Summary: it is difficult to exaggerate the malign influence that Dominic Cummings has had on this government.  The lack of intellectual firepower in the Cabinet has led to a range of bad decisions being made throughout the pandemic.  We have paid already through an enormous death toll and are continuing to pay.  The economic damage will take years to repair with projections of over 6 million unemployed by the end of this year.  If the Prime Minister cannot develop a more coherent plan he should move to let another takeover.

Running the country is not easy.  Everything is interconnected and government procurement programs often go badly wrong.  Examples are MoD procurement and the multiple computer systems contracts for the health service.

Problems start with the decision process in government.  Committees are formed to decide policy and then passed to more junior civil servants to implement the decision, an implementation which may not have been thought about much at all.  Committees love to be fully representative of all the stakeholders but tend not to have those with experience of delivering successful programs.  A Tory government is convinced that everything is better handled by a commercial contractor even if they have no relevant experience.

The present government is widely agreed to be rather third division made up of those blindingly devoted to Brexit, particularly Brexit with no deal.  A wider range of backgrounds and experience is sorely missing in the present cabinet.  This makes them even more likely to be affected by special advisers who happen present at critical meetings.  If a special adviser is notoriously difficult to deal with, argumentative and hectoring as well as being very certain that he is right then the committee will make bad decisions. 

Unfortunately our Prime Minister has got his own gollum hidden away in a deep sub-basement of number 10.  Because of his Rasputin -like grip on the mind of our nominal Prime Minister, and as all are certain that to cross him is to court an early departure from the corridors of power, his power is immense yet nobody really knows what is policies might be.  No one is given a chance to discuss it and policies appear and disappear without much explanation.  This is not helped by Dominic the Mad being well established on the autistic spectrum.  He is generally confident that you are not capable of understanding such matters and therefore can be safely ignored.

People like him are quite common in Cambridge where I have spent many years as a science researcher.  Like Dominic the Mad, they have an intellect the size of the planet yet are fundamentally quite stupid.  They will make decisions thinking that they are conscious of all the ramifications when they are not.  Loose ends are ignored and left to others to tidy up.

We don’t know, of course, where in particular this gollum has had an influence because although minutes of meetings may be published, attendance by “special advisers” is often conveniently omitted.  We can, however, be confident that he was present at many of the critical meetings throughout the management or at least mismanagement of the Covid-19 pandemic still currently raging around.

The initial decision was to preserve the Tory party at all costs by ensuring that whatever happened, the NHS survived.  This produced several fairly damaging policies.  By ignoring what was happening all around the world are government was very slow to regain consciousness after the excitement of BREXIT, the Prime Minister having a couple of weeks in Mustique and generally not wanting to stop any of the fun (the Tories had lots of funding from the racing fraternity so Cheltenham continued in full, and cancelling an international football match) meant that everything was left to slide.

One early decision they are now finding difficult was choosing a social distance of 2 m and not using facemasks when the world health organisation recommended 1 m and facemasks.  Other countries that went for 1 m have found it much easier coming out of lockdown.  This decision ensured facemasks were available for the NHS since of course nothing much had been ordered in advance despite important reviews by key committees months and years in advance drawing attention to our total lack of preparedness.  Not to mention waking up and realising what was going on around the world in the beginning of January.

And then there was the quite unbelievable decision to empty our hospitals of the elderly into care homes without any attempt at testing them.  It was known from the beginning that the elderly were particularly at risk from Covid 19 and to dump 25,000 untested elderly people into care homes without any attempt to provide tests for the refugees or their carers was tantamount to mass murder.

From the beginning it was accepted that testing was critical.  However despite many offers of existing testing and tracing operations in the UK, and from hospitals and laboratories throughout the country all of whom could have contributed to a serious programme of testing as they did in Germany meant that when we went into lockdown we were testing 1/20 of the number being tested in Germany at that time.  Not only did we not use our existing expertise we then gave massive contracts to companies with no experience in this such as Deloitte.  These mega testing centres are still barely working as they should, often taking 72 hours minimum for completing the test and often as long as a week by which time the patient has either recovered or died.  The performance of these centres and the way Public Health England dealt with them and they in turn dealt with the testing procedure is still not being handled properly and these failures will continue and worsen until they are sorted out properly.

Many of these decisions were made by committees with Dominic The Mad present.  We have no idea what his influence might have been but it is unlikely to have been helpful.

Boris Johnson’s government has succeeded in three months killing and injuring many more people than the Luftwaffe managed to kill and injure in five years of bombing.  Poor management and an indifference have delivered suffering on an extraordinary scale.  And now we have many years in which to manage the worst economic outcome of any Western economy all because of our own incompetence.

The only way out is to hope that the backbenchers of the Tory party realise that their legacy is becoming more toxic by the day and do something to change the leadership as well as getting rid of the gollum.

Otherwise, the challenges of these same individuals making key decisions about Brexit is pretty scary particularly when many more voters would now choose to Remain rather than to Leave.  And we also hear that Dominic the Mad is trying to pressurise the government into rolling back on its green new deal promises.  What is he trying to do and can he not explain it to us all?  If the Prime Minister cannot develop a programme for the government without his involvement he should move to one side unless another takeover.  It would be much better for the Tories and very much better for the country.

Summary: We need to make intelligent decisions about what is the right strategy when we progressively soften or remove any of the current restrictions on our behaviour in the UK. We need to accumulate a comprehensive dataset of information about the behaviour patterns of each and every person who becomes infected. With 5000 new Covid-19 cases detected each day we will be able to generate a major statistical database. This would allow us to make intelligence-led decisions about how to manage our escape from Lockdown as quickly and efficiently as possible.

The UK government appear to be allergic to the idea of even talking about how we might ease and eventually leave Lockdown. Perhaps the main strategic error in the UK apart from just doing things far too late and slowly was the decision to abandon testing in place of hoping for herd immunity. All the evidence is that probably only 15% are immune which means that the rest of us still have it to live with or die with. The dangers we are faced with from Covid-19 are in no way diminished by spending many weeks in Lockdown. We have to decide how to manage intelligently the way forward. In another piece (see: http://outsidethebubble.net/2020/04/14/escape-from-lockdown/) we have discussed how different aspects of our containment might be relaxed. The problem is we have very little information about what is happening in the UK and where those infected caught the disease. Only by understanding in detail what aspects of our behaviour is leading to those individuals being infected can we make progress.

It does seem to be agreed fairly widely that any escape from Lockdown is going to depend on a much greater and more aggressive approach to testing for people who have the disease and later for those who may have had it in the past. However there is no point in mass testing until we have a clear idea of what we hope to get out of it. In the UK we have excellent capabilities in artificial intelligence combined with data mining particularly with heterogeneous data. A good example is the work that was being done a few years ago by Cambridge Analytica. There are many other organisations working with other equally complex datasets and we need to use their skills to guide what we do next. The suggestion that the new whizzy smartphone app will sort everything out for us is probably pretty naïve unless there is some considerable investment in analysing the data produced and reacting to it as a matter of urgency. If this is all underway good and well but it is difficult to believe it will be enough.

We still have nearly 5000 new cases of Covid 19 each and every day in the UK. We need to institute as a matter of urgency a serious attempt to find out more about each new case in order to develop a much better understanding of where the problem seems to be in our society. All the evidence is that the British public appear superficially to be respecting the Lockdown pretty rigorously and respectfully. City streets are deserted. Shops are closed. Places of entertainment, restaurants, cafés and bars are all closed. So where is this infection coming from? These apparently very basic questions are ones that we simply don’t seem to know the answer to.

It is important that everyone who is tested is asked all these questions. Honestly is critical and it must be made clear that there will be no penalty for admitting going outside the present lockdown rules. The range of questions that need to be asked has to be very comprehensive and should include:

• Location and environment: Where do you live? Kind of home: house/flat/apartment? Size of home? Number of rooms? Number of people in lockdown in your own home? Any garden? Access to green spaces nearby?

• Employment: What is your job? What is your position in the organisation? Where do you work? How do you get  to and from work? Private car, bicycle, walking or public transport? If public transport question is it crowded and how close do you find you are to other travellers? What is your precise job? How many people do you work with? Do you work in a relatively crowded environment where social distancing is difficult or impossible to maintain? What do your employers provide to ensure your own safety and allow you to follow social distancing rules?

• Financial: What approximately is your current income now? How long has it been at that level? What was it before the pandemic force the Lockdown?  how do you feel you are managing now? What are your immediate expectations financially? Are you anxious, concerned or very apprehensive about the future? Has that been affecting your state of mind and potentially your health?

• Family: Family disease history, colds or influenza or any other recent bugs? Has the patient or other family members any other medical conditions of any significance? Diabetes, heart disease, pulmonary problems or anything else? Allergies including hay-fever and asthma?

• Close Family: Do you see or meet close family members? How careful are you to social distance yourself properly? Are they cautious and meticulous about keeping themselves safe? Do they have any potential problems with Covid-19 such as the elderly or frail? Should they be considered at risk because of your possible infection?

• Managing Lockdown: How are you managing generally? Stress levels? Behavioural problems with other members of the household? Questions designed to tease out any suggestion of domestic abuse towards partners, children, parents or anyone else living with you? How do you contact people outside your home? Telephone or video such as Zoom? Do you have adequate  internet access?

• Behaviour: Facemasks. Do you use them at all? Do you wear them whenever you go out of the house? When you go out for exercise? When you visit supermarkets?

• Behaviour: Gloves. Do you use gloves at all to give you a degree of protection against contamination through touching? How meticulous and careful do you think you are about that?

• Behaviour: Handwashing and use of hand sanitisers: how often do you thoroughly wash your hands? Whenever you come back from being outside? Or only when you come back from shops? Or after taking exercise?

• Behaviour: Meeting other people: Do you ever see people you know apart from at work? Where do you meet them? Do they use facemasks? Do they social distance properly? Have any of them recently mentioned symptoms or just feeling slightly under the weather?

• Behaviour: Exercise: How much do you take? How many times a day and how long do you exercise for?

• Pets: do you have pets and if so what? do you take them out for exercise?

All these tiny pieces of information from one individual  will provide a single set of instances which will not, in itself, be significant. However combined with another 5000 that we already test each day we should expect to see significant correlations that build up in importance. They would tell us very early on, for example, whether people are more or less likely to be being infected at work or in shops, in the street or other places. We would know very quickly whether facemasks should be used much more widely and how important they might be for this.

Each questionnaire should be completed within 10 or 15 minutes while the patient’s test is being processed. These  questionnaire results are really important and it is essential that people are trained to carry them out effectively and reliably. Ideally questionnaire should be completed by an individual trained to do so and not necessarily a medical professional.

The results of such a survey have the potential to give us all the basic information we need about what aspects of British behaviour are likely to be more problematic. These are the areas which should not be relaxed and possibly addressed by stronger regulation. The results will also tell us what appears to be relatively harmless behaviour. This would allow some of the restrictions we have now to be dropped fairly quickly with relative confidence that that will have only a minor effect negative effect on infection.

Only by gathering this sort of information routinely can we expect to have any intelligence driving our escape from Lockdown. A good understanding of British behaviour today that is currently leading to additional infections has to be developed. In this way we might have an intelligence based route by which the UK might escape from Lockdown.

Summary: The British government seem surprisingly reluctant even to talk about how we might manage the winding down of the current fairly Draconian Lockdown. They have not really understood the importance of managing this as soon as possible and getting discussions going. Many are finding themselves very badly affected by it all and wealthy middle-class individuals in government and the media need to engage now with what is actually happening to the poor. This piece is intended to start a conversation and think about how we might make progress right now that would give individuals at every level the feeling that we can see the time when things substantially return to normal.

Public compliance with the Lockdown has been surprisingly good. We all seem to know exactly what we should be doing, and most of us are indeed doing it. However there are short-term concerns that there are relatively large numbers in the UK who are very close to destitution without any income and without any alternative sources of food. You can no longer turn up at a food bank and hope to get anything. In my own area some food banks have found donations have dropped by more than half while demand has more than doubled. People can only access food banks with a note from their GP for example. However as surgeries are closed those are now very hard to get.

A recent piece (http://outsidethebubble.net/2020/04/06/exit-from-lockdown-take-back-control/ ) have tried to focus on what could already be done without significant effect on the workings of the Lockdown but would give the public an indication that there is light at the end of the tunnel. In addition, another piece (http://outsidethebubble.net/2020/04/12/lockdown-collapse/) looks at the social consequences of not addressing urgently the extreme poverty and destitution facing so many in the UK now. This piece tries to put together an outline of how we might see the escape from Lockdown actually playing out. At present the British government seem quite reluctant even to think about it, concentrating above all things on preserving the NHS. However poverty and the economy are starting to move up the priority list and will soon have to be squared against the support that everyone is keen to give the NHS.

There are interesting examples from around the world about how this might be handled. Probably the least lockdowned country in Europe is Sweden. They have relied much more on the good sense of the people to do the right thing. Elderly and frail people know they must isolate for their own health and security while younger people are still able to continue much as they have done. The PM of Sweden has been criticised for not closing bars, café’s and restaurants and may indeed impose tighter restrictions on them medical soon. Higher education is now only online. Primary and secondary schools remain open. Sweden’s relaxed approach to the epidemic has also meant they are suffering from the same shortage of PPE and equipment that they are in the UK because they also never really thought it would become so desperately important.

One of the key changes that we need to implement in the UK in order to move forward is to increasingly pass responsibility for self protection to the individual, as it is in Sweden, and away from relying on following rigorously the instructions from government dictat. A key component of this must be the use of facemasks. Supplies of course in the UK will be hopelessly limited but effective facemasks can be constructed from fabric pieces or by using scarfs in single or multiple layers. It is clear that a thin layer of paper held on your face by a couple of rubber bands is pretty inadequate and more substantial protection from more substantial facemasks is highly desirable. Individuals must be reminded that the dangers of contracting Covid-19 are just as serious as they always were. Your facemask protects others should you be infected but be asymptomatic. It also gives you a first level of protection against infection by others. However it is your responsibility to protect yourself and others from this deadly disease which has in no way been weakened by the weeks of Lockdown. It is just as lethal now as it was at the beginning. Facemasks will provide one level of protection. Wearing gloves and eyewear such as glasses, sunglasses or goggles further enhance protection. Each of us needs to address how we manage the risks that we will come across in everyday life. Each of us has to look after not just ourselves but everyone that we come into contact with. There is increasing evidence that people catch the disease by breathing and when talking which further increases the importance of wearing facemasks.

Some of the current restrictions are really excessive and almost vexatious. A few could be lifted almost immediately and would give the public a sense that progress is being made. Some other areas are inadequately taken care of and so some additional restrictions need to be brought in.

• We should remove all restrictions of being out of the house provided the social distancing rules are maintained at all times.
• We should permit people to drive or travel moderate distances for leisure or exercise.
• Require everyone to routinely wear facemasks and make that compulsory wherever there is any risk of coming closer than the official 2 m separations. Customers visiting supermarkets and any other business premises should always wear facemasks as should the staff and other employees of the business.
• Public transport users and drivers etc must wear facemasks at all times.

There are other areas that can be addressed almost immediately.

• Parks and open spaces should be opened to the public unless they will attract such a high density of visitors that those visitors will find it difficult to maintain social distancing rules. This would allow places such as National Trust parklands to open though not initially their shops and certainly not the cafés. For example a botanic garden could open the parkland but put greenhouse and exhibition areas s off limits. They could allow entrance to season ticket holders and, if space allows, other members of the public provided overall numbers can be managed to maintain social distancing rules.
• There are issues about reopening children’s playgrounds. Children are notorious for wanting to play with one another and therefore pass any infections around to others. How this is handled not only in specific children’s playgrounds but also in more general open parkland has to be considered carefully
• Businesses that are currently closed should be able to operate provided they can manage social distancing regulations for staff, other employees and customers. All these three categories must wear facemasks at all times. Employers should be legally responsible for ensuring this is carried out.
• Other businesses should be allowed to operate but only provided staff and customers can maintain social distancing rules at all times. All customers and staff should wear facemasks at all times. Again, safety must be a legal responsibility of the employer/business owner. If it is felt that business reopenings should be done progressively it would be best probably to start with small businesses that should be easier to get going and start to bring some life back to the high street.

The second phase will include allowing some social gatherings to be restarted. This is a particularly tricky thing since I know as a grandparent how much I want to see and hug my grandchildren as I have done since they were born. However we elderly are still as much at risk as we ever were and relaxation of some of these rules will inevitably increase those risks if we are at all casual about self protection. Parents need to protect their parents as they have been doing so far. It is inevitable that the elderly and frail will continue to be fairly isolated almost to the end of this escape from Lockdown. Only the vaccine will give full confidence that the elderly can return to normal life. This will be hardest for them.

The next phases could be phased in gradually possibly as follows:

• We can start by permitting junior schools to open. The onus must be on the managers of the schools to make sure that the staff always wear facemasks.
• Some sporting events can be started but played behind closed doors (so no spectators). Only sport that can be carried out to provide full social distancing should be permitted initially. Some can be done fairly easily such as golf, tennis though it is clearly difficult to imagine sports like rugby being a success with full social distancing. Soccer is very popular but it is not clear how easily players can be protected initially.
• Senior schools and universities can gradually be brought back into function, again always requiring that staff, other employees and students can manage with appropriate degrees of social distancing at all times. Neither of these are particularly urgent because the target time would be the beginning of the autumn term. If that cannot be managed then there is little point in opening them until the beginning of 2021.
• Cinemas and theatres could be operated by requiring that rows and seats are left between members or family groups of the audience. Whether this could be done while maintaining any kind of commercial viability is another question entirely. We are getting remarkably used to being entertained over the Internet and the pressures for getting back into cinemas and theatres are not what they might otherwise be.
• Similarly, it is likely that restaurants, cafés and bars only reopened after the pandemic is substantially over vaccines are available. These are venues that are fundamentally social and where eating and drinking inevitably means removing ones facemask. Unfortunately this means that the economic pressures on such businesses by the end of the year will be very acute.

It is essential that we appreciate that what we in the public have learned in recent weeks about keeping ourselves safe will have to be maintained until we are sure we can be saved by other routes. Ultimately that has to be with the availability widely of an effective vaccine. There is a great deal of effort going on into these vaccines and it will help that the enthusiasm to find solutions will mean that trials that are usually sequential can be carried out in parallel. The

We must also remember that if we find that we have moved too quickly in any of these areas then we simply have to be prepared to reverse them. It is important that the country starts to engage with the conversation about how all these matters are to be handled. Many of the suggestions will have to be considered carefully because each will have health aspects but also economic aspects. Our economy will be damaged badly by coronavirus particularly given how long it has gone on and how poorly prepared we have been to manage it. Yet it is our economy that will provide the opportunity to start to repair the damage that has been done and hopefully to move on well beyond that.

Summary: The daily Covid-19 deaths statistics only referred to deaths in hospital. Deaths in care homes and at home are only revealed much later. Scottish care home death statistics were partially announced this morning. On the assumption that these will be followed in the rest of the UK pro rata then we should add well in excess of 5000 additional deaths to the UK count and probably very many more. Per capita it seems inevitable that UK deaths will be one of the highest in the world and exceeding those off Spain and Italy.

The death statistics quoted by government ministers and used as the metric of success in the UK in managing the pandemic only reveal the level of deaths in hospital. Others who die at home or in care homes are not recorded. They only start appearing well after the event when the death certificates are processed and the cause of death is given as being due to Covid-19. Those figures are compiled into weekly total debt figures that are only mentioned in passing. For the week ending 27 March 501 deaths were registered in hospital and only 20 in care homes, plus 15 at home.

Around 400,000 people are currently resident in British care homes. We have no idea of the incidence of Covid-19 infection but we do know that in some care homes as many as 70% of residents have been affected. The only clear statistic that we have of care home deaths was given this morning (13 April) for Scotland by the Cabinet Health Secretary. She said on the Today programme that 46% of all Scottish care homes have notified her of at least one Covid-19 death. That gave a total of 406 deaths.

We do not have the figures for England, Wales or Northern Ireland. However we can make some simple calculations. The population of Scotland is 8.2% of that of the UK. Just simply accepting that there were only 406 deaths in Scotland (and the words used were “at least one death”) then simply pro rata we would expect there to be around 4500 deaths in the remainder of the UK making a total of about 5000 nationwide.

Unfortunately, we know from many instances within England that there are often more than individual deaths per care home. We do not have those numbers for Scotland but if we make a simple assumption that on average in each Scottish care home that was not a single death but actually 1.5 deaths then that would correspond throughout the whole of the UK a total death level of about 7500. The UK has officially recorded 10,600 deaths. If we add in those now estimated for care homes the total is in excess of 18,000 before we add in those that may have died at home. Increasingly we are hearing that those who are frail and elderly but become infected at home are generally not being taken to hospital if treatment will be problematic and those deaths are therefore not recorded in the hospital figures.

It seems inevitable therefore that the British death rate from the Covid-19 pandemic is already greater than recorded in Spain or Italy. The population of Germany is about 25% greater than that of the UK yet Germany has managed to keep deaths down to just over 3000.

The conclusion has to be that the real death rate in the UK from Covid-19 will be one of the highest per capita in the world, a remarkable achievement. The well documented delays in the UK for taking the epidemic seriously and trying to manage it without adequate planning or anticipation is nothing short of criminal.

Note added: morning of 14 April:

On the Today programme the head of the largest care home grouping in England, HC1, said that two thirds of their care homes (232 ohms) have reported infections, a total of 2447 cases with 311 deaths and one staff member who died. This suggests that the factor used above of 1.5 deaths per care home is not too far away from reality and that the upper limits described above are more likely to be correct. Richard Murphy on his blog (https://www.taxresearch.org.uk/Blog/2020/04/13/we-wont-just-have-the-worst-health-outcome-in-europe-from-covid-19-we-will-probably-have-the-worst-economic-one-too/) confirms that other European countries are finding that care home deaths are much the same as hospital deaths across Europe.