Coronavirus: malevolent stupidity

12/05/2020

So complicated has prime minister Johnson's pathway to lifting the lockdown become, it seems, that he has had to issue a 60-page "users' manual", presumably in an attempt to help us chart our way through the process.

But, when it comes to dealing with the core functions necessary to deal with the Covid-19 epidemic, suppressing the infection, it is hard not to conclude that we are dealing with a malevolent stupidity which seems to transcend anything the government has done so far.

The issue, of course, is the programme which can be loosely described as "contact tracing" but which, in fact, involves far more than that. An effective programme will require all suspected cases to notify the health authorities, following which three things must happen in short order.

Firstly, if not already arranged, the suspect case is required to isolate – preferably in a controlled environment such as an isolation hostel. Secondly, an immediate test is conducted, with priority given to reporting the result. Thirdly, the case is interviewed by an experienced contact tracer, who will record all relevant contacts for follow-up.

As to the contacts, the procedure is repeated, with immediate isolation and testing. If symptomatic and/or the test is positive, contact tracing is repeated. If contacts are asymptomatic, and their tests prove negative, they are released from isolation.

However, from the lockdown "users' manual", it becomes very clear that such a programme is not what the government has in mind. It has no commitment to the scheme and is not making available the resources necessary for it to be effective.

A clue to this can be found early in the document, where the very first mention of contact tracing is found in a paragraph headed: "There is no easy or quick solution", with the statement: "Only the development of a vaccine or effective drugs can reliably control this epidemic and reduce mortality without some form of social distancing or contact tracing in place".

This muddled sentence follows on from the prime minister's foreword, which puts him firmly in influenza pandemic territory, where he asserts that: "It is clear that the only feasible long-term solution lies with a vaccine or drug-based treatment". But there he does concede that "a mass vaccine or treatment may be more than a year away", and then warns that "in a worst-case scenario, we may never find a vaccine".

Thus, working to the original influenza plan is no longer an option, which sought to "buy time" for a vaccine to arrive, treating the sufferers with antiviral drugs, - which will not stop the spread but could make the virus less dangerous.

Whether in a year's time or sometime never, we cannot afford to wait for a vaccine – we never could. After another year of rigorous controls, on top of what we have just been through, we will no longer have an economy capable of sustaining life as we've come to know it. Therefore, we have no choice but to suppress the infection without resort to a vaccine.

And yet, in this, Johnson has already given up. He (and, presumably, his advisors), are still working to the influenza plan, which states: "It will not be possible to halt the spread of a new pandemic influenza virus, and it would be a waste of public health resources and capacity to attempt to do so".

In his muddle, though, he refers to having "some form of social distancing or contact tracing in place", putting the two entirely separate processes on a par. And then, to compound the error, in the next reference to contact tracing, it is described as one of the government's "mitigation measures".

Therein we get an insight into the government's real opinion of contact tracing. It sees the only control mechanism we have, short of a vaccine, as a "mitigation measure". This is a dangerous – and, for some, a fatal – flaw in the government's thinking.

When we then get to a dedicated section in the "plan", we find that it is not devoted to contact tracing as such, but to "testing and tracing". This perpetuates the muddled thinking, confusing the general testing programme with what should be the high-priority, targeted process of testing suspected cases and their contacts.

Having then conflated the two, however, we are told that: "Mass testing and contact tracing are not, in themselves, solutions, but may allow us to relax some social restrictions faster by targeting more precisely the suppression of transmission".

At this point, what the government is saying is simply not true. This cannot be repeated often enough: without a vaccine, an effective "trace, test, isolate" programme is the only solution we have left to us. It is the only way infection in the community can be brought down to acceptable levels, sufficient for the lockdown to be removed and for normal economic activity to resume.

Unsurprisingly, given its lack of confidence in contact tracing, what the government has on offer is by no means effective. It has put most of its eggs in the "app" basket, in a system that isn't going to work. And while it talks glibly about "using local authority public health services to bring a valuable local dimension to testing, contact tracing and support to people who need to self-isolate", the key word is "dimension".

Of the 18,000 staff allocated to contact tracing, 15,000 are going to be "call-handlers". With one day's training and working to a script, these gig-economy employees are supposed to, "get additional information from people reporting symptoms about their recent contacts and places they have visited, and to give appropriate advice to those contacts".

Needless to say, any isolation is to be voluntary, and the government is still expecting people to self-isolate "alongside their households", thereby maximising their chances of passing the disease on, and keeping the case rates high.

Amongst its many other faults, we then have a system where there seems to be no sense of urgency. Those who believe they have caught Covid-19 are left to report their symptoms, whence they must go through a filter before they are allocated a test – perhaps days later. Then, the contacts are not asked to isolate until "the point of a positive test or after 48 hours - whichever is sooner".

This is going through the motions. It is a travesty of a scheme, and even then it is relegated to the margins. An "enhanced" programme only kicks in when we get to "Level 2" in the government's alert scheme, when the number of cases and transmission is already low (pictured). Apparently, this, with the application of "good, solid British common sense" is what Johnson believes will get us through this crisis.

But far from my being a lone voice, the Guardian is also on the case, bringing prestige to the table in the form of David Hunter, professor of epidemiology and medicine at the University of Oxford. His authored piece is headed: "If we follow Boris Johnson's advice, coronavirus will spread", which couldn't be more to the point if it tried. He too is banging the drum for the basic infection-control practice of "test, trace, isolate", and asks why the past seven weeks haven't been used to prepare for the calibrated end to the lockdown.

The very fact that he asks from the platform of the Guardian however, means that – prestige or no – Hunter will be ignored, just like this blog. But when you have a stupid man at the helm, this is what happens.

At the heart of this crisis we not only have a man who has no idea of what he is talking about. He has no accurate or even adequate mental picture of what he is dealing with. This is a man who, at yesterday's press conference, blathered about having been through the period of lockdown which started on 23 March, at Level 4. In his simple little mind, this meant (in his own words), "a Covid-19 epidemic is in general circulation, and transmission is high or rising exponentially".

Technically, of course, an epidemic is simply a term to describe an incidence of disease above that which is expected for a period under observation. Yet Johnson conveys a vision almost of a living entity, roaming abroad "in general circulation".

Here is Johnson's lack of even the most basic understanding showing through. Like many of the advisors around him, he has failed to grasp that an "epidemic" – and especially this epidemic – is a composite of many outbreaks, some small, and some large.

The way you deal with epidemics is by tackling the outbreaks - one outbreak at a time. And you do that using the basic infection-control practice of: "test, trace, isolate". Until these malign idiots in Whitehall get that through their thick heads, as Hunter warns, coronavirus will continue to spread.