Politicians are our key workers as well. As they face near-impossible choices, telling them “I told you so” won’t help.
980 people in UK hospitals died yesterday.
When these numbers first struck Italy, we gathered around our televisions and watched in horror. Footage of overwhelmed ICUs in Lombardy were beamed into our living rooms. We struggled to comprehend how things had gotten so bad. I was still going to work and promoting my next gig.
980 lives. These numbers don’t shock you like they did four weeks ago. The baseline has now shifted. We’re now in the grips of this pandemic and naturally, we build our new normal.
In France, the figure hit 1,417 hospital deaths in 24 hours. In Spain, 950. In Italy, 917. These were their deadliest days.
I sit in my shrinking flat and think about how lucky I am. How easy it for me. I am not making the decisions that sway these numbers. The blame won’t be laid at my door. The blame won’t roll around my head in years to come when I struggle to sleep.
…
One day I hope we have a public enquiry and we learn the lessons of this pandemic and our response when the dust settles. I am sure we will.
I never had any dreams or ambitions to be a doctor or a nurse. Completing first aid training was enough for me. The last time I went into an ICU ward, I nearly fainted. Hospitals make me nervous and I’m a bit squeamish when it comes to blood and piss.
I have little understanding of the decisions that frontline and supporting medical staff will be making each day to ensure another 980 men and women don’t die tomorrow. However, I do understand that as a society we have a deep faith in the Hippocratic oath and the expertise, neutrality and moral authority of health professions to make fundamental decisions over our lives. We trust that after everything, they did their best in the most impossible circumstances.
I am a politician though. A backbench councillor and the decisions I make are relatively mundane, but there are times when I have to make difficult judgements. I am a layperson, but untrusted by the public with a great responsibility to digest evidence and make important decisions. Evidence is handed to me from civil servants, experts, lobbyists and eager constituents, and digested by my relative knowledge, my gut instincts and my ideological bent.
With this great trust comes a great deal of accountability. The more important the decision we make, the more incisive the focus is on our intellect, our moral fortitude and our ideological perversions. The nature of politics makes us a constant target for someone who wants our position in a few years time.
On Thursday evenings at 8pm we applaud our NHS heroes.
We’d never dare lambast them for their day's work from our balconies or twitter pages. We’d never scold a nurse, accusing them of costing the life of a patient as she misinterpreted conflicting advice from two seniors.
“The patient was not moved onto a ventilator soon enough!” we’d holler. “Their records did not suggest them as high risk, but any idiot could’ve seen they were very poorly and needed to move. Shocking.”
It would be unfathomable.
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We know so little about this novel coronavirus. This virus that leaves one friend in “a sweaty heap for a couple of days” and another friend fighting for their life.
While we know so much more than we did four weeks ago, we still seem to be fighting an illness we don’t fully understand. Be it through an embrace of conspiracy, fatalism, our own righteous moral certainly, or through a renewed belief in our national story — we try and find certainty.
We look for individuals to blame. A caused B. Easy answers give us reassurance and comfort in a world turned upside down.
History tells us this could be just a first wave and that once lockdown is lifted, we could face an even more potent spread. The greatest weapon against a second wave is our own immunity, which we do not have as we spent spring locked in our ever-shrinking flats. But again, there could be no second wave. Loved ones would die as we became human shields to face the cavalry that never arrived.
At the start of March, the Scientific Advisory Group for Emergencies (Sage) shared fears that if the UK government lockdown was introduced too early, the public would not comply and individuals who would need to self-isolate, would find it difficult to do so for long periods.
With hindsight, we can see that the overwhelming majority of the public understood the gravity of the situation. I’ve been struck by how compliant many of us have been in the face of life-altering laws that have confined us to homes for 23 hours day. I think that footage from northern Italy played a part.
Had we initiated the lockdown at the start of March, would the public have been so receptive or compliant? I think they would have. But like everything, it is easier to say that now. It seems we’re compliant creatures in times of crisis and future leaders will be making notes, for better and for worse.
These paragraphs written by Lawrence Freedman in the New Stateman are illustrative. It details just one of the thousands of questions our Government needed to answer and needed to get right.
By 9 March, 319 cases of Covid-19 had been reported in the UK, with five deaths. With the growth in cases appearing relatively moderate, Sage advised the government in a report that there was time to introduce new measures. The paper advocated enacting measures for isolating those with symptomatic cases of Covid-19 over the coming fortnight, followed by isolation for entire households with any infected members, and social distancing for the over-70s in the weeks after that.
But, crucially, this depended on how the outbreak unfolded in the UK. The government advisers were divided about what measures should follow: the stringent quarantine measures, as introduced in Wuhan, or the less draconian social distancing seen in Hong Kong and Singapore? Tougher measures would undoubtedly reduce the spread of the virus, but would this mean a much higher peak in the second wave? Much would depend on public compliance. For the moment the focus was on treating those with symptoms — along with their households — and also the elderly. Together these measures promised to reduce peak hospital bed demand by 50 to 70 per cent and deaths by 35 to 50 per cent.
By contrast, the more drastic interventions — school closures and banning large events — would help to flatten the curve but with negligible impact on total deaths. The advice was counterintuitive: closing schools would mean that parents, including many in the health service, would have to take over childcare duties or else hand them over to grandparents (the age group most vulnerable to Covid-19). The most serious contagion took place in small groups. There would be clusters of groups at sporting events, but if these were cancelled, the same people were as likely to congregate in the confined space of a house or a pub.
We now look in horror at photographs of crowds at the Cheltenham Festival. It took place between 10–13 March.
Freedman paints a picture of a government weighing up the introduction of draconian measures unfathomable to much of free society — based on exceptionally complex modelling, often conflicting in outcomes, and with experts torn on what to do next.
The Imperial College analysis, published on 16 March, which contrasted a heightened suppression tactic with the Government’s mitigation strategy floored many of us. If we continued with a mitigation-only strategy, hundred of thousands would perish. Upon new evidence, the Government sharply changed tack.
There is now a sense that the instigation of the lockdown came too late.
Tom Chivers, science columnist for Unherd recently took a stab at attempting to articulate just how difficult it is to predict the spread of the coronavirus with the current patchy data which we have available. Slight changes in inputs and other variables can have startlingly different outcomes. Chivers’ piece is good at two things. One, it explains in part why different groups of epidemiologists are producing wildly different models and outcomes on mortality and contagion. Two, he successfully illustrates not just how appallingly difficult the modellers’ job is, but the immense pressure on those who need to make the profound judgements on the data and models that are far from concrete.
‘Whereas, if the Imperial College modellers get it wrong, with their far more complex maths and their far more uncertain inputs, they could sway government policy enormously. Whether we lock down society or carry on as normal depends heavily on the outputs of models like these. And it’s not that there’s an easy “better safe than sorry” option; if we crash the economy, it will (eventually) cause real health problems.
A February 2020 review found that 10 years of austerity may have caused the growth in life expectancy to stall, especially among the poorest; I’m sceptical of the “130,000 deaths caused by austerity” stat, but it’s pretty clear that it had a real negative impact. The post-Covid-19 world will almost certainly involve huge austerity to pay for the vast costs incurred during the virus.
Get it wrong one way, and thousands of people die unnecessarily from the virus; get it wrong the other, and you crash our public services and kill people that way. (I’ve only seen one attempt to model the health outcomes of that crash, and I have no way of judging it; for what it’s worth, though, it does say they will be extremely terrible; on the other hand, recessions don’t seem to shorten life expectancy, so who knows.)’
The prospect of successful mitigation-policies to combat COVID-19 would have been extremely appealing. For many of us, it would have been a more normal life. For some, it would’ve meant a sustained livelihood. For others, it would’ve meant we could’ve gone to that gig we had been planning for months.
Successful mitigation could have prevented the unprecedented economic bailout that might cripple my generation’s future. It might have meant crucial operations went ahead, not saving lives today but sustaining lives for many more months and years than otherwise. Successful mitigation and the development of widespread immunity in the public would’ve left us in a far stronger position to manage a second wave.
I can understand why for two weeks the Government pursued this course, based on data and modelling then available, under supervision of leading epidemiologists and behavioural scientists.
But as Iain Leslie notes:
‘Every time I check social media, somebody is confidently proclaiming that they know exactly how to manage a global pandemic, having spent a few minutes looking at data online and scanned a Wikipedia page. They explain, with implacable conviction, why they are right, and why Chris Whitty — chief medical officer, epidemiologist, infectious diseases specialist — is quite obviously wrong.’
I think for some this is just another way of coping. However, like many coping strategies, they can be unhealthy.
It is paramount that we continue to ask hard questions of our government as this pandemic unfolds. However, in doing so, we must understand the unprecedented depth and breadth of the challenges before them. We must remember we are lucky ones. We are not the ones who face the unimaginable burden of making these decisions before hindsight arrives to confirm our own presumptions.
Healthy scrutiny and accountability can only come from humility, not absolute certainty. You ask questions to get clarity on the decision making process in the hope that you can ensure the decision-maker made the best judgement call possible at the time, and that lessons are later learnt. You don’t ask questions with the intention to prove you were right.
We remain in the early days of an unprecedented pandemic and it will take many years for us to start to get to grips on the lessons learnt — about this particular coronavirus, how it spread, how it killed. The economic and social impact of a lockdown and the lives it cut short. The story of the second wave and third waves and the way we viewed the lives taken by COVID-19 compared to other causes, ‘natural’ or ‘man-made’.
I can only imagine the weight on the shoulders of the Prime Minister and his Cabinet. They are on the front line and the decisions they make will cost or save thousands of lives. However, we dare not appreciate the near-impossible choices on offer in front of them. There will be no applause for our politicians — only hot takes on Twitter and ‘I told you so’s’.
