Three things lockdown critics just don’t get

Here in England, the British Prime Minister, Boris Johnson, is under fierce attack from his backbenchers over both the four-week lockdown that is coming to an end, and the system of tiered restrictions that will replace it, which means that almost everybody will still be subject to heavy restrictions. These critics are, for the most part, very muddled. While I would not suggest that Mr Johnson’s management of the pandemic has been particularly competent, I do think his overall strategy is the right one.

Still, the critics are right about a couple of things. The first is that lockdowns will not eliminate the virus, which has been a realistic objective in Asia and Australasia. This is because, unlike them, we cannot seal off the country from people coming in. That would mean closing almost all airports, ferry ports and the Channel Tunnel. The trickle of people allowed in (including returning Britons) would be quarantined under guard. Goods would have to be picked from ports by drivers based in this country. It would make Brexit look like a walk in the park. No European country, or American one come to that, can enforce such a regime. It is remarkable that so many Asian economies, as well as Australia and New Zealand, are able to do this. Without having to deal with such a volume of incomers, it is possible for a rigorous test and trace system to stay on top of the virus. New Zealanders can now go to rugby matches and concerts without social distancing. The economic cost is substantial, but this regime seems to be popular with those that live there.

The second thing that the critics get right is that the costs of an effective lockdown are huge, in both jobs and wellbeing. and that the longer the lockdown goes on for, the greater the cost. But no supporter of lockdown suggests otherwise. They simply say that the alternative is worse. That is because of three things in particular that the critics mostly fail to grasp.

The first is that infectious diseases grow exponentially, and not arithmetically, unless you can impose restrictions that reduce the reproduction rate down to one or less. And that means being very restrictive: the virtual cessation of social life (England’s Tier 1 is not enough, current evidence suggests). If the reproduction rate is above one, then the disease keeps on getting worse, and will accelerate. The critics seem to suggest that there is some form of equilibrium to be found between the level of restrictions and the prevalence of the disease. So, for example, a high level of lockdown means, say, one hundred deaths a day, but a looser one means a thousand. If R is above one, however, there is no such equilibrium. The equilibrium is not a function of lockdown restrictions, but the achievement of herd immunity – which means that 70% or more must be immune (the widespread assumption being from having already caught and survived the virus), and so breaking the chain of infection. The cost of that is massive. In Europe levels of significant herd immunity have only been observed in Italian towns were the disease has killed 1% or so (see this article in the Economist).

And the second point that few critics grasp is that the damage wrought when the virus shows high levels of prevalence is about much more than a few extra dead bodies. The disease will reach a point where it is be seriously disruptive. That people can’t see this was driven home to me when a senior Conservative MP Mark Harper was interviewed on the radio. He trotted out the familiar trope than people were underestimating the costs of lockdown, which had to be weighed against the benefits. He gave star billing among the costs to reduced access to healthcare services during lockdown. And yet there will be no access to such services once the epidemic starts to overwhelm them, and it is fear of just that which is the main driver of lockdowns; without lockdown health services will be overwhelmed as sure as night follows day. And it won’t be just health services that suffer. Absenteeism will rise dramatically, disrupting all manner of services. And fear will keep at least 40% of the population at home, with the inevitable toll on mental health and the economy. Covid-19 is much deadlier than flu (or at least the strains of flu normally seen each winter), and cannot be weathered in the same way.

And the third point? It is simply not feasible to shield the vulnerable while letting those with a low risk of being seriously ill to get on with life as normal. The disease will strike down even younger and apparently healthy people; and it can inflict lasting damage even if you survive it. But the chances of serious consequences for most people are quite small (and for them comparison with flu has more validity). But the flip side to this is that many others are at serious risk: anybody over 60 or with many quite common health conditions such as diabetes or heart disease. I have seen an authoritative estimate that these are about 20% of the population. But these people don’t live isolated lives: they depend on contact to some degree with healthier people. These people also have to shield, to protect those they are close to. This group is not only very numerous (somebody has plausibly suggested another 20%), but it is much harder for such people to successfully shield themselves form the outside world. In the second wave of the epidemic, where vulnerable people have been much more successfully shielded than the first, there has been a clear pattern. Firstly younger people catch it, largely without serious symptoms. Then it is passed on to working people whom they interact with (shop staff, security guards, and so on). and from these it moves on to the seriously vulnerable. It is not enough to suggest that people should simply take the level of precaution that is appropriate to themselves. That would mean that many working people would have to furloughed and somehow replaced at the front line.

There really are no alternatives if you cannot seal the country’s borders Personally I placed high hopes on rigorous test-and-trace systems, such as those operated in Germany. We have not attempted anything like German rigour in the UK, instead going for massed centralised families with a high theoretical volume but almost no impact on the course of the disease. But even in Germany the system gets overwhelmed once the virus reaches a certain level, and you are back to lockdowns. Sweden’s rather laxer regime is sometimes mentioned as an alternative, but that is breaking down too. Its advocates had suggested that infection levels would fall in the Autumn as herd immunity started to impact. But it hasn’t, because in fact Swedes had been exercising social distancing to such an extent that not enough people were being infested (and with the economic and other damage that followed). If enough people had been infected their health systems wold have collapsed.

All of which is very grim, were it not for one thing: the fact that vaccines are on the way. We don’t know much about the various vaccines, beyond basic safety and efficacy. In particular we don’t know how much they would slow transmission of the virus. But they are enough to make huge difference and allow lockdowns to be eased. Quite why Conservative critics are still banging on with their complaints about lockdowns when relief is at hand is one of the pandemics’ many mysteries.

Joe Biden: cometh the hour, cometh the man?

I greeted the defeat of Donald Trump in the US Presidential election with relief rather than joy. It was the most important thing to be decided in these elections: but otherwise it was a poor night for the Democrats. That bodes ill for the success of the new administration. But perhaps the new President, Joe Biden, will rise to the occasion.

The first Democratic disappointment was the failure to suppress Mr Trump’s vote more than it did. In fact “suppress” is not the word: Mr Trump’s vote was huge. Victory depended on a series of narrow wins in key states: very similar in character to Mr Trump’s victory in 2016. Based on polling evidence, most people had expected something more decisive. The next disappointment was the Democrats’ failure to secure the Senate. This game isn’t over yet: it will be decided by the double run-off section in early January in Georgia, but the Republicans are favourites. But the Democrats fell short in a whole series of contests where they were expected to do well, and that was the pattern of the night. The Democrats hung on to the their majority in the House in Representatives, but went backwards. They did not make breakthroughs at state level either: important because these elections will affect redistricting for the House. Down-ticket Republicans polled more than Mr Trump.

If the Democrats couldn’t win big this year, when can they? Looked at strategically it the Republicans are winning the battle to be the natural party of government, albeit by a narrow margin. This should worry Democrats a lot. They have long been expecting a demographic dividend, as America becomes less white, and as older, conservative voters die off. Instead Republicans are managing to recruit amongst ethnic minorities. I don’t know what data on younger voters is, but I suspect it follows educational attainment. Less well-educated Americans gravitate towards the Republicans, regardless of race and age, it seems.

This bodes ill for the Democrats in 2024, and of Kamala Harris’s chances in that election if Joe Biden steps down, as expected. There will be a lot of soul-searching. Some want to go down a left-wing populist route, stoking up anger over wealthy elites rigging the system to their advantage. Such a strategy has worked in Latin America (though whether it has done poor voters there any good is another question) – but I don’t think it has traction in America, not least amongst those of Latin American heritage, for whom socialism is often a toxic brand, based on the record of Latin American socialists.

Beyond that, Mr Biden is going to find it very hard to govern. He needs the Senate to unlock major spending initiatives, or legal reforms, for example to health care, or reforms to make it easier to elect Democrats. Nothing in these election results is going to discourage the dominant no-prisoners wing of the Republican Party, represented by the senate leader Mitch McConnell, as well as Mr Trump himself. Republicans will suddenly rediscover their fiscal conservatism and stoke up worries about public debt, conveniently forgotten when Republicans such as Ronald Reagan, George W. Bush or Donald Trump have been in charge. The new administration will be undermined at every turn. And on top of likely control of the Senate, they have stacked the Supreme Court with conservatives. Mr Biden’s appeals for Americans to unite to tackle the country’s problems are entirely futile. Further, Republicans are trying to undermine his legitimacy by saying the election was “stolen”. The extreme partisan nature of US politics will continue.

So what does Joe Biden need to do? The critical things are to revive the economy, get on top of the virus, and put pressure on the Republicans. The economy is critical. Until 2020 this was looking good for Mr Trump. The acid test isn’t the level of the stock market, so beloved of the President, but whether the economy is running hot enough to push up wages and well as create a plentiful supply of less skilled jobs. Mr Trump’s success there doubtless accounts for much of the strength of his support. How much he was actually responsible for this, and how much he was building on his predecessor, we will never know. The virus, of course, is the test Mr Biden has set himself. On both counts luck looks to be on the new President’s. side. The first of the vaccines is coming good, and other promising ones are behind it. This is already having a positive effect on confidence. This means that he is not as reliant as he might of been on Congress to provide funding for the states. The second piece of luck is that the Federal Reserve takes an expansive view of its role in keeping the economy going, and should not jack up interest rates at the first sign of success.

What do I mean by putting pressure on the Republicans? His life will be a lot easier if a small handful of Republican Senators break ranks. It will also be easier if Supreme Court justices also feel a bit of political pressure to appear non-partisan. This dos not mean indulging in the culture wars (on abortion and such matters), which tend to polarise politics and rally the Republican faithful. It does mean keeping the heat up on healthcare and support for “seniors” and veterans. The Republicans aren’t having it all their own way. MrTrump is not going to disappear; surely the party’s stalwarts are going to tire of bowing and scraping to their monarch. Mr Trump is also likely to face a blizzard of lawsuits – though this is unlikely to change public opinion much.

The interesting thing is that of all senior Democrats, Joe Biden seems to understand what needs to be done best. He has it in him to empathise with the average working class Trump supporter. His campaign was very skilful. He is going to need all of that skill in the years ahead. But he knows that. Cometh the hour, cometh the man?

It’s all about R. Lockdown critics don’t understand exponential mathematics

Quite early in the Covid-19 outbreak, policymakers told us that the critical thing to understand about managing the disease was something they called “R”. This is the reproduction rate: the average number of other people that anybody that catches the virus will infect. If it less than 1.0 the epidemic will fade away. More than one and the disease spreads exponentially. Discussion of R then dropped from view, with people focusing more on the absolute level of infection (usually given as cases per 100k). That’s a shame because R is central to understanding what has just happened here in UK, which also applies to most of the rest of Europe with small variations.

In those the dark days of March, R was a horrific 2-3. That meant the disease was spreading very rapidly through the population. For a moment people thought that might not be such a problem: that herd immunity would develop, and the disease would slow down as the number of potential carriers was diminished. But there are two major problems with this. The first is that if the disease spreads rapidly, then health services (and other infrastructure) become overwhelmed, and there s substantial collateral damage. And that is exactly what happened in the Spring. Hospitals started to fill up, requiring them to clear beds; people with other conditions suffered, and Covid-infected people were pushed into care homes to make room for others, with appalling results. The death rate across the country shot up, and not just because people were dying from Covid, though frightening numbers were. The second problem with the herd immunity strategy was that nobody knew whether, or for how long, catching the disease would confer immunity. It was quite an interesting example, incidentally, of how basing decisions on evidence is not quite as robust as it seems. What do you believe in the absence of evidence? In Britain people believed, absent evidence, that face masks were useless and that you would get long term immunity by catching the disease. There is no rhyme or reason to it being that way round. Too often people who ask where the evidence is are just sticking to their prejudices.

I digress. The only sensible response to an R of over 2 was strict lockdown, which was implemented in Britain on 23 March. This was remarkably successful (it is puzzling why some people suggest that it wasn’t). R came down to about 0.7, and the disease was beaten back to manageable levels in most places. But what next? The government eagerly implemented a general relaxation, while maintaining a certain number of rules on social distancing. By this time few people were talking about R, and it was hard to know what aim of it all was. I think it was felt that the relaxation would take the R back up to 1.0, but no further, thus keeping the virus at manageable levels. It is probable that a lot of faith was being put in the Track and Trace system to contain outbreaks as they occurred. And yet the system they built was not designed to achieve that level of rigour, which needs tough local leadership and timely data, both of which were practically designed out of the system from the start. The result was that R crept up to about 1.5. Much better than before, but also pretty useless in terms of managing the disease. If R is over 1, then the disease will rise up to overwhelming levels much more quickly than people will intuit, because of the exponential way in which the disease spreads.

The government’s next strategy was one of local local lockdowns. The hope was that these would reduce R to below 1 in areas were the prevalence had become high. Over the last few weeks two problems have emerged, though. First is that even with these stricter measures R is above 1, and health services are under imminent threat. Second is that R is rising scarily everywhere else, and to beyond 2 in some places. That meant that most of the rest of the country wasn’t in fact that far behind the hotspots. Just what was going on here will probably not be known for some time. Perhaps people in Tier 3 of the lockdown system felt bolshy because they were being singled out, and did not apply themselves properly to lockdown. Perhaps people in Tier 1 felt they could relax because they weren’t in trouble yet. Anyway, it is very clear that the regional response strategy has failed. And so we are back to national lockdown.

But schools an universities are still open, and weariness is creeping in as businesses fail and savings run out. The death rate is much lower than before (the rate of excess deaths remains negligible) and this is being used to suggest that we should just “live with” the virus. Some conservative newspapers (the Telegraph and Mail in particular) opposing lockdown, even though their recommendations would sentence many of their readers, more vulnerable than the average, to an untimely and horrible death, or perhaps just a long-term deterioration of health. Such critics have failed to understand the logic of R. It is not about choosing an acceptable level of disease and freezing it there: it is about stopping the disease before it overwhelms.

So how on earth do you live with the disease and retain a semblance of normal life? The only proven way is the Asian one (there are many variations, shown by China, South Korea, Taiwan, Japan and Australia and New Zealand). This requires the disease to be stamped out, mainly through strict lockdown, for inward travel to be heavily restricted, and for any outbreaks to be stamped on hard. For some reason Europeans, and not just the British, seem unable to do this (even the Germans are struggling). It’s even worse for the Americans. Asians, and interesting this includes Antipodeans of European heritage, seem much happier to comply with busybody regulations. Not all Asians of course: Indians struggle, as do Indonesians, Philipinos and a number of others.

Absent the Asian approach, thoughts turn to the use technologies that are not yet available. Vaccines may not be the silver bullet they are for diseases like polio, but they could still throw enough sand in the wheels of transmission to stop R getting above one. Mass testing, talked up by the Prime Minister Boris Johnson, offers ways of identifying infected people so that they can be isolated. That raises all sorts of questions.

Locally I have found the most informative source about the progress of the virus comes from the government’s interactive map. I have watched the infection rate steadily go up, with white ares (very low infections) moving to green, and green going moving to blue (over 100 per 100k); in my local patch it is 171. We’re keeping our heads down.

It’s all very depressing. The most important thing to understand about the spread of infectious diseases is that it is exponential. None of the lockdown critics I have heard or read seem to grasp that. And only a few understand that the critical thing isn’t the death rate but the stress on public infrastructure, including, but not limited to, hospitals. In the end it’s all about R.