Villain or Victim?

As the surreal nightmare continues and death-toll rises inexorably, in addition to the battle against the virus there's an information and PR battle going on. Mindful of the recent blog post 'Truth Doesn't Matter' here are two articles from yesterday that rather neatly illustrate the truth v emotion dilemma. This from the Guardian:-  

We scientists said lock down. But UK politicians refused to listen

For 11 fateful days in March, the government ignored the best coronavirus advice. It must learn from that mistake

In mid-February a colleague mentioned that for the first time in his life he was more concerned than his mother, who had been relatively blase about the risks of Covid-19. It felt odd for him to be telling her to take care. We are both professors in a department of infectious disease epidemiology, and we were worried.

Two months on, that anxiety has not gone, although it’s also been joined by a sense of sadness. It’s now clear that so many people have died, and so many more are desperately ill, simply because our politicians refused to listen to and act on advice. Scientists like us said lock down earlier; we said test, trace, isolate. But they decided they knew better.

Am I being unfair? The government assures us that its decisions and timing are based on science, as if it is a neutral, value-free process resulting in a specific set of instructions. In reality, the science around coronavirus is in its infancy and developing daily, with researchers across the world trying to understand how the virus spreads, how the body responds – and how to treat it and control it. The speed at which our knowledge has increased is impressive, from the sequencing of the virus in January through to having candidate vaccines in early February.

Mathematical models are being refined to predict the extent and speed of spread and estimate the impact of control methods. My own group is studying the response of communities, showing how the epidemic is amplifying existing social inequalities. People with the lowest household income are far less likely, but no less willing, to be able to work from home or to self-isolate.

But while scientists carry out observations and experiments, testing, iterating and discovering new knowledge, it is the role of policymakers to act on the best available evidence. In the context of a rapidly growing threat, that means listening to experts with experience of responding to previous epidemics.

When I say that politicians “refused to listen”, I am referring to the advice and recommendations coming from the World Health Organization, from China and from Italy. The WHO advice, based on decades of experience and widely accepted by public health leaders and scientists around the world was clear – use every possible tool to suppress transmission. That meant testing and isolating cases, tracing and quarantining contacts, and ramping up hygiene efforts.

The UK did well in the early phase, but then, on 12 March, the government alarmed many public health experts by abruptly abandoning containment and announcing that community case-finding and contact-tracing would stop. The aim was no longer to stop people getting it, but to slow it down while protecting the vulnerable.

The evidence underpinning the government’s decision appears in a report from 9 March summarising the potential impact of behavioural and social interventions. The report did not consider the impact of case-finding and contact-tracing, but it did suggest that the biggest impact on cases and deaths would come from social distancing and the protection of vulnerable groups.

And yet social distancing was not recommended then. That day, 12 March, after hearing with disbelief the government announcement that didn’t include widespread social distancing, I recommended to my team at Imperial that they should work from home for the foreseeable future. Indeed, I have not been to my office since.

Neither the advice nor the science were followed that week. My colleagues, led by Neil Ferguson, published a report on 16 March estimating that without strong suppression, 250,000 people could die in the UK. The government responded that day with a recommendation for social distancing, avoiding pubs and working from home if possible. But there was still no enforcement, and it was left up to individuals and employers to decide what to do. Many people were willing but unable to comply as we showed in a report on 20 March. It was only on 23 March that a more stringent lockdown and economic support was announced.

Between 12 and 23 March, tens, if not hundreds of thousands, of people will have been infected. Boris Johnson himself may well have been infected that week, and his stay in the intensive care unit may have been avoided if the government had shifted to remote working on 12 March. The current best estimate is that around 1% of those infected will die.

So where to now? Once again, public health experience, including modelling, leads to some very clear recommendations. First, find cases in the community as well as hospitals and care homes; isolate them, and trace their contacts using a combination of local public health teams and digital tools.

Second, know your epidemic. Track the epidemic nationally and locally using NHS, public health and digital surveillance to see where cases are continuing to spread. This will be essential so that we can start to lift the lockdown while shielding the population from hotspots of transmission. Build community resilience by providing local support for vulnerable people affected by the virus and the negative impact of the control measures.

Third, ensure transmission is suppressed in hospitals, care homes and workplaces through the right protective equipment, testing, distancing and hygiene. Investigate the differential effects on black and minority ethnic groups, and provide appropriate protection.

Fourth, ensure that the most vulnerable, socially and medically, are fully protected through simple access to a basic income, rights for migrants, and safety for those affected by domestic violence.

Many, including the Labour leader, Keir Starmer, say that now is not the time for blame. I am not looking to blame – but for scrutiny so that lessons can be learned to guide our response. We need to avoid further mistakes, and ensure that the government is hearing, and acting on, the best advice.

Helen Ward is professor of public health at Imperial College London

--oo00oo--

Now here's the thing. Each of us has to weigh-up the evidence and decide if Boris has/is doing a good job or not. Are more of us dying because of 10 years of Tory austerity cuts to the NHS, callous decisions, poor planning and f*cking Brexit, or just like Trump, is he doing a brilliant job in very trying times? 

We know the blame game has started and this astonishingly-fawning piece from the FT  confirms what many of us must be dreading, that the recent hospital stay has done wonders for Boris and his popularity. Of course there are those who are suspicious as to just how serious it all was and I see FOI requests have gone in to St Thomas' Hospital Trust, but I'm sure patient confidentiality will see that easily batted-off.     

Boris Johnson’s illness has made him more powerful

The UK prime minister’s brush with death has deepened his ties with voters

A strange thing happened last week. An awful lot of British voters discovered they were much more attached to Boris Johnson than they realised. Since Brexit, the UK prime minister has been a divisive figure, but his struggle with Covid-19 left all but his most partisan foes shocked, scared and desperate for news of recovery. One ex-cabinet colleague observed: “It reminded people of why they liked him when he was mayor of London.” 

In such times the country would be fearful for any leader, but Mr Johnson’s vitality made his brush with death more shocking. On news of his recovery, one newspaper seemed to forget the nearly 1,000 deaths that day, declaring on its front page: It “really is a Good Friday”. 

Mr Johnson was already a powerful premier with a particularly regal edifice around him — a court of close aides in Downing Street and a largely untested cabinet. Even so, before he got sick it was possible to see him politically undone by the crisis, not least over the laggardly response and early errors. 

Amid the confusion and strategy shifts, Tories were star-struck by the confident performance of the chancellor, Rishi Sunak. But Mr Johnson’s illness has augmented his authority. He may be recuperating for some time but no one now doubts where power resides. 

Critics will rightly question his stewardship of the crisis. They are right to be angry. The UK death toll may end up as the highest in Europe and there are issues around the availability of protective clothing for health workers. But his personal crisis has replenished his political capital and shown the absence of successors in his league when it comes to shaping public opinion. 

His gift for communication and political nous had long put him closer to voters than opponents would wish to admit. The emotional film released soon after he left hospital was superbly pitched. Since the Brexit campaign, he has allied himself with the National Health Service. Now, with his heartfelt praise for the organisation which “saved my life”, a Tory leader has made himself high priest of the institution, described as the UK’s national religion. 

True, even Winston Churchill’s political skills counted for little in the election after the second world war. But Mr Johnson has more than four years until he need face voters. The facts of the crisis may finally overcome sentiment but, if scapegoats are needed, he is unlikely to be among them. His courtiers are already scrambling to blame early mistakes on others, partly also to justify the drive for Whitehall reform. 

This moment raises him to a higher pantheon of leaders; those who enjoy a direct rapport with the public and who seem to exist at one remove from their cabinet, presiding over ministers who do their bidding. The failures will all be theirs; the success his. No more of this “first among equals” nonsense. Mr Johnson has worn many guises in his career. The political jester, the globalist and socially liberal mayor, the ardent Brexiter, the romantic populist, the British Gaullist and the Conservative leader running against his own party’s record on austerity. After the bitterness of Brexit, he has the chance to recreate himself again, should he wish.

How might he use this new status? We cannot know, but there are some solid bets. To deflect blame for shortages caused by austerity he will shower resources on the NHS and other services, not least social care. A hypothecated health tax, long resisted by the Treasury, may find its hour has finally come. He will champion British resilience in areas that have been shown to be crucial, notably pharmaceuticals, life sciences and medical supplies.

While focused on getting Britain back to business as normal, he will try to weave a narrative of a new social contract — perhaps addressing some of the inequalities most exposed by the crisis. But he will seek to harness the notion of national collective endeavour to ease the pain of the long economic recovery. If, as many in government expect, he needs to extend the Brexit transition, it will now be seen not as a recognition of reality but as an act of statesmanship. 

Another area for readjustment might be immigration, an issue on which Mr Johnson is instinctively more liberal than some of his allies. He will not abandon his points-based plan. But the recognition of NHS and social care workers from overseas, and the disproportionate death toll among those of immigrant origin, gives him room to soften the tone and erase its most pernicious aspects. 

A crisis that might have wrecked Mr Johnson looks set, through the misfortune of serious illness, to have strengthened him. His original agenda has been thrown off course but, as he plans the rebuilding that must follow, his bond with the public is deeper than ever.