Comment

Boris has my full support on lockdown 2.0 - even though I think he’s wrong

Armchair virologists should pipe down - hard experience shows how quickly this virus can spin out of control

Boris Johnson presides over lockdown tiers

At the risk of being shockingly unfashionable, I think the Prime Minister’s health response to the second wave of Covid-19 has been defensible and plausibly proportionate.

This is my reluctant conclusion, even though I also think that the Sage committee is over-egging the dangers and has no scientific basis for projecting 4,000 deaths a day in extremis.

Boris Johnson has had to navigate between the opposing monsters of Scylla and Charybdis, and make instant judgments in a cloud of imperfect knowledge and shifting circumstances. 

Much of the recent criticism has been shrill, intellectually dishonest, or lacks international perspective. Breathless talk of a humiliating “volte-face” or a “Suez Moment” is Westminster infantilism. 

Leaders across Europe are having to abandon their plans and hit the same “nuclear button”, and they are doing so because their hospitals are being overrun. This is what can happen in a pandemic dealing with a novel virus that keeps throwing up wicked surprises. 

Those accusing the Government of waiting too long to impose a second lockdown - and repeating the error of March - overstate a complex case and misjudge the social mood. They do not acknowledge that the Government has until this week been pursuing the current policy of the World Health Organisation and is at least trying to cleave to best practice in Europe.

It was entirely reasonable - arguably optimal policy - for Downing Street to take a wait-and-see approach this autumn, opting for a traffic light policy of regional tiers as the first line of defence. That is what Germany, Austria, France, and others were doing until the constantly-changing balance of risk forced their hand over recent days. It is also WHO policy.

“We’re calling for local, targeted, proportionate measures. National lockdowns are absolutely the last resort. We have to look at the collateral damage to society and the economy,” said the WHO's Europe director, Hans Kluge, just days ago.

The WHO pushed for drastic measures in March because the virus was spreading exponentially and healthcare systems were cracking. It is not more nuanced today because we face a finer judgment call.

This is not wave one all over again. Wave two has a different character. The case fatality rate is now lower. The curve trajectory of the pandemic is flatter.

A study by the Centre for Evidence-Based Medicine (CEBM) found that the death rate for Covid patients in UK hospitals has fallen to 1.5pc from 6pc in the very different situation of early April, when the National Health Service was caught off guard and staff were short of critical supplies. 

Such data must be treated with caution. There are time-lags and countless variables. Yet it is clear that doctors and nurses have learned fast how to fight this disease, with anticoagulants, steroids, and earlier use of oxygen. Germany’s top virologist thinks masks have cut the viral load, giving the immune system a head start for those who are infected. 

The Prime Minister was right to overrule Sage when it called for a circuit-breaker lockdown five weeks ago. At that juncture the country would not have swallowed extreme measures and a suspension of basic freedoms on the basis of  theoretical models.

As he stated in early October - correctly - a second lockdown would be a “disaster”. 

Note that Sage has swung from one extreme to the other. In February it flirted with herd immunity, even though the epidemiological imperative for a lockdown was overwhelming at that moment. It has now reinvented itself as the apostle of zero-tolerance when the imperative is weaker.

A two-week closure in September would have been no panacea in any case. “It is kicking the can down the road. We know that as soon as we open up again, the infections rise,” said Jason Oke, one of the authors of the CEBM study and an expert on UK epidemiology at Oxford.

“Sage are apocalyptic about this and their models keep exaggerating the rise in cases. The graphs over the weekend had eight different ‘R’ rates that weren’t internally consistent, and some of the figures were three weeks out of date,” he said.

Dr Oke said the Government should have held its nerve and persevered with its three-tier regional policy. “Shutting down North Devon is not going to help Manchester or Liverpool,” he said.

Personally, I agree. My preference at this point is for a light-touch ‘Swedish’ approach. Yet it is also self-evident that the UK is not Sweden. The level of social conformity is lower. Population density, obesity, and vitamin deficiency are all higher in the UK. 

Above all, the Prime Minister has suddenly been faced with the spectacle of Belgium, which has seen its 14-day cumulative average of cases rocket to 1,735 per 100,000. This has occurred even though Belgium was a cauldron of infection in the spring.

Clearly it was wishful thinking to suppose that high sero-prevalence from wave one would act as a partial fire-break in wave two.  

The rate in France has spiraled to 771, enough to overwhelm hospitals in 13 French departments. The number of critical care beds taken by Covid patients has hit 100pc from the Loire to the Alps. In Seine-et-Marne it has hit 134pc. Nationwide, the figure has reached 71pc. 

The country is approaching the sort of grim choices faced by Italy’s Provincia di Bergamo in March when doctors had to choose who to save, and who should be left to die. In August I poked fun at Mr Johnson’s quarantine policy for travellers coming from France, so I must eat my words.  

The UK rate is hovering at 469. It may be stabilising but that is far from assured and hard experience has taught how quickly the trajectory can spin out of control.  As the Prime Minister warned, the rise in UK cases has already exceeded the “worst case” scenario and we face the risk of a winter bloodbath. So we pick our poison.

Militant opponents of any serious counter-measures err on the other side, clutching at straws and every mountebank pre-print (before peer-review) promising some magic solution. There seems to be an incurable hope that life and commerce would somehow return to normal if the authorities got out of the way and let the virus more or less run its course.

It is the timeless fallacy of ignoring the counterfactual. The economy would stall anyway because people would batten down the hatches to protect themselves.  

My question for Nigel Farage as he launches his anti-lockdown party - or indeed for Tory backbenchers plotting mutiny - is how a policy of shielding the vulnerable can in fact work. 

Is he aware of the mounting corpus of research - by the Host Genetics Initiative, for example - showing that substantial segments of the population have genetic variants and chromosome disequilibria that leave them easy prey for this virus. Their cytokine and interferon signaling goes wrong.

Since we have not mapped the genetic profile of the nation - though it would not be that costly or difficult to do so, for the next pandemic - we do not know who these people are. They may be any one of us. There is no way of shielding them. So do we throw these people under a bus for our convenience or in the cause of Benthamite utilitarianism and better GDP? Surely not.

The failure of Britain’s Covid response is by now a well-rehearsed theme. It is bitterly disappointing that the test and trace regime has been such a shambles, but then Holland, France, and a string of other countries have each had their own comparable debacles.

It takes intrusive surveillance and enforcement to pull off successful tracking in Korea, Taiwan, and Singapore. Once the virus has gained a foothold it is probably too late in any case.

But that is water under the bridge, a matter for future enquiries. Right now we are at a potentially dangerous moment. Her Majesty’s Government deserves a little more support even in its errors, and a little less self-indulgent criticism from armchair virologists.

Pope Francis let rip over the weekend against the “facile blowhards” (declaracionistas) contaminating public discourse. He fulminated against “those who think only about themselves, who protest or complain about restrictive measures”, with a cool disregard for those most vulnerable to the pandemic. 

Quite so, Your Holiness. We all need to get a grip.