UK Approach to COVID 19

I posted on April 3rd 2020 to suggest that the UK approach to COVID 19 was accepting very high costs from social distancing measures based on very little evidence, while medical judgements were being held to a far higher standard of evidence. I am deleting the original post because it reported claims about the efficacy of hydroxychloroquine treatment that turned out to be false.

At the time, Didier Raoult and his colleagues in Marseilles were claiming a nearly 100% cure rate for treatments involving hydroxychloroquine in combination with zinc and an antibiotic. At the time, though not based on double blind trials, Raoult argued that the results were based on successful treatment of 1500 patients and it would be unethical to offer a placebo. At the time he was the most cited infectious diseases expert in the world, and the treatment was based on drugs long in use and was both low cost and involved negligible risk even if ineffective. The mainstream profession was sceptical based on double blind trials which had reached negative conclusions. Rauolt argued that the treatment only worked in the early stages, whereas the trials had only included patients with advanced disease. There was clearly a need for better trials, but there didn’t seem to be a good reason meanwhile for banning the treatment.

It subsequently became clear that the results claimed were false, and could be argued to be fraudulent. They were based on comparing two groups of patients with different characteristics, and some cases with worse outcomes had been excluded from the reported results. I also became aware that Raoult’s eminent position in the literature had been achieved in part by having his name added to virtually every article published by his institute. I am therefore deleting the post.

The other point made in the post was that the approach to the pandemic in the UK (and in most other countries) involved costs that were disproportionate to any benefits from deaths averted.  It fails the UK Government’s own criteria for cost effective health interventions by a wide margin.

I still think it is reasonable and indeed essential to ask questions about how much damage to our economy and society it is reasonable to incur in order to avert additional deaths. I would not necessarily want to insist on rejecting measures that exceed the NICE guidance that a year of extra healthy life is worth £30,000. I would, however, have expected a far more rigorous approach to assessing which interventions work at acceptable cost. It is appalling that after nearly a year, we have the highest per capita death rate from COVID 19, have incurred deep damage to our economy and society, yet still do not have the epidemic under control. For an island nation, none of that was inevitable. It reflects:-

i. a decade of neglect of the health service, including not maintaining adequate stocks of PPE

ii. not closing the borders

iii. not using existing resources for test, trace and isolate, relying instead on setting up an over-centralised and enormously expensive system contracted to Tory party cronies with no experience. The system is still not working nor is there any prospect that it ever will, but political embarrassment prevents it being abandoned despite ruinous cost in both lives and billions of pounds.

iv. Ditto, multiple other decisions that have wasted time and money and lives by being over-centralised and let to inexperienced contractors with nothing to recommend them but an unhealthily close relationship with the Government. Normal procurement processes have been overturned in ways that can only be described as corrupt.

v. Despite claiming to follow the science, a series of confusing, inconsistent and largely ineffective social distancing measures, poorly timed and poorly coordinated without much consultation with those affected. Some forms of high risk interaction are allowed, others are banned, with the boundaries of what is permitted continually shifting without much rationale.

Had we been willing to learn from the experience of other countries, especially those in Asia and Australasia, much of this was avoidable.

Consequences of the Coronavirus Pandemic

The negative impact of the measures being taken to control the Corona virus look likely to be very severe, and will themselves have profound consequences for public health. While all reasonable measures to save lives should be taken, there is a point beyond which the costs may be judged to be worse than the effects of the virus itself.
The Health Impact of the Virus
Impact of doing nothing
The Government response is largely based on the findings of the Imperial College study . The mathematical modelling suggests that, in a ‘do nothing’ scenario, an estimated 81% of the population would become infected, there would be an additional 510,000 deaths, and the capacity of the health system would be overwhelmed. For comparison, total deaths in 2018 were 616,000 and the increase would represent an increase of more than 80% on the normally expected death toll.
Benefits of a mitigation strategy
The initial HMG strategy focused on mitigation measures: – isolation of suspected cases and home quarantine of those living in the same household, social distancing by the over 70s and others in the high-risk categories.
This approach would reduce the additional mortality to about 258,000, but the capacity of the health system would still be completely overwhelmed. Because the majority of the population would still contract the virus, immunity would build up relatively quickly, and the deaths would be concentrated over a matter of a few months.
The net increase in total mortality might be somewhat lower than this gross estimate to the extent that some of the very vulnerable population would have died in the current year of other causes if they had not contracted the virus, and the public health measures such as frequent hand washing will have a beneficial impact in reducing deaths from other infections.
Impact of measures to Suppress the virus
The unacceptably high death toll even with mitigation measures in place has led HMG to move to more drastic measures aimed at suppressing the virus. The additional measures encompass social distancing for the entire population (not just vulnerable groups) plus school and University closures. These measures have the potential to reduce the total number of deaths to a much lower level, estimates vary according to when the measures are triggered, but the total mortality in most scenarios is expected to be contained below 50,000 deaths.
The further reduction in mortality only occurs if the measures are kept in place until an effective vaccine can be made available. Universal social distancing means that herd immunity has not been built, and the modelling predicts that the epidemic will experience a second peak as soon as the measures are lifted. There may be some options for partially lifting restrictions in some areas, aided by expanded testing and isolation of contacts. However, for suppression to work, the Government assumption in an announcement made on 20th March is that the measures will need to stay in place for at least a year.
Economic Impact of Measures to Suppress the Virus
Reduction in output and incomes, and increase in firm failures
The economic consequences of the epidemic take the form of a severe interruption to the capacity of the global economy to supply goods and services. Some of this is directly the result of the epidemic with workers off sick, but most of it is the consequence of the unprecedented measures being taken to reduce travel and all kinds of social interaction.
Massive Government spending commitments
The reduction in social interaction has profound consequences for output, for incomes, and for the ability of firms of all sizes to survive. Governments around the world are therefore planning to massively increase their expenditure in order to limit the impact on household incomes and prevent the collapse of firms that suddenly find themselves without customers, or unable to produce without breaking the social distancing guidance.
In the UK, measures already announced include £30bn of support in the budget, a further £330bn of loan guarantees announced on 17th March, with further support promised. The loan guarantees alone are equivalent to 15% of GDP. With more to come and with GDP shrinking, the final percentage will be even higher, and is without precedent.
The dangers of ‘Stagflation’
We have become used to very low levels of inflation and of interest rates, but that is about to come to a dramatic end. Stagflation – the combination of a stagnant economy and high inflation – classically takes place when a reduction in supply is not matched by a reduction in demand, resulting in too much money chasing too few goods and services. We last saw it in the 1970s, when OPEC related interruptions to the supply of oil were accompanied by relatively loose monetary policy. What is about to happen globally will be on a rather larger scale.
If the Chinese precedent is any guide, Western economies may face supply reductions of up to 20% of GDP while increasing Government spending by an equivalent amount.
How will Governments finance this increased spending, when their tax revenues are eroded by declining GDP, while their existing spending programmes are already facing increased demands from the health sector, from benefit claims, and from rising costs due to supply interruptions? The Government will have to borrow more.
If it was concerned about inflation targets, the Bank of England would need to make room for the increased Government borrowing by tightening monetary policy in order to reduce the excess demand by squeezing out corporations and households from credit. This would completely defeat the object of the Government spending, by tightening the squeeze on households and firms rather than alleviating it.
If the Bank of England accommodates the excess demand, as it has said that it will, then inflation will be the inevitable result. This will have profound implications for the distribution of wealth and of income. Firms and workers who are able to increase their prices and wages will benefit. Those with less bargaining power will lose, including many of the poorest and most vulnerable.
The most worrying aspect of the situation is that inflation can easily spiral out of control. Government will find that the costs of everything it is trying to do continue to increase as excess demand enables firms and workers to increase their prices and wages. Excess demand will also spill over into an increased balance of payments deficit as Government spending not matched by demand sucks in imports. Loose monetary policy may keep interest rates low in sterling but the excess demand will contribute to pressures on the exchange rate which will further intensify the cost pressures by reducing the sterling value of our exports while raising the cost of imports.
We do not know how much of the money that Government has committed will result in extra spending, nor do we know how severe the impact on the economy will be. However, we can make some assumptions to give an indication of the possible scale of what lies ahead. It is not implausible to envisage that: –
– Additional COVID 19 spending adds £350bn to the Government deficit;
– Government revenue falls by about 10%, adding a further £80bn to the gap
– GDP falls by about 10%

This would result in a sharp increase in the Government deficit to £490bn, or about 24% of GDP, with Government debt increasing in a single year from 80% to over 100% of GDP. This level of deficit clearly could not be sustained for long.

The nightmare scenario would be hyperinflation, of the sort experienced by Germany in the 1920s and more recently by Zimbabwe. Hyperinflation destroys savings and causes untold misery as the currency becomes worthless. I am not saying that this is likely to happen, but it would be reassuring to know that policymakers are alert to the potential risks of such a massive increase in spending beyond our production capacity. I have seen nothing to suggest that they are.
The only way out of a process of accelerating inflation is to end the excess demand, either by the supply of goods and services increasing to close the gap, or by austerity measures to raise revenue and cut spending.
There will be a significant supply bounce back once the epidemic is defeated. We do not yet know when that will be, and it may not be enough. Despite the Government efforts to sustain demand, many firms will be financially a lot weaker, and will be poorly placed to invest in increased output, especially as consumption will also be depressed by the legacy of lost livelihoods and increased indebtedness. The Guardian on 19th March was already reporting that motor industry firms that have closed due to the Coronavirus may not re-open, the virus representing a major additional burden on companies that were already considering their position in the light of BREXIT.
A significant part of the adjustment will therefore need to take the form of harsh cuts in public spending and increases in taxation. That will be politically very difficult, and the risk is that Governments will instead resort to trying to inflate their way out of their difficulties. A prolonged period of recession or slow growth looks probable, possibly accompanied by high and unstable inflation..
Is the cure worse than the disease?
This discussion inevitably prompts the question, is the cure actually worse than the disease? The most severe economic costs are not the result of the disease itself, but of the measures being taken to suppress it.
It is worth contrasting the Coronavirus death toll with estimates of the health consequences of a prolonged recession and associated cuts in health spending. Two studies of the excess mortality experienced by the UK during the years of austerity have estimated the number of excess deaths . The study by UCL estimated an additional 120,000 deaths over the period 2010-2017; a study by IPPR estimated 130,000 preventable deaths over the same period compared to the pre-austerity trend.
Both studies are at pains to point out that causality cannot be proved. However, it is important to also recognise that the likely death toll from Coronavirus under alternative mitigation and suppression strategies is also highly uncertain.
It seems reasonable to assume that UK recovery from the severe recession and budget financing crisis associated with the measures taken to suppress the virus will be both slow and painful. There are ample examples of developing countries facing a decade or more of lost growth as they tried to stabilise their economies after debt and deficit problems of similar magnitude. It seems plausible to assume that such a prolonged period of economic difficulty will be associated with some increase in mortality, both as a consequence of increased poverty and economic distress, and as a result of constrained post-virus spending on health and social welfare.
Conclusions
The Coronavirus induced recession is likely to be deeper than that following the 2008 financial crisis, and is likely to be more prolonged given the scale of the shock to output, the already weaker state of many economies, and the fact that it is global.
The initial UK response of mitigation would have limited the economic damage caused by the virus. We have subsequently joined the rest of the world in taking severe measures to supress the virus, measures that will cause much deeper damage to our economy and the fabric of our society (will the village pubs we will lose ever come back?)
Nobody sane would argue against trying to reduce the health impact of the virus.
If the modelling is correct then we face the prospect of 250,000 additional deaths if we mitigate rather than perhaps 50,000 with measures to suppress the virus. The problem is that the costs of the additional measures now being taken to try to achieve this further reduction are staggering. The health benefits are likely to be offset by further deaths as a result of the prolonged period of austerity that will then be needed to stabilise the economy. The damage to every aspect of our way of life is incalculable.
We have never contemplated similar measures for any previous health emergency, yet have implemented them now with little or no discussion. There needs to be a debate on whether they are disproportionate to the uncertain benefits.

Labour offers a more credible policy mix -but BREXIT means neither party’s vision is achievable

 

The vision of the future offered by the Tories implies, according to the Institute for Fiscal Studies :

 

I. Living standards in 2022 will be no higher than in the pre-financial crisis year of 2007, which means the Conservatives will have presided over the longest period of stagnating incomes since the Napoleonic wars.

 

ii. The poorest third of the population will actually be worse off than in 2007, due to the benefit cuts that have yet to take effect.

 

iii. Further misery will be caused by collapsing public services, as the Tories extend to 12 years the most severe squeeze on the NHS since it was founded in 1947

 

The Labour manifesto offers a less bleak outlook, with significantly higher borrowing to fund investment (something the IFS supports), and higher expenditure on public services funded by taxes on the better off. The Labour vision would imply a role for the state somewhat larger than at present, but in line with other high income countries in Europe.

 

The main IFS criticism is that Labour may need to extend some tax increases beyond the higher income groups that it says it will target, because IFS analysis suggests  that just hitting the very well off will not raise as much as claimed. That need not be a fundamental criticism:- it requires an adult debate when and if Labour are in Government concerning what can be afforded and what levels of taxation the electorate are willing to support in order to secure better services. It might also require some better targeting of expenditure promises – but at least an attempt has been made to cost the Labour manifesto, something that the Conservative manifesto does not do.

 

The bigger problem for both manifestos is that they may not be deliverable if the UK is simultaneously self-harming by proceeding with BREXIT. BREXIT will mean:

 

I. Economic growth is likely to be slower:

 

a. We are in for a prolonged period of uncertainty as to our future trading relationships not just within Europe but in the wider world. Decisions to invest will be delayed, some investments that might have come to the UK will go elsewhere to avoid the uncertainty, some activity will re-locate to the EU.

 

b. There is no evidence to suggest that there are offsetting benefits to growth as a result of looser regulation or lower taxation. Our growth rate within the EU has been comparable to that of Germany and the US and slightly higher than the average of high income countries – so there is no reason to believe that the EU has been holding us back. The fast growing countries are those like China who are still catching up with income levels in the rich countries, and no mature economy can expect to do as well.

 

ii. The budget situation will be even worse:

 

a. Any savings on our contributions to the EU will need to be offset by the cost of existing commitments, and the cost of expensively creating at national level equivalent institutions to those that currently provide needed services at European level (or paying for continued use of EU institutional arrangements). The amount of unnecessary or wasteful expenditure that we pay for is likely to turn out to be a relatively small share of our contribution, outweighed by the higher overheads and duplication of creating UK equivalents from scratch after 50 years without them.

 

b. If we succeed in reducing migration, which seems to be a major demand by those who supported BREXIT, there will be an immediate impact on the budget through the loss of tax revenues the migrants would have paid,  the increased cost of training and recruiting national staff to do jobs nationals were previously unavailable or unwilling to do, and the cost of expensive and inefficient non-solutions like trying to recruit agency staff to cover the gaps.

 

c. The biggest impact of leaving the EU is likely to be felt initially in London and the South East. Those elsewhere in the country can be forgiven for shedding no tears for the wealthy city folk, but the impact on the budget is less easily dismissed, with London and the South East the only part of the country that raises more in taxes than it spends on services. If the impact on London turns out to be significant, as seems worryingly likely, then the effects of a reduced tax surplus will be felt in even less money for supporting public services and paying benefits in the regions.

Whichever party forms the next Government will face severe economic and social problems caused by the unprecedentedly long period of flat incomes and underfunded public services. It seems utterly bizarre that both parties are committed to making these serious problems disastrous by proceeding with a BREXIT that offers no benefits. We are ‘taking back control’ of the ship in order to steer it into the iceberg. Both parties are grossly irresponsible to continue to steer full speed ahead on the current course on the basis that a fairly small majority of the crew thought that it was a good idea almost a year ago.

‘Hamlet’s Bastard’

I am quite excited that my first novel is now out on Kindle, go to amazon.com./author/mickfoster to find out more.  I now need to sell enough of them to feel that I haven’t just wasted several months of my life. Apologies to friends, family and casual acquaintances that they are likely to be bombarded with my attempts to bully them into buying it, sharing it, reviewing it.  You may as well give in now – especially as it costs less than a pint.

DWJQ

On Dec 14th at 8 p.m., the Dave Warren Jazz Quartet are back at the Three Elms https://www.facebook.com/pages/The-Three-Elms-Chignal-St-James/640784632746021?fref=tson .

We are also playing in a jazz festival on December 10th at the Morden Arms in Greenwich  https://www.facebook.com/morden.arms. We have an  hour slot at 3.30 and I am really pleased that a couple of old friends have promised to drop in to see our set. It should be a good day, with about a dozen bands playing from mid-day onwards, reflecting a variety of jazz styles.

You can here us at http://www.guitar-ukulele.co.uk/jazzquartet/     though we have evolved quite a lot since that recording was done. We still play some tunes from the great American Songbook, but mixed in with some Latin tunes and a lot of groove-driven material from the likes of Gabor Szabo, Roy Budd, Ernest Ranglin, Hugh Masekela and John Scofield.

 

Why so little BBC coverage of Yemen?

Listening to the Today programme on Radio 4, they found time for a long piece on Emojis, and continuing fact-free speculation about what might be happening to the child abuse enquiry, but nothing at all on Yemen the day after the debate in the Commons. The only explanation I can think of for the continuing neglect is that BBC news values have been corrupted by a desire not to upset the Saudis, the Americans, and our arms industry.

How Labour Can Win

How Labour Can Return to Power

There is a possible route back to power for Labour, based on three strong policy platforms:-

 

i. Remain in the EU

Be the party for the 48% who wish to remain in the EU, and for the many more who are coming to that view as the lies of the leave campaign and the shambles of the negotiation become increasingly obvious.

ii. Reduce Inequality

But also be the party for those who have been left behind by globalisation, many of whom voted Brexit because they had so little to lose. Labour was always the party of redistribution, taxing those who can afford it in order to help those who need support. We need to focus on the hardships faced by so many and tackle head on the inevitable Daily Mail critique that Labour wants to tax ‘hard working families’ to provide handouts to the workshy. The approach cant be just about taxation and benefits, it also concerns investment in infrastructure to support a more balanced distribution of economic growth, less biased towards the South East. But we also need to say explicitly that economic growth is not the only goal, we have to concern ourselves with how the benefits are shared.

 

iii. Invest in public services – including a commitment to adequately fund health and social care.

We spend far less on health than other richer countries including our European neighbours. Comparison with others suggests we already have the most cost effective health system in the world. Meeting rising demand effectively is only possible with more money, something we should be willing to pay for.

 

There are several good answers to the question ‘how do we pay for all this?’:-

Relax Austerity: As argued in a previous blog (’public expenditure cuts:not needed, but very damaging’, https://mickfoster.wordpress.com/) , there is no pressing case for further austerity, and a higher share of public expenditure in GDP is prudent in current circumstances where debt service remains low by historic standards, and is likely to remain so. Without making the further cuts proposed by the Tories, the debt will fall as a share of GDP simply through economic growth at historic rates, and there is also scope for higher taxes, ending our participation in a race to the bottom.

 Better In than Out: If we do not leave the EU, we will save ourselves considerable costs of adjustment and will benefit from rather higher economic growth. This theoretical result from modelling is already being confirmed by the plunge in the value of the pound at the prospect of a hard Brexit.

Stop Tory Vanity Projects: We could liberate some funds for worthwhile public expenditure by changing our priorities – scrap the dubious Hinkley and HS2 projects, and (ideally) the entirely pointless expenditure on Trident.

 

Can this bring Labour back together?

With the exception of the possibly contentious issue of Trident (though I have never understood why such lunacy has support in the party), I would imagine that a platform based on these three pillars could be attractive to most Labour MPs. There will need to be debate based on research to help forge evidence-based compromises on how far to push issues such as redistribution and a more expansionary fiscal policy. The prospect of a reasonable shot at forming a Government should focus minds.

 

What is the alternative?

I doubt if there is one in the short term. I suspect that there will be an opportunity for a no-confidence vote that might prompt a new general election at some stage in the run up to triggering Article 50. The only hope for Labour to be a relevant political actor in that process –or indeed in 2020 – is if it has something distinct and clear to say on the case for remaining in Europe. That is the only issue where there is a real possibility of attracting enough new voters to evict the Conservatives. When the Tory Government seem set on inflicting enormous and irreversible damage to our economy, our society, and our Union, there is a once in a lifetime opportunity to be the party of the sane alternative, attracting voters who would not perhaps normally vote Labour. We must seize that opportunity.

 

It seems that every BBC interviewee now has to answer the question 'how does that make you feel?', usually followed up by prompting them to seek redress or apology from someone. These interviews never elicit any useful information, but encourage us to wallow in others' joy or excitement or (all too often) their grief or distress. The intereviewer prompts people to respond with the expected cliches. Only very occasionally does the BBC broadcast the obvious response -'how the hell do you think I feel?', or 'why are you asking me, I am a victim but that doesn't make me an expert.' 
I am not sure when the BBC became so sloppy and so tabloid. It is especially annoying when the focus on emotions squeezes out interviews and analysis that might shed light on broader issues. I want the BBC to inform, educate, and entertain. Asking someone in grief how they feel does none of these things, it is simply lazy journalism. Our shared humanity makes such questions at best unnecessary, and at worst insensitive and intrusive. Please share if you agree and we might try to put a bit of pressure on the Beeb; I would also be interested in any comments if you disagree.

Some thoughts on why we need to vote Labour in coming local elections in Essex

The Essex County Council election is important to YOU if you:

 

Have elderly relatives in need of support to maintain their dignity and independence

 

Have children in State schools

 

Use the roads and highways that cross our county, and that the ECC is responsible for maintaining

 

Are concerned about the services available to support vulnerable children and adults

 

Use and enjoy the library services and the opportunities for further and adult education

 

All of these services are under threat.

 

In 2016-17:-

 

-The Tory Government is cutting the amount of money it provides to ECC by a third – some £50mn.

 

– But a bigger population and the cost of paying the National Living Wage mean it will cost the council an extra £40mn just to deliver the same services.

 

– Together, this means ECC needs an extra £90mn in 2016-17 just to stand still. It has increased Council Tax by 4% – the maximum it can increase it without calling a referendum – but this will bring in only an extra £22mn.

 

– The council plans to fill the remaining gap in 2016-17 by drawing down reserves to dangerously low levels (just 23 days of expenditure), and by continuing to cut overall expenditure despite the severe pressures from rising demand and increasing costs.

 

– On it’s own website, the Tory run Council admits it does not know how the increasing shortfall can be met after 2017-18.

 

This is happening across the country –indeed, relatively wealthy and fast-growing Essex is better off than most councils.

 

The Tory Government is not putting public finances on a sound footing – it is transferring the problems to local authorities and to health Service Trusts, and building up problems that are becoming increasingly apparent and will be expensive to solve.

 

What difference would a Labour Council make?

We will need a Labour Government to solve the underfunding of the services on which those of us who are not Eton educated millionaires depend.

 

But There are four key reasons to vote Labour in the ECC elections:-

 

To send a message to the Government that you are not happy to see money wasted on tax cuts for the rich while our roads are full of potholes and basic services on which we and our loved ones depend are in risk of collapse.

 

To elect a council that you can trust to prioritise the things that ordinary people want and value.

 

To fight back at local level against extreme Tory policies that undermine your public services, and for which they have no mandate – including the forced academisation of primary schools, and the creeping privatisation of almost every public service.

Vote against Private affluence for the few – but Public Squalor endured by all of us.

 Vote Labour