Coronavirus: a political disease

15/05/2020

If there was one word which could be used to convey the current situation, it is "uncertainty". It more or less defines where we are because just about everyone wants a way out of the lockdown, but no-one knows precisely how to achieve it without exposing the population to more infection.

That much is the tenor of a Telegraph article headed "Second more deadly wave of coronavirus 'to hit Europe this winter'" – a typical clickbait type of headline that doesn't actually match the content.

What we have is Dr Hans Kluge, director for the WHO European region, warning about complacency now that the number of cases in some European countries is beginning to fall. The decline does not mean the pandemic is over, says Kluge, especially as the epicentre of the European infection is now in the east, with the number of cases rising in Russia, Ukraine, Belarus and Kazakhstan.

But Kluge's nightmare scenario is that, as we approach winter, we could find ourselves engulfed in a second wave of Covid-19, which could coincide with local epidemics of other infectious diseases, such as measles or seasonal flu – with potentially catastrophic results.

Of course, no-one knows for sure that this is going to happen. The Telegraph is running on its front page a report of "new modelling" by Public Health England and Cambridge University which suggests that fewer than 24 people are catching coronavirus each day in London.

If cases continue to decrease at the current rate, the paper says, the virus will be virtually eliminated in the capital by the end of the month, raising questions about whether the strict lockdown measures would need to continue.

Assuming that this decline is real, and that it was replicated throughout the country, by winter, Kluge's fears might never materialise. And, with so many vulnerable people having died, we could see an overall reduction in the death rate when other diseases fail to materialise, and more healthy survivors last through the winter.

To rely on this, though, would be unwise. If the key word is "uncertainty", then Kluge's remedy is preparation. Rather than celebrate their relative good fortune, those countries with declining Covid-19 incidence should "use this time wisely and start to strengthen public health systems as well as building capacity in hospitals, primary care and intensive care units, he said".

What no one in the WHO dare do, though, is direct overt criticism at any one country, or make pointed recommendations for improvements in any of the national systems – although Kluge does make reference to the need for "rigorous public health measures including comprehensive contact tracing and testing".

Where we have a problem in the UK, though, it is one step removed from seeking structured improvements in our public health system. The bigger problem is going to be getting the government to recognise that there has been anything wrong with its handling of the epidemic, or that there is any need to improve.

Militating against acknowledging the need for improvement are several issues. Firstly, there is Labour's Keir Starmer on the warpath, looking to exploit government failures for party political advantage. Then we have legacy media outlets perennially looking for "gotcha" moments that they can parade to their declining audiences, to show how clever they are.

Faced with these, the government is taking a tribal stance, rejecting all substantive criticism in an attempt to shore up its own supporters. And then, with the need to maintain public confidence in the system, it will not be wanting to admit what a terrible job it has done, or indeed how little control it has over the instruments of state, to the extent that it is not in command of events.

However, it is fair to say that infection levels in the UK are too high for comfort, and while Johnson's administration may succeed in convincing its fan base that has done a good job, the public mood is likely to be fickle. If infection continues at this rate, the general unease is likely to hamper any major easing of the lockdown.

This puts Johnson and his cabinet team in a bind. The longer and deeper the lockdown, the greater the economic damage – and the greater the pressure from some factions within his party to lift the restrictions come what may.

And yet, if there is going to be any chance of driving infection down, and keeping it down, it will require a more effective public health system and a sustained effort that may have to support high-intensity operations for a number of years.

Looking at it another way, if the government decides to "bet the farm" on the UK epidemic continuing to fade away, moving to open up the economy and get people back to work, Johnson could be the hero of the hour, seeing off the Coronavirus "bedwetters" – as Delingpole describes them – and returning us to normality.

Should such a gamble backfire, though, an escalating case rate could have the left charge that the "heartless Tories" are putting "profits before lives". As the deaths mount, it would be easy for Labour to portray Johnson with blood on his hands, seeking to make him personally responsible for the toll.

It would seem to make sense, therefore, for the Tories to hedge their bets. It they – along with the rest of the country - want to end the lockdown but minimise the risk of recrudescence, then the most obvious way forward is to introduce changes to the way the public health system operates. With deft PR, they could even put such changes in a "lessons learnt" category, distancing themselves from any admission of previous inadequacies.

The judgement here must be on how prepared Labour is to challenge Tory performance. We see, for instance, in the New Statesman, a belated recognition that the government had planned for the wrong disease. They get there eventually.

Author Ian Leslie actually refers to the 2011 flu pandemic plan and the section much quoted in this blog, except that he uses a reference in the summary and misquotes it, claiming it states that "it will not be possible to stop the spread of, or to eradicate the virus", thereby omitting the all-important "pandemic influenza". My quote is: "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".

It strikes me that the full quote could be far more damaging to the Tories – not least because the plan was signed off under Cameron, whence it could be argued that this was an attempt to put wealth before health.

This is especially the case when the next phase in the deterioration of the public health service in the UK was crafted under Cameron's health secretary, Andrew Lansley, who crafted the Health and Social Care Act 2012, which did so much damage.

Lansley's 100-page strategy for public health, published as a White Paper, clearly shows how the government of the day dropped the ball when it came to dealing with infectious disease. In the entire document, there are only 25 references to infection and infectious disease, while the main emphasis is on "lifestyle" (which gets 33 mentions).

A report from the National Institute for Health Research (download) had already set the scene and it did not take long for more reports to emerge, from environmental health and elsewhere, indicating that the Lansley reforms weren't working.

Should an invigorated Labour under Starmer choose to make mischief here, there is plenty to go on, and there is nothing in the New Statesman piece to warn Labour politicians that the rot started under Blair. For once, the opposition have some real meat, with which to argue for change.

One fears though that the political process in this country is so corrupted that Labour might actually prefer to see Johnson fail, despite the cost in lives and economic damage. But that too is a gamble for Starmer. If he "bets the farm" on a second peak and it does not materialise, he will have missed a major opportunity to demonstrate that Labour means business.

The tragedy is that our fate is now down to party politics. It will be long-term electoral prospects which decide the next moves of both government and opposition. What is good for the nation seems to be of very little importance.