I was listening to George Osborne on The World This Weekend yesterday and heard him say (15m 43s into programme) that his personal opinion was that the current government had got off ‘to a bit of a slow start’ in dealing with coronavirus. I think that is what everybody probably thinks. And in times of crisis it isn’t unusual for things not to be done as quickly as they should have been.
But what does ‘a bit of a slow start’ really mean?
The graph of a different epidemic, Ebola virus in West Africa, above, shows the course of an epidemic a bit like the one we are experiencing at the moment. As many have said, coronavirus is not just one epidemic, it’s lots of outbreaks, or mini-epidemics, superimposed on each other to make one big pandemic. But just look at the shape of the green curve for Liberia.
The green curve rises in a manner that looks exponential in form. Let’s deal with what exponential means – it doesn’t technically mean ‘very quickly’ which is how you will have heard it used quite a lot over recent weeks. Exponential means that the rate of growth is proportional to the amount of stuff being considered. Populations grow exponentially when the average mother has several daughters who survive to have several daughters who survive to have several daughters and several is a number bigger than 1. If the number of daughters falls below 1 then the population declines (quickly in short-lived species, slowly in long-lived ones). With diseases, if every infected person infects at least one other person the disease persists, if it is a lot more than 1 then the disease spreads very quickly but if it is below 1 then the number of cases falls.
The green curve for Liberia rises quickly then it levels off and then declines – that’s what we are looking to happen with coronavirus. I know nothing much about Ebola in Liberia but it is tempting to think that someone did something that caused the leveling off and decline.
What we have done in this country is to tell people not to go out much so that they can’t get coronavirus or give it to others. We’re hoping that we see a levelling off in the number of new cases as a result. Because it seems that it takes 1-2 weeks for a person to develop and report serious symptoms then we are hoping that the measures taken two weeks ago will start to be seen to be having an impact very soon. Like – today! But the lockdown is continuing for another week before being reviewed to give as all a chance to look at the shape of the curve.
If the curve is levelling off in a week’s time then we’ll be told to keep isolating for some time as it is working, and if it isn’t levelling off then we’ll be told to keep isolating even more! Let’s hope it is levelling off – for all our sakes.
But back to George Osbone. I admire the former Chancellor although I don’t like him. I’ve never met him, all I’ve seen of him is through the media, but I’ve always thought, and sometimes written here, that he is a great political operator, and he was a great Tory Chancellor. I didn’t want a Tory Chancellor, that’s why I voted Labour, but if you did want one then you certainly got one with George Osborne. But he’s no biologist – in fact, you’ll struggle to find a biologist anywhere in Parliament.
I wonder what George Osborne meant when he said ‘a bit of a slow start’? Four or five days? It must be more than a day or two, and I’m guessing he means, to the extent that he knows what he means, less than a week, so let’s say 4-5 days slow.
Having ‘a bit of a slow start’ means that cases grow exponentially for a few days longer, maybe 4-5 days longer than otherwise would have happened. We don’t know when the curve (and we have to call it the current curve – see later) is going to reach its peak – we’re hoping it’s today, tomorrow, or very soon. But this is what it looks like at the moment;
That’s a mathematically beautiful but socially terrifying curve. We, the UK, are on 47,806 cases; five days ago we were on 29,474. So, 18,000 cases – that’s the cost of a putative 5 days delay. And that’s assuming that the curve stops going up now. And actually if the curve starts heading downwards, exponentially, then because it is starting at a higher point than otherwise, there is an added cost to delay. A few days delay makes a massive difference.
Now, there’s some good news and some bad news. Let’s do the bad news first then I can end on the good news – but the bad news is worse than the good news!
The bad news, of course, is that if we all stay locked up for weeks more, and the number of cases declines dramatically, then it isn’t over. Many of us, but we don’t know who, will still be at risk and susceptible, and some of us, but we don’t know who, will be immune. Relaxing restrictions allows the disease to spread again and we start a new curve. Testing for immunity and causing immunity through immunisation would be a great way to move forward, but both appear to be beyond us in the short term and a vaccine seems a long way away.
The good news is that there is some evidence from the curve above that the rate of increase of cases is slowing down just a little already. Here’s the graph from above but reproduced on a logarithmic scale:
These are exactly the same data as in the previous graph – it’s just that the vertical, Y-axis is different on the two versions. On a log scale, as the curve lessens, as it very gradually seems to above, then the rate of increase is declining. Yes, the number of cases is increasing still, but they are increasing at a slower rate than a while ago. Instead of the number of cases doubling every 3 days, the number of cases is doubling every week (roughly). It’s still going up, but it’s not going up as quickly as would have happened without us all acting differently. And let’s hope that the social isolation of the past two weeks shows up soon as a bigger impact still.
While you’re mulling this over, stay indoors please. And spare a thought for each of the 47,000+ cases, including Boris Johnson, but by the end of today the number of cases will be higher still even if we are beginning to get a grip on the first stage of this crisis.
[registration_form]
Whether the lockdown was introduced too early or too late is an interesting question and probably revolves around various competing factors. One is that people are already pretty sick of it. There may come a time when it’s no longer effective. You might also start to see serious civil disorder. Time that with the peak of the outbreak and you have a serious problem. It’s also true to say that one can analyse at a later date what the decision should have been with data that simply wasn’t available then.
There does seem to be an impression that there is only one curve and that once we’ve got the numbers down then we’ve beaten the virus. IF at the end of the curve we’ve achieved some kind of “herd immunity” then that would be the case but I doubt it will be. I suspect we will just be back to square one. The question then will be what policy do we then adopt. The same one again with potentially the same results or a different one. If it’s a different one that leads to the question whether we could originally have implemented that different approach.
Another issue is that of ‘listening to the experts’ and being guided by ‘the science’. I’ve listened to quite a few experts and what I learn from that is that there is a huge amount of uncertainty about the disease.
There is the question of immunity which is hugely important. How much immunity do we get from this coronavirus? And how long does it last? If we look at other coronaviruses which cause the common cold we can see that the answer is not very long. That would be bad news and as vaccines essentially trigger the same immunity it could well be the case that the same applies to them when and if they arrive.
Another big unknown is how many people are infected. The BBC often refers to the headline number of confirmed cases as the number of infections. This is simply false. We know the true number that has had the disease is greater than the number of confirmed cases and we know the number that has been infected is greater still. What we don’t know is by how much. That figure has huge implications for public policy and we need to find it out ASAP.
One respected epidemiologist in Italy says the number who have been infected there could be as high as 20 million – that would be a big difference from the number of confirmed cases which is 128,000.
So yes listen to the experts and the science and learn both what we know and what we don’t know. I was listening to Tony Blair on the radio saying ‘yes we need an expert epidemiologist’. The truth is we need expert epidemiologistS who’s views differ in good faith. Someone then has to make judgement calls in the light of incomplete data which will always be the job of the politicians, and lets not be too hard on them when those judgement calls turn out to be imperfect.
The briefing yesterday was interesting in that the DMO was answering most of the questions and even seemed to be owning the decisions taken about social restrictions – ‘we’ did such and such… Following the scientific advice is one thing but it has to be the politicians taking (and then being accountable for) the decisions.
Agree Ian except for your use of “the”. There is no single set of authoritative scientific advice.
“It’s still going up, but it’s not going up as quickly as would have happened without us all acting differently. And let’s hope that the social isolation of the past two weeks shows up soon as a bigger impact still.”
Almost certainly true but it’s pretty unclear to what extent. The curve would flatten anyway at some point so really you need to produce two plots with and without lockdowns and everything else constant to fully gauge the effect. Two unknowns to bear in mind – (I’m sure there are others). We don’t know the true level of infection – that could flatten the curve. We can’t be fully sure if the virus isn’t airborne. There has been research suggesting it was present in the air of rooms in which infected people had been. If that’s the case then a lot more people might be getting some exposure from visiting shops. Against that there is the issue of ‘viral load’ which suggests repeated exposure to more virus hits the system a lot harder than one off exposure to a little. It could be that a lot of people without underlying health problems getting tiny doses of the virus works a bit like a vaccine building up immunity without killing (that many) of them.
Also – what IS a coronavirus death? Coronavirus (specifically SARS-CoV-2) is the infectious agent COVID 19 is the disease that it can cause. This website is probably a good source of data https://www.worldometers.info/coronavirus/#countries – however even they seem to muddle the two when they say: “The coronavirus COVID-19 is affecting 208 countries” as does the NHS when it refers to Coronavirus (COVID-19). Are the death figures for people dieing OF COVID19 or WITH coronavirus – there might be a big difference. And when we look at different countries or even the same country at different times are we comparing like with like?
You can see what a difference such things make by looking at the BMJ’s rapid response to the Government’s claims about 2017/2018 flu deaths https://www.bmj.com/content/361/bmj.k2795/rr-6. The BMJ does not imo cover itself in glory here because it seems to suggest that the ONS suggested 50,000 flu deaths: “On this basis, the number of deaths in England and Wales in an admittedly exceptionally bad year would have been only in the region of 335-340 deaths, and the ONS seem to have exaggerated the risk to the public by in the region of 150 times.” in fact at that time the ONS was suggesting on the basis of the PHE report 15,000 flu deaths for part of the season ( I think the final figure was 26,000). The BMJ claims “the truth” is 335 flu deaths. If you read the PHE report that both the BMJ and ONS are using it gives the figure of 15,000 for deaths associated with flu. Perhaps the BMJ’s figure is ‘confirmed’ cases or cases with a positive test – if so I suspect we know that this isn’t the “true” figure.
Maybe a similar thing happens with the debate around hen harriers. One side might point to “confirmed cases” ie successful prosecutions – another side might use statistic methods and come to a wildly different figure. We shouldn’t leap to conclusions on these things based on our prejudices or politics but always look behind the data.
There is a grain of truth in Stalin’s famous maxim: “one death is a tragedy a million deaths is a statistic”
giles – your comment went to the Spam folder (I don’t know why) but you were lucky I spotted it (I don’t normally these days because this blog gets hundreds of genuinely spam comments a day).
On the substance of what you wrote – ‘the curve would flatten anyway’, well yes it would but that might be when everyone has been infected, or everyone except any who are naturally immune. You aren’t trying to muddy the waters are you?
I’m not trying to muddy the waters Mark and I find the implication that I might want to somewhat disturbing. My aim is not to sow doubt to reduce the effectiveness of our response. I have aging relatives who might die from this disease – we all in fact have powerful interests in common.
I’m pointing out that the waters ARE muddy and we cannot therefore cannot fully determine facts which are vital for us to know the best course of action. I base that view on reading a lot of material from experts in epidemiology like Neil Ferguson, Carlo La Vecchia, Sunetra Gupta and Dr Sucharit Bhakdi. None of these people are purveyors of fake news – they are all highly respected academics in the relevant field.
You are correct the curve WOULD flatten anyway – in fact not when everyone is infected but when enough people have been infected to mean that each carrier is infecting less than one person.
This is why the IFR is a crucial piece of missing information. If it is 5% then the curve would flatten at a very different level than if it’s 0.03% I’ve seen both these IFRs suggested as possible. I’d have thought they are both outlandish and the truth lies somewhere in between but where is a crucial question that we need to find out ASAP.
We are currently taking decisions as a country and as a world which are going to have a pivotal impact on world history. It is obviously vital that we establish as soon as possible various critical currently unknown facts.
Sorry to go on but with regards to the “stay indoors” advice I certainly haven’t been doing that because I am lucky enough to be surrounded by 40 acres of beautiful countryside I can wander round in this beautiful weather without leaving my own property. Moreover even with that situation I’ve also been getting on my bike and cycling for miles round the huge area of beautiful countryside. All within the law and in accordance to current guidance. There are pros and cons of living on a farm in Devon but in the current circumstances I am truly blessed.
That may sound as though I am rubbing people’s noses in it but I do think we need to beware of the middle classes sunning themselves in their back gardens castigating people couped up in flats visiting the open spaces around them. They can and should do so in a responsible manner according to guidance. No doubt the guidance iS being flouted but we need to get to grips on the extent to which it is being flouted before completely restricting people’s right to exercise out doors as has been mooted. Beware also of journalists and others using photos of people who actually ARE 2m apart but taken from an angle where it looks as if they are not. That’s IMO a downright evil thing to do and from looking at some of the pictures I have seen I think it is going on to an extent.
So Mark please don’t stay in doors – get out of doors if you can. Maybe dig a veg patch or get a bike and have a pootle round the country lanes – all the while sticking to government guidance and the law.
‘A bit of a slow start’?
We knew for weeks that the virus was coming. We ignored the threat. We had mass sporting events involving people from affected areas coming here.
We’ve had no mass testing, no tracing of contacts, no quarantining of affected cases.
Consequently we are playing catch up. Fire fighting rather than fire prevention.
All in the context of a decade of cuts meant we were starting with inadequate material and personnel resources.
And an irresponsible, cavalier, dishonest clown in charge. A man whose every utterance is only ever half a sentence away from a joke (‘operation last gasp’).
I have to say I am somewhat fascinated by the dynamics of UK politics. We saw an abundance of comments like the above during the election and referendum campaign combining what may be good points with personal vitriol whether against Boris Johnson or leave voters or whoever else the chosen target is. To my mind the vitriol is deeply counter productive (especially when the target is ill in hospital) and symptomatic of people talking in bubbles. I sometimes wonder if there was an organised tory troll-bot campaign being run. If so maybe an ‘I am not a robot’ CAPTCHA would filter some of it out?
And I’m somewhat fascinated by the media ignoring the fact that Johnson is a nasty piece of work.
Amoral, reckless, irresponsible and utterly consumed by personal ambition.
Those traits influence how he has dealt with this issue.
They should be discussed, whether he’s in hospital or not.
Well I think you will find that Johnson’s character has been and continues to be discussed even though perhaps it does not dominate the news agenda in the way you might like and people may have differing views on a matter which as with everybody is a complex mix of good and bad rather than the simplistic cardboard cut out villain you seem to wish to characterise him as. Some people also probably think that in the grand scheme of things there’s a lot more to our complex world than a politically motivated charicature one man.
Giles, several really good comments on my opinion. Well done
I notice you aren’t actually challenging my assessment of Johnson’s character or denying that it informs how he has dealt with the current crisis.
And my assessment of Johnson isn’t confined to those who disagree with him politically. There are plenty of Tories who know him for what he is.
I wonder if you would have been so generous if this had been Labour and Corbyn?
Would the nation, would the media?
That is the litmus test for self honesty.
Here in Portugal, the kids have been off school for 3 weeks and we’ve been in a state of emergency for two weeks. If you look at the graph on the Johns Hopkins dashboard (click the individual countries) then we’re over the worst but we don’t know how that tail will continue to decline. People are able to go out but there’s a strong police presence keeping an eye on things. Everybody appears to be behaving responsibly etc. – it’s a small country so somethings just work better on a small scale. Having said that I doubt the schools will reopen for at least another 4 weeks and that’s being wildly optimistic. More likely they are now closed to the end of the year.
That’s a long way of saying there’s at least another 3 weeks here before the government will think about relaxing things – only a hunch I have not data to back that up. Realistically, you have that long to go in the UK but there’s a decent chance it will be longer.
https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
What has happened perfectly reflects the Osborne/Cameron version of Government – laissez (lazy?) faire, ‘there is no such thing as society’ – and the rich will do ok so who cares. Osborne’s economics may have had a little to do with much vaunted deficits, but had far more to do with cutting everythng in sight onbthe basis that poor people don’t matter – and rich ones can pay for the public services everyone else has lost. Commentating from the sidelines, he is on factas responsible as anyone for both the state pf the NHS and the too little too late dtyle of Government.
This virus attacks on two fronts – it’s a killer but also attacks the wellbeing state of a human brain. I’ve been somewhat disappointed that the issue of wellbeing has been sidelined to some extent by the sensationalism of reporting that this virus is spreading throughout the media. Colin Murray on 5 Live to my mind has done an excellent job in promoting wellbeing on his programme, combatting a lot of the scare mongering.
This virus is a latent instigator of anxiety and trepidation, and that is as deadly as the pathogen itself, those reading this who have experience any form of anxiety attack will understand that. The trigger can be miniscule event; a careless comment on social media or on TV is enough to get this ball rolling.
I believe there’s a bonding synergy between man and nature, now is the time we need the natural world in all its glory, all I see is us cocking it up.
I don’t care if your left or right wing at this moment in time, it’s irrelevant, I want this disease gone and all of us safe and back to normality, and maybe the world in a better state.
“I want this disease gone and all of us safe and back to normality, and maybe the world in a better state” I generally try and progress on the basis that the vast majority of people want that too.
Start? Did i miss something?
Apart from the public hiding from the herd immunity plan and then the gov copying that, what start?
I have to believe serial liars that there is a plan.
Never changed from herd immunity just spun to be something different
https://bylinetimes.com/2020/04/09/leaked-home-office-call-reveals-uk-government-wants-economy-to-continue-running-as-we-will-all-get-covid-19-anyway/
Another thing that I feel is deeply concerning is the erosion of our liberty in this crisis. We’ve heard a lot from various people about how Johnson is ‘far right’ and yet often not a peep when the government passes one of the most draconian pieces of legislation for centuries – without due scrutiny or even a vote. Yet we appear to have very little opposition to aspects of this law. Is this a ‘far right’ government? If so then surely it is very scary that we are in a position where the police are publishing threats that they may take action against people just for not following ‘guidance’. Guidance is not the law. No doubt we SHOULD follow guidance but we HAVE to follow the law. That’s an important distinction and one that it is important to maintain at a time of crisis.