is to make any dissenting opinion look eccentric.
No doubt Professor Whitty knows a whole lot more about epidemiology than I (or you) do; but, as James Surowiecki explains in The Wisdom of Crowds: There’s no real evidence that one can become expert in something as broad as decision-making or policy.
Lessons from WWII
In his book Britain’s War Machine, Professor David Edgerton explains how the British civil service convinced the politicians at the beginning of the WWII that there would be millions of British civilian deaths in short order as a result of the bombing of civilians by the Luftwaffe. As early as September 1939 hospitals were emptied and the mass evacuation of children from the major cities began.
The initial estimate by the War Office was 50 killed and wounded per ton of bombs dropped. The Home Office then raised this estimate to 72 casualties per ton of bombs dropped, based on analysis of Nazi air raids on Barcelona in March 1938. Professor Edgerton writes: Some evidence also from Barcelona suggested seventeen casualties per ton, but that was ignored. The Air Ministry warned Neville Chamberlain that there would be 2.5 million casualties in the first ten weeks of the War.
As early as February 1939 Anderson shelters – mass-produced with corrugated iron – and gas masks were being issued to the working classes. Predictably, Labour argued that these protections were inadequate and demanded that more be done. But when it came, the bombing was far less deadly than expected. Professor Edgerton estimates that the final death toll during the Blitz was 2-3 casualties per ton of bombs dropped. Though, that still represents 150,000-200,000 lives lost.
***
My grandmother saw off my mother and her two younger sisters from Paddington in the bleak January of 1940. No one knew where they were going. They ended up in Northampton. In later life they never spoke about the three-and-a-half years they spent there, though I knew they had been separated. I wish I had thought to ask them – but now it is too late, as they are all gone.
They returned to London at the end of 1943, when the Home Office relaxed its evacuation policy – just in time for the end-of-war doodlebug attacks which nearly killed them all one evening. That’s experts for you.
I was mowing the lawn the other day and suddenly an image came into my head of three young women on a train heading to an unknown destination and an uncertain future. I felt a stab of vicarious anguish.
As for my father, he was sent to Exeter. He didn’t care at all for his host family and – literally – got on a bicycle (which I suspect he stole) and peddled back to London. Once there, he delivered himself to an RAF recruiting station, where he lied about his age (he was only 17). A few weeks later he was on the Old Queen Mary, then acting as a troop ship, heading for Canada. He spent most of the War flying Hurricanes over the Great Lakes.
A few years ago my partner and I were touring California and we stayed on Queen Mary I, which now serves as a boutique hotel in Long Beach, in the sprawling suburbs of LA. After an admittedly bibulous dinner, I wended my way back to my “cabin”; and, as I was negotiating the long corridors, I conceived the extraordinary notion that my father was present beside me.
I’m not sure that I believe in ghosts or spirits. But, as Hamlet said: There are more things in Heaven and Earth/ Than are dreamt of in your philosophy, Horatio.
[i] Corona Wars. The Spectator, 18 April 2020.