Purgatory : Lockdown: The issues, ethical political and practical
Let me start by admitting I am a lockdown skeptic. However, I hope that does not prevent me from seeing both sides. The issues that I see are:
1. The need to protect NHS workers which is made more difficult due to the poor preparation by key bodies (like PHE) and the NHS is general to prepare. However, there has not been an NHS disaster in Sweden and their preparation wasn’t great. But this is IMO the greatest argument for lockdown.
2. The relative valuation of old people’s lives versus the young. I personally have no doubt that more (mainly old) people would die without lockdown. But the costs are borne by the younger. So if you do any analysis based on QALY (Quality of Life Years) you are implying that people who have had a good life can reasonably be placed at higher risk than those whose life is before them. To me (74 with mild comorbidities) that’s just common sense. To others it’s a fundamental denial of the sanctity of life.
3. Economics vs risk of death. How high would the risk of death have to be for you to voluntarily think it worthwhile to wreck your business? Or job? Your answer to this will influence your view.
4. Civil liberties vs risk of death. How high would the risk of death have to be for you to accept the sort of police-state infingements on civil liberty being imposed on us now?
5. How far do you view the extreme down-turn in the economy as actually quite a good thing. I’ve heard this a lot, and if you think that creating a self induced recession is a good corrective to rampant materialism, then all I can say is I disagree. There are better and fairer ways of tacking this problem.
Maybe there’s more. My main sympathy with those taking the precautionary approach is that it can never be proved to have been worth it. It’s just like the famous 2000 IT bomb. I worked on that and it paid my salary, and – nothing happened. Was that a triumph of our work? Or was the whole thing a cooked up panic? They same arguments will be revived about lockdown.
We will never know. Any thoughts?
1. The need to protect NHS workers which is made more difficult due to the poor preparation by key bodies (like PHE) and the NHS is general to prepare. However, there has not been an NHS disaster in Sweden and their preparation wasn’t great. But this is IMO the greatest argument for lockdown.
2. The relative valuation of old people’s lives versus the young. I personally have no doubt that more (mainly old) people would die without lockdown. But the costs are borne by the younger. So if you do any analysis based on QALY (Quality of Life Years) you are implying that people who have had a good life can reasonably be placed at higher risk than those whose life is before them. To me (74 with mild comorbidities) that’s just common sense. To others it’s a fundamental denial of the sanctity of life.
3. Economics vs risk of death. How high would the risk of death have to be for you to voluntarily think it worthwhile to wreck your business? Or job? Your answer to this will influence your view.
4. Civil liberties vs risk of death. How high would the risk of death have to be for you to accept the sort of police-state infingements on civil liberty being imposed on us now?
5. How far do you view the extreme down-turn in the economy as actually quite a good thing. I’ve heard this a lot, and if you think that creating a self induced recession is a good corrective to rampant materialism, then all I can say is I disagree. There are better and fairer ways of tacking this problem.
Maybe there’s more. My main sympathy with those taking the precautionary approach is that it can never be proved to have been worth it. It’s just like the famous 2000 IT bomb. I worked on that and it paid my salary, and – nothing happened. Was that a triumph of our work? Or was the whole thing a cooked up panic? They same arguments will be revived about lockdown.
We will never know. Any thoughts?
Comments
What is the effective Ro rate?
How serious is the impact on health?
An infection with a high natural Ro rate (like COVID-19) can spread very rapidly if unchecked. That in itself may not be significant if the symptoms are relatively mild. But if the impact on health is serious (and in some 20% of case with this infection that appears to be the case) then an unchecked rapis spread will both overwhelm health services and seriously impact normal economic activity through ill health absences.
And these are the key factors leading to the practical issues of control.
So far as ethics are concerned, I do not see any binary good and bad arguments. I went into voluntary self-isolation on 9th March as a means of self-protection but was at that stage not fully aware of the danger I might represent to others if I got the infection. I did feel a strong sense of personal responsibility to look after myself, not just for my own sake but for others I support in various ways. But I'm retired and on pension. The issue of personal responsibility bites in a different way if you need to work.
So far as politics are concerned in the UK, and despite noises at the beginning, no UK government could countenance a policy which put the NHS at risk, nor was any overt policy of trading off the lives of the old for the economic welfare of the rest going to fly. In the event, that isn't binary either. This isn't exclusively a threat to the old and infirm. And the deaths of Health Service and Care Workers have demonstrated very clearly that this is so.
Right now, I'm not even sure how you can do the arithmetic to trade off the economic costs and benefits of lockdown, even supposing that money and economic activity should ultimately determine policy. All governments are in unknown territory and are feeling their way through the medical, economic, political and ethical complexities. This is a novel virus.
As for not having the lockdown, it isn't just the elderly. It's everyone with diabetes. Everyone obese. Everyone with asthma. Everyone with a suppressed immune system. Almost all of these are people with normal life expectancy under other circumstances. I'm wary of the "quality adjusted" part of QALY as it tends to massively underestimate disabled people's self-understood quality of life and privileges ableist understandings of quality of life. Even locking down when we did we had a thousand people dying a day at one point. Without lockdown you're choosing to allow everyone (or at least 80%+) to be infected. Even if the death rate is 0.5% we'd be looking at 250 000 + deaths UK wide. The reality is that if the virus is allowed to run rampant the health service will be overwhelmed and we're looking at a death rate closer to 5%, or more like 2.5 million people. Do you want to guess the economic impact of that?
It’s unthinkable.
I’m not quite sure what a ‘lockdown sceptic’ is?
Freedom means nothing without responsibility. If the responsible thing to do is to stay at home until the R rate is low enough and then find ways of working that are safe, then so be it.
Freedom to to harm to others is not freedom, it’s chaos and anarchy.
In this case ‘harm to others’ happens to be breathing the same air as them. So, until there is a vaccine, we need to care for each other by keeping physically separate from each other whenever possible.
We will adapt. Businesses will adapt. It’s what humans are eminently good at.
As an example, Arteta, the football manager, tested positive on 12 March. Football stopped, but also I remember my wife and I were horrified, as it made it real. The Tube seemed too dangerous.
I suppose the skeptics are also saying that the modellers have exaggerated, and some seem to suggest that exponential growth isn't real. Well, the precautionary principle comes in.
The extreme skeptics are saying let it rip, and let hundreds of thousands of old people die. That seems unconscionable to me.
It is. I know two young (hitherto fit) young men who had it for weeks, they were very unwell indeed. Now they keep having recurrence of the breathlessness and are constantly fatigued and unable to go back to work.
If this is the effect on two people I know, there will be many others, I imagine. So letting the virus run its course could well have serious implications for the health of many - whatever their state before they caught it.
Some do not value the lives of those who don’t work or who they don’t think contribute to society.
Aaron had a golden calf made for the people to worship. Some still worship a golden idol. Yes, the economy is important. So is the environment. And so are our fellow human beings. All we need is love.
What you often find is people (off ship) looking at the numbers they have,
Realising that virus v no-virus is an easy choice, and ending up with a mixed thing that with some internal gish-galloping looks ok (a bit like you say happened with the millenium clocks).
A similar thing I would say affects point 2, yes at the moment health-young deaths are fairly near the tragic but "it can't be helped" levels (175 in Uk under 40). But that's with the lockdown (although it also includes those with issues).
And for that matter, points 3&4, I lost christmas and new year with whatever that bug was (and from works point of view it was luck it was in my time).
I think they are important things, and though it sounds brutal, yes we have to weight them against human lives and say having the football is worth say 10 lives a year (maybe it stops 3 suicides, 3 groundskeepers starving and ...). Now obviously a single crowded game would blow that allowance away.
Behind closed doors, maybe (but of course that is less benefit). Local football at sufficiently low prevalence, maybe. Maybe paying the staff benefits and getting the stars to do something for Samaritan's would be better.
What are the bad effects of the lockdown that exceed hundreds of thousands of deaths and millions more with long term health effects plus the trauma of all the medical staff who watch the NHS collapse around them with people dying who could have been saved?
Where does the figure of hundreds of thousands of deaths caused by a Swedish style approach come from?
The bad effects include:
1. Psychological trauma
2. Long term reduction in health services due to loss of resources
I agreed that collateral deaths caused by suspended treatments cannot be attributable.
I have lost the capacity to go to the gym. This impacts on my physical and mental health rather badly. But, on the other hand, it is a very high risk activity, and there is no agreement to date to do the things which would be needed to make this remotely safe. Very careful mask wearing of a suitable mask, and wiping down of all the equipment, would have to be universal for that to be remotely safe. And the effect of the virus on both mental and physical health has to weigh into that argument.
I have lost choral singing. Again, this is a brutal blow to my mental health. Again, this has been shown to be a very high risk activity, and again there is no idea what measures might make it safe. I got croup a couple of years ago, which devastated my capacity to take the type of breaths required for singing; it took me three months to be able to sing to any meaningful extent. I have no idea how long it would take if I got the virus, but there is no guarantee I would ever be able to take that type of breath again, and certainly the post-viral syndrome can be very lengthy.
I can't go and see my mother, who has been going through chemotherapy. This has not been good for either of our mental health. But the virus could easilly have killed her.
I can't go and see my lover in Chicago: there is no idea when I will be able to, or whether I will be able to afford the cost/s when the opportunity presents itself again. This is a loss of freedom which is costing us both dear. On the other hand, when I went there last November, I eiither took or transmitted in the plane a virus which laid me low for at least half of my time there, and I could well replicate the experience with COVID-19, affecting my own health and/or that of others profoundly. The precautions which might reduce the risk to an acceptable level have to be tolerable for the length of a 9 hour flight, and the process of getting off and on the plane. Security and other processes have to be redesigned to be compatible with these processes.
Individual freedom from the virus is only available (probably) following the development of successful antibodies to it. Until then, a balance has to be struck, and in the absence of far greater understanding of the virus, this has to be precautionary. So lockdown, modified for essential protection of some level of mental and physical health, such as individual distanced exercise, has, to my mind, to be the conclusion for now.
On the other hand, we will have to gather up the courage to come out of it when we reasonably can. Voluntary diminution at this level is a sign of mental ill-health in itself, of a psyche, individual and collective, overwhelmed by anxiety.
Loss of resources due to the lockdown? How?
Hundreds of thousands of deaths are inevitable if you do not prevent the virus spreading, just based on the level of infection required for herd immunity (~80%) and an estimated death rate of 0.5% (which is almost certainly a low estimate). We've had north of 30 000 deaths even with the lockdown, and even with the NHS having enough capacity.
Lockdown is about trying to protect the vulnerable, and about trying to manage the level of the seriously ill so as not to overwhelm the health service. At the moment they are beginning to talk about possibly being able to manage some elective procedures again as the level of Coronavirus cases seems to be being managed.
In practice depending on the number of asymptotic people and survival ratios and demographics things would probably not have continued for 2 weeks.
These people really bother me. I feel like they’re rubbing their hands with glee and praying that the lockdown lasts until Christmas so that the whole evil edifice of capitalism can finally be utterly destroyed (regardless of the human cost). These are the people for whom no amount of safety precaution will ever be enough, for whom the virus will never cease to be an existential threat to the whole country, not because of any genuine concern over people’s lives but because it suits their own political ends for it to be thus.
I’m sure none of that applies to anyone on the Ship.
Faced with any threat one acts sensibly, and like you I play music (a wind instrument even which are the best for pumping out the bugs) and before the lockdown I had stopped going and all three bands I play with totally stopped before the official lockdown start. We didn't need to police to enforce it.
But my croquet club is a different case. It is very easy to keep social distancing, and we had workable arrangements which could have continued. Our members include an eminent ret'd Professor of Medicine who had no time for people who made light of the virus, but happily played with me - we just kept distance. There is no reason why this harmless pastime should be legislated away. Same for Churches. I am appalled by how quickly the clergy including ABC rolled over to have their tummy tickled. If all they'd done was say mass in their Church, it would have been a slight protest against a totally unnecessary attack on freedom.
I admit I hate being told what to do as if I'm a little kid. It's true we haven't suffered the bully police tactics that many have, but I hate being treated as an idiot to be told that if I want to have a nice drive out into the country, never being within 100 metres of anyone else, I can be stopped and told to go home. Maybe you don't feel this. But I do. And is has happened with no debate in the popular media.
Taking a walk in the country is already a higher risk pastime without adding coronavirus to the mix - I'd love to be spending some of these good weather days we're having putting in some good walks, but do I really want to have someone coming out to get me if I slip and twist an ankle (or worse). Admittedly in 30 years of walking the hills and fells of this fair land I've only had mountain rescue called out on me three times (two occasions we were fine, just seriously underestimated the time needed for the walk, and the third was a member of the group who'd slipped and twisted her ankle on Snowdon and got a lift down by Sea King) and one other occasion avoided injury by nothing more than good luck allowing me to walk out. But, if I have a call-out rate of once a decade that would mean a 10% chance of me needing help this year if I went out walking, which is way too high for my liking given the additional risks those coming out to help me will be taking.
The measures taken had to be simple enough to be widely understood, and stringent enough to have an effect. Give or take some reservations about how well they were actually communicated, that's how we ended up with what we have.
The problem is that to be effective everyone needs to follow the rules. If you go for a drive in the country then at some point you need to buy more fuel, which means at the very least contact with the pump and probably the person at the till. Then 1000 people do the same thing and 1 of them is just starting to show symptoms and 3 people get it off the pump or the guy working in the kiosk and we're off to the races. Each extra activity where we're near other people carries a small extra risk and those risks add up on a population level. Does it suck? Yes. Is it unreasonable? No. The good news for you is that the restrictions on outdoor activities that can be socially distanced, like your croquet, are likely to be the first to be lifted. It would, however, only take one person handling a ball handled (or breathed on) by someone shedding virus to cause transmission.
As for clergy celebrating in church, that's the CofE, not the government. The government guidance is about gatherings, and other churches such as the SEC are streaming at least some services from churches and cathedrals.
As for "no debate in the popular media", what the hell has Toby Young and his fellow travellers been yammering about then?
- its spread coincides closely with a lot of our traditional social and leisure activities
- there is a delay between the spread and the appearance of symptoms
- the nature of exponential growth means that despite being quite infectious, there is a delay between a cluster infection and the large number of cases it can generate
The combination of these factors makes our potential individual responsibility in making the problem a whole lot worse very difficult to gauge and to bear. It also makes the construction of motivating policies for the common good extremely difficult.
Not to mention the now not even coherent on his own terms Peter Hitchens.
Finding out the facts about the IC model is not exactly facilitated. Here's what I believe to be true. Please fell free to counter any points made.
1. It has never been peer-reviewed.
2. When given figures for Sweden is foretold 40,000 deaths with no lockdown. There have been about 3,500.
3. They refuse to allow the code to be inspected. The official reason: it is undocumented and purely structured. Apparently a monolithic wadge of C++.
4. A version was, according to reports, sent to Microsoft to be made more respectable and this has been put on an open source repository and has been analysed, but this also has not been systematic.
5. A lot of bugs were found. Apparently IC know there are problems.
6. It has been reported that the models only examined two scenarios: 1. Total lack of any avoidance measures (aka a national hug-in). 2. Total lockdown. The idea that you can make recommendations that people will take into account (as Sweden) was not considered a possibility.
7. Other qualified epidemiologists do not accept his model. No it is not based on any scientific consensus.
Having said that, I think Hitchens is a pain in the arse, and one of those people who could lose an argument with all the facts on his side due to his arrogance.
I am more influenced by Dr John Lee who has written on this subject for the Speccie, and who is a moderate skeptic. He doesn't seem to dispute that the lockdown was politically unavoidable (I agree) but that it should now be lifted quickly rather than slowly (I also agree). And he is a medic though not an expert on virology.
What I fear is that Boris's main aim is to make sure nothing he now does makes his original lockdown decision seem flakey. I hope I'm wrong.
ETA but distancing might exacerbate individualism, too.
That the Swedish constitution meant that the lock down was initiated by a public body of experts rather than politicians doesn't make the lock down any less real. I can see the advantages of a constitution that says responses to national emergencies should be made by existing public bodies of experts in the relevant field rather than politicians; I'd previously only had experience of it in emergency exercises for a nuclear accident I attended as an observer 20 years ago ... so very different from similar UK exercises, no politicians in sight.
This lag is never reflected in headlines. One I saw today: "number of deaths down as lockdown due to ease" or some such. As though the lower number of deaths was immediate grounds for easing the lockdown. If only it were that simple.
Which is doubly odd as a lot of them ought to have come across it from the economic contexts.
You mentioned that nothing happened from Y2K. Actually, lots of things happened, including nuclear-related problems in Japan:
Year 2000 problem--Documented Errors (Wikipedia).
The problems were played down because so many people thought the whole thing was ridiculous. I worked on it, too. I was told not to mention it on my resume, because it might interfere with getting a job.
And there was a similar problem early this year. (Listed at the end of that section.)
The reason things weren't as disastrous as they might have been is because a whole lot of people, all over the world, put in a whole lot of work..
1. Code that couldn't cope with the date change would fail in ways which would depend on what the code did;
2. Vulnerable code that was corrected would continue to work;
3. Vulnerable code that wasn't corrected would fail.
4. Lots of effort went into moving vulnerable code from category 3 to category 2.
Anyone claiming it was never a problem in the first place is, with all due respect (ie none whatsoever) a blithering idiot.
Anyone who makes the same mistake concerning COVID-19 death rates is also a blithering idiot.
To be consistent they shouldn't look both ways before crossing the road because their lifetime chance of dying from being run over is very low.
So what do I feel about this? I feel that the only way in which a society can be constructed in which this model works at scale is by consensus, one person at a time. If we take the time to do this, hopefully a vaccine will be developed before it's completed. Meanwhile, a cruder collective model is required to stop the medical services from being overwhelmed. During the imposition of this crude freezing, people can move, individually and collectively, from angry denial through tears to a point where reality can be properly accommodated in a model that works for all, if only in that has possible levels of engagement. Otherwise, the result is a hurricane with the only other option being complete disengagement. What do I mean? If everyone accepts some impositions, of which the wearing of a mask is probably the most distasteful, we can probably most of us do most things - except choral singing, which I love most. Those who refuse all impositions create a vortex of infection, from which the only protection is total self-isolation, with its toll on physical and mental health.
So my response is, wear a mask, keep a distance and get on with it. And leave individualism where it belongs, in an absurd idealisation of the wild west.
Of course this whole discussion could end up just being a discussion of the meaning of lockdown, For me it means I am locked down (or up) in my house by default and can only go out so long as I can convince a law officer that my visit is included in the list of things that they will allow me to do. And they can challenge and fine me if they are not satisfied by my reasoning. So my freedom to move outside my house is only at the discretion of the law.
Are you saying this is also the case in Sweden? Not so far as I know.
And it would only take one such infected person to spread the disease to an otherwise unaffected area.
As has been pointed out here before, it also creates the potential for otherwise needless breakdowns, accidents, etc. all of which could expose others and chew up emergency services' time.
And if everyone else has the same idea? The roads get clogged, there are accidents, breakdowns, punctures, stops for petrol. Completely anti-social.
Were like this before all this started? And from what you say I would assume that you have no future intention to visit your home. Which is fine as long as you don't expect the same of me, not that I have a home other than the one I am living in.
But were I lucky enough to have a home in Devon, I think I could get there without clogging the M4 single handed. And I would then obey the rules of social distancing.
Well, that's all me, me, me. OK.
Personally, given the choice between putting all those decisions into the hands of experts acting on their knowledge and expertise or putting them in the hands of politicians without expertise and looking only to what will get them elected again I'll probably go with the experts. But, most of us live in nations where there's a middle ground of experts advising politicians, which I'd prefer assuming the experts are actually listened to (which in some of our nations doesn't appear to be the case). But, the drafters of the Swedish constitution obviously thought that in such circumstances of national emergency the politicians should be kept out of decision making and gave the expert bodies a lot more legal authority than most of us would experience in our countries, or even want.
And the misperception that an individuals' actions can't and don't have an impact on what happens overall. No man is an island and all that.
This has come up before, too. I can't find a country in the world where lockdown restrictions are permanent. Why no future intention?
(I can travel freely a whole 99km further in less than six hours' time! Whoopee!)