Witless and Unbalanced

Witless and Unbalanced defend their Graphs of Doom to MPs
In the midst of the clamour for a new lockdown with frantic warnings of the NHS being overrun and MPs voting later today, a bombshell dropped last night: leaked NHS documents that show hospital and ICU occupancy are normal for the time of year. The Telegraph has the details.
Hospital intensive care is no busier than normal for the majority of trusts, leaked documents show, raising more questions about whether a national lockdown is justifiable.

An update from the NHS Secondary Uses Services (SUS) seen by the Telegraph shows that capacity is tracking as normal in October with the usual numbers of beds available that would be expected at this time of year - even without extra surge capacity.

An NHS source said: "As you can see, our current position in October is exactly where we have been over the last five years."

The new data shows that even in the peak in April, critical care beds were never more than 80% full.

Although there has been a reduction in surge capacity since the first wave, with the closure of the emergency Nightingale Hospitals, there is still 15% spare capacity across the country - which is fairly normal for this time of year.

The documents show there were 9,138 patients in hospital in England as of 8am on November 2nd, although had since fallen to 9,077.

It means COVID-19 patients are accounting for around 10% of general and acute beds in hospitals. But there are still more than 13,000 beds available.

In critical care, around 18% of beds are still unoccupied, although it varies between regions.

But even in the worst affected areas such as North West, only 92.9% of critical care beds are currently occupied.
How welcome - finally - to have this information in the public domain, and just in time for MPs to vote (not that it is likely to make much difference with Labour pledged to support the lockdown and few Tories looking like rebelling). But why did it have to be leaked? Why is this crucial data not routinely made public? Why have all requests to release it from journalists and researchers been turned down or pointed towards making an FOI request (which takes weeks)?

Professor Carl Heneghan, Director of the Centre for Evidence-Based Medicine at the University of Oxford, told the Telegraph:
This is completely in line with what is normally available at this time of year. What I don't understand is that I seem to be looking at a different dataset to what the Government is presenting. Everything is looking at normal levels, and free bed capacity is still significant, even in high dependency units and intensive care, even though we have a very small number across the board. We are starting to see a drop in people in hospitals.
Alongside this good news, Professor Tim Spector yesterday tweeted that King's College's ZOE Covid survey app was showing that R had fallen to 1 nationwide. "More good news as the Zoe CSS app survey continues to show a plateauing and slight fall in new cases in England, Wales and Scotland with an R of 1.0."

This is in line with what the current daily "case" data suggests - though I'm unable to show you today because, with impeccable timing, the Government Covid dashboard went down at 4pm yesterday (let's assume cock-up).

Many are quick to credit the current three-tier system with bringing the spread down. But is that what the data says? Hardly. Recall it was the areas under local lockdowns that saw the greatest rise in positive tests in September. Ah, you say, but then Tier 3 was imposed and that brought the rate down? Not at all. In Liverpool "cases" peaked around October 7th and have been declining since, but the city was only put into Tier 3 on October 14th. Similarly in Manchester, local restrictions were first imposed on August 15th, which didn't prevent positive tests surging in September. But then they peaked on Sept 30th and have been largely flat since, slightly declining - yet the city was only put in Tier 3 on October 23rd. Tell me again how this shows the tier system working? What it shows me is we're more likely seeing the autumn surge among those who were spared in spring when the epidemic was curtailed by the warmer weather.

Despite the encouraging data, Chief Medical Adviser Professor Chris Whitty and Chief Scientific Adviser Sir Patrick Vallance appeared before MPs yesterday and were emphatic that the epidemic is on a devastating trajectory which only radical intervention will forestall.

Vallance told the Science and Technology select committee: "The R remains above one everywhere, the epidemic continues to grow." Whitty added: "You don't need that much modelling to show you that we are on an exponential rise" - with deaths, hospitalisations and cases already rising rapidly. He conceded there is some evidence of a slowing epidemic, particularly in the North East and to some extent the North West. But - "the trouble about things doubling is you move from a few to many cases very quickly." Vallance said there is a serious risk of hospitals being overrun "if nothing is done".

Comment: You don't need much modelling in order to be a complete and utter idiot, and liar, to boot.

One issue, it appears, is that the R is mainly levelling off in younger age groups. "My hope is that it is levelling off in older ages as well," Whitty said, but added there is no data to confirm this hope and it would be "very imprudent" to act on this since it is this group who will need hospital care. Spot the insidious precautionary principle again. And why would it fall among younger people and not, sooner or later, among the older? Besides, there is no particular reason that this winter should be any less deadly for older people than earlier winters. Recall that 2020 has so far seen fewer deaths than each of the years between 1993 and 2000.

Oddly, Whitty claimed that lockdowns mean people will be more likely to be treated for other health conditions rather than less. "The way you prevent those services from being impinged on or in some cases cancelled is by keeping Covid cases down," he told MPs.

Whitty and Vallance defended their models and the graphs they had displayed on Saturday, denying they were trying to frighten people. Whitty said: "There is a danger with these extreme forward projections that people misinterpret them as 'this is going to happen' and get unduly worried about something that is not intended to happen. The whole point of a reasonable worst case scenario is to say, 'Right, we're going to do something to stop this happening.'"

Comment: Manipulative liars. They are showing worst-case scenarios to frighten people. And by showing such outrageous numbers, they are setting themselves up to run a victory lap for successfully avoiding their own worst case predictions, which only ever existed in their own twisted imaginations.

Vallance added: "We went through this a bit on the September 20th, when we said we thought we could be heading to 50,000 cases a day if we had a doubling and that deaths might reach 200. It was there to give a scenario. As it happened, the numbers turned out to be pretty close by the time we got there, so it's very difficult to project forwards in a way that doesn't inevitably lead to a problem of 'Is that real?' No, it's not real, it's a model... These are not forecasts, they are models that tell you how things should look."

This is drivel, not least because it seems to define the purpose of a model as making unreal predictions of the future (which may in fact explain a lot). But if, as Whitty says, a model scenario is something about which something must be done to prevent it from happening then it is unavoidably a prediction, otherwise why must something be done? And if nothing is done and it does not come to pass then the prediction is flatly wrong.

Vallance is also being misleading to claim his 50,000 "cases" by October 13th was "pretty close": the seven-day average on that day was 16,228, less than a third of the prediction, which no action had been taken to avert (switching to another measure of "cases" such as the ONS survey is an invalid move as it was clear at the time he was talking about the daily reported "cases"). Likewise, Saturday's 4,000 deaths scenario which included 1,000 deaths by the start of November, but for which averting action obviously had not have been taken, was demonstrably a failure.

Tom Goodenough in the Spectator says the pair's defence "makes sense". I can only think we must have been listening to different people. But it shows how easily people can be convinced by fine-sounding words even when they are nonsense.

MPs pressed the scientists on publishing the models. Vallance said: "The assumptions underlying the models will be published in full," adding that the intention is to publish all the data as soon as possible. How far in advance of the vote, though? Defending the model, he said: "It's not at all fair to say it's discredited. I think the right graphs to focus on in terms of forward projections are the six-week forward projections and to base it on the data today which shows where things are in hospitals at the moment which are filling up." Indeed, just like they do every October. And as we now know, not any worse than normal.

Whitty conceded test and trace only really works for smaller outbreaks: "Even under optimal conditions, test and trace will do much better in lower conditions." The lockdown will allow the test and trace system to work more effectively, he argued. Though even then, test and trace is just one element that needs to be in place, he says - though didn't specify what else was required. Some sort of ongoing restrictions, presumably, somewhat undermining the Government's latest line that mass testing will let us get back to normal.

On whether SAGE looks at economic questions, Vallance was blunt: "We don't. That's not the role of SAGE. We have been very clear that this sits in the Treasury. We do not look at the economic impacts and we are not mandated to do so." Odd that this was having to be clarified to MPs in November, showing again the opacity in the way Government has operated during the pandemic. It also exposes why it is such a problem for Government to be committed to following "the science" when scientific advisers are taking a deliberately narrow view. We also need to ask why the Scientific Advisory Group for Emergencies is not looking at public health more widely instead of only one factor.

MPs asked about the aim of the lockdown, to which Whitty gave a vague and circular answer that it is to ensure there is a "realistic possibility" that restrictions can be lifted on December 2nd and that England will move to a "different state of play". He later added the Government's primary strategic goal is to reduce mortality, though said this is one of many, including protecting the economy. So that's clear then. No criteria of success were given, or any sense of how it will be assessed.

Vallance called lockdown a "blunt instrument" and admitted they "do not have good evidence on the exact value of each intervention on R". Pressed about church closures in particular, Whitty bizarrely argued that although churches may be following social distancing guidelines, the problem is when people congregate outside after a service. Ah yes, a known hotbed of Covid super-spreading.

Whitty and Vallance both laid into the Great Barrington Declaration. Whitty said he means "no disrespect" to the experts involved (and not forgetting Vallance was an enthusiastic advocate in March) but he considers the plans to be "dangerously flawed, impractical and ethically really difficult". The biggest weakness, he says, is the starting point that herd immunity will inevitably be acquired if you leave it long enough. This, he says, is not the case for most of the diseases he has worked on, including malaria, HIV and Ebola. Surely he knows that these are completely different kinds of disease and malaria isn't even a virus? Herd immunity "never occurs" he says. "The idea that this is a fundamental thing is simply incorrect." I somehow think three of the world's leading epidemiologists know what they're talking about better than Chris "herd immunity never occurs" Whitty.

The second problem, he says, is it is "practically not possible" to identify and shield the vulnerable population. "Theoretically that is attractive, but the idea you can do that and for year after year is simply impractical. We have looked at this, everyone says what a great idea until you look at the practicalities." (Er, the NHS identified those most at risk in March and they were told to self-isolate.) But no one is saying you should do it "year after year", just until the epidemic passes, say around two-three months, until there is widespread immunity.

His third reason, he says, is that very large numbers of people would die if you had any hope of achieving some sort of herd immunity, as this would require up 70 per cent of the population to contract Covid. This once again shows an ignorance or rejection of the evidence for pre-existing T-cell immunity.

Vallance added that even if you were able to totally shield those at most risk, you would still see a significant number of deaths in younger people. This seems to suggest he is unaware that the death rate in younger people is minuscule, less than 0.05%. He threw in the "long Covid" argument too, for good measure. He also said multi-generational households are common in the UK, especially in some of the communities hardest hit by Covid, making it hard for the young and old to remain separate. This seems pure defeatism, as solving this problem would surely be far cheaper and easier than everything else we've been doing.

Most disappointing, I think, was the lack of any challenge from MPs about putting the current situation in the context of hospital capacity and a normal autumn and winter. MPs should be demanding these figures be published routinely so the full picture can be known and scrutinised. We shouldn't have to rely on leaks - that's no way to run a democracy.