Thursday, June 04, 2020

List of Johnson Government errors in managing the Covid-19 pandemic

Every death is a sad event to those who knew and loved the one who died. The sadness is compounded if relatives are unable to visit them when they are dying to say goodbye, and becomes even worse if they are unable to have a proper funeral, supported by all the people that loved, knew and respected the one who died. That is the individual, personal reality.

The statistical reality is that Boris Johnson has led our nation into the position of being, to use his own phrase, a word-beater in Covid deaths per million. Johnson is second only to the idiot Trump, although another would-be fascist, Bolsonaro of Brazil, is coming up fast to challenge Johnson for second place.

Boris Johnson's Government is responsible for this situation. The Conservatives have brought it about through a series of errors and mistakes of such magnitude that it makes you wonder whether they are doing it on purpose.

Here is a brief summary of some of Johnson's major errors:
  1. Austerity. Not strictly Johnson's fault, but an important factor, since it puts everyone in a situation of stress, which is a known depressant of the immune system. It could be argued that austerity stresses the body politic itself.
  2. Exercise Cygnus. Johnson failed to address the institutional weaknesses thrown up by the 2016  Exercise Cygnus, which was a kind of war-game scenario of an influenza pandemic. It suggested that there would be severe shortages of PPE. Instead of learning from this, and setting up plans to avoid shortages, the Conservative Government went to great lengths to suppress public knowledge of the findings of Cygnus.
  3. Herd Immunity This eugenicist notion was that instead of stopping disease transmission in the classical public health model, we should "take it on the chin" as Johnson put it, and let the infection run through the community until about 60% of the population had antibodies, at which stage the infection might  fizzle out. It was only when modellers showed that this theory would entail up to 500,000 deaths and would utterly overwhelm the ability of the NHS to cope that Johnson decided that even he, with his tame Tory media trotting along behind, could not get away with this. However, rather than switching to a full-on classical lock-down to combat the infection, Johnson dithered and went for a half-hearted version which aims to slow the spread rather than to try to suppress it entirely.
  4. Failure to learn from China, Italy and Spain. Johnson's mantra is "We are following the science". Science begins with observation.  They must (mustn't they?) have sent medics over to these countries to see what was happening, although I personally have not encountered any reports or recommendations from them.  Either their reports and recommendations were buried, or observers were not sent out in the first place. Whatever happened, it was a major fail.
  5. SAGE, the scientific Advisory Group on Epidemics was at first not transparent in its deliberations, and the minutes of some meetings are still not available. SAGE's method is to look at subjects one by one in an analytical and critical way, seeking for hard evidence, which is often not available for matters connected with pandemics, especially with an entirely new virus. They did not taks a systems approach to the pandemic. SAGE also made a serious mistake early on in assuming that Covid would behave just like an influenza epidemic. As a result of these weaknesses, an independent version of SAGE was brought together by Sir David King, a past chief scientific adviser.
  6. Late lock-down. Johnson was late to order everyone to stay at home. The nature of a doubling series (2,4,8,16,32,64, etc) is that it must be stopped at an early stage. It is easier to stop two cases becoming four, than to stop 64 cases turning into 128.  Greece locked down before is had any deaths, and its total deaths are in the region of 150. By contrast, UK official deaths from Covid are 37,000, and the real figure (based on excess deaths) is in the region of 55,000. Johnson faffed about for two or three weeks before announcing lock-down. That delay has been calculated to have resulted in the loss of 13,000 (thirteen thousand) lives.
  7. Big Public Events. In those weeks of delay, Johnson allowed three major events to take place : The Cheltenham Gold Cup races, a football match in Liverpool against Milan (which was in a bad way with Covid) and a  Wales v Scotland Six Nations rugby match in Cardiff. All three places were hit badly with coronavirus cases after the events.
  8. London was badly hit, and no attempts were made to prevent or relieve overcrowding on Underground trains, and masks on public transport were only ordered in mid-June, four months into the pandemic.
  9. Testing Fiasco. One of Health Secretary Matt Hancock's earliest pronouncements on Covid was that "Britain leads the world in coronavirus testing technology". After this empty boast, we were treated to weeks of agonised explanations of why we did not have an adequate coronavirus testing programme. There was an irrational failure to test front-line medical staff, and instead they were obliged to self isolate for 14 days if they were suspected of being infected.
  10. Laboratories. One of the causes of the testing failure was said to be the lack of laboratory facilities. There were many small laboratories that could have been brought into play, but their offers were ignored, and instead the Government gave contracts to large centralised laboratories.
  11. PPE. For weeks the news programmes were filled with stories of the lack of PPE for front-line staff. This was responsible for many infections and deaths in our front-line medical staff. It is very obvious that one of the reasons for the lack of PPE is that manufacturers were unable to keep up with global demand for disposable, single use kit, and that they should have gone for washable kit instead.

    Southampton University developed an excellent PPE that supplied filtered air to the wearer, with added advantage that the face of the doctor or nurse was visible. Sadly, this has not been brought into general use.
  12. General Practice. General practice has been sidelined. Its special knowledge and influence in its practice area has not been brought into play. Information sharing between testing agencies and GPs has not been good.
  13. Privatisation. Instead of using existing institutions, Johnson's Government has tended to go for newly created private companies whose competence has not been tested. As a result, many outcomes have not been good.
  14. Local Authorities. Similarly, local Directors of Public Health and Environmental Health Officers have not been used for contact tracing. The decision not to do contact tracing was made because there were too many cases in London for contact tracing to be feasible, but in many other areas the low number of cases meant that EHOs could have kept their area Covid-free. Generally, the Government seemed more interested in passing contracts to newly set up private companies than using established institutions. Contact tracing when it was set up was late and chaotic, with web application forms not working, and a four month delay announced before the scheme would be fully operational.
  15. Digital contact tracing was attempted using new technology created by an ethically dubious entrepreneur instead of going in with a stable system shared with other countries.
  16. Masks reduce the range of infected droplets emitted when anyone carrying the virus speaks or coughs. They are particularly effective in situations such as public transport or at work where social distancing is not possible. Government and its media have obfuscated this simple point and have not given a clear lead to get the majority of people wearing them.
  17. Irrational rules. People are allowed to have cleaners come in to their homes, but not allowed to have family members to the same. B&Q were allowed to stay open, but not garden centres.
  18. Nursing Homes. Hospitals were allowed to discharge Covid-positive patients to Nursing Homes. Nursing and care homes were last in line to receive PPE, and clearly were low on the list of Government's priorities.
  19. Procurement. There was a failure in the procurement procedures for oxygen and pharmaceuticals. Johnson refused to go in with Europe's effective procurement procedures.
  20. Airline passengers. Incoming airline passengers were not checked for fever until late in the pandemic. Britain was almost unique in this regard. It is especially odd that while Johnson as a Brexiter is at pains to keep foreigners out of the country, infected foreigners are not to be excluded.
  21. Early release of lock-down. Johnson is desperate to get people back to work before the pandemic was receding. As a result of the Tories' impatience with the scientific realities of infection, the economic outlook is that Britain will still be flopping around with recurrent outbreaks and intermittent lock-downs when China, South Korea and Europe have brought their infections down to trivial levels and are in full economic mode again. Greece has already opened its borders to countries that have had success in containing the virus, but has insisted that Britons must be quarantined. Other countries will be doing the same over the coming months.

    One of the errors of Johnson's exit from lock-down is that he is setting dates for further liberalisations. Instead of dates, we should be liberalising on the basis of targets in the Reinfection Rate.
  22. Dominic Cummings broke the lock-down rules by driving his wife to Durham while she was suffering from Covid. Johnson failed to sack him. He claimed that he did this for child care reasons, but the clause that he was using was designed for exceptional cases such as child abuse. The social psychologists in SAGE could have predicted the result, that a large part of the population will now follow Cummings' example and take a relaxed view of lock-down rules.
This is an egregious series of errors. It strains credibility to believe that they have all happened by accident. In view of the early interest in allowing the disease to rip unhindered through the population in pursuit of Disease-caused Herd Immunity (as opposed to herd immunity produced by vaccination), it is possible that many of these errors were intended to allow the disease to progress. As a result of Johnson's choices, tens of thousands have suffered an unpleasant and unnecessary death.

Johnson does not deserve to remain Prime Minister.

Further reading: Here is an excellent piece from the Financial Times which gives more detail and background thinking on most of the points in my post.

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