Covid: the consensus fragmenting

15/06/2021

It's been such a long time coming, and predicted so widely, that there can hardly be any sense of surprise that Johnson has delayed the lifting of the final set of Covid restrictions until 19 July.

Mind you, it is so long since I took any notice of the array of confused and often conflicting rules that I cannot say, with any honesty, what restrictions still apply – much less unravel the difference between "guidance" and statutory requirements. More to the point, I don't care enough to expend the time looking them up.

Obviously, those most affected, and especially financially, by what restrictions remain will be those who will complain longest and loudest. But many people will get on with their lives and ignore most of the petty restrictions where they can.

After all, they have the superb role models of the G7 leaders who don't seem to have been troubled by masks and social distancing for most of their mini-break in Cornwall. And bluntly, when details of how to make hugging safer are being published, it really is time to give up.

Financially, the biggest losers, it appears, are pubs and restaurants, and the "live event" sector, comprising theatres, cinemas and the like, which cannot operate to capacity because of social distancing requirements.

However, even if I was sufficiently motivated to find out what the rules actually are (or will be), it transpires that the actual details haven't yet been published. The government is carrying out a series of "reviews", to work out what changes will need to be made.

This is "lockdown", but not as we know it, Jim. Actually, it's lockdown, but not as anyone knows it. Then, we can always do as the government does and make it up as we go along.

But then, when it comes to making things up, we are told that even the 19 July date is provisional. Johnson is only "confident" that a four-week delay is all that is needed, but he is not prepared to guarantee that we will see the end of restrictions then. Some pundits are suggesting that it may be next spring before they are finally lifted.

This might be more tolerable if there was any sense that we were being given the full picture, and that the people in the driving seat knew what they were doing. But it has been a long time since – if ever – that those conditions were fulfilled.

What is particularly disturbing is that, while the epidemic profile has changed – with the advent of the Indian variant, and the growing cohort of vaccinated people – the Janet & John explanations delivered by the likes of Whitty don't take this into account.

In particular, we are still pointed in the direction of hospitalisation data – as the key parameter which supposedly tells us whether NHS hospitals are likely to be overwhelmed. But "hospitalisation" is a portmanteau term, ranging from a patient presenting to A&E and being kept overnight for observation, to a critical care patient spending months on a ventilator in ICU.

There are some indications that ICU admissions are down, but data are difficult to acquire, and there is no distinction made in publicly-available figures between those who need "routine" critical care, and those who need ventilation. In terms of resource requirements, though, there is an enormous difference, so to talk simply about hospitalisation, without qualification, is misleading.

Thus, while cases and hospital referrals are on the up, numbers are still relatively low. And if the overall effect, in terms of resource implications, are now the same as, or less severe than, pandemic flu, there may be a case for winding down the covid response and focusing on reducing the NHS's dangerously high waiting lists.

Whether this is the situation, there is no way of knowing from the easily available public data – and no assurance that a deeper search will yield dividends. But it does seem that, at official level, the epidemic paradigm under discussion has not materially changed.

This especially seems to be the case when it comes to the distribution of illness. The small print is telling us of a new(ish) phenomenon, labelled "middle super output areas" (MSOAs) – small geographic units with an average population of 8,000.

There are apparently more than 6,000 of these in England, and analysis reveals pockets with very low levels of protection in every region. Without being told, we have to infer that some of these (if not most), are communities of Indian origin which, through the lax travel controls, and the equally lax quarantine rules, have become reservoirs of infection for the Indian variant.

Where there are also crowded conditions, multi-generational families in the same dwellings, and low vaccine uptake amongst qualifying groups, this creates conditions which are more than sufficient to sustain the levels of illness observed, without the rest of the country being affected.

Here, it is interesting to reflect on the severity of movement controls during the Foot & Mouth epidemic, where some parts of the country were, effectively, under martial law. Where there are known hotspots, with the potential of seeding the rest of the country, one would expect similar provisions to apply, where the stakes are so much higher.

Instead, it might seem to some that the nationwide lifting of restrictions is being held back, not because of the general prevalence of illness, but because of localised outbreaks, which are not being fully addressed with the powers government has at its disposal.

While little of this is being openly discussed, the political fallout is potentially serious for Johnson. Following the announcement yesterday, his fan club has broken ranks, with the Telegraph accusing him of giving in to "a backlash from a risk-averse scientific-technocratic class that has never appreciated lockdown's costs". The rise of the Indian variant, the paper says,

…gave licence to officials to revive their irresponsible campaign of fear. First, warnings about the effects of variants convinced the Government to go backwards on foreign travel, with suggestions from ministers that limiting our freedom to go abroad would protect freedom at home. Now even the return of freedom at home is being sacrificed, to what is being described as a sensible delay.

Now, it says, Johnson "risks being remembered not only as the prime minister who took away our freedoms, but who was unwilling to give them back again". And, even as he was speaking yesterday, crowds of protesters were assembled outside Downing Street.

Predictably, the Guardian takes the official line, arguing that delaying lockdown easing is "sadly unavoidable", basing its view on a parade of dubious and ambiguous statistics. But, while The Times is mirroring the Guardian view, talking of a "prudent postponement, the Mail conveying the "Tory fury" as "freedom is delayed".

This clear split in sentiment suggests that Covid is about to become politicised in a way that it hasn't been before, with the consensus fragmenting. Johnson's vaccine "bounce" is beginning to fade and he now treading on extremely thin "political" ice.

Also published on Turbulent Times.