Saturday, 4 April 2020

I ain't no epidemiologist but...

This is one of them "I ain't no epidemiologist but..." posts. I ain't no epidemiologist but... I am capable of understanding that like for like statistical comparisons between countries are next to worthless when you factor in wealth, mobility, languages, population density and ethnic makeup, and that people (quite unhelpfully) do not necessarily conform to patterns you might expect.

You then have to look at population age structure, breadth of healthcare coverage, reliability and availability of testing facilities, and data collection methodologies. Outbreaks may spread faster in poorer areas due to an overall lack of sanitation or observance of religious practices/beliefs, and then something as obscure as city centre parking charges can influence where people go and when. You may be geographically closer to a city centre but for convenience and cost it may be easier to go to the next town.

By the time you've listed all of the generic factors along with the locally influenced factors, some unique to the geography of a region, you start to see the implausibility of statistical modelling. Models can give you an outline of how things might develop but it's all contingent on the quality of the base assumptions. As as we know from election data and recent shifts in political tides, even the most sophisticated polling can lead you up the garden path.

More to the point, as The Guardian notes, what we are presently experiencing isn’t just one big epidemic. It’s lots of outbreaks at different stages, starting at different times that all need to be tackled locally through local teams, and local action plans in each area so measures can be lifted over time. What works in London doesn't necessarily work in rural Yorkshire.

As a humorous aside, I have to laugh at the boss of Northamptonshire plod telling us they wouldn't; impose roadblocks unlike North Yorkshire. Having recently lived in Huntingdon I can see why there'd be no point. Nobody is in a hurry to get into the district and there's nowhere to go without driving for at least an hour and a half. In Yorkshire, however we have place people would actually want to go to. Regional differentials matter, which is why the plod have had to take action to deter the public descending on Whitby en masse.

As regards to measuring the performance of countermeasures, the same set of statistics can produce opposite conclusions at different levels of aggregation. You then have differing local governance structures between regions and countries which distort the data even further. Really all we're left with is a lurid league table of death; a rolling body count which is still subject to debate and dispute depending on whether Corona is is causal or contributory. It's the same old argument we've had over smokers dying aged 92 of lung complications.

For me though, there is one overriding consideration. In this game, these statistics are highly political, largely deployed by tribalists seeking to attack or defend a political stance and the more tribal it gets the less value it has. Right now all eyes are on Sweden which has taken a differing approach to the rest of Europe that has the Tory contrarian "it's just the flu" brigade hoping like hell the health outcomes will vindicate their stance. 

Here we have to remind ourselves that this is not an epidemiological debate. This is pure politics. This we can extrapolate by sticking to the known facts at the most basic level. Since becoming alert to Coronavirus I have largely cut myself off from most human interaction. Being that there were fewer than five cases in the entire region and I have not suffered any symptoms it is likely that I have not contracted the virus and am highly unlikely to have spread it. The "lockdown" is essentially encouraging everyone to do the same. 

If most people participate in good faith then we can reasonably assume the virus cannot spread like wildfire, allowing authorities time to develop and refine their local containment strategies, also in the hope of managing the stress on health services and perhaps even buying the time to develop a vaccine. 

Taking a light touch approach for the UK would likely lead to very rapid spread of the virus since most households outside of London have cars, we endure long commutes and share densely populated public spaces. In terms of deaths, you're going to pay the full price sooner rather than later. As to which approach is right is a moral and economic question. We can each enlist credentialed opinion to support a case for either but the decision has to fall to the politicians, not the experts - especially when there is a breadth of conflicting expert opinion.

You can argue that quarantining 68 million people will have a devastating long term effect on the economy that over the longer term could have a more subtle but more lethal effect on public health, but we simply do not know what would happen if we simply let the virus rip through the population. Once people start dropping like flies and there's a mass panic, people will likely impose their own lockdowns and we'd see public and union pressure on business and institutions to close their doors. Politically it's untenable to be behind the curve - which is why Sweden is now contemplating a u-turn. Such a mass panic with a collapse of confidence in government could rapidly lead to disorder and vigilantism which has lasting implications of its own.

If we are going to get through this then whatever action governments take must have a degree of public confidence and overall consent. I'm certainly not volunteering to partake in a laissez faire slaughter on the off chance it might save a few points of GDP. Ultimately, Corona, like Brexit, means transitioning to a wholly new political and economic paradigm whether we want it or not. The deed is done. It seems that, if my social media is anything to go by, the same people who would invite the full brunt of a no deal Brexit are the same ones happy to indulge in a state sanctioned cull. It is on that basis I make my estimations and trust my instincts that this lockdown, for what it's worth, is for the greater good.

Ultimately we are not in control of this thing and though we can manage our response to it, we are still at the mercy of nature's most ruthless regulator. We can do more to give ourselves a fighting chance and do what we can to ensure we can pick up the pieces but since every government is facing the same difficult questions, GDP relative to others ceases to be a pressing concern. Like the brexit question, it's entirely a matter of where you place the premium. You can play games with numbers til the cows come home and pay Top Trumps with expert opinions, but this remains fundamentally a moral question to which there are no easy or straightforward answers. Like all matters Brexit and much else, the more confident the assertion the less I trust it.

I don't doubt the enormous cost that comes with this shutdown, nor do I take it lightly that we must give up certain freedoms for it to stand a chance of working, and if we have to come out fighting to retake those freedoms then so be it. British society and British law is rooted in an idea of freedom that cannot be erased by a short term public health intervention - and for all the overzealous jobsworths pushing us around, it won't last. The whole Brexit saga has demonstrated that there is a thirst for democracy and fairness and it is that process, whatever side you were on, that will arm us for the fights to come and the debates that were long overdue anyway. It's a long time since we could (if ever) say our democracy was fit for purpose.

If you came to this blog looking for answers then I'm sorry to say I don't really have any. But I'm starting to value my uncertainty about most things because it means I'm still listening and still have an open mind. The course of action we have chosen can be modified, eased or abandoned and the lockdown at least buys us choices. Better that than to gamble away lives and later regret it. In any case, I suspect we shall not have to wait long to see just how serious this gets. This time next month, this whole debate may seem like a distant memory. We shall have to see. 

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