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11 April 2020

Intensive Care

Tag(s): Foreign Affairs, Politics & Economics, Current Affairs
For weeks now it seems there has been only one story in the news, that of the coronavirus. As a global story it has many dimensions and its impact on health, society and the economy is incalculable but that does not stop the economists and the journalists from trying to calculate it and in the process they get into incredible difficulties, particularly the ones who can’t add up.
The number one story in the UK this week has been the condition of the Prime Minister Boris Johnson who was taken into hospital on Sunday and then into intensive care on Tuesday. At least this had the effect on some of the more sceptical members of the public realising that this really was a dangerous virus that could infect anyone and has now infected the heir to the throne; the head of government; and other members of his cabinet. But it also had the effect of destabilising the country even more because the media has been leading us down the path for years now of behaving as if we had a presidential system of government instead of a constitutional monarchy.
The journalists that I was reading, watching and listening to seemed to be unaware of how our constitution works. Only the sovereign can appoint a Prime Minister and the idea of a deputy Prime Minister has no constitutional status. Those who have been designated as Deputy Prime Minister in the past like Willie Whitelaw, Michael Heseltine and George Osborne were given such titles to massage their egos. None of them ever acted as Prime Minister. Now Dominic Raab is deputising for the Prime Minister while he is incapacitated. This will become a problem if Boris remains incapacitated for weeks rather than days as may well be the case. And it would be an immediate problem if there was a military threat to the UK.
But the crisis had already caused a constitutional crisis before Boris was laid low. When Parliament was suspended it meant that from then on that Government would only be able to act through Orders in Council. But this refers to the Privy Council and meetings of that must be chaired by HM the Queen or the Prince of Wales. Her Majesty is in isolation in Windsor while Prince Charles is recuperating in Scotland. So no such Privy Councils have taken place. How then did Boris gain the power to instruct us to stay at home?
Ironically, on the day he was taken into intensive care my wife and I received the letter from Boris that we have all received saying “…we are giving one simple instruction – you must stay at home”. But he had no power to give us such an order even if it was the right thing to do.
Every day journalists solemnly read out the number of new cases and the number of deaths and report them as if they are facts. But they are only the number of reported cases and the number of deaths where the death certificate states that the cause of death was Covid-19 and only those that occurred in hospital. They exclude deaths in care homes or at home. Noone can possibly know how many have already had the disease without knowing and recovered from it. That is because there is as yet no test anywhere in the world that can verify this. Similarly, a doctor may diagnose the cause of death as Covid-19 when in fact it may have been some pre-existing condition that became aggravated by the new infection.
Further, the problem becomes more complicated with more testing. The WHO says we must test, test and test and in one way they are right as that is the only way we can know when it is safe to relax the ‘lockdown’. But the more tests we carry out the more cases we will discover, so the numbers will go up before they go down.  Matt Hancock wants to go from testing 10,000 per day to 100,000 per day by the end of April. Therefore, we will discover more cases but when the media report that as the number of people with the disease is increasing we do not know that because we will be comparing different kinds of data from different sizes of population.
 I think the comparison between countries is highly problematic. Firstly, all the numbers are wrong. They are estimates based on data from tests and diagnoses which are not 100% accurate. Some countries, China, Iran etc are clearly lying about their numbers and massively under reporting. Germany, on the other hand, may be over reporting in the sense that a lot of their testing was on younger people returning from skiing holidays. That is one reason why their death rate is so low, but another is undoubtedly they were better prepared with more than four times the number of critical care beds per head of population than the UK.
I think there are also demographic factors to consider. Italy has the second oldest population in the world after Japan. It also has a strong family culture with many households consisting of three generations. So the kids catch it at school and give it to their grannies. Italians also still have a high number of smokers and in the North where they have the worst concentration that is also the industrial centre with lousy air quality. And the majority of the deaths are male. So you have a collection of old smoking men breathing in polluted air living with their children and grandchildren, clearly very vulnerable to respiratory diseases.
Meanwhile in Sweden, where they have taken what they call the “adult” approach, over 50% of households are single people so there is much less risk of infection.
The lack of preparedness in the UK is woeful. Apparently, in 2016 the government commissioned a high level study into the risks of a pandemic. The results were very alarming. But nothing was done. For many years when successive governments considered overall levels of risk and their level of impact pandemics always appeared in the top right hand corner of the graph with a high level of likelihood and a high level of impact.  But nothing was done. The NHS, which at the moment seems likely to get a medal for bravery like Malta did in WWII, was operating at full capacity or more before the outbreak. There is no redundancy in the system.
It is too easy to criticise the politicians and indeed for them to criticise each other, but it is true that they are all just out of their depth. Winston Churchill had many years of preparation for war. He had fought in war. He had held high office as a comparatively young man. He had been in charge of the Navy in WWI. He had studied and written history. He had warned of the Nazi and communist threats for many years. He had made many mistakes and learnt from them. Boris likes to compare himself to Churchill but he is a pale shadow by comparison. He is a brilliant campaigner; a good writer; an entertaining speaker. But he is not at all prepared for this crisis. But nor is his civil service. There are experts except that this is a novel coronavirus and so no one is yet an expert on this.
On the question of health vs economy, I can see that no action was not an option as the number of deaths would have overwhelmed the NHS and indeed other public services. If mass graves had to be dug as is happening in Tehran and now New York City then the whole world would have seen.
The comparison with war is invidious because, and here Matt Hancock is right, it is a global war between humanity and the virus. Therefore it needs global solutions. And that is what happened with previous pandemics of SARS, Swine and Bird flu. But this time every nation state is acting for itself and, with a few exceptions competing with each other for key resources like chemicals. One big change is the Trump factor as he has been withdrawing support from global institutions that his predecessors led the way in their establishment. This includes the WHO whose principal funder is now China, hence the WHO’s willful collusion with China to hide the real numbers and not criticise them for their dishonesty in originally denying the facts. Extraordinarily, this week Trump claimed that the US provided the majority of WHO funding. It is normally the largest funder with about 23% of the funds but 23% is not a majority. But this year the US has withheld all funds from the WHO![i]
I had thought that the fact that this pandemic began in China might start reorienting the developed world away from its reliance on China for so much of its supply chain. But it would seem that while the US and indeed most European nations just look after themselves and compete with each other and with poorer nations for scarce resources, China is stepping into the breach helping disadvantaged nations with the supply of millions of masks and other key items.

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