Thursday 21 May 2020

Is it incompetence or subterfuge?

Yesterday, the English PM told us that his government was recruiting 25,000 contact tracers, who would be able to deal with 10,000 cases per day. Now he could, of course, have been lying, either about the number being recruited (the original target was only 18,000) or about how many cases per day they would deal with. He’s not exactly famous for his honesty. Or, more charitably, he was merely demonstrating his own lack of mathematical capacity. Again, he’s not exactly famous for his grasp of detailed fact. But let us suppose, just for one moment, that he was accidentally telling us the truth for once – what does that mean in terms of strategy?
We know that the rate of new infections has been coming down and is now around 2500 per day. We also know that if there is more testing, then the number of new mild or asymptomatic cases will increase without increasing either the hospitalisation rate or the death rate. And we know that it would be prudent – in the light of the incompetent approach to testing and PPE to date – to ensure that the capacity is higher than the anticipated need (although I don’t really have much faith that the government has learned that lesson yet). We also know that the strategy – insofar as there is one – is not to try and emulate the most successful countries in the world by more or less eliminating the virus, it is simply to keep the number of infections at a level which does not overwhelm the NHS. All that probably tells us that, for the foreseeable future, the government is planning for somewhere between 5,000 and 10,000 new cases per day.
It’s a compromise, of course. It’s a question of balancing the extra short term cost and effort involved in a more aggressive elimination strategy (likely to be large, having allowed the pandemic to reach current levels) against a lower longer term cost of simply managing the levels. And if a vaccine emerges fairly soon and if being infected / vaccinated confers a degree of protection (both of which are currently rather large ‘if’s) then it’s a reasonable approach to follow, provided that the limitations and calculations are properly explained. It’s a gamble, though – if neither of those things comes to pass, then merely managing the rate of infection rather than trying to eliminate the virus means that eventually at least 50 million are likely to be infected across the UK. Although they claim to have abandoned the ‘herd immunity’ strategy, their actions speak louder than their words, and it still appears to be the default policy.
Simple mathematics tells us that at that level of infection, it will take at least 5000 (50,000,000/10,000) days (or more than 13 years) before that number of people have been infected. Even if the death rate (given a higher number of detected mild/ asymptomatic infections) reduces to around 0.5% of those infected (another big ‘if’), that amounts to some 250,000 deaths. Because they are spread out over a lengthy period, they may not have the same impact, but that’s little comfort to the deceased or their families. It looks, most of the time, as though the government aren’t taking decisions on the basis of any strategy at all – merely reacting to events and pressures as they occur, bending this way and that in an attempt to escape blame or responsibility. I wonder at times, though, whether all the bluster and apparent incompetence isn’t a cover for the fact that they have taken some big decisions, but just don’t want to share those decisions with us. And I’m not sure which of those two options worries me most.


Anonymous said...

You have clearly misunderstood what is going on.

No-one is trying to 'eliminate' anything. South Korea and other countries are trying to 'contain' the virus. Here in the UK we are trying to 'manage' the rates of infection to ensure health services are available to all those in need.

John Dixon said...

I think you're playing at semantics here. Some countries are trying to reduce the incidence to a level as close to zero as possible for which 'eliminate' is a useful shorthand; others arr trying merely to ensure that the level of infection is such that there is always an ICU bed available. You suggest that the UK is in the latter category - that was precisely my point. But they're not being honest about the consequences of that.