I’m actually not sure about this

Thousands of businesses are braced for a “truly devastating” blow from Boris Johnson’s second lockdown amid fears that the economy will collapse 12pc this month.

12 %?

I think we’ve learned a lot about how to continue to do things even while locked down/social distancing.

Sure, there’s going to be a hit but I don’t think it will be that large. Not that I can prove it in any manner, it’s just a feeling in the water.

Put it down to prejudice perhaps. Prejudice about the flexibility of market economies.

59 thoughts on “I’m actually not sure about this”

  1. I think you need to factor in all the businesses that made huge outlays to keep up with all the rules and now can’t recoup that outlay in the busiest run up to Christmas.

    Also the fear that it won’t end on 2nd December after all…

  2. The economy, like money below it, is a confidence trick. I’m glad you’re feeling confident, Tim, and sincerely hope most others feel the same.

    One thing’s for sure – it will look quite a bit different after all this is through.

  3. There are lots of people whose job involves going round to people’s houses to do stuff – carpet fitters, painters, electricians etc. All that stuff becomes difficult under the conditions being imposed. All those things that take place in small industrial units. A lot of services have to stop – hairdressers, nailbars, gyms. Construction becomes tricky to manage. We know that the NHS is running at roughly 30% of capacity, so that’s a large chunk of GDP by itself. The hospitality industry. All those activities could get up to around 10% of GDP

  4. An entire swathe of human activity has been cancelled: getting a haircut, taking the train, going to a football match or concert, having a drink and a meal out, staying at a hotel, and so on. Everything fun, everything that makes life worth living (except children) is stopped.

    But it gets worse. If you’re not seeing your friends or colleagues, you don’t need new clothes. If you’re not seeing your relatives this Christmas, you don’t need a new car to show off. If dating is off the cards, a lot of expenditure stops. The virus has given us licence to stop spending, and that’s what we see happening.

    If anything, 12% is an underestimate.

  5. For what it’s worth, my monthly spend is easily down by about 25% on pre lockdown months. The same would seem to be true for our children. If that kind of pattern is prevalent across the nation then what would you expect to happen to GDP?

  6. JuliaM,

    Yes. Very good point. I worked for a retail business where 30+% of their sales were linked to Xmas. IIRC music sales are over half (hence Xmas singles).

    For me, it’s that we’re doing the hokey cokey with lockdown. If government had done what it was supposed to have done: locked down to build capacity, built enough ventilators and beds that we could get back to normal life (this was never about eradication, but making sure the NHS could cope with the demand, remember?), we wouldn’t be in this mess. You can’t run a business in hospitality or leisure or all sorts of things, if the government is just going to drop the boom at 5 days notice. it cripples all confidence in creating a business.

    I mean, we could just pray for a vaccine (but that probably won’t go to manufacture until the middle of next year, as the trials are still months away from completing Phase 3 recruitment, let alone dosing the patients).

  7. Ah, yes, but you see we have to be in lockdown when Boris fudges Brexit so we can’t take to the streets.

  8. I think 12% is optimistic, we are looking at many of those businesses ( hospitality especially) that survived the first lockdown simply giving up.

    Diogenes said “We know that the NHS is running at roughly 30% of capacity, so that’s a large chunk of GDP by itself.”

    Does it matter how busy the NHS is ? Surely it is parasitic on the economy, its budgets are fixed so it will spend our £135billion a year whether it is doing anything or not ?

  9. Bloke in North Dorset

    The other thing to consider about retail is that they will have placed their Christmas orders at the start of the year, possibly pre-pandemic and probably pre-lockdown #1. Supplier will have started preparing production almost straight away for non-perishables, requiring investment. Retailers will have started to take delivery at the end of summer, early autumn and will have paid for a large part of the goods.

    Suppliers will have now started preparing perishable orders, depending on time lag, and be expecting payments and they won’t want to be holding on to those stocks.

    There’s going to be a huge impact because there’s no such thing as non-essential in a complex economy.

  10. Imagine how bad it would be if there was a real pandemic, with thousands of working age people dying, emergency orphanages and so forth.

  11. @bom4

    Building capacity in order to return to everyday life would work okay if we were switching – after some transition in the dynamics – from one equilibrium point (lockdown) to another (relaxed), and once in its steady state, the relaxed equilibrium settles down to require higher bed usage that fits within expanded capacity. But dynamics of infectious disease don’t work like that – if the reason you need more beds is because cases are growing, then in the absence of harsher intervention or substantial rises in population immunity, you’re going to just keep needing more and more beds. You don’t want to see infections rising 40% in a week (fortnightly doubling), or even 15% (five-weekly doubling), because a few weeks of that and any feasible additional capacity will get burned through.

    Bear in mind that healthcare capacity is hard to expand rapidly – you get constraints on staffing that are harder to beat, particularly once you already have the recently retired back at work, than beds or kit. The Nightingales provide surge capacity, and while they were intended as useful for any future wave or winter demand pressure, they could never serve as a long-term solution. Building extra surge capacity just buys you time and gives you insurance in case whatever system you put in place doesn’t work, it doesn’t by itself give you a way to relax contact restrictions in a sustainable way – you need to address the transmission dynamics to achieve that.

    To reach an acceptable equilibrium in terms of healthcare usage, mortality rates, economic and social wellbeing, or whatever else, you need a way of reducing transmission even as you allow people more contact. Part of that is protecting the vulnerable since they produce biggest healthcare demand and suffer the worst consequences if infected – you can’t hermetically seal care homes and hospitals but you can try limiting staff working at multiple sites, introduce regular staff testing etc. You can’t expect more independent older people to retreat away though.

    The thing that was supposed to allow the non-institutionalised to return closer to normal wasn’t the Nightingales, it was systems to lower transmission across everyday life – social distancing and “Covid-safe” workplaces, shops, hospitality venues etc, and a lot of hopes were pinned on Test and Trace, though it’s most useful if infection levels are successfully kept relatively low.

  12. MBE,

    OK, I’m pretty much steaming and I think you know a lot more about this, but let’s take account then:-

    mass hospitalisation: doesn’t work
    social distancy stuff: doesn’t work, despite everyone doing a pretty good job in that regard.
    test and trace: doesn’t work (probably because government couldn’t organise a gangbang in a brothel, and there’s no changing that)

    So, what’s the plan for after December 2? Because no-one can plan anything right now unless it involves it being delivered by Amazon or Nintendo. The market I work in is really bad. Lots of projects are on hold because there’s zero confidence out there. You can’t plan when there’s a hokey cokey around lockdowns if you work in hospitality.

    Hope for a vaccine? And when’s the best possible date for when trials are completed, approved, manufactured and administered in sufficient volumes? 2022? Later?

  13. 2ND December is a pipe dream. Blojob will continue this for months.

    Unless millions just take no notice of the shite.

    Those –business people–with most to lose seem the weakest.

    If everyone stayed open and reopened Johnson could do nothing.

    But you are way off Tim–4-5-6 more months of this shite will leave little standing –which is why I still think it is a plot.

  14. MBE–Absolute virus-freak bullshit. There is less going on in hosp than in ANY of the last 5 years.

    For Christ’s sake GET IT–this damp squib is NOT the Black Death 2 so stop bullshitting about measures needed against it. If it was it would police itself not needing cop thugs/squaddies/lying bureaucratic and political cunts to try and force their cockrot capers on us.

  15. p.s. my mates daughter-in-law works at Broomfield Hospital, Chelmsford. They are discussing redundancies for some of the nursing staff. Hardly the actions of an NHS under stress surely?

  16. “my mates daughter-in-law works at Broomfield Hospital, Chelmsford. They are discussing redundancies for some of the nursing staff. Hardly the actions of an NHS under stress surely?”

    Thats not surprising, given that just under half of all hospitals in the UK on the 27th Oct had not one Covid patient on their books at all. Loads of them must be like ghost towns.

    https://lockdownsceptics.org/2020/11/03/latest-news-182/#ross-clark-boffins-cherry-picked-data-to-frighten-us

  17. I am not sure about the numbers. But what we can see is that all governments fail all the time. If you have big government what you get is big failure. And by government I do not just mean Johnson and his crew. I mean the whole Damn’ thing – civil (hah!) servants. Quagoistas. Parliament etc. etc.

  18. As an aside, on the state of the NHS, my neighbour has a bad back. He’s self employed (he’s a handyman/builder) so has to struggle on working on painkillers. He does a lot for work for my mother so she paid for him to have an MRI scan done privately (available at a weeks notice, £400). Armed with this he finally got his GP to refer him to an NHS specialist for a lower back injection. Last week he got his appointment letter. It was for 22nd Feb 2022. He thought it was a typo, it meant Feb 2021, but no, it really is for 16 months time.

    The Wonder of the World…….

  19. Mentioning “Nightingales”…

    They look very much to me like a panic-induced “something must be done or millions will die” move which was made before the dynamics of the disease had been studied sufficiently. Essentially they’re nothing more than industrial-scale ventilator units – which would have been fine for treating a straightforward respiratory illness spread evenly across the population. Problem was that it quite quickly transpired that the seriously ill and possibly dying almost invariably had one or more severe comorbidities, meaning that they couldn’t be treated in Nightingales which had neither the facilities nor the trained staff.

    They are basically white-elephants as the profile of the disease has remained remarkably steady and continues only to mop-up the same geriatric and ill cohort. Additionally, as the yanks found out quite quickly, ventilating covid patients was killing them and treatment has moved to much more successful alternatives such as CPAP – which can be administered in-ward rather than needing the facilities of an ITU.

    @Addolff and Jim… I had the “pleasure” of attending my local hospital (one of the only two large establishments in the county) a couple of weeks ago – I have POA for a relative who needed emergency treatment – and was in A&E and the AMU for most of the day. The place was like the Marie Celeste.

    One wonders whether the admission criteria for “covid patients” is likely to be freed-up in order to provide some scarier numbers…

  20. @bj

    Yes the Nightingales were a bit of a panic measure but the concept of assembling field hospitals for basic care in order to add surge capacity wasn’t a brand new idea. Just one reserved for emergency and, like I said, something of an insurance measure. You’re right that the ventilator panic has moved on now (remember when the government was getting slated in the press for not signing up to the EU ventilator scheme?).

    @bom4

    Excellent question. In fact the possibility we would end up in a lockdown hokey-cokey due to lack of a long-term, sustainable solution until a vaccine comes was raised relatively early on if you read the old SPI-M reports. Or indeed the famous Ferguson paper. The code was crap and the numbers well off – though not always in the direction you might think – but it did suggest, qualitatively (which is often all you could hope for from a model), that you could get stuck in dynamics where out of lockdown transmission continues unsustainably and then once short-term hospital demand forecasts shoot up (as has happened now – how much skepticism those forecasts require is another question I’ve warbled about elsewhere) another lockdown gets called. That was a plausible outcome but as @baron points out above, not enough was known about the transmission dynamics at that time (particularly under whatever systems we would try to put in place – this was before mass testing and contact tracing, let alone “Covid-safe” protocols) to know whether it would actually happen.

    In places like Taiwan, whatever they’ve done seems to be enough to control spread in “normal” circumstances. In Britain we came close but we probably needed to knock another 20-30% off out of lockdown and we didn’t manage it. Track and trace didn’t do it, the app didn’t do it, the rule of six didn’t do it (indeed contact studies suggest it made literally no difference to people’s contact patterns).

    Perhaps the tier system might have done it if local areas had been aiming to really clamp down on cases – lots of people in power seem to have thought a general upwards drift was acceptable so long as it wasn’t too fast. But as I pointed out elsewhere, due to policy lag, it doesn’t take much of that before projections start saying NHS capacity will be in danger in six weeks or so, at which point lockdown became a political inevitability (I’m saying this separate from whether or not it’s a good idea – I’m purely replying to @bom4’s question of what government/advisors thought or hoped would happen).

    The next thing will be the “rapid tests” which are being rolled out shortly – there was optimism about these too but they’re several months later than hoped for.

    Sweden remains an interesting comparator but I’m not sure if their strategy to date will last over winter without some substantial modifications, since their transmission numbers are heading in the wrong direction currently. We’ll see. I hope they manage it because it would be an indication that a Western country can manage the virus sustainably.

  21. Given the huge number of in-hospital transmissions the Nightingales could be used to separate infected from non-infected patients. Except problem is most of those infected patients need some other form of specialist care, not just a bed somewhere they can be sick for a while without infecting other people.

    The “case” numbers are not comparable to the epidemic phase because we were not testing very much then. Over the summer testing a lot, with quite possibly a majority of “cases” false positives. That won’t be so now with the positive tests running at about 5%. Extrapolate the numbers to the population. Every day something of the order of a million new infections, maybe less if the testing is really concentrated on symptompatics, though we know a large proportion of patients seeking testing are not symptomatic. It will not stay at that rate for very long, it is physically impossible for it to stay at that rate for very long, lockdown or no.

    If there is to be overwhelming demand that is already baked in. There is not going to be overwhelming demand because the susceptible were largely killed off last time around. We will have a slightly higher new susecptible population because of the last several months of shit, and if the lockdown achieved anything it was to kick the already half-empty can into the winter season. Genius move, that.

  22. “Or indeed the famous Ferguson paper. The code was crap and the numbers well off – though not always in the direction you might think – but it did suggest, qualitatively (which is often all you could hope for from a model), that you could get stuck in dynamics where out of lockdown transmission continues unsustainably and then once short-term hospital demand forecasts shoot up (as has happened now – ”

    I will say one thing in defence of the infamous Report 9, which will surely ensure Ferguson is the first man to win the Nobel prizes in both Medicine and Economics: it told us to turn things on and off as capacity limits were approached. No one has actually done this, rather tinkered around the edges of pointless measures. If you wanted to create a “new normal” this is how you would do it.

    “Taiwan”
    The weather in Taiwan, even in Taipei, is still pretty nice at this time of year. I would have been there delivering some training right now if this hadn’t happened. Still waiting for the court order to get a refund on my flights. Let’s see if things stay so low when winter comes. It will also depend if they bother doing the widespread population testing for 1 of dozens of currently circulating respiratory viruses that we have done.

    The only interesting thing about covid-19 is its novelty. Even established coronaviruses kill a single figure percentage of frail elderly patients. We don’t notice it because it is background and endemic, as covid-19 will be within a year if we stop trying to eradicate it.

  23. “this bunch of incompetents spent £569M on 20,900 ventilators in April”: don’t be an idiot. It’s fair game to criticise them for things they should have done but didn’t. And for things that they shouldn’t have done when good judgement was lacking. To criticise them for doing what every medic told them was essential is just daft.

  24. A friend of mine has had his op for removal of his colostomy bag postponed 6 times since March. Each and every time the hospital calls him the day before his pre-op and tells him there are no beds available for post-op care. NHS – the envy of the world.

  25. “It’s fair game to criticise them for things they should have done but didn’t. And for things that they shouldn’t have done when good judgement was lacking. To criticise them for doing what every medic told them was essential is just daft.”

    This. But let’s extend it. If politicians were ever capable of saying “we got this wrong in good faith” we would not currently be in this situation.

  26. ‘quite possibly a majority of “cases” false positives. That won’t be so now with the positive tests running at about 5%’

    You could be right but nobody knows. It’s perfectly possible that the false positive rate is 3% in which case false positives could be the majority. Add to that the problem that true positives might just be a sign of viral RNA fragments up your nose, rather than a sign that you are incubating live virus, and you still have the problem that the data used for decision-making are ropey, and unavoidably so.

  27. Yes – also an error of me to equate the proportion of positives today with new infections today.

    We would know the FPR if there was half-reasonable QC going on. I used to do (admittedly boring old bog-standard) PCR every day, for years, in my past life, to diagnostic standards. If you got any amplification of anything at all in your negative control you had to throw away all the results and start again.

    In fact, QC with this probe-based technique, using a number of negative controls (air-exposed swabs, swabs from patients with known clinical infection > 2 months ago, papayas, turtles, whatever) should be even easier. For any diagnostic lab test there are consortia to establish quality standards, track how things are changing over time, etc. Why not for this? Presumably because PCR has a very niche diagnostic role and the results, when you are looking at individuals with a strong clinical indication for the test, are usually quite reliable.

  28. I’d be a whole lot more pessimistic than Tim. I reckon economies may be headed towards a critical point where you get a cascade effect. Where it’s not just the businesses directly affected by the restrictions but the suppliers of their materials & services & it’ll carry on working it’s way back up the chain. You lose a significant amount of that & it’ll be very hard to build it back up again. Where we were in February took many years to create. You’re not going to recreate it overnight. It could take the same number of years. At the rate they’re going they could push economies back to where they were in the 60s or 70s. How long would you even be able to hold on to the infrastructure if it’s not being used sufficiently to justify maintenance?

  29. Bloke in North Dorset

    Addolff
    November 3, 2020 at 12:59 pm
    BoM4 and MBE, this bunch of incompetents spent £569M on 20,900 ventilators in April – isn’t that enough?

    I see dearieme has already commented but I’ll say my piece anyway …

    That’s nothing but hindsight bias. At the time everyone, in every country, was screaming for ventilators. Only a few doctors had started to realise that they could be part of the problem, but as doctors in Italy and Spain were pulling old people off ventilators and giving them palliative care so they ventilator could be given to someone younger. Politicians cannot be blamed for this one.

  30. I’d add to the above: The first time all this was built up, there wasn’t the tax bill hanging over people’s heads for government spending on alleviating Coronavirus effects. That’s going to end up haunting us for years. Everything’s going to be more expensive to do.

  31. @dearieme

    You could be right but nobody knows. It’s perfectly possible that the false positive rate is 3% in which case false positives could be the majority. Add to that the problem that true positives might just be a sign of viral RNA fragments up your nose, rather than a sign that you are incubating live virus, and you still have the problem that the data used for decision-making are ropey, and unavoidably so.

    For all the problems with PCR testing, and the daily data is indeed very problematic, for the UK situation at least there’s a lot of clarity from the weekly ONS household survey. Doesn’t cover people in institutions (care homes/hospitals), doesn’t give city-level coverage (though good enough to show regional trends). But if you see that doubling, you have a reasonably clear idea that infections in the community are doubling.

    Re 3%, if you look back to earlier ONS surveys: “Our latest estimates indicate that at any given time during the two weeks from 14 June to 27 June 2020, an average of 25,000 people in England had the coronavirus (COVID-19) (95% confidence interval: 12,000 to 44,000). This equates to 0.04% (95% confidence interval: 0.02% to 0.08%) of the population in England or around 1 in 2,200 individuals. This estimate is based on swab tests collected from 23,203 participants, of which 12 individuals tested positive for COVID-19.

    The most recent numbers are far higher, see https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/30october2020

    @big

    The weather in Taiwan, even in Taipei, is still pretty nice at this time of year. I would have been there delivering some training right now if this hadn’t happened. Still waiting for the court order to get a refund on my flights. Let’s see if things stay so low when winter comes. It will also depend if they bother doing the widespread population testing for 1 of dozens of currently circulating respiratory viruses that we have done.

    Yeah, I could have named maybe half a dozen Asian countries, plucked out Taiwan at random, but frankly I’m not sure anybody knows why those countries have managed to retain a degree of normalcy (particularly since the measures they’ve taken seem so different to one another) and how much of that is transferable to the West anyway (climate and cultural stuff isn’t going to be, for example). I read far too much guff earlier this year about how the “strong public health systems” and “decisive governmental response” in countries like Argentina and the Czech Republic had led to their excellent performance in the Covid League Tables, but look what’s happening in them now. Probably best not to pay too much attention to the league tables before half-time. Just interesting, and frustrating, that there seems to be a half-way house between European-style on-off lockdowns and Australia/NZ-style elimination efforts (and all the long-term problems they’re going to have), that appears to be sustainable in the long-run, yet we just haven’t quite managed to get there.

    Every day something of the order of a million new infections, maybe less if the testing is really concentrated on symptompatics, though we know a large proportion of patients seeking testing are not symptomatic. It will not stay at that rate for very long, it is physically impossible for it to stay at that rate for very long, lockdown or no.

    If there is to be overwhelming demand that is already baked in. There is not going to be overwhelming demand because the susceptible were largely killed off last time around. We will have a slightly higher new susecptible population because of the last several months of shit, and if the lockdown achieved anything it was to kick the already half-empty can into the winter season. Genius move, that.

    “Million new infections per day” is probably well off. You seem to be working from the daily positive test numbers and trying to extrapolate. I don’t know how the data situation is in Germany, but for the UK doing that is pointless (the daily test results are more useful for finding local hotspots) when we have the random survey data. The results from the ONS survey suggest about 50k daily new infections in England. REACT reckons somewhat higher.

    Like you say, if we were taking a million new infections a day and the hospital capacity looked tight but manageable, you can just ride the epidemic out. Having said that, I’ve pointed out before that Covid adds extra political risk. With seasonal flu politicians have preferred to “rationally” take the chance of hospitals going over-capacity in a bad winter rather than slosh billions at raising capacity, in the knowledge that while nobody likes this and the headlines each year are full of doom and gloom, usually voters forget by springtime. If Covid produced such scenes, the political fall-out for “not protecting people” is likely to be much harsher. Also worth bearing in mind that the tail-risks are worse with a novel pandemic: while you might forecast the worst week will still fall within capacity, the uncertainty beyond a month in advance is going to be huge – your 5% worst-case scenario can easily be twice as much capacity required, and these models haven’t proven well-calibrated in previous pandemics, so the true uncertainty (bearing in mind the model itself might be pap) is even larger. Again, if you’ve been racking up many millions of infections per week and been coping okay to date, this gives some reassurance that things aren’t going to get that much worse than you’ve already experienced, and it couldn’t possibly last much longer. Moreover, what with policy lag, it’s probably too late to do anything about it anyway – like you say, the worst effects are already baked in.

    The good news about circa 50k infections per day is that it’s probably low enough we could sustain it fairly comfortably, provided it wasn’t growing. The bad news is that it is growing very quickly, and the fact it’s so low then becomes double-edged – it means there’s headroom for it to grow much higher, and continue growing quickly, while at the same time suggesting only a quite limited number of people have been exposed to it so far. That’s bad both from an immunity perspective (which would slow growth) and for the “tinder” hypothesis that lots of oldies who survived previous mild flu seasons were easy victims for Covid, but that a second wave won’t have such a dramatic effect since, as you put it, “the susceptible were largely killed off last time around”. But for all the care home outbreaks we read about, many care homes were largely unaffected. Only a small percentage of the old and vulnerable were wiped out in spring (the death figures would have been far higher otherwise). There are still plenty more who escaped the first round and remain vulnerable. Now you can make a fairly brutal QALY calculation about this – deaths in this group are, I’m afraid, simply the ones we care about the least from that perspective – but it seems the issue in lockdown decisions hasn’t been so much the death toll but healthcare capacity. Vulnerable people have higher infection hospitalisation risk, so the more of them start getting infected (and the ONS survey data shows clearly that the rise in infections in younger age groups is now being shadowed by a rise among the old) then bed demand starts heading north quickly.

    The UK government ignored earlier advice for a more limited “circuit-break” (which seems to be a euphemism for “lockdown” used by proponents to make it more politically palatable), but instituted lockdown in England once they were told internal forecasts showed that unless implemented by the start of November, current infection rate plus growth was sufficient to produce capacity breach (including Nightingales) by December. Until that point, and despite being told delay was expected to result in deaths, the government had held firm on trying to see if the Tier system would be sufficient, so it seems that running out of beds, rather than raised death toll generally, represented a political risk they felt unable to take on. This paragraph isn’t a normative statement – there’s plenty to criticise in both these decisions and the forecasting they were based on – but a descriptive attempt to identify what’s driving their current choices. If their position doesn’t change – and certainly the approach of the scientific advice they’re receiving is unlikely to – then I think we’re likely to see an on-off cycle of lockdowns until we’ve had a vaccination programme, or we hit upon some kind of system that allows us to prevent runaway growth of infections again (the current hope is on mass rapid testing at large travel hubs, workplaces and schools), or enough population immunity develops to slow things down for us.

  32. Bis I imagine you must be seeing the cascade effects. We have been caught up in at least 2 such processes. We ordered some bespoke blinds from a small local business just before the middle of March. It’s a family firm – wife takes the orders and measures up and hubby does the fitting. Their supplier went into lockdown and so our delivery could only happen once the restrictions were lifted and the order backlog was worked through.

    Then at the start of September we escaped to a holiday apartment in France to find that the water heater had corroded and was leaking red water all over the place. The plumber warned us that stock levels were really low because all his suppliers had been caught in the French lockdown.

    It’s also affecting the wine trade. Because the hospitality industry has been all but wiped out, all the vineyards and wine merchants have built up massive stocks of wine they would usually sell to hotel chains and restaurants etc. It’s good for the individual customer as we can get hold of stuff normally out of our price zone but it’s going to be messy for the producers. I kind of wonder why they bothered with the harvest this year but I guess the costs of not keeping the vines tended would make it tough to restart production

  33. BiND,

    “That’s nothing but hindsight bias. At the time everyone, in every country, was screaming for ventilators. Only a few doctors had started to realise that they could be part of the problem, but as doctors in Italy and Spain were pulling old people off ventilators and giving them palliative care so they ventilator could be given to someone younger. Politicians cannot be blamed for this one.”

    I’m not judging in hindsight. I had a lot of patience with government at the start because we had no idea about the state of this. It hit fast. We had no idea about what it did. Shutting stuff down to manage capacity made sense, under the circumstances. We couldn’t build/buy ventilators fast enough, we didn’t have enough beds, so, everyone hibernates to give us time to build capacity. Seemed like a pretty good plan.

    At the end of it, I expected us to have capacity, or to be gradually living more as we got the capacity to the required level where we go back to life, and deal with the sick. We built the beds. We spent £569m on 10,000 ventilators (of which 802 are in use). If it’s not enough, we should build more. If we don’t have the people, well, we’ve had 8 months to give people specific medical training around Covid. Plenty of civil servants sitting around on furlough, or doing far more trivial jobs, who could have been told to do it or lose their job.

    We’ve now shifted from “protect the NHS” as a temporary measure to eternal winter until a vaccine arrives. And my guess is that even the most vulnerable won’t be getting that until the end of next year, let alone everyone else.

  34. The issue with capacity for ICU is staffing, it’s possible to have a 2:1 ratio of patients to staff for some situations, but that’s pretty much the limit and most ICU operate a mix of 1:1 and 2:1 already so how much extra you could squeeze out of enforcing 2:1 if possible is still limited
    The training for a standard nurse who joins an ICU is around 6 months, obviously you could specialise in some areas of training and have experienced staff working with less experienced staff so the experienced staff could be spread thinner. This is what you should be using time for in building capacity, targeted Covid critical care trained staff should have been put in place by now.
    The problem is that none of this seems to be going on, locally my wife who gave up working ICU due to back problems few years ago has been approaching managers to ask if they would like her to come back on a casual as needed basis and so far no offers

  35. Regarding cascade effects we can look at areas like the South Wales valleys and see the knock on effect of taking out a chunk of GDP, plenty of examples around

  36. In an interview on Irish TV one lockdown sceptic asked the question, if the Irish govt has had to borrow 100 million for lockdown costs how much health care capacity could we have bought for that much money, that’s the other side of the Sweden picture, better to spend more on Heath care than people doing nothing

  37. Training ICU nurses can also have a high burnout rate as not every person (including trained nurses) is suited for dealing with that environment and the daily exposure to death it involves. As I said my wife is volunteering to go back and work with Covid patients with my full support, contrast that with the teachers unions campaign to close schools again

  38. I wonder if any government ministers are independently paying attention to the covid case numbers. It’s possible the second wave has already peaked, as the numbers are either level or dropping. Even if this is just a weeklong blip, at the very least it should be obvious that an exponential increase is not happening.

    A pointless lockdown. Just like last time except plainly visible.

    If Boris had any leadership skill about him he should have told Vallance and Whitty during the planning stage that if they are wrong it means their fucking jobs, pensions and titles.

  39. @ Jim & Henry Crun
    Both the cases you mention seem pretty straightforward. Probably less than a grand for the treatment.
    The NHS is obliged (they won’t tell you this, of course) to pay for treatment if NHS service is unreasonably delayed. Normally you have to have a consultant’s letter but you have “dates” booked so far ahead it’s pretty bomb proof.
    Get a section 2 form, take it to your doctor or another private provider (from Spain to Estonia via private UK clinic) and book the operation. Pay and apply for the refund, or some of them will charge the NHS directly.
    (Better make sure the chap jabbing steroids into your back or sewing up your arsehole knows what he’s doing of course.)

  40. BiG
    Bit of mental arithmetic for ya.
    If we have a million infections per day and the vast majority don’t die, then we can get a 100% herd immunity in 60 days. Allowing 10 million already immune, 30% of the population with T cell immunity, 20 million kiddies effectively immune, and herd immunity achieved at 60% then we’ll get over the covid in…
    Less time than the lockdown.
    OK, it’s a bit more nuanced than that…

  41. philip,

    That was a brainfart on my part. I am having more than usual at the moment (pendants’ mileage on that may vary).

    You can test true positive for covid on many days from some point after infection until you clear it (or some point after you clear it, going on the “dead viral RNA” hypothesis, which seems reasonable). So the number of people testing positive today divided by the number of tests today doesn’t tell you the new daily infection rate.

    I think the general point stands and all things considered this is over even before the current lockdown. Perhaps some truly evil scientist, rather than the merely incompetent ones advising HMG, has worked that out and this is all a plot to claim political victory over a natural process. Nothing would surprise me any more.

  42. NDreader, it’s gonna vary from place to place. Pipettes are probably the biggest contamination source here and that is a matter of practice, and keeping your hand in. Physicists can probably explain very well why biologists pipettes have a nasty tendency to suck liquid up in a narrow jet into the body of the pipette, thereby contaminating everything you subsequently manipulate with the same pipette, if you release the plunger too quickly.

    To save on cleaning costs, and having any more of the supposedly expensive (about £500 for a full set, if memory serves) Gilsons on hand, you can even buy filter tips (https://www.scientificlabs.co.uk/product/F171203) for the lab babies.

  43. @PJF

    Even if this is just a weeklong blip, at the very least it should be obvious that an exponential increase is not happening.

    You’re focusing on the daily testing numbers, by the looks of it, which are indeed fairly encouraging. Just remember all the biases that’s subjected to – a lot depends on the testing capacity, where tests are available, who’s encouraged to seek a test out, and so on. Also, check out the age and local breakdowns. While total numbers are static, that’s concealing a number of other trends – notably a fall in some but not all of the areas with high rates (local restrictions are some but not all of this story), but rises in other places. There also seem to be a lot of university outbreaks that worked their way through testing system and that source seems to be declining now. But numbers in the older age groups are particularly important, since this drives (at a lag) hospital bed demand.

    For a much clearer picture, the next set of ONS random household survey data will be released on Friday. That cuts out all the worry about the effect of testing strategy, capacity, test-seeking behaviour etc on the results. If that has also flattened out, particularly at older age groups, that would be great news and much more convincing than the flattening of the daily results. Unfortunately they haven’t always moved in lock-step in the past, and of the two, the one you want to be focused on is the ONS figure.

    @NDReader

    According to https://ourworldindata.org/coronavirus-data-explorer there have been periods when the “Share of positive tests” in the UK was just 0.5%. So that’s the upper limit for false positives.

    Repeat of what I said upthread in case you missed it, but in the final June ONS random household survey (where you’d expect a far lower proportion of people to have Covid than in tests that people were actively seeking out), their estimate of 0.04% of the population having the disease at any moment in time was “based on swab tests collected from 23,203 participants, of which 12 individuals tested positive for COVID-19”.

    @philip/BiG

    Now do the maths if it’s only 50k new infections per day but growing. It just ain’t as pretty.

  44. The test isn’t worth shit and most positives either don’t have C19 or will have nary a sniffle in the event they do. Your bullshit does play into the hands of Commissar Blojob however. Those dying are–by a massive majority–old/v ill and would be dying anyway.

    So lets all defy the Commissars LD bullshit from minute 1.

  45. @bom4 – writing while watching the election, apologies if this goes over-length

    At the end of it, I expected us to have capacity, or to be gradually living more as we got the capacity to the required level where we go back to life, and deal with the sick. We built the beds. We spent £569m on 10,000 ventilators (of which 802 are in use). If it’s not enough, we should build more. If we don’t have the people, well, we’ve had 8 months to give people specific medical training around Covid. Plenty of civil servants sitting around on furlough, or doing far more trivial jobs, who could have been told to do it or lose their job.

    On that last bit, the issue with healthcare capacity isn’t low-skilled staff. Plenty of HCAs (healthcare assistants, what used to be known a couple of generations back as “auxiliary nurses”, dunno what they’re called in Leftpondia) but doctors with useful specialisms and ICU nurses are harder shortages to deal with. See @Ummmm above. From what I’ve seen from a distance, there’s been a lot of work on training, procedures etc. Trying to arrange things so the lowest qualified person possible can perform a task. I get the impression from what I’ve heard that the easy wins have been largely achieved here, and that the NHS has showed more flexibility than usual.

    Re capacity letting life get back to normal, I think you might have a fundamental misconception about how this aspect of pandemic planning works. Actually worth getting your head around it, since it makes the strategies of various governments around the world make much more sense, and if you understand the rationale behind it, gives a decent clue what’s next around the corner. What follows isn’t intended as defence or criticism of particular policies, just a description of the underlying thinking. Based on what you wrote, I’m guessing your mental model looks roughly like:

    1) Government twiddles with a policy dial (bans crowds/audiences, sends kids home from school, issues stay-at-home order, etc),
    2) With some lag, this determines the contact rate between people,
    3) With some more lag, this determines the rate of infections in the population that’s roughly stable in the medium term (in the long term, changes in the proportion of population with some immunity will shift this infection rate, but that takes time),
    4) With even more lag, this determines the level of healthcare demand.

    If this were true, a government can figure out the healthcare demand produced if they twiddle the policy dial to “pretty normal”, build up the required capacity, then turn the dial. This is consistent with your statement which is why I’m guessing you’re thinking this way. But it doesn’t work, because 2) and 3) aren’t linked like that. Suppose the government implements a set of measures that fixes R at 1. Then since each infected person infects, on average, one more, the rate of new infections stays the same – indeed you can make any infection rate sustainable. Moreover, if they fix R above/below 1, every infection rate is unstable, and will trend up/down. The way it works is more like:

    1) Government twiddles with a policy dial,
    2) With some lag, this determines the contact rate between people,
    3a) This determines whether infections trend up/down or stay roughly stable,
    3b) The new value of the infection rate is determined by the previous rate plus the trend from 3a),
    4) With even more lag, this determines the level of healthcare demand.

    This is why whenever anyone proposes a long-term sustainable way to let us get back to something resembling normal life, it’s invariably something that acts on the transmission part of the equation, so that other policies can be relaxed. Handwashing stations popping up everywhere at the start of the epidemic, Test and Trace, smartphone apps, rapid mass testing, even the proponents of masks rather optimistically cited a “return to normality” as one of their advantages…

    This explains why the government has been so obsessed with the R number, even down to attempting R-budgeting for their interventions (the idea that closing gyms knocks about 0.1 off R, for example). Expanding capacity is simply at the wrong end of the chain to be useful for “returning to normality” permanently – if R sticks above one, you can lay down extra capacity, but it’ll just get burned through. (A lot depends on whether you’re stuck in the exponential growth phase of the epidemic, or whether rising immunity levels can bring the R down for you so that the epidemic burns out before your capacity does. The government’s modellers reckon that with Covid, capacity would fail first, and by a long way, which underpins their caution about R values above one.)

    Extra capacity has benefits, like giving you insurance in case things take you by surprise. You’ve got only indirect and lagged control over a process variable that’s also affected by other, often noisy/poorly understood inputs (seasonal factors, behaviour and compliance changes, new school/uni term, etc) so it’s helpful if you’ve got more leeway over the target range you’re trying to keep it within. Means you don’t need to twiddle desperately on your interventions dial whenever you see things move in the wrong direction (not saying it was a sensible or effective policy, but the hospitality closing times restriction was this kind of somewhat panicked response to an uptick in the stats). Buys some time before the really big calls – I think it’s pretty clear Johnson ignored the earlier advice for a “circuit breaker” (far as I can tell, euphemism for “lockdown” from people who wanted to make it more politically palatable) but apparently caved on Lockdown 2 when told if he didn’t do it by the start of November, due to policy lag, the Nightingales would run out of capacity by December. Without the Nightingales, almost certainly he’d have agreed to lockdown earlier. If he’d had enough capacity to postpone the decision another week, all indications are he’d have preferred to wait and see whether the purported benefits of the Tier system were kicking in. But I don’t think capacity buys all that much time – 20% extra capacity is huge in healthcare terms, but if you’ve got an epidemic growing 10-20% per week (and far higher is possible) then that only grants you an extra couple of weeks before your advisors start saying the forecasts look terrible and you need to make the lockdown call imminently.

  46. MBE, everything you say is fair and reasonable.

    If you are only looking at one output variable.

    NPIs as currently implemented are like trying to fly a plane by looking at the speed dial and deliberately ignoring the altitude. Things might seem fine for quite a long time but at some point you will crash. very badly.

    As we’re on a medical topic an analogy to drugs is apposite. As you know you don’t get any drug on the market without an expensive and intensive procedure in which you have to persuade a skeptical authority (who suspects you are committing spin if not outright fraud), that (a) there is evidence that your product does what you say it does (it moves some clinical outcome dial in at least a known proportion of patients taking it), (b) that thing is of benefit to the patient taking the product (you’re turning the dial in the right direction), and (c) the harm the product does to the patient is less than the benefit accruing to that patient.

    Leave aside the fact that weighing drug benefits and risks is a dark art, as comparing apples to oranges inherently is. Instead, consider for which of the NPIs has any attempt at a cost-benefit calculation been made?

    For masks, for example, it is claimed that these are of no benefit to the wearer at all. The benefits and the harms are still only postulates because there has been no study that provides evidence of sufficient quality to quantify these. Or rather, the publication of the one that comes closest has been suppressed.

    Where in medical ethics do you find support for a treatment for which no benefit to the person being forcibly treated is even claimed?

  47. Jim
    Hope it works out.
    Medical tourism is a big and growing business. For some conditions the costs abroad are so much lower than NHS internal accounting it’s economic to close down some surgical wards and subcontract the jobs to Eastern Europe. They won’t though.

  48. @big

    Not sure you’re likely to check the replies. My point was descriptive. How are the actors making decisions?

    SPI-M and SAGE have, at various times, worried about the overall death toll, the Qaly/YLL cost of Covid itself, the hospital demand, and – not often enough in my view, but they did occasionally attempt to evaluate it – a cost-benefit analysis including costs of the intervention.

    For what it’s worth, https://en.m.wikipedia.org/wiki/Multiple-criteria_decision_analysis has become very voguish in UK public health circles in the last decade. So they do tend to look from multiple perspectives.

    The government (Boris personally? Cummings? The cabinet? Would like to know who is driving this but don’t) however seems almost entirely driven by hospital capacity and the fear of it running out like North Italy experienced. Whether that’s political optics or a deeper concern for the NHS or something else altogether, I dunno. The government has repeatedly and explicitly rejected advice it was told would save lives, so people who complain the government has developed a monomaniacal obsession with preventing Covid deaths while ignoring other deaths aren’t quite right. A looming higher death toll in its own right doesn’t seem able to drive UK policy, but when accompanied by hospital capacity warnings, they seem willing to U-turn (both now and Lockdown 1). As I observed above it’s interesting that historically politicians have been prepared for a bad winter flu season to overwhelm the NHS but will pull out extreme measures to stop Covid going the same way, but perhaps my comparison is unfair given that the tail-risk of Covid getting out of control is worse.

    Re the medical law/ethics. Absolutely agree and have made this point myself to other people, almost exactly as you put it actually. I think a proper write-up of the ethical side will be fascinating – I find it odd that they don’t seem to have called in ethicists for high-level advice, regarding the judgment and objectives questions as primarily or exclusively political, not ethical. But an ethicist might at least have pointed out decision-making needs to consider certain factors, and arguably this could have been used to improve models (to ensure they produced more ethically relevant output) and perhaps even managed to persuade researchers or research-commissioners to put more focus on estimating both benefits and costs of interventions. For the legal side of it, Lord Sumption has made some excellent points even if I’m not sure he’s always got the science spot-on but I think his legal analysis hangs separately from that anyway, so not someone who should be ignored by dint of not being a scientist.

  49. MBE, many many thanks. Yes, am checking as you can see.

    These are powers no government should even have. You can’t just go “TINA, everyone stay home”. Germany has even written and passed an enabling act, while lambasting Orban as a “fascist” for distraction. When it’s the AfD of all parties that stand up and criticise the anti-democratic aspects of this, even if only opportunistically, you know the world is fucked up. Merkel should know better than to give them ideas by giving herself powers that no one should ever wield. The consequences of this won’t turn up in any decision model.

    We can’t possibly have a “second wave” that is worse than the first, although ironically the NPIs make that statement less secure than it otherwise would be. If they were effective (and I think we really don’t know how effective they were) then we could have a worse second wave.

    But in general “no waves” is infectious disease 101. It’s the global gaslighting (there is no prior immunity, will be no acquired immunity, is no such thing as herd immunity) on this, from respectable scientists, really pushes me down the conspiracy theory route. I am with Yeadon on this, they are lying, and they know it. Saying there is no such thing as herd immunity is like saying there is no such thing as male and female on the scale of things that are just plain wrong. So perhaps the cultural Marxists are in charge of medical science as well now, and that is bad.

  50. @BiG

    Fwiw I reckon Yeadon is well off on some of his factual claims but some of the pro-lockdown counter-arguments from certain quarters have been poor too, particularly the illogical rejection of herd immunity as an idea when their long-term hope of a vaccination strategy absolutely rests on it!

    As far as I can tell the government scientists are well aware of herd immunity and cross-immunity from endemic coronaviruses, their position seems to be a bit more nuanced: in their view the rate of infections at which we are getting towards herd immunity needs to be carefully controlled and the transmissibility of Covid makes this hard, hence their abandonment of their original strategy of letting it wash through the population at a rate compatible with healthcare capacity; cross-protection may be real but maybe only partial, and they would need to see more evidence before they rely on it. But the more outspoken “cheerleaders” for lockdown seem to discard any nuance. Not that the chief advisors did themselves any favours presenting out-of-date projections at their last press conference – SAGE minutes explicitly admit that scaring us into compliance is part of the strategy, which is why I’ve said from the beginning (before those minutes were publicly available, but their likely strategy was obvious) that what the government say to justify what they’re doing needs to be take with a pinch of salt. (Mostly pointed that out on forums with less robust scepticism than Timmy’s place has.)

    Through my personal grapevines, what I’m hearing is that the worry over NHS capacity is genuine (I’m not saying accurate, and I’ve made my scepticism about the modelling clear elsewhere hopefully, rather I’m saying that the government’s own modellers and capacity planners genuinely believe it and this was the message that was passed to Boris with the stark “lockdown now or else” warning) even if the graphs presented in the public briefing, like Vallance’s controversial and obviously unrealistic projection a few weeks back, had more than an element of scaremongering.

    Re waves. This is something I actually know a bit about from an epi/infectious disease modelling point of view. They just seem very amorphous and not well-defined and generally unhelpful as a concept. Read an interesting journal article about them a while back which I now can’t remember the link to. But yes, if you can see a pattern that looks like “waves” (I would probably prefer “multiple peaks” but the term seems to have stuck in the public consciousness) it’s worth digging up what’s driving it, The NPIs we have used seem very strong candidates to me. I know there are some people saying the “wave” effect is really just seasonality showing up, but I’m sceptical – my personal guess is that immunity levels are still lower than where the optimists reckon they are, and what we are seeing is just a consequence of postponing things with the first lockdown. Managed to time it to give ourselves a new peak in the busy winter season too, wasn’t that clever of us…

  51. “my personal guess is that immunity levels are still lower than where the optimists reckon they are, and what we are seeing is just a consequence of postponing things with the first lockdown.

    If that’s true, then I’m still waiting for anyone to explain what actually then happened in London (and Sweden obviously). In London, peak infection was reached circa 17th March. I don’t care if that’s not 100% accurate (we are estimating it in any case, proxying back from deaths / 111 calls etc), the point is that London stopped going exponential and went towards flat (never mind R dropping back below 1) well before 23rd March. Ie voluntary changes to behaviour impacting R0, not enforced lockdown.

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