Introduction
This is just a brief update post to confirm that my Coronavirus model is still tracking the daily reported UK data well, and doesn’t currently need any parameter changes.
I go on to highlight some important aspects of emphasis in the Daily Downing St. Update on June 10th, as well as the response to Prof. Neil Ferguson’s comments to the Parliamentary Select Committee for Science and Technology about the impact of an earlier lockdown date, a scenario I have modelled and discussed before.
My model forecast
I show just one chart here that indicates both daily and cumulative figures for UK deaths, thankfully slowing down, and also the model forecast to the medium term, to September 30th, by when the modelled death rate is very low. The outlook in the model is still for 44,400 deaths, although no account is yet taken for reduced intervention effectiveness (from next week) as further, more substantial relaxations are made to the lockdown.
Note that the scatter of the reported daily deaths in the chart below is caused by some delays and resulting catch-up in the reporting, principally (but not only) at weekends. It doesn’t show in the cumulative curve, because the cumulative numbers are so much higher, and these daily variations are small by comparison (apart from when the cumulative numbers are lower, in late February to mid-March).
It isn’t yet clear whether the imminent lockdown easing (next week) might lead to a sequence of lockdown relaxation, infection rate increase, followed by (some) re-instituted lockdown measures, to be repeated cyclically as described by Neil Ferguson’s team in their 16th March COVID19-NPI-modelling paper, which was so influential on Government at the time (probably known to Government earlier than the paper publication date). If so, then simpler medium to long term forecasting models will have to change, my own included. For now, this is still in line with the Worldometers forecast, pictured here.
The ONS work
The Office for National Statistics (ONS) have begun to report regularly on deaths where Covid-19 is mentioned on the death certificate, and are also reporting on Excess Deaths, comparing current death rates with the seasonally expected number based on previous years. Both of these measures show larger numbers, as I covered in my June 2nd post, than the Government “all settings” numbers, that include only deaths with a positive Covid-19 test in Hospitals, the Community and Care Homes.
As I also mentioned in that post, no measures are completely without the need for interpretation. For consistency, for the time being, I remain with the Government “all settings” numbers in my model that show a similar rise and fall over the peak of the virus outbreak, but with somewhat lower daily numbers than the other measures, particularly at the peak.
The June 10th Government briefing
This briefing was given by the PM, Boris Johnson, flanked, as he was a week ago, by Sir Patrick Vallance (Chief Scientific Adviser (CSA)) and Prof. Chris Whitty (Chief Medical officer (CMO)), and again, as last week, the scientists offered much more than the politician.
In particular, the question of “regrets” came up from journalist questions, probing what the team might have done differently, in the light of the Prof. Ferguson comment earlier to the Parliamentary Science & Technology Select Committee that lives could have been saved had lockdown been a week earlier (I cover this in a section below).
At first, the shared approach of the CMO and CSA was not only that the scientific approach was always to learn the lessons from such experiences, but also that is was too early to do this, given, as the CMO emphasised very clearly last week, and again this week, that we are in the middle of this crisis, and there is a very long way to go (months, and even more, as he had said last week).
The PM latched onto this, repeating that it was too soon to take the lessons (not something I agree with); and indeed, Prof. Chris Whitty came back and offered that amongst several things he might have done differently, testing was top of the list, and that without it, everyone had been working in the dark.
My opinion is that if there is a long way to go, then we had better apply those lessons that we can learn as we go along, even if, as is probably the case, it is too early to come to conclusions about all aspects. There will no doubt be an inquiry at some point in the future, but that is a long way off, and adjusting our course as we continue to address the pandemic must surely be something we should do.
Parliamentary Science & Technology Select Committee
Earlier that day, on 10th June, Prof. Neil Ferguson of Imperial College had given evidence (or at least a submission) to the Select Committee for Science & Technology, stating that lives could have been saved if lockdown had been a week earlier. He was quoted here as saying “The epidemic was doubling every three to four days before lockdown interventions were introduced. So had we introduced lockdown measures a week earlier, we would have reduced the final death toll by at least a half.
Whilst I think the measures, given what we knew about this virus then, in terms of its transmission and its lethality, were warranted, I’m second guessing at this point, certainly had we introduced them earlier we would have seen many fewer deaths.”
In that respect, therefore, it isn’t merely interesting to look at the lockdown timing issue, but, as a matter of life and death, we should seek to understand how important timing is, as well as the effectiveness of possible interventions.
Surely one of the lessons from the pandemic (if we didn’t know it before) is that for epidemics that have an exponential growth rate (even if only for a while) matters down the track are highly (and non-linearly) dependent on initial conditions and early decisions.
With regard to that specific statement about the timing of the lockdown, I had already modelled the scenario for March 9th lockdown (two weeks earlier than the actual event on the 23rd March) and reported on that in my May 14th and May 25th posts at this blog. The precise quantum of the results is debatable, but, in my opinion, the principle isn’t.
I don’t need to rehearse all of those findings here, but it was clear, even given the limitations of my model (little data, for example, prior to March 9th upon which to calibrate the model, and the questionable % effectiveness of a postulated lockdown at that time, in terms of the public response) that my model forecast was for far fewer cases and deaths – the model said one tenth of those reported (for two weeks earlier lockdown). That is surely too small a fraction, but even part of that saving would be a big difference numerically.
This was also the nature of the findings of an Edinburgh University team, under Prof. Rowland Kao, who worked on the possible numbers for Scotland at that time, as reported by the BBC, which talked of a saving of 80% of the lives lost. Prof Kao had run simulations to see what would have happened to the spread of the virus if Scotland had locked down on 9 March, two weeks earlier.
A report of the June 10th Select Committee discussions mentioned that Prof. Kao supported Prof. Ferguson’s comments (unsurprisingly), finding the Ferguson comments “robust“, given his own team’s experience and work in the area.
Prof Simon Wood, Professor of Statistical Science at the University of Bristol, was reported as saying “I think it is too early to talk about the final death toll, particularly if we include the substantial non-COVID loss of life that has been and will be caused by the effects of lockdown. If the science behind the lockdown is correct, then the epidemic and the counter measures are not over.”
Prof. Wood also made some comments relating to some observed pre-lockdown improvements in the death rate (possibly related to voluntary self-isolation which had been advised in some circumstances) which might have reduced the virus growth rate below the pure exponential rate which may have been assumed, and so he felt that “the basis for the ‘at least a half’ figure does not seem robust“.
Prof. James Naismith, Director of the Rosalind Franklin Institute, & Professor of Structural Biology, University of Oxford, was reported as saying “Professor Ferguson has been clear that his analysis is with the benefit of hindsight. His comments are a simple statement of the facts as we now understand them.“
The lockdown timing debate
In the June 10th Government briefing, a few hours later, the PM mentioned in passing that Prof. Ferguson was on the SAGE Committee at that time, in early-mid March, as if to imply that this included him in the decision to lockdown later (March 23rd).
But, as I have also reported, in their May 23rd article, the Sunday Times Insight team produced a long investigative piece that indicated that some scientists (from both Imperial College and the London School of Hygiene and Tropical Medicine) had become worried about the lack of action, and proactively produced data and reports (as I mentioned above) that caused the Government to move towards a lockdown approach. The Government refuted this article here.
As we have heard many times, however, advisers advise, and politicians decide; in this case, it would seem that lockdown timing WAS a political decision (taking all aspects into account, including economic impact and the wider health issues) and I don’t have evidence to support Prof. Ferguson being party to the decision, (even if he was party to the advice, which is also dubious, given that his own scientific papers are very clear on the large scale of potential outcomes without NMIs (Non Pharmaceutical Interventions).
His forecasts would very much support a range of early and effective intervention measures to be considered, such as school and university closures, home isolation of cases, household quarantine, large-scale general population social distancing and social distancing of those over 70 years, as compared individually and in different combinations in the paper referenced above.
The forecasts in that paper, however, are regarded by Prof. Michael Levitt as in error (on the pessimistic side), basing forecasts, he says, on a wrong interpretation of the Wuhan data, causing an error by a factor of 10 or more in forecast death rates. Michael says “Thus, the Western World has been encouraged by their lack of responsibility coupled with uncontrolled media and academic errors to commit suicide for an excess burden of death of one month.”
But that Imperial College paper (and others) indicate what was in Neil Ferguson’s mind at that earlier stage. I don’t believe (but don’t know, of course) that his advice would have been to wait until a March 23rd lockdown.
Since SAGE (Scientific Advisory Group for Emergencies) proceedings are not published, it might be a long time before any of this history of the lockdown timing issue becomes clear.
Concluding comment
Now that relaxation of the lockdown is about to be enhanced, I am tracking the reported cases and deaths, and monitoring my Coronavirus model for any impact.
If there were any upwards movement in deaths and case rates, and reversal of any lockdown relaxations were to become necessary, the debate about lockdown timing will, no doubt, revive.
In that case, lessons learned from where we have been in that respect will need to be applied.