Lack of humility could kill us

One of the most impressive threads I’ve seen on Twitter about Coronavirus is by Professor Francois Balloux, a computational/system biologist working on infectious diseases, who has spent five years in a world class ‘pandemic response modelling’ unit.

What solution did he offer?

He offered none, and that was what was so impressive.

He said that, after considerable study, he had failed to identify the best course of action, and wasn’t even sure there was an acceptable solution.

He thought a more severe wave of the pandemic in the winter is the most plausible scenario. He linked to the graph below of the deaths from the second wave of the spanish flu pandemic during the winter of 1918 as a warning of what this might mean.

He warned that we don’t know for sure if this pandemic will be similarly seasonal, or if infection will induce long-lasting immunity. If immunity is short-lived, that will create problems, not just for the ‘herd immunity’ approach, but also ‘flattening the curve’. This could mean that, in 18 months, when we may have a vaccine, a vaccination approach might hit problems.

He warned that, if the pandemic leads to a global economic collapse, many more will die than will be killed by the virus.

His only specific recommendation was that this be treated as a global health problem, and should be tackled with an integrated global approach.

For me, the big take-home from his thread was this: “There is no simple fix, and poorly thought-out interventions could make the situation even worse, massively so.”

In other words, if we want to save as many lives as we can, we need to learn intellectual humility.

* George Kendall is the acting chair of the Social Democrat Group. He writes in a personal capacity.

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44 Comments

  • A very good article George. If only more of us were prepared to accept that in so many instances we are not as clever as we like to pretend and we certainly don’t know for sure what is best in uncertain times, we might just start to make better decisions.

    The unwillingness of so many people including on Lib Dem Voice to accept, even to themselves that we need to consider other possibilities we may not particularly like and come to a rounded judgement rather than just charge ahead based on limited and inadequate data which supports our personal instincts, is always a disappointment to me.

    “I’m an optimist” can be too often a precursor to “I’m a failure”.

    Not dismissing different opinions particularly from other Lib Dems with a different perspective on a personal strongly held opinion is not necessarily to accept bigotry, but instead should be a real exploration of what we really want to achieve and sometimes much more importantly what we don’t want to happen if things don’t work out.

    Diversity is a strength, not just a slogan.

  • Should we not bring back the milk round? A delivery of vitamin C enhanced milk to every household plus say a large loaf of bread, just to make sure there is no starvation in the system. It would also keep an eye on the elderly if the deliveries pile up. Not sure how much milk and bread the UK can produce. Later, the fleet could be converted to deliveries for the supermarkets etc.

  • The thing is the virus aspect pandemic itself is unlikely to lead to economic collapse (mortality rate is too low, with those sadly dying to the virus overwhelmingly not economically productive), but the reaction by states to the panic will.

    The virus could kill tens of millions globally. Mostly the old and the sick. Reckless reactions by governments that first cripple the economy, and if prolonged then cause it to collapse causing social breakdown that could lead to the deaths of hundreds of millions (from all demographics) and set the world back years in terms development.

    There aren’t good or nice options here. The prime minister was correct to be steered by experts and tell the public the truth (that people will lose loved ones). Unlike some of our counterparts on the continent who gave their populations false hopes by appearing strong and decisive and taking supposably life-preserving measures. It wouldnt be the first time the UK “went it alone” taking a course of action and accepting that many will die, whilst others in Europe deceived themselves of being able to achieve short term life-preserving outcomes.

    I don’t buy the whole “credentials” card of being allowed to express an opinion, and loathe people who start a sentence with “As a ……” as if it affirms their opinion. Anyone can engage with concepts and information with reason, even if the subject is unfamiliar to them. But for those who insist on “credentials” before being allowed to be speak or be heard, I have a degree in Medicine, a Masters degree in International Health Policy (awarded jointly from LSE and the London School of Hygiene and Tropical Medicine), experience of working in healthcare both abroad and internationally, as well as experience working in central government (including Government Office for Science as well as the Chief Medical Officer Unit in the DH).

  • Daniel Walker 16th Mar '20 - 12:34pm

    @Frank West “Should we not bring back the milk round?

    There are a few new companies – ours is The Modern Milkman – which do old-style doorstep drops now, but I think mainly in the larger cities.

  • Bringing back the milk round is an excellent idea. It could be built into the system/structure of the country It would be as posties are/were a contact for people who are seen regularly COMMUNITY WRITTEN LARGE Milk left on the doorstep is a clue of something wrong. Coming to collect the money at they end of the week can see if there are any problems (nit to mention having a chat. At the moment it is sporadic but it could be organised otherwise.
    There is an arguement that the ‘just in time’ system of economics (and that includes food system) can break down cos of the virus. As we only supply around 40/45% of our food encouraging an ‘allotment’ mentality or blitz spirit of the war (grow your own) could be of benefit.
    The World is interdependent, everybody needs everybody to cooperate in all structures. Isolation leads to stagnation. The US after the Wall Street crash isolated,it did not grow until the war when it got ‘new customers’ for its goods It grew leading to the structures of today that some people want to destroy. However a global World needs all to make it function.

  • Tony Greaves 16th Mar '20 - 12:58pm

    Don’t mention the Modern Milkman in Pendle! But more seriously, a very sensible contribution from James Pugh. We probably have some very sensible top experts in this country, but their job is not to prescribe solutions but to offer the best advice on options and their consequences to the top politicians. It is they who have to make sensible decisions and that means we need sensible and competent politicians. That may be our main problem.

  • David Allen 16th Mar '20 - 1:50pm

    James Pugh: “The virus could kill tens of millions globally. Mostly the old and the sick. Reckless reactions by governments that cripple the economy… could lead to the deaths of hundreds of millions (from all demographics). …. The prime minister was correct to be steered by experts and tell the public the truth (that people will lose loved ones).”

    Well, the Prime Minister claims to be being steered by medical experts, who, it seems, are mostly there to tell him that drastic medical actions are not necessary. But you are advocating that the Prime Minister should instead be steered primarily by experts in business and the economy. They would – in your view of course – be telling him that economic considerations are paramount. And, that apart from preserving the wealth of wealthy Tories, putting the economy first will also cost fewer lives in the long run – or so you assert.

    What upsets me most about this stance is the dishonest way it is being put foward. When Johnson claims to “level with the public”, he is doing the opposite. If it is of primary importance to keep the economy afloat, why should Government not present the reasons why they believe this is the case, so that we can all see if we agree?

    I suspect there are actions – school closures for example – where the harm due to economic disruption might genuinely outweigh the benefits. I don’t really know, beause nobody has sought both to analyse the question and to tell the public what they conclude. I am pretty sure there are other actions – not banning football until the football business did that for themselves, for example – where the Government has clearly prioritised business-as-usual rather than bother unduly about what happens to “the old and the sick”.

  • Barry Lofty 16th Mar '20 - 1:56pm

    Well that’s ok then as it’s only the unproductive in the world that are going to die in this epidemic, we wouldn’t want stop the world’s development any further than is necessarily and as for Boris Johnson’s rather inappropriate statement regarding the death of love one’s, well I would not expect anything different from him, he is just the person to give me confidence in a crisis, I don’t think!!!

  • But then, before locking down the whole country, Italy did try the hand-off approach and only implemented strict measures quite late. It failed.

    James Pugh – experts also give different opinions/solutions, particular British vs foreign/WHO experts (to be honest, this makes our side looks like a bunch of contrarians), so it is not easy for many people to trust the government, especially with the miserable communication from the government so far. Regarding experts and governments abroad, I am inclined to trust the Korean and Canadian ones, as they both have a fairly good track record of competency, and Korea has literally been preparing for a bioweapon attack for years.

  • If this all comes down to survival of the fittest
    Then good luck to the rest of you If and when this crisis is over in however many years time.

    What a lovely world you would have created for yourselves, you might as well say goodbye to any Liberal Values and Liberal Parties.

    At a time in History when the world has a unique opportunity to come together and world leaders start working together to save lives instead of killing each other like they normally do.
    Instead, you will be advocating more isolationism and creating a far more dark and dangerous world that what we are used to now.

  • Peter Watson 16th Mar '20 - 2:42pm

    Like others above, I welcome this article.
    I’ve felt like a lot of the comments in other threads have started from the position that whatever Boris says/does must be wrong because he’s Boris!
    This article is a reminder of how awfully difficult it must be for anybody in a decision-making role at the moment (and how easy it is for us armchair generals to snipe!).

  • Johnny McDermott 16th Mar '20 - 2:47pm

    Very sobering piece, making that key point we will all have to grapple with – a lack of ultimate control. In modernity, with so many advances, younger generations especially, I think (speaking as Millenial/X) are not used to it.
    Last such reminder of our mortality was roaming ISIL attacks. Before that 9/11 and 7/7. The only days I remember that were truly disturbing, like these ones. But those enemies, although camoflagued among us, and are more tangible, and defeatable. Yet, not always. And that is ok too. Failings are regrettable and must be learned from (in both security and the pandemic), but there will always be risk we can only manage, harms we cannot prevent. That was acknowledge then (2017 attacks… not early 00’s ‘War on Terror’) by spy chiefs and the PM, to their credit. It’s been acknowledged by Johnson to his.

    Sometimes it helps to hear the truth, no matter how horrible. It’s frigthening, but we demand such transparency today. We must be able to cope with those grim realities when presented them.

  • In the current climate, it is worth taking note of the professionals who actually use the words “I don’t know.” I have been fortunate over the years to have been registered with a series of GPs across the North who have inspired my confidence in them with that phrase. Harold Wilson famously responded to the tricky bits of an interview with “I’m glad you asked me that question.” One of his successors in Downing Street last week declined to go beyond “That’s an open question.”

  • Barry Lofty 16th Mar '20 - 3:31pm

    I am not an armchair sniper but feel that the continual doom scenarios can get very depressing for we older folks, they maybe true but a few uplifting and hopeful words would not go amiss to relieve the constant barrage of despair. I speak as one who recovered from childhood infantile paralysis,Polio, and was rather too close to the 9/11 incident for comfort!

  • I just watched the press conference from the director of who.

    I trust what they are saying far more than what we are hearing from our government.

    The answer is Test, Test, Test and Isolate those that are infected to stop the spread of the virus.

    We need to give the medics space to treat the number of cases that they already have and the opportunity to learn from this virus what medications that we currently have and is licensed for works.

    We need to give scientists the time for coming up with a vaccine.

    More than anything I found the words from the director of Who comforting, he was calm clear and yet honest and was rallying public spirit with calls of solidarity that together we can get through this.
    The world needs to come together on this more than ever to fight this horrid new virus and its not going to happen if Governments are divided.

  • David Allen 16th Mar '20 - 4:47pm

    “I’ve felt like a lot of the comments in other threads have started from the position that whatever Boris says/does must be wrong because he’s Boris!”

    Well, I’ve felt that a lot of comments have started from the position that because Boris has at last raised his game above buffoon level, and no longer sounds like a British Trump, we should be desperately grateful for the small mercies, and so we should let him have a free ride.

    However – We know the man. For example – First he said a border down the Irish sea was unthinkable, then he signed an agreement to adopt one, now he says he won’t implement it. And so on. Just because he now wears a sober expression, and is tackling a very sober subject, doesn’t mean the leopard must now have changed its spots.

    It is the duty of political parties outside government to provide critical oversight. Knee-jerk opposition isn’t right, but rational scepticism certainly is. Here is some very rational scepticism, this time from a “nudge” expert:

    https://www.theguardian.com/commentisfree/2020/mar/16/social-distancing-coronavirus-stay-home-government

  • Phil Beesley 16th Mar '20 - 4:57pm

    I appreciate that advice needs to be simple because ‘social distancing’ is a measure which will have a big impact on infection control. Advice also needs to be realistic and proportionate.

    ‘Self isolation’ as currently defined is not a realistic proposition. If people stay in their own homes for long periods, they will go mad, and I am using ‘mad’ loosely in the context of angry and mentally unwell. We are all going to feel the need for some fresh air, to do normal-ish things. Lots of us need to ‘go for a pointless walk’. I live far enough away from a city centre that I can walk on fields without social encounters, giving a distant wave to familiar locals. It’s more difficult for those living in denser populations, but if ‘self isolation’ is to be meaningful for a sustained period, advice about isolated living needs to improve.

  • Coronavirus: Isolation for over-70s ‘within weeks’ – BBC Newswww.bbc.co.uk › news

    5 hours ago – “A briefing will follow a Cobra meeting which is expected to look at what steps the government could take to protect elderly and vulnerable people.

    The Government is shortly going to announce every Briton over the age of 70 will be told “within the coming weeks” to stay at home for an extended period to protect themselves …”

    And, big deal, “The over-70s have been told they are allowed to go out for walks when their period of staying at home begins”……..

    Thanks, Boris, most grateful. Hope you apply it to Stanley. The mind boggles at how they can enforce any of this….. it’s getting like Hunted on Channel 4. As for the impact of the last ten years of cuts and austerity on Social Care and the NHS ….. ?????

    On a lighter note, is it a not so subtle Johnson ploy to stop 70 year old Jeremy Corbyn from besting him at P.M.Q.’s ? Is Her Majesty’s Leader of the opposition to be under house-arrest ? Is the House of Lords to be suspended ? And what a comfort to know that Grant Shapps is in charge of Transport.

  • @Joseph Bourke

    The issue goes beyond just the medical advice, though – I’m sure Prof Whitty is perfectly capable himself, but this isn’t just a medical matter.

    For just one example, as you say in your later post, people should be encouraged to stay at home if ill, no presenteeism, etc. But there are lots of options to do that, politically:
    – as you suggest, encourage employers to offer sick pay
    – as Labour suggests, give everyone a decent level of sick pay directly
    – as the Conservatives are doing, stick with the current situation
    And those would all have different levels of impact on
    – how many mildly ill people can actually afford to self isolate
    – how much it costs companies (short and long term)
    – how much it costs the government (short and long term)

    Even if we’re confident in Prof Whitty, there are lots of other people in and advising government we also need to be confident in. It’s not clear at the moment that we should be confident in all or most of them.

  • Phil Beesley 16th Mar '20 - 5:53pm

    David Raw: “Coronavirus: Isolation for over-70s ‘within weeks’ – BBC Newswww.bbc.co.uk › news”

    Indeed, David. I understand why it may take two weeks to make and deliver something which is not available off-the-shelf. I’m British so I’m accustomed to queuing, and I have done those computer modelling exercises in which you play around with serving time and queue jumpers.

    When you hear a news report that “So and so will announce that something will happen”, you interpret the news report to mean that something will happen

    I thus do not understand our Prime Minister’s woolly words. If he means that over 70s should ‘self isolate’, he should just say it. He should get somebody with a calm and convincing demeanour to provide realistic and practical advice about ‘self isolation’.

    There’s a shared principle in medical care (triage) and utilitarian philosophy — act to do the least harm and most good — which we all need to consider.

  • Phil Beesley 16th Mar '20 - 6:34pm

    Close all pubs and cafes? It sounds like the right thing to do, but is it the right behaviour?

    People who are travelling for necessary work need places to eat and drink. People living in hostels or B&B where they cannot cook for themselves need somewhere. If your car breaks down, you’ll need a place with friendly faces.

    Imprisonment? I’m sure that diligent civil servants and prison managers are juggling this difficult problem. How do you release prisoners who may not have a home to which to return? How do you even get the lucky ones home?

    Other places in Europe are working through lockdown scenarios but I fear that we in the UK are not learning from their lessons.

    It’s rather like our first understanding of HIV/AIDS. Nothing is safe but we can make things safer. And in hind sight, some of the measures we take will look ridiculous.

  • I dont understand

    These measures which have been introduced to “avoid” public gatherings, pubs, clubs restaurants etc is only to advise, but they are not actually enforcing any of this.

    They say that these measures are vital in order to stop the spread to not only protect the NHS but to save lives, Lives of people not only from Coronavirus but also people who may have other illnesses accidents that would rely on critical care and unable to receive because of limited resources.
    It seems to me that Boris is putting the responsibility back on to the people in order to do this so he can pass the buck if people do not do it.

    Clearly Boris wants to continue on with his plan but has come under intense pressures from Leading scientists, the public and the WHO to change tact, so he wants to be seen as listening to that advice and acting but making it only “advisory”

    What we are going to see over the next few days in the papers are photo’s of pubs and clubs etc full of people not adhering to the “advice” and the rest of the public getting angrier and angrier, splitting the nation against each other. That is not wise.

    I was also concerned to hear that he is not banning Mass gatherings but stated that we are just no longer going to be policing them. Is anyone else concerned what kind of message does that says to terrorists who would think of taking advantage of the situation?
    Maybe I heard it wrong, if I did please please someone correct me

  • Phil Beesley 16th Mar '20 - 7:46pm

    Health Secretary, Matt Hancock: ‘but all of this evidence is kept constantly under review’.

    The word ‘evidence’ is usually used to mean something which is concrete or uncontradictable.

    If we read the full quote, Hancock is using the word in a more fluid way: ‘But for most people this is a mild to moderate illness and once they’ve recovered, the vast majority of the evidence is that the illness does not come back for some time – but all of this evidence is kept constantly under review.’

    Hancock’s version of ‘evidence’ is what we used to call a clue or suggestion.

    It is time to end question and answer sessions with politicians and government advisors who are managing this crisis. It would be a sad hiatus in politics — it’s a form of censorship — but it is necessary. Politicians are generally good at communications, somewhat inclined to not knowing the thing they are talking about; experts know their domain subject well but can’t tell you much else.

    It is time for measured words. Government statements need to be written by people who understand words, delivered by people who appear to know what they are doing.

    (Matt Hancock walks around like a man who has put his shoes on the wrong feet but doesn’t feel confident enough to look at them.)

  • Phil Beesley 16th Mar '20 - 8:25pm

    Matt: ‘What we are going to see over the next few days in the papers are photo’s of pubs and clubs etc full of people not adhering to the “advice” and the rest of the public getting angrier and angrier, splitting the nation against each other.’

    Pubs and clubs won’t open if employees stay at home because their employers expose them to unnecessary risk. Pubs and cafes will stay open if they look after staff and customers — sensible advice will matter.

    Healthy people will possess an essential attribute: they can walk away from every bad employer and find a better job.

  • With regards to my previous comment about mass gathering, am I right in thinking that although the government is not banning them and is just not policing them, that means mass events cant go-ahead because to have permission to do so and Insurance, they have to have “x” amount of police, ambulance staff for which they contribute towards the cost? I would use a major football match as an example, but know that football sporting events had already been cancelled by their own choice.

    I am just trying to understand the Governments reasons not to use the same language and enforcement measures as other european countries.

  • Phil Beesley – “People who are travelling for necessary work need places to eat and drink. People living in hostels or B&B where they cannot cook for themselves need somewhere. If your car breaks down, you’ll need a place with friendly faces.” – for restaurants, you can still allow them to serve takeaways or serve at reduced capacity. However, things like bars, casinos and nightclubs must be closed 100%.

    “Lots of us need to ‘go for a pointless walk’. I live far enough away from a city centre that I can walk on fields without social encounters, giving a distant wave to familiar locals. It’s more difficult for those living in denser populations, but if ‘self isolation’ is to be meaningful for a sustained period, advice about isolated living needs to improve” – you can still ban people from pointlessly gathering together on the streets (I mean, things like the Smurf rally in Paris earlier this month).

  • Lorenzo Cherin 17th Mar '20 - 12:18am

    As usual a very sensible and moderate article by George. Might be good to think of this, for reflection. Too many ideas are not the bother, attitude is the thing.

    James and those who support his comments, great, but the rather denigrating tone expressed to me in response to a very measured article, during which I made two or three points, not liked, bothered me, and, humility or not, got me to reading back my points.

    I discovered that I had no errors, yet was told my article should not have been published. It was because I had, howlers, gaffes, fake news.

    I said that there are known cases of people who have got the virus more than once, coming from China.

    I said that leisure was closed by Cromwell, in the aftermath of the Civil war in the capital much of the ww2 years.

    I did not go into detail, but did provide an example to illustrate that.

    I wrote from the view of someone who cares, mentioned the reason as my own personal family history, Italian father with TB when he was a young man, Italy on the mind now.

    Discussion, yes from some, humility, too. And insults.

    So too here, we read those who are wise, clever, kind, mean, many differ.

    As do the ways to combat this crisis.

    We only need all hands on deck and all to be nicer.

  • @ George Kendall It was the ” “The over-70s have been told they are allowed to go out for walks when their period of staying at home begins”……..I found both unacceptable and slightly hilarious, George.

    Personally, out of self interest, common sense, and for some very good reasons, we’re staying at home…. and going for walks. So far I’ve not seen an over 70’s enforcer hiding behind a wall waiting to pounce, and I haven’t seen Stanley Johnson.

    @ Lorenzo Don’t be so bothered, old lad. I always enjoy your articles even when I disagree you !!!!!!!!!

    PS I do wish more people would watch Holyrood on the BBC Iplayer. A magnificent, competent grown up performance by all on coronavirus this afternoon …. Nicola, the Scottish Cabinet members, the Tories, Labour, the Greens and good old Willie. Westminster could learn a lot.

  • Phil Beesley 17th Mar '20 - 5:15pm

    Joseph Bourke: “There are immigration detention centres and mental health wards to think about also.”

    I intended to thank you for that comment earlier. It is very easy for those of us with a home, supportive family, all of that, to forget the advantages which stability provides in life. If you have a flat or a house, you don’t need to go into a pub or cafe to warm up.

  • David Raw,

    “PS I do wish more people would watch Holyrood on the BBC Iplayer.”

    If the Alex Salmond trial was televised, I don’t think the Scottish Parliament debates would be able to compete for ratings. It may not be quite as sensational as the O J Simpson trial, but the reporting of the proceedings will be of interest to many in Scotland and the broader ‘me too’ movement nonetheless.

  • @ Joe Bourke That may well be true, Joe.

    Fortunately for the Lib Dem Party matters associated with be-knighted representatives from East Lancashire and Cambridgeshire never got to this stage.

  • George Kendall – “By appearing to make the measures voluntary, Johnson may reduce the backlash. As I want the measures to succeed, I don’t think this is a bad thing.” – OTOH, an approach that seems to primarily place the onus on the victims/people doesn’t sound right.

    We can reduce fatigue by starting managing expectation. For example, in Germany, the head of Robert Koch Institute flat out said that the worst case scenario is two full-years of social restriction. Doing so can set an expectation among the people that restrictions will not end soon, instead of “it will stop in the summer”.

  • Peter Watson 18th Mar '20 - 9:32am

    @Thomas “OTOH, an approach that seems to primarily place the onus on the victims/people doesn’t sound right.”
    But is it a more “liberal/Liberal” approach than some Lib Dems appear to be calling for?
    This seems so be a situation where, for very understandable reasons, there is suddenly a demand for a much more interventionist “big state” approach after years of what has felt like a general reluctance to consider (or fund) such a thing.
    I wonder if one of the longer term consequences might be a bit of a rethink around this.

  • We are still learning about how this virus operates. Flexibility is key as the endemic progresses. Information is essential so people can make informed decisions and alter them as necessary. We certainly need more testing.

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