Regular readers of this column will recall that my main effort has been  to focus attention on the number of hospital admissions as the key to release from lockdown: once there is no danger of the NHS being overwhelmed then, I submit, the lockdown restrictions on our lives -that are so costly- should be lifted.
Alas, the goal posts have been moving from hospital admissions to  the number of infections, or the number of deaths. The danger arising from this ‘mission creep’ is that we will find it ever harder to escape from lockdown at all, with evermore devastating economic and social consequences.

Last September I raised the issue of ‘false positives’ in the Commons with the Secretary of State. I was not satisfied with his answer (see my blog https://www.desmondswaynemp.com/ds-blog/false-positives/ ). Now however, given the shift in policy towards a target of reduced infections, typically being touted at below 1000 new cases daily as the condition for lifting lockdown, the issue of false positives will loom ever larger.
I have seen estimates for false positives ranging between 1% and 6% over the last year. The Secretary of State told us it was 1%.  Inevitably, it will vary dependent upon the type of test and the different laboratories processing results.
Let’s be really conservative however, and take the  published false positives figure for the lateral flow test at a mere 0.32%.
Now, imagine that Covid-19 died out overnight -it completely disappeared off the face of the earth.
Nevertheless, with 500,000 or so tests carried out the next day we would still detect 1,600 new cases from the false positives and consequently refuse to lift the lockdown.
It gets worse because the ambition is to increase the level of testing tenfold in project ‘Moonshot’ , so the false positives will take us ever further from the desired level of infections.

The same principle will apply to any target based on the level of deaths from Covid-19, because all hospital cases are tested on admission and weekly thereafter.
The only sensible discussion of ‘acceptable’ death rates from Covid-19 would have to be based on a ‘tolerable’ excess over the current winter deaths from all respiratory conditions which, pre Covid-19, was typically 300 per day. Any question of tolerable death levels, is sensitive one, which is why it is essential to stick with a daily level of hospital admissions with which the NHS can deal effectively.

So don’t move the goal posts.

 

(I am indebted to Professor Anthony Brookes of The  Department of Genetics & Genome Biology at University of Leicester)

I Have been taken to task for ‘spreading misinformation’ because in this column on the 5th of September 2020 I stated that UK deaths in the preceding 12 months had been by no means exceptional.
A critic however, has provided figures clearly showing a 15% increase in deaths in 2020 over the average of the preceding three years.

First, the criticism is based on figures for the whole of 2020, where my column was written at the beginning of September before the surge in infections and deaths consequent upon the advent of the new variant. Only two weeks after publication of the column, the Secretary of State told me from the despatch box, on the record, that average deaths were consistent with the long-term average. I consider my column to be a fair analysis at the time it was written.

Furthermore, when I wrote the column I was considering a much broader sweep of recent history than my critic.

From early in the pandemic I have complained about how we are manipulated by the ways in which statistics are presented, especially without context.
Most recently I have been appalled by the way that last year’s figures for deaths have been presented with attendant hyperbole.
On the morning of their release the BBC R4 Today Programme trumpeted that they were the worst since WW2. The statistician in attendance said that this was a quite illegitimate comparison given the number of profound changes since then, not least the vast increase in population. Nevertheless, the BBC persisted with the characterisation.

Likewise, The Guardian ran with a headline on the 12 January 2021 that “2020 was deadliest year in a century in England and Wales.” Such a sensationalist headline looking at deaths recorded in a calendar year did not account for the size or composition of the population. 

A useful measure for understanding deaths is the Age-Standardised Mortality Rate (ASMRs). ASMRs take into consideration both the population size and age-structure allowing comparisons over time. The ONS notes that the provisional ASMR in 2020 for England and Wales was 1043.5 deaths per 100,000 population which was around 8% higher than the five-year average. Since 2001 the ASMR has decreased annually but an increase was seen in 2019 and 2020. It is granted that the ASMR was higher in 2020 than recent years but it was surpassed in 2008 (1,084.2), 2007 (1,085.1), 2006 (1,099.1), 2005 (1,137.6), 2004 (1,155.4), 2003 (1,224.8), 2002 (1,225.5) and 2001 (1,229.8).

Another way of assessing the number of deaths in the UK is the Crude Death Rate (deaths per 1,000 population). Based on ONS’s monthly deaths spreadsheet and population projections for 2020 a provisional crude death rate for England and Wales can be calculated at 10.1 deaths per 1,000 population, compared with 8.9 in 2019. The ONS’ Annual data: Deaths (numbers and rates: total, infant, neonatal) shows that the crude death rate in England and Wales was higher than 2020 when records began in 1953 (11.4 deaths per 1000 population) until 2003 (10.2 deaths per 1,000 population) in every single year.    

There is little doubt that the UK had a greater number of deaths in 2020 than in the preceding decade. However, it is far from exceptional. Under the Age-Standardised Mortality Rate (ASMR) measure the rate of mortality was higher in every year prior to 2008. Likewise, under the crude mortality rate every year preceding 2003 saw a higher mortality rate than 2020.

In any event, given that my principal complaint is that lockdown is a failed policy: It comes at an astronomic economic and social cost. So, the more dramatically one presents the death rate, the more its abject failure is manifest.

Scientists and politicians ought to be able to dispute the interpretation of data sensibly and without rancour or name-calling.

I despair.
Apparently the polls show a large majority approve of ten-year prison sentences for anyone caught trying to evade quarantine after a visit to Portugal etc.
This new offence and sentence will come into effect without either a debate or vote in Parliament.
What have we come to?

Imagine ending a trip confined to your hotel room for ten days, and having to pay a whopping bill, in addition.

The UK is not some backwater that can cut itself off from the world, on the contrary, we are one of the world’s greatest trading and travelling nations. Restrictive measures may have devastating consequences for our national income and livelihoods.

The danger is that it is always easier to impose a quarantine policy than to lift it.
The policy is a direct precautionary response to new strains of Covid-19 that have emerged in specified countries.
Will the Government feel able to lift the quarantine once our vaccination programme is sufficiently advanced?
Or will there be a temptation for further precaution against the possible emergence of new mutations of the virus?
 After all, mutate is what viruses do. What’s more they do it anywhere, not just in the designated destinations. Indeed, currently the world’s most successful mutant variant originated in Kent.
The fear of a new mutant variant need not be confined to Covid-19, any virus could be mutating anywhere.

If we are ever to return to normality and prosperity we have to encounter risks with a proper sense of proportion.

Speeches from Hansard that I made years ago in debates about the repeal of Section 28 and reducing the age of sexual consent have surfaced, in which my antediluvian prejudices are quite shocking, even to me.
How could I have ever believed such things, let alone said them?

My transformation from extreme social conservative to libertarian deserves some explanation. How was it that I opposed those measures only to become the champion of the Equal Marriage Act, the Lord Commissioner responsible for whipping it through all its stages in the Commons.

Long term readers of this column would have witnessed that transformation as it took place in these blogs. I call it a transformation not an evolution, because it was sudden.
I put my original prejudice down to intellectual laziness. I simply never challenged, or even thought about the views that I held. Furthermore, when I received a very large correspondence in support of my position and against the liberalising measures that we were debating, it was so much easier to simply reply by stating that I agreed with them, rather than investing any intellectual effort in the matter.

My mind changed when the Government presented Parliament with the Sexual Orientation Regulations. The purpose of this measure was to prevent the providers of any commercial service from discriminating against a potential client on the basis their sexuality.
It prompted a huge lobbying campaign by certain elements of organised religion. I received hundreds of letters, most of them containing the same example: a Christian couple running a B&B would be required by regulation to accept as guests a gay couple, notwithstanding the offence to their deeply held religious beliefs.
In a flash of enlightenment the question occurred to me ‘ what Gospel is it they could possibly have been reading?’
How on earth could they imagine that, were Our Lord the landlord, that he would have turned the quests away?
Having made that leap, I then put time and effort into studying the Scriptures. The result of which study I put to use when the controversy arose when the Equal Marriage Bill was before Parliament. I published a number of defences of the Bill from a biblical perspective. One of which, entitled Too Much Leviticus, was even written-up in The Guardian in a column by Chris Bryant MP (a former Vicar) and which prompted an attempt by a national evangelical association to reclaim me for the ‘truth’. It resulted in a very unpleasant meeting, the only one in which I’ve ever had to ask my guests to leave.

It is easy to forget the virulence and bitterness of the Campaign against the Bill. My stance led to a significant number of resignations from my political association. I was assured that I was destroying marriage, to which I responded that the marriages to which they were objecting would be occasions of joy and celebration to the participants, their friends and relatives, but wouldn’t make a blind bit of difference to anyone else.
Events have proved me right: marriage has survived and, I believe, it has been strengthened.

There are examples of politicians having radically revised their opinions. The ‘journey’ of John Bercow comes to my mind. Many of my colleagues derided him for it, but -though I still disagree with him about almost everything- I rather respect him for it.

For months now, I have been attempting to keep the focus of the Government and of the readers of this column, upon what was the stated Aim of our Coronavirus policy. (I have never doubted the wisdom of that aim, although I have always questioned the government’s lockdown policy as a means of achieving it)
We’ve all seen and heard it so often, and can call it to mind instantly: our united purpose is to save lives by protecting the NHS.

The logic is simple: if the NHS is overwhelmed by too many hospital admissions then not only will it be unable to provide care to those with suffering with Covid-19 – resulting in many more of their deaths, but equally it will be unable to treat people with many other serious and life-threatening conditions, so they will die in greater numbers too.
So, we aim to save lives by limiting the number of hospital admissions.
The aim is not just to save lives themselves, but to do so by protecting the NHS.
This is an important distinction.
Were the objective just to save lives, then we would only achieve it by a policy characterised as ‘zero Covid’.
This is the very ‘mission creep’ against which I have been warning. Right on cue this week Jeremy Hunt, Chairman of the Commons Health Select Committee, has argued forcefully that the aim should, instead of being expressed in terms of hospital admissions,  rather it should be a specific reduced target of daily infections.
By failing to maintain the original aim, we lose the proper sense of urgency about achieving it, as if we had the luxury of delay until some other desirable objectives were achieved in addition.
Of course it would indeed be wonderful, were it possible, if we extended our objective to complete ‘zero Covid’ so nobody had to die of it again, or as far along that path as can be practically achieved.
However fanciful this may sound, there is nevertheless a growing lobby in support of it. Daily it is expressed in cautionary statements about the need to maintain restrictions on our lives and not to lift them too quickly.
The danger is that we are losing proper and realistic appreciation of the cost in terms of the long term damage to livelihoods, education, and a terrible toll on mental health. In short, we’ve lost all sense of the cost/ benefit analysis of current lockdown measures, and the sense that we urgently need to lift them as soon as possible, before they inflict even more lasting harm.
That moment of ‘possibility’ was defined by a level of  hospital admissions with which the NHS could cope. Substituting some other new objective appears to be defined only by the length of a piece of string, keeping us in devastating elements of lockdown almost indefinitely.

As controversy has raged about my views on lockdown I have been encouraged by an enormous correspondence overwhelmingly in support of the stance that I have taken.
There is however, an element in that correspondence which I must contradict: When commenting on the staggering number of deaths, some of my correspondents add that overwhelmingly those who have died were elderly or suffered from other life-limiting conditions, as if this somehow made the scale of lesser importance compared to the deaths of others.  We must not diminish in any way those who have died. No life is worth less than another. All their lives were shortened and they have friends and families who grieve. 

* 

One other aspect of my correspondence includes unflattering international comparisons of  UK performance  in terms both of the number of deaths and the damage sustained to the economy. I suspect that the fatuous conclusions drawn are more the result of ignorance than malice, but the fact is that these comparisons do not compare like with like. There will come a time to focus on comparative performance and the lessons to be drawn, but not yet.
Of one comparison though, I am absolutely certain: if you are unfortunate enough to be struck down with the virus, then there is no better place to be in the world than in the care of the NHS and its fantastic staff. I’ve heard from so many of them: they’re exhausted and emotionally drained, yet they just carry on regardless. It has been a magnificent effort 

Should we bring forward school staff to the front of the vaccination queue? 
Clearly, if our priority is re-opening schools, it follows that this priority should be reflected in the vaccination programme.
The counter argument is more nuanced. We believe that schools are safe; they are not vectors of infection; that school staff are no more exposed to the possibility of infection than other occupations. The Schools are closed only because of the impact on community activity generated by children coming and going, which is at variance with the requirement to ‘stay at home’ (regular readers of this column will know that I have profound difficulties with this aspect of the policy, but I simply state the case as made by the Government).
Given all this, it would be quite wrong to fast-track hundreds on thousands of school staff at the expense of the most vulnerable citizens.
I’ve said it before: this is war!
The first principle of war is the selection and maintenance of the aim.
The selected aim is to save lives by preventing the NHS from being overwhelmed by hospital admissions. The key must therefore, be to vaccinate first those who -were they to catch the virus- be most likely to end up in hospital.
Once the most vulnerable have been vaccinated, by all means then prioritise school staff thereafter.
My question to the PM last Wednesday and his answer sum up the matter precisely.

Sir Desmond Swayne  To lift lockdown, will my right hon. Friend focus exclusively on the progress of vaccinations of those who are most likely to be hospitalised if infected? Mission creep beyond hospitalisations would inevitably lead to the diminution of our sense of urgency to lift the restrictions – wouldn’t it?

The Prime Minister My right hon. Friend is completely right and he gets to the heart of the problem in the pretend policy that has been announced by the Opposition party. If we were to interfere with the JCVI 1 to 9 list, which is intended to target those most vulnerable and those most at risk of dying or of hospitalisation, we would, of course, interpolate it with other people appointed by politicians, taking vaccines away from the more vulnerable groups and, as he has rightly said, delay our ability to move forward out of lockdown. He is spot on. 

The idea of paying everyone £500 for a positive Covid-19 test appears to have got the thumbs down. I was encouraged nevertheless, because it indicated that at least some government advisers are thinking radically. In that respect it was a mild corrective to the very depressing impression that there is a loss of any sense of urgency on the part of government about the need to find ways of expediting the lifting of lockdown restrictions. It is just incredible to hear government scientists musing in public about keeping businesses closed until June: There would be no such businesses left.
The cost of lockdown to the Government alone is £9 billion per week, never mind the cost to the Economy as a whole; the future of young adults; and of our children’s education.
 So profound are these costs that we should consider spending any amount of money on initiatives that could contribute to ending them. Whether paying for positive tests to encourage testing is an idea with such merit, is something on which we might reflect further.

But here is an idea from the Adam Smith Institute on we should spend vast amounts straight away.
Expediting the vaccination program is the principal means by which we can reduce hospital admissions and so prevent the NHS from being overwhelmed and therefore, justify ending the lockdown.
The restraint on our vaccination effort is limited supplies of vaccine.
The Pfizer vaccine costs £16 per dose, but the Oxford / AstraZeneca vaccine -because it was seed-funded by the Government on the basis of a not-for-profit distribution – costs a mere £2 per dose.
We should offer AstraZeneca a commercial rate for each dose in order to subsidise an exponential growth in its productive capacity, allowing us to proceed much faster with vaccinations and ending lockdown.
That greater productive capacity would also be a further contribution on our part to enable developing countries to acquire the vaccine inexpensively, leading to fewer new strains and greater freedom to travel.
It would be worth every penny, and seems vastly more promising that paying someone for testing positive.

I have been criticised by a family doctor on the grounds that a question I put to the PM in Parliament was ‘demoralising for NHS staff’.
I am at a loss as to how this could be the case.
The question to the PM was this:
“Pubs cannot compete with supermarkets for off-sales. Even within a household, people cannot play tennis or golf. Notwithstanding the assault on liberty and livelihoods, why are the regulations pervaded by a pettifogging malice?”
I used the word pettifogging to describe the interference in the minutiae of our lives, and malice because of the unfairness of allowing supermarkets -which have so done well out of lockdown- to sell alcohol for consumption off the premises but to prevent pubs from doing so.
In all this I merely represent the views of my constituents: I have been lobbied hard by pub landlords, golfers and tennis players. There is something rather vindictive about preventing one from playing golf alone, or with a member of your own household. It is hard to see how the restriction reduces the spread of the disease.
I’m sure that very few NHS workers were ever aware of the exchange, and I doubt that many more have had it brought to their attention by the intervention of this local doctor.
In any event, I’m confident that they will ignore it and carry on with the magnificent job that they have been doing on behalf of us all. 

From the very outset of the pandemic the objective of the Government’s policy has been to ‘protect the NHS’ from being overwhelmed with more hospital admissions than could be accommodated. The political imperative was to avoid the scenes of chaos at hospitals that we witnessed in Lombardy last February.
For this reason the restrictions were placed on human contact in order to reduce the rate of infection and so to slow the pace of hospital admissions. Stating the obvious, these restrictions have come at an enormous economic and social cost, so it is vital that they are lifted as soon as possible.
When to lift them has to be a political decision. Yet, over recent days a number of the Government’s scientific advisors have been speaking in public about the need to maintain restrictions to the end of the year and even beyond.
They need to be reminded that the main effort of the entire policy is not to eradicate the disease,  but it is to prevent the NHS from being overwhelmed.
The key issue, is to identify the point in the progress in the vaccination programme where a sufficient proportion of the most vulnerable groups (which, if infected, are more likely to be hospitalised) have been vaccinated so as to reduce the risk to the NHS to an acceptable level. The job of the scientists to model the data in an attempt to match vaccination levels with the potential for hospital admissions.
It is for politicians to consider the result of these deliberations, and to balance the risk of lifting the restrictions against the social and economic costs of keeping them in place.
Scientists have a legitimate point of view, but it is exactly that: only a point of view.