TWO SETS OF COVID-19 ACTIONS NEEDED IMMEDIATELY

Credit: The Sun 6 June 2020

Weston General Hospital had to close its doors to new COVID-19 patients on 25 May.  That meant cases in that area were rising and the transmission Reproductive number R must have gone over 1 locally.  The limit for R stated time and again by the government and its scientific advisors as the top limit that would be allowed at a national level.

Since then there have been problems with hospitals in the North West.  R has clearly been rising in other parts of the UK too, as a growing army of commentators agree. 

Yet on 5 June the “latest” R was announced as nationally in the range 0.7-0.9, usually referred to in the press release slides as "Current", with ministers saying no region is currently over 1.  But as the Sun reported on 6 June, so very near to 1 everywhere in England

I wrote about R on 28 and 29 May, a week ago, and the fact that the “current” R is actually an estimate of what it was two or three weeks earlier.  Whilst this page still says the same words about timescales in “How R is estimated”, the equivalent words to these effective then have been removed:


Nonetheless we should assume the "Latest"/“Current” R reflects the situation at least a week previous to when announced.  Indeed when regional Rs calculated by the modelling group in the London School of Hygiene and Tropical Medicine were tweeted on 4 June as “the latest” they are clearly marked at the top of the table as being 'as of Sunday 24 May'.  Yet these regional Rs are still spoken of as “current” now two weeks later:

 
In the meantime Spain has indicated that whilst they will be welcoming visitors from much of the world, British holidaymakers will not be welcome this summer as British coronavirus figures "still have to improve".  Similar restrictions will inevitably apply around the world for British visitors, both tourists and on business.  

So how about a staycation in the UK?  Whilst regions reliant on tourism like Devon, Cornwall and the Lake District are desperate for visitors to return, they are currently staying “Stay away”.  This is because the fear an influx of infections, and their local hospitals being overrun.

So it makes sense for R to be brought under control for a number of reasons:

• Avoid a second wave that would mean tens of thousands more deaths, and other social and financial troubles for months ahead
• Conversely rapidly and more safely open up the economy within a  few weeks
• Allow people to get away on holiday to other parts of the UK and potentially abroad (Subject to more practical re-entry restrictions.  But the 14-day quarantine is a separate issue)

As this graph shows, an R of 0.5 rapidly reduces new infections to near zero within 20 days, which would be before the end of June if a second lockdown was to be implemented now.. Targeting 0.5 also makes it far less likely that 1.0 would be breached:

So there are three recommendations:

1. Immediately set the R target nationally to 0.5, and deal with any local breaches
2. As the only practical way to do that, immediately re-introduce full lockdown until end of June or possibly mid July, but which time new infections should be back under control
3. Rapidly develop a realistic set of anti-transmission measures and advice that collectively can replace lockdown.  This needs to be suitable to allow the hospitality industry to substantially open for the summer.  

This would be with as little reliance on Test/Track/Isolate as possible, given the many problems with all three stages.  That means clearer advice on the use of masks, along the lines of the recent WHO announcement, together with clearer Enhanced Hygiene advice and any other suitable measures.

The problem with actioning these three recommendations is that the current government is unlikely to do so.  Having threatened to re-tighten restrictions, there is no sign that will do so. 

Unless the absence of scientific advisors at recent press conferences, and the cancellation of those this weekend, indicates they are deep in discussion about doing so.  But possibly terribly conflicted.


AS AN ASIDE

Back on 19 May [link] I said that R would be 50:50 chance of being above 1.0 by 31 May, requiring a lockdown.  I meant the effective R, not the "latest" R which is at leasta  week out of date.

So at the end of the coming week we’ll see if the efective R on 31 May was in fact nationally over 1.0.  Now on 7 June I’m expecting R then to have been over 1.0 in more parts of the country, and for the national range to be edging up to or over 1.0.


THE 'CUMMINGS EFFECT'

There are three reasons the government are unlikely to re-tighten restrictions:

• A general reluctance to do anything.  Late to lockdown in March, and the same now.  Partially due to concerns about the economic effect, though surely the Treasury realise the economy will be far worse if a necessary lockdown is delayed again. Don’t they?
• The UK would be the first to re-introduce lockdown anywhere in the world.  Embarrassing.  But then so are the death figures, which are getting worse.
• The stranglehold Cummings seemingly has over this government.  There is something weird going on behind the scenes.  There are indications that he has links to private sector organisations that have been given lucrative contracts outside of normal procurement rules. Watch this space.

Which leads us on to the 'Cummings effect'.  I should first say I have no political allegiance to any of the principal political parties in the UK. I'm looking at the situation entirely dispassionately.

It is crystal clear that Dominic Cummings broke the lockdown rules on more than one occasion in going to Durham and then the day trip to Castle Barnard.  The Durham Constabulary pointed out in their statement that they would have turned Cummings back had they stopped him on that day trip.

This and other problems with his statement angered many people. But more importantly a lot of people have taken his actions to mean that there is no need for anyone to comply with the restrictions.  Whilst it is difficult to know to what extent R has increased because of the Cummings effect, there is no way that a senior advisor should flout the rules, undermine the messages, and get away with it.

Cummings has got to go.

The Cummings fasco  is likely to be a key factor in the marked deterioration in the polls for PM Johnson and the Conservative party relative to Labour.

That and the total deaths and excess deaths for the UK now being the highest in Europe, in numbers and per million of population.  Bottom of the league.

What would a football manager expect when finding themselves with their team in that position?  The Board of Directors would sack them.

PM Johnson has got to go too.  For that and backing Cummings.

Indeed it is amazing that the Spectator magazine has published this article titled “Boris Johnson isn’t fit to lead” followed yesterday by "Boris Johnson needs to get a grip".  The magazine that Johnson had himself edited from 1999 to 2005.

So why hasn’t the Conservative party replaced Johnson, and insisted that Cummings should be dismissed?  I can only guess.  But those reasons don't alter the urgency.

An Interim PM is required immediately.  Chosen from one of the 40 plus MPs who publicly asked for Cummings to resign or be dismissed.   Brexiter or Remainder.  There are both types on the list.

The Interim PM would then sack Cummings and appoint their own cabinet.  Whilst continuity is important, all the senior members of Johnson’s cabinet supported Cummings and ought to be replaced.

Really?  Make such a momentous change in the middle of a pandemic?  I had hoped to avoid it.  But needs must.  It’s the lesser of two evils.  Stayong with the governemnt we have is just not a credible option any longer.


IN CONCLUSION

There are two sets of actions needed immediately:

1.    The Government need to get control back over COVID-19 and bite the bullet:

• Set an R target of 0.5, nationally and in each region
• Re-establish lockdown as the only realistic way to achieve that target. 
• Finalise and communicate a set of anti-transmission measures.  This should be with as little reliance on Test/Trace/Isolate as possible, given its many practical and cost problems
• With expectation of being able to substantially release restrictions by end of June or mid July, including in the hospitality industry.  That is the carrot.

2.    The Conservative party need to replace PM Johnson with an Interim PM:

• Who would dismiss Cummings
• And appoint their own cabinet

I doubt the first set of actions would be possible without the second set.  It is now down to the Conservative party to do what is neessary.  Now.