As life begins to return to normal, it is perhaps a good opportunity to look back on the past few months and reflect on how the UK has done so far in responding to the COVID-19 pandemic. I say “so far” because we are still not out of the woods yet. The virus is still with us and there are concerns both about localised spikes and a possible second wave. The long-term historical judgement will depend on a number of factors that we don’t know yet. These are likely to include
- If there is a second wave in the UK and how we respond to that.
- Whether or not we are able to successfully contribute to a vaccine or cure.
- The extent to which measures taken in order to mitigate the effect of the virus exacerbate other negative effects including morbidity from other diseases, emotional health factors, social cohesion and economic well-being.
- Longer term health effects. If as appears to be the case, those who suffer from a serious dose of the virus experience long term health effects then we may also expect to see longer term pressure on the health service and further mortalities caused by the virus even though much later on.
As I have said from the start, we need to be wary about creating league tables based on mortality. This is because of a number of reasons including:
- That different countries have been reporting mortalities differently.
- That we may not be comparing like with like. The way that a virus spreads and behaves in a country with a temperate climate, high population density and major migration hubs may differ to countries with different climatic, geographical and social-economic conditions.
- That even without those factors, when looking at such a small percentage of the population, the results may well be within a normal distribution curve of outcomes so that in effect there isn’t a statistical difference in terms of how countries have done.
- That it is just plain crude and wrong to turn this into a kind of competition and that probably reflects the way in which the virus has primarily been reported on by political commentators as a partisan political event.
Indeed, if there is one major lesson to learn at this stage, it is that we need to do better at understanding statistics. One example of this has been the way in which we have reacted to events after the peak of the virus in the UK. To give two examples.
First of all, we have seen a number of incidents where social distancing measures were clearly broken. The two obvious examples were the Black Lives Matter demonstrations and the rush to the beaches during the mini summer heatwave. People sat and looked for a resulting spike from those incidents and did not see one. So, they concluded that those incidents did not have an effect on our response to the virus. That seems pretty naïve to me.
Suppose that I have been on a keep fit regime. I have been exercising daily and I have been dieting responsibly, eating healthy food and losing weight. Then one day, I am tempted by the beautiful cooking smells coming from my local Chinese take-away. I head in there and order all my favourite dishes, take them home and enjoy them in one sitting. At the end of the meal, my hunger is satisfied. However, in the night, when I’m awake with that raging thirst you get after a take-away I’m also troubled with regrets. Th nosh up must surely have trashed my diet. So, the next day when I get on the scales, I am relieved to see that I have not gained weight. “Fantastic news” I think, and so I resolve to get another take-away the following night.
You can see all the problems there can’t you? The key one for our situation here is that I have not factored in that my weight was in fact declining at a specific rate until then. The affect of my falling off the healthy eating wagon is not seen in whether my weight has gone up again, rather it is seen in whether I managed to reach my target weight for the day.
Similarly, when looking at the virus data, we should not just be looking for upticks as a result of relaxations in social distancing. We should also be asking “where would the data have been if reductions in cases and deaths had continued as expected?”
Secondly, in the last few weeks we have started to see those spikes in cases appearing. Now, we must be vigilant about the risk of a second wave. However, panicking about spikes now may mean that we are jumping to conclusions about the stats in a way that is just as unhelpful as when we were complacent about the absence of a spike. You see, at this stage, we should expect to see more examples in the data that look like spikes. In Scotland for example where they have had no recorded deaths for quite a few days, even 3 or 4 deaths would look like a spike on the data.
So, in evaluating how we are doing and how we have done, we need to be careful about how we handle statistics. At the same time, though I think that some evaluation is possible. So how do we measure success.
Well, I want to suggest that the first measure of success has to be “did we achieve what we set out to.” This is important because I think that at times we have forgotten the initial objectives that were set out. SAGE helpfully reminded us of the purpose of the proposed behavioural and social intervention measures at their meeting on the 16th March.
“The objective is to avoid critical cases exceeding NHS intensive care and other respiratory support bed capacity.”
Now, it is worth remembering that another factor in play at the time was the potential for deaths to exceed 250,000 and potentially to hit the 500,000 mark. So one indicator of “success” is that they came no where near to that forecast. However, it is on that primary, stated objective that we as a country should be measured. And the answer seems to be “so far, so good.” The Health service was protected, the curve was flattened, the crisis in the NHS was averted.
So, against the aim set out by the Government, we did okay. However, I’m not convinced that this completely answers the question “how did we do.” To properly answer it, we also need to ask:
“At what cost did we achieve that objective?”
“Was it the right objective?”
We will come back to those questions in future posts.
 You will notice that I talk about how “we” did, not how the government did. That’s because the responsibility for responding to COVID-19 has sat with the whole community not just the state.