Have COVID interventions worked -more on difficult decisions in uncertainty

Were the Government reckless in failing to bring in additional COVID measures for England over the Christmas and the New Year period? Or did Scotland and Wales jump the gun with pointless measures that haven’t worked, were never going to and weren’t necessary anyway? A lot of people think so and hold their views very strongly on this.

So, I thought it might be helpful to have another look at why such judgement calls are a little tricker than we might assume from the comfort of our armchairs.  Whilst most of us are unlikely to be making big pandemic type decisions, it might also help us think through the smaller scale decisions were are likely to have to make often in the face of uncertainty.

First of all, why might people be saying that the Scottish and Welsh Governments made the wrong call? Well, not that long back, people were arguing that we should be looking to Mark Draxford and Nicola Sturgeon’s example. Clear, brave, rapid decisions were made that gave people certainty over Christmas. Other European nations also decided to implement measures. Even last week, a rather misrepresented and misused chart was being circulated that showed cases falling in the different countries except in England. The problem was that the chart showed days when English case data was being reported but Scotland and Wales were not reporting due to the holiday season. We have of course seen a massive catch up in the data for those areas now. I suspect that most people circulating the chart were at worst a little naïve.  However, some kept sharing it even when corrected which is disappointing.

When we see the case data side by side, it becomes clear that England has not been an outlier with extremely high cases compared to the other nations. Indeed when we measure new cases as a percentage of the population, England has been overtaken by the others. 

Does that mean then that the measures didn’t work in Scotland and Wales. Or what about France where there is a COVID wave dwarfing even ours?

Well, we should be very careful about claiming something isn’t working as Professor Irene Petersen makes clear in this tweet.

How do you know an intervention hasn't worked in country Z?

Intervention Y may have reduce Re from X to X – a

With #omicron it is not a question (right now) about being able to get Re < 1, but simply to reduce Re

— Prof Irene Petersen 💙 (@i_petersen) January 6, 2022

In other words, we need to be careful about making casual comparisons and drawing up those awful league tables.  What really matters is whether or not the different countries would have experienced higher or lower case growth than what they are experiencing without the measures they’ve introduced or with measures they failed to introduce. That’s something we cannot be certain about because there are other variables at work too.

This cuts both ways doesn’t it? England may well have taken exactly the right course of action for England – this may be the best that it was always going to be here but that doesn’t mean that Scotland and Wales got their decisions wrong either.  The measures in place in those contexts may be right. Perhaps we need more scope for regional variation. For example, do you need the same measures in place for London and the Home Counties as you do for Cornwall or Cumbria?

There is another factor that comes into play when we think further about Peterson’s point. To be sure, measures may help dampen case growth even if it isn’t eliminated altogether. On that level the measures work within the parameters of what they are intended to do. Yet that still does not mean the measures were right. You see, what really matters is not what is/isn’t happening with case growth but the impact that has on the health service. Will our hospitals be overwhelmed? Will we see an significant increase in mortality. If case numbers grow by a little less and the health service is still overwhelmed then we may not have gained much.

This comes back to the point that there are costs involved with all actions taken or not taken for COVID.  These include social, economic and other health (physical and mental) consequences of decisions. As I’ve mentioned before, the Government therefore has to make decisions. They have to look at the financial cost of measures including the direct cost of paying for things such as furloughing and the economic consequences. They also have to consider how they are going to use political capital. That’s right, COVID decisions are political ones and that is the way it has to be. This is because the Prime Minister has a responsibility to govern and lead. If he exhausts his political capital then he is no longer in a position to lead. And the need for consensus in an emergency means that like it or not, Boris Johnson is spending the political capital of the other party leaders too.

So, Government and devolved administrations had a big call to make as the Omicron wave began.  Did they invest their political capital in reintroducing lockdown type measures? That would have cost them support and goodwill in certain quarters.  Or did they accept that they would have to spend political capital by allowing emergency ward facilities went up in hospital carparks and for waiting lists to go up as the NHS absorbed the wave.

Now, with the decision presented that way, a lot of us might think “but isn’t it obvious” – you protect the health service at all costs. What, however, if the advice is that no matter what you do, you are still going to see a crushing wave of cases, leading to pressure putting the health service at close to breaking point. You might manage to reduce the wave by 5 or 50% but you will still have those temporary wards going up, you’ll still be rationing healthcare, you’ll still be cancelling appointments.  You’ll have spent political capital on the measures but will not have avoided the problem. You’ll be the authoritarian Prime Minister who still presided over an NHS crisis.

Cast your mind back to 2020, remember the promises the Government unwisely made. They told us that if we went into lockdown, it would be over by Easter. They promised us that late Autumn measures would save Christmas and then when Christmas was lost came the promise of a brighter new year only for that optimism to be swept away on the back of the Alpha wave.  I’m sure such memories will have been in Government ministers’ minds as people called them to bring in a circuit break to save this Christmas. We could have ended up cancelling all of our plans only to still witness horrific scenes in our A&E departments.

So, I wonder what call we would have made if we were asked to leave our armchairs and take up the hot-seat at Downing Street. Would I have held my nerve and stuck with the plan I suggested on this blog to focus energy into developing surge capacity or would the rising case numbers of pushed me into supporting emergency measures? If you were making the decision instead of Nicola Sturgeon, would you have followed through with the tough measures you thought Boris should have brought in or would the hesitation from Westminster have caused you to paise before signing the relevant orders?

Well, we won’t find ourselves in that situation but as I said at the start, we do and will have to make tough decisions from time to time.  When we do, it’s helpful to remember that few I any decisions come without any cost. When we see others making decisions we don’t like, it’s also worth remembering that too and  responding to those decisions with grace, humility and kindness.