I was impressed. I knew Henry was in Naval Intelligence, but not at this level. Was my grandad M, then?

‘Well,” said my father, “Not M. A few letters back from that. Maybe H. He could speak German, was the point.”

Henry Clanchy loved languages. We have his Russian vocabulary words, still, written in fountain pen, tucked in a silver cigarette case. He might have been happier as an academic, like his son, Michael, but he was sent to sea at the age of 12 instead and was sea sick on every boat — even the ones he commanded.

These memories didn’t come just because my father was 83 and in the last year of his life. Lockdown, with its apocalyptic quiet, its empty streets and filmic light, returned him to foundational experiences of authority and fear. My father’s first years were passed in Stalinist Moscow where Henry was Naval Attaché. He returned to England only in 1939, on the last train across Europe, an experience of terror which resisted 40 years of therapy. Then, just under six years old, and speaking Russian and German in preference to English — he’d had a German nanny — he was sent to a brutal, chaotic prep school. A Catholic version of Ronald Searle’s St Custard’s, or a ‘School’ in Decline and Fall, a place where the boys would sell poached rabbits and kindling to the hungry junior masters.

My father’s deepest feelings were set against authority. His refusal to sit on any sort of high table had cost him all his life. Now, when orders were being given from a single desk in Downing Street and the press talked in hyperbole and numbers, when the careful, fragile threads of his web of social contacts — the Norman French Seminar, the vegetarian café, his grandchildren — were all cut at once; when friends in nursing homes arbitrarily found themselves in confinement more solitary and hopeless than would be handed to any prisoner, his jaw set again. “Obviously,” he said, squinting up at me — a dystonia had recently collapsed the nerves and muscles of his neck — “Obviously, what you do in these circumstances is look around and see who else is not going to fall in with it. Who is your friend?”

By “fall in with it” he meant: performatively join in any rituals of shunning, add to the tangible fear. As a personal protest, he insisted on continuing to walk each day to the mini-market to collect the Guardian, leaning on a stick, chin to chest like a condemned prisoner, saying good morning to each person who stepped wide of him. More than once, he was asked by a self-appointed commissar, or train guard, or Grabber the school prefect, where he lived, and why he was out of his own street, and he would explain he wasn’t shielding, he was still allowed to walk about. He took comfort in going in to the whole food shop where the hippy owner remained disbelieving and merry, greeting him warmly as she raised the price of chana dal yet another notch.

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Mostly, though. I was his friend. He’d trained me well. I walked round the corner to see my parents every day of lockdown, even before it was clear this was permitted. They weren’t well enough to be on their own: they had between them two sorts of cancer, lupus, depression, osteoporosis, shingles, heart damage, nerve damage, and recurrent cellulitis. They couldn’t reach their own bulb sockets, high shelves, weeds, and feet.

They needed help too with the NHS. Help with the late letters, the contradictory emails, the cancelled dates, the disappearing consultants, the tangled medications, the finding out if you had to go private, who you paid, for how long, under which name, when, help with the whole vast behemoth of the thing. It had dominated our lives for several years already, and it didn’t seem so unexpected somehow that it had become our national Authority, our religion, a thing we sang to and clapped.

It’s not that my parents weren’t grateful to the NHS or the extra years of life it had brought them: they were. But under pressure, first austerity and now lockdown, they had seen it drift into an ever more attenuated, disparate, emergency-orientated system. With Covid, the imperative to save lives, through high-tech medical measures, especially the lives of elderly frail people like them, intensified, while the means of delivering simple, limited medical care, such as podiatry and physiotherapy, withered away. This, though, was the reverse of my parents wishes. They had each had more than their fill of hospitals. They had sore backs and feet. They wanted no more drastic interventions. If their conditions couldn’t be humanely managed, they wanted to die at home.

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Over lockdown, my father was diagnosed with Parkinson’s Disease, entirely over the phone. He never met a nurse or received physiotherapy. In order to change his drug regime he had to come off his antidepressants: a terrifying step when the Parkinson’s locked his mood, made his depression unshiftable. But no new prescription was forthcoming. Each day, after I’d reached something down from a shelf or photographed a wound, we would supplicate another doctor. Eventually, we were told the consultant had gone on holiday and forgotten the prescription. I walked my shaking father round the water meadow and he remembered his father.

“Henry,” said my dad, “was very upset when he got to the prison cell to find Dönitz’s uniform and personal things had been taken away. In particular, his watch was missing. The guard had taken it.”

“Now Dönitz,” said my father, picking up his pace a little, “was a terrible man. It was ridiculous the way he was treated as a sort of gent. He was a fascist like the rest of them.” My father was a scholar, among other things, of Henry III and Simon de Montfort. He taught me about the English pogroms before I was 10, taught me about the evils of blood libels, the lie of Hugh of Lincoln, and to never, never think that England was more free of anti-Semitism than any other place in Europe.

Nevertheless, Dönitz was the same age as Henry. He was also a Catholic, also a boy who had been sent to sea and buffeted by war. He had been a British POW when Henry was fighting the White Russians. There are lonelinesses which speak to other lonelinesses in the shadow of authority. There are human gestures which benefit the giver as much as the recipient.

“And the next day,” said my father, “the next day, when he came home, he got Dönitz’s watch back. He was pleased about that.” And he raised his head, with difficulty, to smile at me. My father, I am sure, associated the gesture with his German psychiatrist, who always replied to letters by return, who was soon to get hold of Neurology and shake the prescription out of them.

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My parents surely had more, and more detailed, Advanced Decision documents about their future medical treatment and death than any other pensioners in Britain. I had a drawer full of copies. They had carefully prepared folders to take to hospital with them, documents to offer the authority at the border. But, as I have written elsewhere, for my mother, this did not work. On a first hospital stay, one set of advanced decisions went missing. On her final journey, she did not have them at all, as she was supposed to be going for a day visit.

In January, 2021, under peak Covid Authority rules, alone without documents or an advocate, everything happened she had specified against: a drastic operation, intensive care and a ventilator. “It is as if,” said my father, as we sat despairing at the kitchen table, “she had been kidnapped.” In hospital, she contracted Covid-19. Track and Trace phoned the house repeatedly, lending a Stalinist note to proceedings as they demanded to speak to my mother. We were permitted one end of life visit, during which my father also contracted Covid-19. Ten days later, after repeatedly pulling feeding tubes from her own throat, my mother died, entirely alone.

Covid and grief weakened my father’s heart. Two days after my mother’s death, I had to pick up my father’s advance directive and follow its very clear instructions: if he suffered a stroke or heart attack, he wanted to die at home. I had to be grimly determined. First, I denied, like Judas, an ambulance three times. I took surreal calls from the council, explaining that I was entitled to help with care, but as there were no carers, none would be coming. Track and Trace called again, asking for my mother.

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But help came. My cousin, whose father had been to prep school with my father, and had inherited his anti-authoritarian streak, crossed the country to be by my side. My brother was always present. With that, I remember the humanity of the medical people who came: the district nurse, the GP, and the teams who arrived in the night with morphine and tranquillisers. Each one of them affirmed my father’s wishes and enabled them, and said, very often, that a death at home was what they wanted for themselves, what they wanted for their relatives. I remember a nurse at 3am pulling the visor off her sweating face and saying, with the vehemence of a secret, of information passed under the castle walls, ‘This is the right thing to do. This is what everyone wants for the people they love.”

I loved my father and my mother very much. A year later, I am haunted by the loneliness of my mother’s death and comforted by the intimacy and peace of my father’s. I wonder if those deeply humane doctors and nurses — and the equally humane, I am sure, doctors and nurses who cared for my mother — are more or less able, now, to allow people like my parents to choose to die out of hospital and die without intervention. Over Covid, the numbers dying at home have leapt by 39% , but this remains little spoken of, as if each of those deaths were an accident or secret, a subversive happening under the shadow of authority, a watch taken back from a guard. But each one is a just a small, human exchange, and the walls of this authority are made only of ourselves.

Later today, I’ll give evidence to Parliament’s Public Administration Committee on the operations of Number 10. It will focus on the usual controversies and challenges faced in that poky building. But as I reflect on my five years there I can’t help but conclude that the worst thing about Downing Street is its addictive power.

Politics and elections are bad enough: I was once told by a campaign organiser that blisters on my feet weren’t a reason to sit down. I should only stop delivering leaflets if they started to bleed, and only then in order to apply plasters. But once you’re working for the Prime Minister, fatigue becomes a badge of honour.

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How I learned the Tories weren't evil

By Polly Mackenzie

You don’t need to look far to see leaders boasting about their inhuman resilience. Margaret Thatcher claimed to only need four hours sleep. Donald Trump has done the same. When Dominic Cummings advertised for new special advisers, he made clear they’d not see their friends or daylight if they took the job. Boris Johnson claimed for two weeks he was working through his Covid symptoms, because sickness — like sleep — is for wimps. It was only once he was admitted to intensive care that they admitted someone else might need to take the tiller of government for a couple of days.

Did they learn from that? Of course not. A couple of weeks ago,  minister Nadhim Zahawi was challenged on Sky News about the performance of Dido Harding, the beleaguered boss of the beleaguered test and trace system. He leapt to her defence and claimed she is working 19 hours a day, seven days a week. We can only hope he’s mistaken, because if this is true she might as well be running the place drunk.

The impact of chronic sleep deprivation on cognitive performance is profound. The scientific literature shows people think slower, and — if pressed for time — make more mistakes. Their memory gets foggier. They learn less easily. And they have “difficulty determining the scope of a problem due to changing or distracting information”, a phrase which sounds like it came from a public inquiry report into the Test and Trace shambles.

The AA estimates that up to 25% of fatal accidents are caused by motorists falling asleep at the wheel. If you’re driving an organisation, rather than a car, you’re running the same risk. “Working 19 hours a day” is a sure fire way to make yourself worse at your job. But what’s madder: doing it, or seeing someone else do it and being impressed? Zahawi clearly thought he was complimenting his fellow minister for her dedication and self-discipline. He — and most of the nation, it seems — has fallen prey to a collective delusion that working yourself to exhaustion is the way to look tough. It’s a rotten mix of machismo and masochism.

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It’s not just politics. Step into the swamp of LinkedIn and you’ll find endless “hack your body” mentors instructing you to get up at 4am. This is wakefulness inflation: 20 years ago Robin Sharma created the “5am club”, advocating people get up at this ungodly hour for 20 minutes learning, 20 minutes planning, and 20 minutes exercise before anyone else woke up. But once 5am was popular, you had to be in the 4.30am club to be special. And then 4am. Soon you’ll have to get up before you go to bed in order to keep up with the business influencers.

The absurdity of this is that it’s not about what you’re achieving. It’s about showing that you’re working more than other people. You want to be the first in the office and the last to leave because it looks good. The most depressing part is that it often works to help individuals get ahead. So many bosses are rubbish at measuring performance, so they measure who’s there instead. Men end up working more hours than women, because they’re less likely to have caring responsibilities. They’re more likely to be able to put their hands up for the overtime. And that drives the gender pay gap even wider.

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But if our work addiction is toxic when it comes to overtime, it’s even worse when it comes to sick leave. If you want proof of our cultish delusion, spend half an hour watching adverts for cold and flu remedies on YouTube.

You know the routine. Person feels ill. Person drinks medicine. Person gives a brilliant presentation / performs brilliantly on stage / plays enthusiastically with their children at a crowded activity centre. The message is obvious: take our pills and you can carry on with your life, regardless of how far you spread your disease by doing so. There was even a postie coughing all over the letters and parcels before he delivered them. After all, nothing says hard work like pushing disease vectors through people’s front doors.

In fact, a decade ago when Benylin launched an advert encouraging people to stay at home when sick the Federation of Small Businesses reacted with horror and disgust. “These terms make a mockery of how serious it is not to turn up to work,” said the boss of the FSB. “If people have real flu then of course they should take the day off, but if it is just a cold then they should not.”

Are they stupid? It’s completely counterproductive to tell people to come to work while infectious, even with a cold: you’ll just end up with the whole team falling ill. And yet the official representative body of small business says that’s precisely what we should do.

The work-til-you-drop culture is reflected in our ludicrous sick pay system, which only requires your employer to pay you if you’ve been off for more than three days. Even then, it’s less than £100 a week. So — unless your employer is more generous — you basically have to show up for work unless you physically can’t. Which means people trek their viruses and bacteria to work and we end up losing more — instead of fewer — days to ill health. And that’s before you even count the productivity loss of wooly-headed snifflers trying and failing to do their jobs when they should be at home with Netflix and a duvet.

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By Polly Mackenzie

If Covid-19 has taught us anything, surely it has taught us to change these rules? And change the culture that underpins them. When you’re sick, you should stay at home. When you’re tired, you should sleep. Sick people and exhausted people are bad managers, they’re bad leaders, and they’re bad colleagues.

In the early days of the pandemic, the money guru Martin Lewis was presenting a live TV show about how to manage your finances during the crisis. At one point, he had to cough. He shocked his audience by observing that it was suddenly less socially acceptable to cough on live TV public than to fart. But I’ve realised this is a social stigma we should stick with. I’m no particular fan of flatulence, but what harm does it do? It’s coughs that spread disease. We shouldn’t be shaming people for staying in bed to cough and sneeze. We should be shaming them for taking their coughs and sneezes out with them to the office, the shop, the factory, and the bus. Freedom for farts. Stigma for sneezes. It’s the way forward.

It’s been more than 200 years since Welsh mill owner and labour rights activist Robert Owen argued that what we need each day is simple: eight hours labour, eight hours recreation and eight hours rest. Those 200 years haven’t changed human nature. If you’re working more than Owen prescribed, chances are you’re not being a strong and powerful leader. You’re taking work away from others who need it and undermining your own performance.

Being at work is not a virtue in and of itself. Being productive is what matters. When we see a crisis of bad management like Test, Trace and Isolate, we shouldn’t ask why the team aren’t working harder. We should ask why they are working so much. You cannot run a marathon at a sprinter’s pace. Whether it’s senior management or a junior worker, in public services or private enterprise, we will get more from our people if we ask them for a little less.

There are important debates taking place about the effectiveness and necessity of restrictions and lockdown measures. Now that the pandemic has taken hold in communities across Europe — and many governments have been incapable of operating effective test and trace systems — there is unlikely to be a ‘perfect’ strategy. 

On one hand, if we entirely reject restrictions, there is a substantial risk of lethal second waves, overwhelmed healthcare systems, and tens to hundreds of thousands of deaths. On the other hand, as ‘lockdown sceptics’ have rightly argued, these measures cause immense economic, educational, social and health damage, and undermine our civil liberties. We are, for now, stuck between a rock and a hard place.

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There are, however, some people on the lockdown sceptic side of this debate who would deny the existence of this tradeoff; they are flirting with a sort of ‘Covid denialism’. The pandemic, they claim, if it ever existed, is over because ‘herd immunity’ has already been reached. There is no true increase in cases, they insist, just more testing and ‘false positives’. 

This approach deserves interrogation, we believe. And a key proponent of the herd immunity and false positives theory is the well-credentialed Dr Michael Yeadon, a PhD in respiratory pharmacology and a former leader in pharmaceutical companies. Yeadon surmises, in a post for Lockdown Sceptics, that:

“The susceptible population is now sufficiently depleted (now <40%, perhaps <30%) and the immune population sufficiently large that there will not be another large, national scale outbreak of COVID-19. Limited, regional outbreaks will be self-limiting and the pandemic is effectively over. This matches current evidence, with COVID-19 deaths remaining a fraction of what they were in spring, despite numerous questionable practices, all designed to artificially increase the number of apparent COVID-19 deaths.”

Yeadon’s central assertion is that, by his calculations, a large proportion of the population have already had the virus (32%), have prior immunity to it through exposure to other coronaviruses (30%), or are too young to spread the virus (10%). This, he says, leaves relatively few (28%) susceptible. 

While Yeadon admits in his report that the precise numbers are not “mathematically perfect”, they could, if true, mean we already have herd immunity (typically estimated to require 60%-70% of the population to be immune). We could all get back to life as normal. Everything could reopen; social distancing, testing, and vaccines would be unnecessary; and we could return to our terrible former hygiene habits. 

Sadly, we cannot. Yeadon’s claims are riddled with leaps of logic and illustrated with highly inflated, speculative statistics that most infectious disease experts dispute, and which are being disproved by the explosion of second waves across Europe. To understand why he’s so wrong, we need to address his claims about how many people have already had Covid, the alleged existence of prior immunity, and whether false positives explain the second waves. 

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So let’s start by examining how many people have already had the virus. Serological surveys, which assess whether people have been infected by Covid-19 and have developed antibodies to it, provide weak evidence of population immunity, even in some of the worst affected cities. Despite large outbreaks this year, only 23% in New York, 18% in London and 11% of people in Madrid have Covid-19 antibodies. Overall, the REACT-2 survey found just 6% of England had antibodies by July. A US study estimated 9.3% seroprevalence nationally.

On the positive side of the ledger, it is possible that a higher number of people, even some who lack antibodies, are developing longer lasting T cell memory. T cells ‘reactivate’ the immune response when a virus, which has previously been encountered, is encountered once again. They help reduce the severity of symptoms upon reinfection, but are highly unlikely to prevent it — meaning that those who have T-cell memory may still be reinfected and spread the virus again.

The possibility that some patients develop T cells but not antibodies does complicate the calculation of how many people have actually been infected by Covid-19 and are immune. But it is, nevertheless, a leap to claim one-third of the United Kingdom has been exposed and is immune. This is because most people who get infected do develop antibodies: between 91.1% and 100% of cases who tested positive by PCR then developed antibodies; studies show that antibodies last for several months at least. Thus, only a small proportion of people would be missed by serological surveys, by only having a T-cell response to the virus.

Yeadon’s claim that 32% of the population have already been infected derives from his estimate of the chances that someone will die from the disease if they have been infected, i.e. the infection fatality rate (IFR). He estimates the average IFR is 0.2% which, with 43,000 Covid-19 deaths in the United Kingdom, equates to 21.5 million people having been infected (i.e. 32% of the population.) Yeadon admits this “might be a little high”. 

Indeed. It is dependent on a substantial underestimation of the IFR. The WHO has estimated the Covid-19 IFR is around 0.5%-1.0%. A meta-analysis in September put it at 0.68%, and another analysis puts it at 0.53%, while in England specifically, it is estimated to be 1.5%. A Swedish government study put the infection fatality rate at 0.6%, based on a sample of PCR-positive individuals in late March. An IFR between 0.5% and 1%, and 43,000 infections, equates to between 6% and 13% of the population previously being exposed in the United Kingdom and likely to have immunity.

In sum, Yeadon may be right that serological surveys underestimate the extent of previous infection and immunity, but by nowhere near enough to mean we already have herd immunity.

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So let’s turn, then, to his claim about prior immunity. Yeadon states a large number (30%) have prior immunity because they have previously encountered other seasonal and endemic “common cold” coronaviruses. It appears that some individuals have T-cells circulating in their blood which are able to react to the novel coronavirus in laboratory conditions, even though they have not been infected by the virus. A study of donor blood specimens in the United States between 2015 and 2018 suggested half displayed various forms of this “T cell reactivity” to SARS-CoV-2, and a German study found reactivity among one-third of donors.

But this reactivity does not necessarily mean, as Yeadon asserts, that these people are immune. First of all, these studies had small numbers of participants, 20 and 37 respectively, meaning they may not be representative of entire countries. Secondly, their T-cells were found to react to virus particles in cell cultures in laboratory conditions specifically; we do not know how they behave in practice, how these individuals would actually respond to an infection by Covid-19. And contrary to Yeadon’s implication, it would be unprecedented for cross-reactive T-cells to prevent an infection entirely, reducing its spread in the population so substantially.

In reality, T-cells reduce the ability of viruses to make copies of themselves over the course of several days and may potentially reduce the severity of disease. And in previous small human challenge trials, participants were exposed to common cold coronaviruses and re-exposed to other similar coronaviruses later, or the same virus one year after, and most were reinfected and developed symptoms. 

For now, there are reasons to believe cross-reactivity may not have much impact on the threshold for herd immunity. There are too many cases in which too large a proportion of a population has been infected to indicate widespread pre-existing immunity to infection. Two large outbreaks on ships this year, for example, resulted in 67.9% and 85.2% of their passengers being infected. By April, 57% of the population of Bergamo in Italy had been infected and developed antibodies to the virus. By July, 54% had in Mumbai, while 55% in Karachi in Pakistan had by September. Clearly, huge swathes of populations are susceptible to infection.

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Finally, Yeadon claims that two thirds of those aged 0-11 years old cannot spread the virus (10% of the population). There is, indeed, widespread evidence that young children are not likely to develop disease from Covid-19; but there is scant evidence that they are unable to be infected or spread it. In fact, the evidence is mixed when it comes to how much less likely they are to be infected than adults or how much they contribute to the spread of the disease.

In any case, if people have T-cell immunity from their exposure to other coronaviruses in the past, that is already considered in empirical estimates of the R. The R for the coronavirus has been estimated in a variety of different ways that examine the way the virus is demonstrably spreading in the population — accounting for any pre-existing immunity they might have. If there were isolated groups of people who did not have this pre-existing immunity, however, it would imply that the R0 (and hence the herd immunity threshold) in those groups would be higher than in the populations that scientists have already looked at — in other words, harder to reach.

Besides, the ultimate proof of whether or not we already have herd immunity is being provided by events unravelling right now. The second wave of infections, hospitalisations and deaths all demonstrate that there is a large proportion of people who are still susceptible to being infected.

This is where the second key facet of denialism comes to the fore. The rise in cases, we are told, is a function of greater testing and widespread ‘false positives’, which is when people who are not infected are receive positive results. We are apparently experiencing a ‘casedemic’, not a pandemic. But this claim is crumbling under the weight of new evidence. 

Back in September, Yeadon said that “because of the high false positive rate and the low prevalence, almost every positive test, a so-called case, identified by Pillar 2 [community testing] since May of this year has been a FALSE POSITIVE.” The inaccuracy of tests is so dire that, according to Yeadon last week, we must immediately stop “lethal PCR testing” that is driving fear and restrictions (rather than helpfully spotting cases to prevent outbreaks). 

You could, perhaps more reasonably, have made this claim during the summer, when far fewer people were infected by the coronavirus. But explaining why the UK has uniquely high false positives rates would be difficult, and so would the observation that many other countries have undertaken similar numbers of tests with much fewer positive results.

As Tom Chivers pointed out in September, tests are used more frequently by people who have symptoms, meaning the chances that a person who is tested is actually infected by the virus is higher, which reduces the chances of false positives. Yeadon’s argument would also require ignoring the presence of false negatives (cases where people are infected but test negative), which occurs very frequently in the first days of the illness. 

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In any case, more recent data from the UK dispels the notion that false positives alone explain the rise in cases. This is because the proportion of positive tests has been increasing dramatically across a number of measures, from as low as 0.4% at the start of July to 8% at the start of November. This would mean, even with Yeadon’s claim that 1% are false positives, almost all of 7% are true cases. The increasing proportion of positive tests cannot simply be explained away by false positives, as that would mean testing quality is severely declining.

It is a similar story for the Office for National Statistics infection survey, the most reliable source on community infection in the United Kingdom (because it is a large representative survey of the population). The ONS indicates that the proportion of the population who tested positive during the fortnight they were tested had risen from 0.03% in late June to 0.1% at the start of September, and 1.04% by mid-October. Again, the change is important: even if much of that 0.03% in June were false positives, it is not likely the number of false positives have increased 35 times. 

This can also be triangulated against the ZOE COVID Symptom Study, which uses a large number of daily symptom reports and tests to estimate the total number of cases in the community. They estimate the case numbers have risen from 22,000 at the start of September to over 540,000 by late October, with about 43,000 daily new infections. Imperial College’s latest REACT-1 study, from another large community survey, is more pessimistic, estimating an increase in community prevalence from 0.60% in late September to 1.28% in late October, which would mean about 100,000 new cases a day. 

Over and above the dramatic rises in cases are the rising numbers of hospitalisations and deaths. The time between new cases and a rise in deaths typically takes around four to six weeks: it takes time for the virus to spread from the young to more vulnerable groups, longer for them to develop symptoms, be hospitalised, die, and finally have their death recorded officially. The average time between infections and deaths is around 22.9 days, and deaths are registered and reported in official statistics even later.

In the United Kingdom, we can see that hospitalisations are in fact rising proportionately to new cases, and while deaths have taken over five weeks to start rising, they are certainly on the way up. There are now already over 10,900 people in hospital with confirmed cases of Covid-19 in the United Kingdom. There are also a few hundred people dying a day, and that number is rising. Across Europe, including in Spain, France, Germany, and Belgium, there is a similar story of rising cases, followed by hospitalisations and deaths. Even Sweden is now instigating a new voluntary lockdown in the face of growing case numbers.

Yeadon’s typical response has been to point to the lack of excess deaths in recent months. But this is simply a reflection of delays in reporting. The death registrations from the Office for National Statistics are now showing excess deaths.There were 980 excess deaths in the week ending 23 October, 10% above the 5-year average, after 726 excess deaths the week before. These numbers are near identical to the number of deaths involving Covid (978 and 761, respectively). The ONS have also found nine-in-ten death registrations listing Covid-19 as the underlying (main) cause of death. This is consistent with the 28 day death numbers from Public Health England (which provides daily death count figures), showing deaths picking up from mid-October — again, about five weeks since cases started increasing at a substantial rate in September.

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The precise relationship between cases, hospitalisations and deaths, as well as the speed of the outbreak, is not the same as it was in March. There are some who have already been infected, and there is ongoing social distancing, improved hygiene, local lockdowns, more frequent use of masks, better testing and tracing, and improved treatments. If we stopped taking precautions, as lockdown sceptics insist, the cases would increase at a faster rate. 

But even though the pandemic is not over, we should not despair. The smartest forecasters are expecting at least one of the dozen promising candidates to produce a workable vaccine by early next year. We have learnt a lot about the virus and how to treat it, with drugs such as dexamethasone, tocilizumab, potentially remdesivir and monoclonal antibodies — making the disease less lethal than it was earlier this year. We also know that the use of continuous positive airway pressure (CPAP) instead of invasive ventilation, anti IL-6, and blood thinning provide benefits to patients. And although treatments would be hard to scale up to everyone who required them, they could make the disease far more benign. 

Meanwhile, effective testing and tracing can prevent outbreaks and save lives — as in Singapore, Hong Kong, South Korea and Taiwan. We are also on the cusp of a large number of cheap and rapid testing technologies — LAMP, antigen strip tests, and, even, breath tests — that could allow life to return more or less to normal even sooner. 

Earlier this year, exceptionalism blinded many Western countries to the coming carnage of Covid-19. Overconfidence and inept bureaucracies led to dramatic failures in border controls and testing, tracing and isolating that could have prevented widespread outbreaks. The result was harsh lockdowns and tens of thousands of deaths.

Europe is in the foothills of a second wave of Covid-19. This has, rightly, led to a renewed debate about the appropriate policy response. It should not lead to a denial of reality.

If they don’t, they may be fined £1,000 — like the woman in Cumbria who got a call from Test and Trace telling her to self-isolate, and within half an hour was in a cab to a bar. Test and Trace did their job, traced her movements, and gave her details to the police, who issued her with a fine.

Now, you may think (as I do) that this whole pandemic would go a lot easier if people who were actually infectious stopped going out to infect people. But you may also be squeamish about lining up your mates for police attention and a fine, especially since the police were given access to Test and Trace data on people who should be self-isolating.

It was a move greeted with much face-palming by Public Health teams and doctors, many of whom have dealt with these situations before (apologies to anyone who’s getting flashbacks to youthful encounters with Sexual Health clinics, by the way) and know that confidentially and trust are very important if we want these systems to work.

We often think of ethical issues around data as being a new problem arising from digital technology, but who gets to collect and use data, and the consequences, are problems as old as writing. It’s not about technology, it’s about trust.

In fact, this might be the time to consider downloading the NHS COVID App, if you haven’t already. You don’t need to worry about who gets that information, thanks to the decentralised system that keeps all your data on your own phone unless you decide to share it.

That system wasn’t the first choice of NHS Test and Trace (and the Department of Health and Social Care). They would have preferred a centralised design that gave them more data on who was potentially passing the virus to whom, and where. However, they may find more people willing to use the anonymised technology than to be open with a human-run system that could tell the police their test results.

This is an unexpected example of Covid-19 accelerating the importance of technology in healthcare, perhaps, but it’s not the only one. Digital technology has been quietly gaining importance in healthcare for years.

Medical research depends increasingly on access to large quantities of data, on combining diverse data from different sources, and on using programmes loosely described as AI (artificial intelligence) or Machine Learning to turn the data into useful information. To supply researchers with this information, engineers are ingeniously putting sensors and transmitters into forms that can unobtrusively monitor patients as they go about their lives. This also has short-term benefits for the patients, who get continuous, real-time attention, albeit from software.

You can now wear sensors that monitor not just heart rate and temperature, but blood pressure, blood sugar and blood oxygen levels. Commercial devices like fitbits and Apple watches collect health data and (with your consent) share it with medical professionals. The US Defense Department is using such off-the-shelf devices to monitor personnel for physiological changes that could be early warning signs of Covid-19 infection, using 165 biomarkers to alert them before symptoms emerge.

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In fact, you don’t even have to wear a device. Researchers at the Harbin Institute of Technology in China can print sensor circuits directly onto your skin, or you could swallow a pill-sized sensor that will draw power from your stomach acids to monitor temperature, heart rhythms or the chemistry of your digestive system.

Because big data techniques can capture weak signals from large quantities of data, early warning signs of common diseases may be detectable in the patterns of everyday life. Researchers into Alzheimer’s and Parkinson’s disease are looking for clues in gait, in typing behaviour, in speech patterns and eye movements, that could be picked up by the devices we already use, before any symptoms emerge.

Even population-scale patterns of internet use are being harnessed to predict the pandemic’s movements. Mayo Clinic researchers found that frequency of searches like “Coronavirus symptoms” or “loss of smell” on Google preceded rising cases in an area by around a fortnight.

This is the kind of pattern-spotting at which AI and Machine Learning excel, outperforming humans at certain, specific tasks. Algorithms analysing brain scans and X-Rays often spot abnormalities missed by humans; a Stanford University-designed algorithm performed as well as dermatologists in sorting skin lesions into benign and potentially cancerous.

Several hospital trusts were already experimenting with an AI-based triage system to reduce pressure on their Accident and Emergency (A&E) departments in 2019. Health tech company Babylon’s Ask A&E service uses a series of questions to sort patients into those who really need to go to hospital, those who could instead have a remote consultation, and those who just need over-the-counter remedies. Now Ask A&E is being used to reach patients without bringing them into hospital, and to identify Covid-19 cases via a specific triage route.

Babylon’s symptom-checking algorithm has been criticised for inaccuracy in the past, with fears that patients might be offered wrong diagnoses and fail to seek life-saving treatment. The current program relies on association, identifying which symptoms are most often correlated with which ailments. Now Babylon are developing a counterfactual diagnostic algorithm, designed to go beyond correlation and infer likely causes. Published research claims the new algorithm outperforms real doctors on average.

People who enter their data into Babylon’s system can also opt in for future research programmes, in partnership with universities or NHS researchers. The NHS has long recognised what a valuable asset it has, in the form of comprehensive patient records for an entire population — valuable to researchers, and hence valuable in financial terms.

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But patients feel a sense of ownership over their own data, and have some doubts about donating it for the use of commercial companies. Recent research carried out by the Wellcome Trust found that two-thirds of people were unaware that the NHS gives other organisations access to their data. Those surveyed felt strongly that use of their data should result in better health outcomes, though they recognised that might include administrative uses, and even revenue for the NHS.

At the moment, as we hope that public-private partnerships will bring a Covid-19 vaccine to end the pandemic, we may feel exceptionally willing to share our data for research. If thousands are willing to volunteer their bodies for clinical trials, why should we be squeamish about our anonymised data? And, when surveyed, we are very willing to altruistically donate our data for medical research, even before Covid-19 grabbed our attention.

However, public willingness to trust research organisations with our data is not unconditional. It depends strongly on how competent we think they are, and on the purposes for which they use it.

Like me, over 4 million people use the COVID Symptom Study app, the creation of private company ZOE and King’s College London. It’s completely transparent about using our data for research, and sharing it with others. By gathering so much data on symptoms, test results, and other relevant details, the scientists behind it were able to refine their understanding of the disease, and spot higher-risk groups and regional trends in infection.

But health data can be used for other purposes: insurance companies, for example, to predict what kind of people are more likely to make claims. Public health zealots might find correlations between health outcomes and dietary preferences, and then go on to campaign against your favourite fast-food outlets.

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Which brings us back to the potential consequences of sharing your health information with the Test and Trace system. On the positive side: preventing the further spread of coronavirus. On the negative: the choice between losing work, money, possibly your job, and unwanted police attention — with a large fine.

Lacking confidence in the competence of the system (too many rows for an excel spreadsheet, anyone?) or in the Government’s willingness to support you (almost no chance you’ll get enough money to cover a fortnight’s earnings, even if you keep your job) it’s understandable that many people will choose not to participate in the system. Understandable and, on a society-wide scale, disastrous.

This Government seems obsessed with building large-scale technological solutions to social and medical problems. There is nothing wrong with harnessing technology, and the UK certainly has some catching up to do in many fields. But even the most brilliant and efficient system can’t function without trust, and you can’t automate that, any more than you can program hope or mechanise social solidarity. Matt Hancock and his team need to stop building databases, and start rebuilding public trust.

This, in a nutshell, is the difference between the political and the scientific ways of thinking. Over the past eight weeks, on Lockdown TV, I have interviewed scientists and experts who sometimes disagree sharply with each other, but there’s a humility in their answers that is entirely absent from politics. Generally speaking, they accept that there’s much that they don’t know; very few things in science are anyone’s “fault”; instead scientists use odd words like “stochasticity”, referring to the fundamentally unpredictable aspect of nature.

The very different effects Covid-19 is having in different parts of the world are still not well understood, except as part of a complex context including pre-existing immunities and resistances, underlying health levels, demography, community and transport structures, perhaps even ethnicity and climate. Nobody really understands why it has not really taken off in sub-Saharan Africa, or why despite fears for Florida’s older population that state has not yet been badly hit, or why Japan has fared so well, despite its half-hearted government interventions.

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What we do know is that the virus started in China, that it was exported by air travel, that there was already community transmission in Europe and probably America as early as December. London and New York are the two busiest global travel hubs in the world — Heathrow alone had over 20 million passengers pass through it in December, January and February — so knowing nothing else you would expect these two places to be among the worst affected. In one of very few predictable outcomes, they have indeed suffered the world’s two worst outbreaks.

The political argument has zeroed in on the idea that the UK and the US should have acted earlier within the month of March, by 10 days or two weeks. Through a combination of shutting their borders, locking down earlier and ramping up testing and tracing, everything could have been different, or so the argument goes. We’ll never know for sure, but it seems oddly credulous to think that that short period was a silver bullet that would have changed everything — countries that did ban flights from China early, such as Italy and the US, were hardly spared.

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Back in March, the UK Government was still following its longstanding plan, endorsed by its scientific advisors — it is not spoken about much these days, but it is still there on the website if you fancy looking it up. It was based on the now-heretical principle that there would come a point when containment (with its testing and tracing) would no longer be viable, at which moment we would move to simply  ‘delay’ as much as possible and then ‘mitigate’. That is why contact tracing and community testing were dropped: it was always the plan. Some scientists still think this original approach was the sensible one, but faced with the alarming projections from Imperial College on March 16, the Government understandably ditched it.

To those who say that they should have seen what was happening in Italy, there remains the awkward fact that Neil Ferguson’s projections, based almost entirely on what was happening in Italy, didn’t materialise either. The revised Government plan was precisely designed to avoid becoming like Italy, with its horrible images of overflowing hospitals and triages in car parks — and that meant two urgent things: acquiring ventilators and increasing hospital capacity.

Off Matt Hancock went, brimming with rather more energy then than he has today, trying to succeed in his two big goals. But while the epidemic arrived, and with it a tragic number of deaths, it didn’t behave as expected. Remember the great ventilator race? As many ventilators as our good British companies could make, the Government would buy! Dyson, Rolls Royce and dozens of less glamorous and probably more relevant factories started frantically “re-tooling” for what the Prime Minister grimly dubbed “Operation Last Gasp”.

Turns out, they weren’t needed. Not only did the advertised wave of Covid patients never arrive in the promised number, it became clear that ventilation wasn’t the universally effective treatment everyone had thought. Reports emerged from New York that 88% of patients put on ventilators were dying; for many patients it turned out to be better to simply lie them on their front without ventilation. So the official number of extra ventilators the Government needed dwindled from 30,000, to 18,000, to 12,000 and then, quietly, to zero. James Dyson was sent back to his vacuum cleaners.

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As for all those additional hospital beds that the situation in Italy implied we would need — the virus once again had other plans. In a huge Government-led effort, routine procedures were suspended, people were urged to avoid hospital, and existing patients were cleared out of wards. The Nightingale Hospital in East London was opened on time with its 4,000 additional beds, and thousands of further additional beds were created around the country in other Nightingale facilities.

From this unprecedented effort close to zero beds were ever used; these hospitals are perhaps the only example in history of a highly expensive and entirely unused government facility escaping any media criticism. As it turned out, the frantic preparing-for-Italy action plan may have only made things worse, as it led to additional avoidable deaths from other untreated conditions and accidentally seeded devastating secondary infections in care homes.

So, first the flu-like pandemic we had been initially well prepared for didn’t happen; then the Italy-style crisis that we subsequently prepared for with impressive speed didn’t happen either. All these well-intentioned government action plans, scrutinised by the political media, ended up struggling to be relevant amid a pandemic that defied prediction.

Fast forward to today and the big government action plan is now “test and trace” (they seem to have dropped the ‘track’ part, presumably because polling revealed people didn’t want to be tracked). Across the political divide, everyone is signed up to it — it seems modern and proactive and the “winning” countries have done it, so the only question apparently worth asking now is whether or not it will be well-enough implemented. But what are the chances that this plan, like all those earlier plans, ends up creating a lot of noise and finger-pointing but not making much difference to the trajectory of the disease?

I spoke to experts in South Korea and Hong Kong, the countries that pioneered the ‘test, track, trace’ method, and it seems clear that, even more than earlier initiatives, playing whack-a-mole with a virus in this way requires a coming together of surveillance, technology and buy-in from a biddable public. It also requires a manageable number of cases: it has worked in Asian countries as a way of keeping the virus out but it has never been tried in a scenario like the UK which has had millions of infections already and where the virus is now endemic.

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Take South Korea, often held up as the example we should follow. Jerome Kim, Director General of the International Vaccine Institute based in Seoul, told me how on the back of a single individual infecting people in a nightclub the authorities ended up testing 65,000 people. They found 175 connected infections, some of them three or four ‘generations’ away from the original event. Yesterday, on day one of our equivalent scheme, we identified nearly 2,000 new separate infections nationwide, and the ONS estimated that 133,000 people are currently infected — to be as thorough as the Koreans, we would have to be testing the entire UK population every day.

Even in South Korea they are not finding it easy. In the Seoul nightclub example they had to allow people to come forward anonymously (it was a gay club) and then threaten police visitation if they didn’t — bear in mind this is a country which allows government surveillance of both mobile phone GPS data and credit card transactions to establish people’s whereabouts. In Hong Kong, which has also kept the virus at bay, the authorities send people to ‘quarantine camps’ for mandatory isolation.

The UK situation is not comparable. Even without our higher infection levels, we don’t have an all-powerful tech-enabled command-and-control government, and aside from some members of the cabinet, nobody wants one. Test and trace UK-style consists of thousands of hastily-trained agency workers asking infected people who they remember being with, then calling those people up and asking them politely to self-isolate for 14 days. No quarantine facilities, no app (yet), no police enforcement. It’s something to be getting on with, I suppose, but does anyone truly believe this will keep a highly contagious, already endemic virus, contained?

Much more likely, the virus will continue on its trajectory upwards or downwards and it won’t have much to do with government policy. If the estimates that only 7% of the population are immune are correct, and the virus is as contagious now as it ever was, we’ll soon know about it. As it is, with summer upon us, the virus seems to be in retreat everywhere across Europe. If the downward trajectory continues, it won’t be thanks to the ‘test and trace’ call centres.

Meanwhile, if Covid-19 does comes back with force later in the year, it will be because seasonal elements have combined to make it more contagious and effective, and our test and trace system, especially if it’s rusty by then after a long summer in abeyance, stands little chance of defending against it. We’ll soon be back to Plan A, focusing on providing medical care to the sick.

So as you read, in coming weeks, furious news stories about technical incompetence, citizen non-compliance, threats of stricter enforcement and blame in all directions — as if everything was hanging on the latest government policy — remember the humility of scientists instead of the solipsism of the political class. Yes, the Government action plan will most likely be ineffective, but politicians were never in charge of this anyway. It’s bigger than they are — the best they could ever hope to do is tinker around the edges. Coronavirus is nobody’s ‘fault’.