The latest relaxation of the lockdown is a political rather than a scientific decision, and it will put thousands of lives at risk without a fully functioning Test, Trace and Isolate system. Mike Downham argues that UK Government should not be allowed to hide behind appealing to ‘the science’.
The UK Government has taken another lurch to the right by announcing that the two-metre distancing rule will be reduced to one metre from 4 July, and pubs and restaurants will open. There’s no scientific evidence that one metre reduces the risk of the virus getting from one person to another, whereas there is evidence that two metres reduces that risk. Furthermore, not even 40 pages of guidelines for pubs and restaurants will prevent people from coming closer to each other than one metre. Just think of your average pub on a Friday evening.
What are we to make of this new round of official relaxations, which as with previous rounds will bring with it a tendency for people to relax independently, bending the rules to suit their particular situation – rules based on politics, not science?
Should we send our kids back to school? Should we yield to employers who ask us to return to workplaces? Should we get on the bus again? Should we give in and hug the grandchildren? Should we go to the pub?
For people whose living situation, with or without mental health issues, has made lockdown most difficult, these decisions aren’t easy to make. It’s completely understandable that they will be inclined to bend the rules. For many people the over-riding factor is bound to be an immediate need to find work so they can afford to feed themselves and their families.
Hidden behind what we are confidently told is ‘The Science’ is the truth that there’s a lot which is currently unknowable. Because this virus is new and so unlike any previous viruses, there are important things we still don’t know about it. In particular, we don’t know how long-lasting or how strong immunity is in people who have had the infection. And we don’t know how the virus spreads in communities. Yes, we know it spreads from person to person mainly through droplets, but who are the people and what are the social settings most likely to spread the virus? Are children critical to spread, or not? Are schools critical?
Many weeks ago, quick research into how the virus spreads in sample communities was proposed. But because testing and public health personnel weren’t given the capacity to do that research, it wasn’t done. Now the moment when there was enough infection around to do this research has passed. Most fundamentally, we don’t know the risks associated with specific relaxations, like going back to school or going back to work.
But there are two things we do know. The first is that a ready-to-roll and well-designed Test, Trace and Isolate system is critical in reducing the risk of each relaxation. A good TTI system can quickly spot new outbreaks of infection and nip them in the bud before they develop into a new epidemic wave. Last week the Chinese Government was able to snap its fingers and within hours of the first sign of a new outbreak in Beijing have 100,000 workers, trained in testing and tracing, on the streets. We know how this works from long experience of epidemic control in the UK, with Glasgow historically a world leader. We also know it from the experience in this pandemic of countries which do have strong and tested TTI systems – China, South Korea and Denmark in particular.
A new TTI system in Scotland was launched on 28 May – necessarily new because the formerly robust Public Health Service had been hollowed out over many years of neoliberal governments, a process accelerated by austerity. Since the launch, the Scottish Government has been silent about the progress the system has made. My experience with Scotland’s NHS Inform website is that its name is highly misleading. Ask it anything critical like this and it drops you like a hot potato. This silence is not reassuring.
There is more information about the similar TTI system in England, launched on the same day, though the information needed disentangling from spin. In its first week 8,117 people who tested positive were contacted and asked to provide names of people they’d been in close contact with. 2,710 of these (33% in round figures) refused to supply the names of contacts. Of the 31,794 close contacts that were named and asked to isolate for 14 days, 4,800 (about 15%) refused to isolate. Was there ever a better demonstration of the extent to which the public does not trust this Government, and that trust is a vital ingredient of any TTI system? In the face of these results Baroness Harding, who has accepted responsibility for the scheme, has said that it won’t be fully functional until the end of June. And yet the UK Government pushes ahead with relaxation and will probably make the same fatal mistake it made in January by taking no notice of what’s happening in China.
The second thing we know is that whatever the unknowable risk of a second wave its impact would be huge. Once the rate of infections begins to rise exponentially not even the best TTI system has a chance to stop it – there will quickly be too many people to test, trace and isolate fast enough. That’s a basic fact which has been recognised by Public Health Services for well over a hundred years.
With immunity unknown, but predicted to be weak and short-lasting, it’s more than possible that a second wave could look much like the first. We now know, with horrible clarity, the real impact of the first wave in the UK in terms of lives lost. ‘Excess deaths’ – the number of deaths above the five-year average for each week in the year – captures the people who have died from Covid-19, those who have died from other conditions as a result of the epidemic’s impact on health services, and those who have been too frightened or well-intentioned to contact services in the context of the epidemic. The excess deaths figure for the UK from 23 March to 31 May stands at 63,596.
Science for profit
Science isn’t absolute, it’s contextual. Even at the fundamental level of particle physics, it’s been demonstrated that how the particles behave depends on whether or not we’re watching them.
I first learned that science is contextual some 50 years ago. As a junior researcher into children’s respiratory virus infections, I found myself caught in a power struggle between the professor I was working under and other leading international virologists. He put pressure on me to come up with a set of results which supported his personal status and opportunities for funding his department. The other professors put pressure on me to come up with another set of results which would block my professor’s pre-eminence.
In the context of the neoliberal period, we’ve been persuaded by increasingly authoritarian regimes that we aren’t competent to think for ourselves. This has helped those regimes get away with the stealthy privatisation of health services, care services, and universities. Science, along with all knowledge, has become commodified for profit.
The production of medical drugs was, fatally, never put into public ownership. In recent years, we’ve become more aware of the huge extent of illness caused by the side-effects of drugs, many of them not necessary for our health. The most devastating and scandalous example of this is the biomedical model of mental health, pursued successfully by drug companies since the discovery of lithium in 1949. This has been responsible not only for immeasurable suffering for millions of people with mental health issues, but also for the epidemic of drug abuse. At last, there’s now a movement to tear up 60 years of psychiatry and replace the biomedical model with a psycho-social one.
In the context of the Covid-19 pandemic the corruption of science has been laid bare. As Richard Horton, Editor of The Lancet, says in his book The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop it Happening Again, published this week, the SAGE Committee has acted as ‘the public relations wing of the Government’. The whole medico-scientific establishment (which is to say, the medical Royal Colleges, the Academy of Medical Sciences, the British Medical Association and Public Health England) is, as Horton puts it, a ‘broken system of obsequious politico-scientific complicity’.
Richard Horton’s own publication, The Lancet, also reflects some of the problems with contemporary science, though. The Lancet is lauded for its objective science by the international medical community, but its publisher Elsevier is a huge Dutch analytics company whose profits last year were £982 million, and yet has by far the worst gender pay-gap among UK academic publishers.
The truth of the matter is that science, to be beneficial to human society and the planet, has to be based on common sense and learning to think rationally. Working class people can make informed and critical use of scientific knowledge, coming together to make sense of the way the world works and to find solutions to problems collectively, calling on the opinions of experts as necessary.
Disempowered as we have been by neoliberal governments in hidden collusion with the experts, this is a big psychological step for us. But whether in relation to climate change, or the pandemic, or our health and care services, or our educational system, we have to take that step. It will take time, learning and experience.
If all this seems unthinkably radical, now is the moment when we have to think radically, because we may never get another chance. Science and Medicine are sacrosanct elements of the system we have to change. We can’t leave our health to the doctors, or science to the scientists.