Monday 15 June 2020

Time to take some risk or get a two word answer

The government's strategy of using its scientists as human shields may be about to implode. We've heard ad nauseam that it has been either "following the science" or "guided by the science". Yet the  "science" has not yet had the answer to more than a small proportion of the many relevant questions we are facing in tackling the novel coronavirus. So we are being guided by the judgement (or guesswork) of some admittedly knowledgeable scientists. Scientists whose advice continued to be based on a flu type rather than a SARS type virus in the early stages of the outbreak, which may have contributed to some of the missteps made by the decision makers.

While support for the government was very high at the start of lockdown it was always going to be the case that it would wane as we started to ease, with some feeling we are going to fast and others feeling we aren't moving fast enough. But the government has exacerbated this natural dichotomy by appearing indecisive at best.

A classic example of this is the face mask issue. It was understandable in the early stage of lockdown, when there were severe PPE shortages in health and care settings, that the government was not inclined to recommend face coverings. After all the "science" (and the WHO) always said there wasn't much, if any, benefit. For what it's worth I've always believed that bit of the science. But whether there is any benefit also depends on the particular situation you are in. More significantly it seemed to me that, to purloin a phrase from health and safety legislation, wearing a face covering is "reasonably practicable". Home made versions aren't costly and don't reduce the availablity of PPE for others. It's not particularly onerous and it might make the wearer feel safer though at the risk of giving false confidence. Or, since the main benefit is to others not the wearer, it might make wearers feel better about themselves. So it seemed to me that it was an easy thing for the government to say at the outset that the wearing face coverings, but not medical standard PPE, was a sensible precaution while warning that the benefit might be small.

While the science didn't change, some circumstantial evidence showed that countries with a mask-wearing culture were doing better in terms of controlling spread of the disease. That might just be noise on the line as there are a lot of confusing patterns when you look at what various countries are doing and their stats on numbers of cases. But another opportunity to advocate face coverings was missed. They didn't go there, resisted when Sadiq Khan called for face coverings on public transport and then finally back tracked and made them compulsory as part of the lockdown easing as two metre separation is impossible in that context.

For what it's worth, as I don't normally use public transport or have to work in an environment where 2 metre separation is problematic, I'm going with the original science and not wearing a face mask when I shop, having tried it early in lockdown and found it extremely uncomfortable. There is also a problem with spectacles misting though I've been told if you dunk them in the washing up bowl and leave them to dry the detergent film stops them from misting. But from a political point of view the face mask issue has made the government look confused and indecisive. Playing catch up with Khan after about a month was embarrassing.

There was a lot of criticism in the early stages of lockdown about the absence of an exit plan. At the time I pooh-poohed this criticism but I was wrong. If ministers (and their advisers) had thought some of these steps through at the outset then they might have taken some different decisions - on advising face coverings for starters - and they might have adopted different messaging from the outset. I've written before about people who could have worked opting to be furloughed. Having put the fear of God into most people and given many the financial opportunity to stay at home it isn't a surprise that some are reluctant to engage in the move back towards normality.

In the case of schools there is nothing the teaching unions like more than to defy a Tory government. As the risk to children has always been small and evidence from other countries seems to show that schools being open does not contribute significantly to the spread of the virus the teachers protestations about risk have always rung hollow. I could understand concerns about the welfare of older and BAME teachers but the blanket resistance to schools opening appears to me a blatantly politically driven tactic. Making things awkward for the government and increasing the depth and length of the recession is just too tempting.

But here also the government has failed to look more than a single step ahead. It was always obvious that there would be a capacity problem for schools as well as public transport with a 2 metre separation distance. Charging ahead and trying to get schools open more or less normally before reviewing that restriction was always doomed. And why is it only now that we are hearing plans for summer schools to allow some catch up? Mrs H will confirm I've been advocating this since March, taking advantage of the (normally) better weather to have more outdoor classes - and more healthy sport - to split class sizes and provide separation.

Indeed I'm a bit surprised both Gavin Williamson and Grant Schapps (responsible for education and transport respectively) didn't press back on the 2 metre rule saying there was no point in planning any resumption with it in place. But these ministers aren't part of the inner "quad". Williamson's days may be numbered because, as the Sunday Times reports one government insider saying, once you've realised he looks and sounds a bit like Frank Spencer there's no unseeing that image. But the quad is overly influenced by the fact that half of them have been ill with coronavirus and, in Johnson's case certainly, he looked under the weather for a long time after he resumed his duties and he may well not be fully recovered yet.

For education I feel we have already reached the stage where it might be better to aim for a full restart in January 2021, with all year groups starting where they were in January 2020. I accept a cohort of youngsters going to further education aged 19 rather than 18 might present a problem for the universities but I'm sure solutions can be found. The intervening time can be used to broaden educational opportunities for a group that otherwise will have only had reduced levels of teaching. One of my concerns is that a generation of engineers and doctors may be pushed through the system with gaps in their knowledge just to try to keep this and the next academic year moving on the normal timescale.

While we start to collect the worst economic performance data anyone alive has ever seen there is some evidence that
  • the number of new cases in the UK was already declining before we went into lockdown*
  • covid-19 might have been much more widespread at a much earlier stage than previously thought with anecdotal stories of people with covid type symptoms in January and February now being joined by some positive antibody tests for some of those people
  • if there is any substance in those points then taken together they mean that Prof Ferguson's model (the mathematical one which predicted a quarter to a half a million fatalities in the UK, not his floozy) quite possibly had completely the wrong input data. As his model could give flaky answers anyway (see University Challenged - it's all in his head 8 April and It's On His Head 24 May) Ferguson's estimates for covid may well have been as reliable as his 2009 estimate of 65,000 UK deaths from swine flu. (The actual number turned out to be 457 and this isn't his only "form" in apocalyptic predictions). I've not seen this garbage in - garbage out (or in this case gospel out) argument anywhere else but its seems more than possible to me. 
All told we probably locked down too late, then understandably went too hard without much thought on how to exit. Now we are struggling to make coherent changes to ease the lockdown and save the economy, leaving people confused and confidence evaporating.  

At the start I said the government's strategy of using its scientific advisers as human shields could be about to implode.  Sources told the Sunday Times there was concern that Prof Whitty and Sir Patrick Vallance could quit: their posture was "much more aggressive" and they were on "resignation watch" (I thought this was normally called "suicide watch" in political circles, but they are scientists not ministers). The flash point may well be the 2m rule.

So where does the 2m "rule" come from? It dates from basic scientific research in the 1930s which showed that droplets released by coughs and sneezes mostly land within 1-2m. Sure, aerosol could get blown further (but also presumably diluted) and MIT recently showed specks could go up to 6m using high speed cameras.  But, surprise, surprise the chance of exposure and therefore catching the virus diminishes with distance much as per the classic inverse square rule. Time of exposure, and so the total "load" of virus one gets exposed to, also comes into it. A recent study published in The Lancet concluded that keeping at least 1 metre away from others was "the best way" to limit the chance of infection, saying that the risk is 13% within that distance but 3% beyond it. Sir Patrick Vallance has said spending 6 seconds at a distance of 1m presents the same risk as a minute at 2m implying that the extra metre reduces risk by a factor of 30. But the key question for that statement is what the risk is at 1m: Vallance says it goes from "small" to "very small" at 2m. He also said what you do with this information is a risk-based call rather than "science" per se.

This presents the government with a big problem. The population has never been comfortable with processing information on risks over which they feel they have little control, so-called "involuntary risk". In contrast, where the risk is one they choose to take because of a perceived benefit, whether it be speeding, jaywalking, or going for a bungee jump, they will accept remarkable levels of risk voluntarily. So we had the spectacle of people asking how come schools were dangerous and closed on Sunday 31 May but safe and due to re-open on Monday 1 June: what had changed? (This was a question that might well have been asked by families sitting on a crowded beach that weekend). The question was easily answerable but the government has proved incapable of explaining to people that they weren't completely safe staying at home and they aren't now at huge risk going to work or school. This is a problem the government could have anticipated and could have been preparing the ground for, with information on the benefits and risks of lockdown and easing. The stat that kids are more likely to die by being hit by lightning than going back to school gives some perspective.

I'm not normally one for blaming advisers but it is possible Dominic Cummings is partly to blame as the architect of the mind-numbingly simple messages which worked well in getting people to stay home but have now served their purpose.

But what if Matthew Parris is right* and the scientists are "wrong"? They can look at the wreckage of the economy at some stage in the future and say "it was only prudent to be cautious". Whitty acknowledges the health detriments of lockdown but I can see no evidence that he actually factors that into his advice, let alone the broader impacts.

The government will have to move on this at some point. They might as well make a virtue of doing it sooner rather than later. But there will be a political crisis if the key scientists resign. However, there are plenty of reputable scientists who think it is high time to relax the lockdown and plenty who think it far too early. This is a risk based judgement - a political call where the costs, risks and benefits to the whole country have to be weighed, based on gut feel as much as science.

So the government might need to urgently convene a broader group of scientists if it thinks its current appointees are, ironically, too "conservative". Or it can say that, on this point, it is going to follow the WHO advice - which is 1 metre, pointing to the many countries that have adopted this distance some of which, admittedly, have better track and trace or other measures in place to limit the risk.

The government also urgently needs to communicate a more nuanced message. Two word soundbites won't do the trick. Or they'll be told two words at the next election.

* Matthew Parris, The Times, 12 June


4 comments:

  1. 'In the case of schools there is nothing the teaching unions like more than to defy a Tory government.' Now where's your evidence for this Phil? As a Trust Member of a High School Academy I've seen no evidence of the teaching unions using the pandemic as a political football. Yes I might be an old trade unionist at heart but seriously that's just a Daily Mail-type
    line which does not need repeating as I see teachers and indeed their union reps working hard to get children back into school.

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    1. I only need to quote Mary Bousted, joint general secretary of the National Education Union who said in a Zoom meeting pupils were 'mucky, who spread germs, who touch everything, who cry, who wipe their snot on your trousers or on your dress'. She said this was part of the reason why a June 1 reopening date was unacceptable.
      This was of course in the Daily Mail so it might be true, but Bousted didn't deny it, she said she could react too quickly and be wrong at times and hid behind being a "blunt northerner" which is a weird bit of self-stereotyping.
      It is also notable that academy schools seem to have made more progress towards re-opening. It would be interesting to know if that is a factor in the more constructive local dialogue you report. After all, most of the issues are school specific on account of layout etc.
      As more evidence, in the state sector the NEU has actively discouraged its members from using live-stream technology to teach children in their homes with Bousted prominent in that too. A private school head has said "The unions have discouraged online classes on safeguarding grounds. In normal times that would be a consideration. But these have not been normal times. The real reason for the NEU's opposition is that remote teaching is difficult. It has been a huge effort for our teachers to make this work. The unions don't believe their members should make that effort. And now they are arguing there should be a moratorium on exam results next year because they want to disguise the effect of what they have been doing. Or rather not doing".
      Other countries have made much quicker progress on re-opening schools without apparently leading to an increase in rates of infection.
      I'm sorry but I expect I am far from the only person who thinks that teachers unions have been obstructive to reopening and more generally to change, especially if the change comes from a Conservative government, for decades. Teaching is the most heavily unionised profession in the country and it shows.
      Teaching unions protect bad teachers facing disciplinary measures in a way no union in industry would. The almost permanent tenure of bad teachers in the UK state sector is a major factor in poor school performance. There is an interesting international comparison which is relevant right now. It's just as hard to sack a bad cop in the USA because of
      union strength. Derek Chauvin, facing charges of murdering George Floyd, had at least 17 misconduct complaints but only two letters of reprimand. His local trade union president, Bob Kroll, accused the authorites of "despicable behaviour" and "selling out" his members. Kroll himself is the subject of 29 known complaints.
      I applaud all teachers and their local representatives who have worked hard to keep schools open for key worker families during the lockdown. But I'm afraid I see more obstruction than attempts to solve problems at national level in their unions.
      This issue has been badly mishandled by the government, partly because they seriously underestimated the capacity of the unions to give all possible support to re-opening short of anything that could provide actual help.
      In an ideal world government and the unions would have worked collaboratively together to get schools open by now. I don't criticise the government for not achieving that because, with the NEU, it's pie in the sky.
      Unions can be a great force for good. You can see I feel that is an extremely weak force indeed in the case of the teaching unions.

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  2. Well the evidence of my eyes has been very different Phil. I can't claim to have seen the NEU leader on a Northern rant though but the documents I've seen from the NEU have been calm and sober.

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  3. Oh and just a further thought. Trade union leaders often tend to be over the top. I rarely found one in my time as a trade union officer that I had much time for. Showmen often - notice men rarely women. But I do like Frances O'Grady who leads the TUC. I met Dave Prentice of UNISON once but it would be impolite to say what I thought of him.

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