Humanity is not a Herd
The Great Barrington is a place name in Massachusetts. It is the home of the American Institute for Economic Research (AIER), which describes itself on its website as: “Founded in 1933, American Institute for Economic Research educates Americans on the value of personal freedom, free enterprise, property rights, limited government and sound money.” It has the aim of promoting its ideas through the Bastiat Society, targeting specifically the business community throughout the world.
The Great Barrington has come to prominence in the UK suddenly, following the delivery of the Great Barrington Declaration on COVID-19, signed by three epidemiologists, and supported by other specialists. The Great Barrington thesis is not advocating orthodoxy, at least as currently interpreted by mainstream epidemiology to most governments throughout the world. The Declaration is here. Much of it seems eminently reasonable, and probably easily reconciled with conventional opinion. Yet it is unquestionably radical, and this comes to the surface here in its change of focus on the problem of solving the coronavirus conundrum for nation states throughout the world: “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”
This policy is not pursued by most governments throughout the world. It is striking that the unstated sub-text of the Declaration to achieve these aims is implicitly to open up the economy fully, and return to ‘normal’ business, work and activity, without mentioning either the economy very explicitly in the Declaration, or providing a statement of the fundamental principles of the AIER that sponsors the Declaration.
The Great Barrington Declaration has been challenged by mainstream scientific and medical opinion. C4 News interviewed Professor Devi Sridhar, Professor and Chair of Global Public Health at the University of Edinburgh on its proposals, and her response was to say she did not agree with the Declaration, and did not believe it was “scientific” or “accurate”. Matt Frei, who conducted this interview with Professor Sridhar went on to interview an advocate of the Declaration, Professor Livermore; who did mention the economy. The problem came with Professor Livermore’s reply to Matt Frei’s striking and telling observation; “…the problem surely is that the path to this ‘herd immunity’ is just paved with too many corpses?”. Livermore hesitated, then said he wasn’t “convinced” by the current policy. Lack of conviction is one thing, but convincing the public requires a great deal more than subjective conviction and sweeping Declarations.
I am not an epidemiologist, but I am affected by such policies, just like everyone else. I need to see the substance, not the rhetoric. The Declaration does not provide detailed evidence, or circulate comprehensive research. It is a statement of policy. The problem is threefold: first, if the prevailing view in epidemiology is wrong we will all certainly suffer further hardship in the struggle to protect life, but if the Great Barrington thesis is adopted and subsequently found to be wrong the result, as far as I can see is utterly catastrophic for human life. There were around 65,000 excess deaths in the UK following the initial wave of coronavirus; that is excess deaths above the five year average of all UK deaths in the relevant months taking into account all the flus, cancers etc., combined. There, is the real balance of risk. This is what it means to face a real pandemic in our lifetime.
Second, the Great Barrington thesis presents the dichotomy as a choice between the economy and the health of the vulnerable or elderly. This is a false distinction. As the countries who have tackled this problem best (principally in the far east, like Taiwan; and with a functioning, highly efficient public health Test and Trace system that is not merely an exercise in rent-seeking neoliberal opportunism, as in Westminster), have shown; success for both public health and the economy appears to depend rather on rigorous application of the current prevailing principles as the only realistic way to ensure a prospering economy can be recovered in time. The problem here in the UK that makes this especially difficult, is the end of furlough and the lack of adequate financial support; combined with a Test and Trace system that is fit for purpose. Test and Trace should never have been privatised. Local Public Health operations was always the only reliable, proven solution. For example, the best way to ensure that everyone self-isolates after a positive test, is to ensure there is an immediate, favourable, emergency financial package of publicly funded support for the individual/family through the seven or fourteen days of self-isolation. In national economic terms that is cheaper than the alternative.
Third, the Great Barrington thesis presents the concept of ‘protecting the vulnerable’ as if this was deliverable in a society rife with coronavirus. They explain how this is to be done only in very general terms, without working out the implications of the consequences of their own proposals on these aspirations: “By way of example, nursing homes should use staff with acquired immunity”. How do we do that if there are not enough staff who meet the criterion; and what evidence do we have that anybody has definitely acquired “immunity” from COVID-19? What is the time scale for the achievement of this outcome? How de we arrive at this outcome without disaster before it works, if it ever works? It seems that the Declaration assumes it has achieved its goal, before it has even begun.
The outcome of separating off the vulnerable from society is simply to exclude them. Their fate is the fate of care homes at the beginning of the pandemic; they are separated in order to be forgotten. The ‘protection’ is simply another word for exclusion; an opportunity to leave people to their fate. We have a long history of failure to attend to people put in care in this country; over generations. We have been ‘found out’ time after time; by Charles Dickens, to look no further back. Need I cite the tragedies that have affected the infirm, children or the elderly as exposed by harrowing accounts of the abused in Britain, over decades? We produce reports and hand-wringing, but we have never shown in Britain the least capacity or even the real wish, to learn anything at all. I would sup on such claims to special protection, with a very long spoon.
The ‘protected’ over time will be treated as an irritant, then they will become pariahs; the untouchables. The Great Barrington thesis is not an advocacy of individual liberty, but rather, far more the promotion of tyranny; consciously, or more likely unconsciously. The road to hell provides the paradigm. The liberty of the vulnerable depends on the close support of those who are younger, healthy and able. The vulnerable will otherwise be left to their own devices, and they have none.
Humanity is not a herd; that is the first principle of liberty.
Beautifully written and spot on in terms of analysis.
The advocates of market chaos (they call it the “free” market) will always value profit for the super rich few over safety of the many.
Clearly those born into wealth and privilege are now finding it mighty irritating that the economy we all sustain is no longer the ever-giving cash cow they have milked to the full for so long.
Ironically it is the same rich-boy, toff self-selecting elite who share the market chaos beliefs of the Barrington report who have made such a mess of handling Covid 19 in this country. Bojo the clown and his lah-de-dah buddies have brought us nothing but a very unfunny comedy of errors that is a disaster for the people and economy of this country alike.
Hi Mr S Warren, you well express the emerging accepted main stream view about all this. But this analysis seems lacking in a number of areas.
Even if you accept that Covid-19 is directly responsible for 65k excess deaths in the UK (and remember, correlation does not equal causation) the World Bank has just reported that: “COVID-19 to Add as Many as 150 Million Extreme Poor by 2021”. I will not post the link as when I include links in posts to Bella my posts often seem to get blocked! Search for the title and you will find the article. The article states that the economic impact of Covid is driving tens of millions of people into poverty. I think we can all agree the poverty is well recognised as a fundamental cause of Ill heath and low life expectancy (early death! ). How do you reconcile saving lives with lockdowns that are massively increasing poverty and hurting (and ultimately killing) the economically vulnerable?
Also, I’ve seen this idea a few times now (The Guardian, BBC etc, and now stated in your article above) that trying to protect the vulnerable is futile. An yet that is what all the social distancing and sanatising measures in place are designed to do. Are you suggesting that we drop these measures?
Yours as ever, the anonymous, and therefore obviously a troll, Michael
‘How do you reconcile saving lives with lockdowns that are massively increasing poverty and hurting (and ultimately killing) the economically vulnerable?’
You can’t. It’s a moral dilemma. You can’t reconcile moral dilemmas.
So it very much looks like we are choosing to save a few thousands or tens of thousands of those near their natural end of life and sacrifice the welfare of millions, all while normalizing extraordinary invasive policies. It is deeply worrying.
No, it looks more like we’re trying to control the rate at which infection spreads through the population so that we can (hopefully) achieve herd immunity without our infrastructure being overwhelmed.
And what are these extraordinary policies you claim are being ‘normalised’? And in what ways are they ‘invasive’?
…I can’t think of any other time in history when there was a blanket law making it illegal to invite family and friends into one’s home. Mass forced closure of small businesses. Unprecedented state power to intrude into our lives. Marginal cash businesses not recived government support. While those fully integrated into the utterly corrupt baking system (especially the big corporations) reciving huge hand outs to keep afloat. We are seeing a massive shift in the financial /business world towards complete dependants and oversight on and by the global banking system – joy of joys.
Since the 1340s onward, every pandemic in the West has been accompanied by the implementation of health regulations for its confinement. Isolating the infected was one of the measures practised in early modern Europe; a number of Italian city-states established general quarantines, such as that recorded by Giovanni Boccaccio in The Decameron, and the practice of general confinement was frequently adopted by the European maritime powers like England and France during the 16th to the 18th centuries. London’s great plague of 1665, and the Marseilles outbreak in 1720, convinced European administrations to enforce isolation measures in order to slow the spread of deadly diseases from overseas.
Quarantine measures in early modern Europe also served an ideological function, enabling the emerging European states to elevate public welfare over the private lives of individual subjects. In fact, quarantine powers weren’t relaxed until the mid-19th century when the rise of liberalism rebalanced government in favour of laissez-faire again.
So, the use of general quarantine measures to control the spread of infection is hardly unprecedented. But you were also saying that we’re ‘normalising’ these extraordinary measures… Where’s the evidence for that?
I’m sure quarantine measures have been used widely throughout history, as you say. But it is not clear to me, from what you have said, that we’ve ever had anything on the scale, or as blanket, as we are experiencing now. And certainly never before within the context of such a technologically centralised and repressive global financial system… and quarantine measures are only a part of the worrying policies being rolled out, that I mentioned.
In terms of normalisation, you say yourself that in the past when these kind of measures have been adopted they have been used for political reasons over long periods and only relaxed when oposed by countering political/economic forces.
If lockdowns had been implemented in Feb (when it would have been useful) to provide time for data to be gathered and a sensible strategy developed, I could understand it. But to now have rolling lockdowns with the MSM and Bella etc seeding the idea that is is all for the best and will likely go on into 2021 and beyond – essentially until a vaccine is developed (which history strongly suggests there is no garuntee of or that any vaccine can be proven to be safe without long and extensive trials) seems very worrying to me. Were is the wider debate about the damage lockdowns are doing? Where is the scientific inquiry? Where is the data? We’re is the open discussion and listening to people’s legitimate concerns? There is abounded evidence to suggest that we are being normalised into an ongoing state of bio-fear, and insane policies that will be justified based on this.
I can tell you like a good debate. But I sense that we have differering opinions and interpretations of the “facts”, as they are curated and managed. And I don’t want to waste my time getting into a useless tit for tat. But please do tell me, are you not concerned by any of the political implications of what is going on under cloaked of “keeping us safe”?
Judging from the media coverage, there’s a huge amount of research into and open debate about the harm that the measures we’re taking to manage the spread of the virus are having on our so-called ‘mental health’. Seldom an hour goes by without some business proprietor girning about the damage we’re doing to our businesses, especially in the arts and hospitality sectors. Both the CBI and the TUC have been vocal in their apocalyptic propheteering. And WHO, no less, has recently been questioning the whirlwind of economic damage the poor will reap from the measures we’re taking.
You simply repeat that there is ‘abundant evidence to suggest that we are being normalised into an ongoing state of bio-fear’. So, I’ll simply ask again: what is this evidence? I know you’ve said you don’t go in for argument or evidence; but if you can’t substantiate your claim that we’re being so normalised, I’ve no reason to be afraid. Without evidence, it’s just another scare-story.
I’d be surprised if we didn’t differ in our respective curation of ‘the facts’. In fact, if we didn’t, my whole philosophical world, in which dissensus is the ‘natural order of things’, would come crashing down about my ears.
I’m not overly concerned about the ongoing tension between our social security and our individual liberty; that’s the tension that drives, has always driven, and will always drive the dynamic of democracy. Heraclitus forfend that this vital dilemma should ever be resolved. The prospect of that ever happening would concern me.
“Both the CBI and the TUC have been vocal in their apocalyptic propheteering. And WHO…” I guess we’ll see how prophetic they are when the job losses and economic hardships starts to really bite. And yet these concerns are seeemly being sidelined as we enter more lockdowns measures and restrictions on economic activity, job losses etc. For raising these simple concerns I feel I have been demonised here. Not that bothers me, but I find worrying that the Bella readership are so closed minded. But that is as it is.
“I know you’ve said you don’t go in for argument or evidence…” this is just low. I’d like to think that if we were chatting about this in the pub that you would not stoop to such retorical tactics. I disagree with John that it is anonymity that drives hostile debate online. But rather I think it is the public nature of the debate and that people get invested in being right and protect their reputation. I notice that in private conversations people are much more willing to try and understand and mover their position. Not so in public debate where the ego is on the line. At least, I have been aware that this can comes up for me!
The evidence for normalisation is all around us in the fact that we are living with continuing lockdowns and all the extraordinary measures, with little likelyhood of them being reversed anytime soon – that is the message I take from much of the official statements That this is the new normal. And much of the “alternative media” clamouring for it! And I say again, you provided historic examples of these kinds of measures being normalised. It seems self evident to me. Especially given the wider context of technologically and financial transformation of global society that is underway. The evidence is our lived experience and the trajectory of official retoric and policy. We’ll see I suppose.
Thanks for the discussion…
Yep, the world is changing all the time, as it has always done. The fact that you can’t step into the same river once, as Cratylus is reputed to have said, makes the very notion of ‘normal’ a bit of a nonsense.
For my part, the greater concern is nationalism. As a general rule, it would be much safer, with regard to both our social security and one’s individual liberty, for risk assessments to be made and mitigations decided locally rather than nationally. Balances need to be struck in our ‘real’ communities between the risks presented to our security by, for example, biohazards like the most recently discovered coronavirus and the risks presented to our liberty by, for example, the coercive measures we take to mitigate the risks to our security. The risk factors vary from community to community; it follows, therefore, that so too will the mitigations that are required.
The problem is that, since devolution at least, our local infrastructures for the identification, assessment, and mitigation of security risks has been nationalised, and we have consequently lost much of our capacity for the kind of localism that our response to the current emergency calls for. It has also rendered impossible the achievement of the optimal balancing of our security and our liberty that democracy demands.
Some acknowledgement of this has been made in the announcement by the nationalist administrations in both Westminster and Holyrood of a ‘tiered’ system of local quarantining to mitigate the risk to our liberty in localities where the risk to our security is comparatively less than in other localities. The system in England doesn’t disperse power nearly widely enough, and I suspect the system that the Scottish government hands down to us won’t either, but at least it’s a step in the right direction – a wee chink in the concentration of coercive power in national centres of government in this country.
Indeed. If the nature of reality is something like an ocean of awareness giving rise to the surface ripples of temporary dulistic experience, then all efforts, especially to control and dominate, are at best temporary, and probably a completely misplaced waste of time. But still, all the world is but a stage and it is incumbent on us to do our best.
I like your ‘ocean of awareness’ metaphor. Its radical empiricism offers a useful heuristic in the realisation of one’s autonomy; that is, one’s capacity to think and make decisions for oneself and thereby have some degree of control or power over the events that unfold within one’s everyday life towards death.
Given the ultimate meaninglessness of existence, which, for each and every one of us, dissolves in death back into the nothingness from which we emerged at our birth, everything except what one makes of the short span of one’s experience is valueless and a waste of that time. This is it, my friend – your life; use it or lose it, it’s entirely up to you.
But then you go and spoil it all by admixing your metaphor with another, confuting this ‘ocean’ with a ‘stage’, which is altogether a quite different thing, missing crucially the vast and unfathomable formlessness that an ocean has and suggesting crucially the possibility of rehearsal time and a run of performances.
Shucks. You just can’t please some people! I disagree that life is meaningless. The realization that we are at one and the same time the ocean and the ripple means that we are both powerful and everlasting and vulnerable and temporary. Always here and always passing through. Unlimited opportunities to practice. But also we have to realize that every thought, sound and action we procedure has consequences – is meaningful. This realization of course takes much more courage to come to terms with than the view that life is ultimately meaningless.
I made friends with a professor of philosophy at Delhi University when I was in India and he had this lovely phrase: “Western philosophy stops where experience beings. Easter philology goes into the experience”. Ultimately a discussion like we are having can only go so far using the limited medium of concepts and language. I have enjoyed you insightful conceptual take on things and your elegance as an accomplished wordsmith. But often our strengths can also be our greatest limitations!
If you are interested in this kind of discussion I suggest the following presentation by, Alan Wallace, who is I think one of the brightest and accomplished minds of our time (and happens to be a Scot!) – The Nature of Reality: A Dialogue Between a Buddhist Scholar and a Theoretical Physicist: https://youtu.be/pLbSlC0Pucw?t=1448
Yep, you’re right to disagree that life’s meaningless per se. It’s meaningless only ultimately, from the point of view of eternity. From the point of view of one’s own historicity, life can have whatever meaning one gives it. That’s the principle of autonomy. That’s what, as the sons and daughters of Europa, we’re trying to realise.
I think you may be on to something with your pragmatic theory of meaning; namely that the meaning of any event consists ‘finally’ in its consequences rather than ‘effectively’ in its causes. Historically, that theory emerged itself as a consequence of the radical empiricism of David Hume. It’s certainly a theory that would be worth running with, to see where it takes you in experience.
I’d have to disagree with your Delhiite professor. Western philosophy (or just ‘philosophy’, since philosophy is a peculiarly Western phenomenon that we’ve since extended as part of our cultural hegemony across the rest of the world) begins with experience and, from there, excavates and tests the coherence of the conceptual structures by which, through language, we process that experience into a ‘world’.
Consider, for example, this present thread, which begins with our respective experiences of and dissatisfaction with the measures by which, as a society, we’re managing the spread of a new and potentially dangerous virus, and which has ended up here, with an examination of some of the concepts by which we inform those respective experiences. This is philosophy we’re doing. I don’t know what on Earth your Delhiite professor was doing when he claimed to be doing philosophy; some pre-Kantian thing, perhaps.
I expect you mean that the linguistic label of Philosophy (from Greek philosophia, ‘love of wisdom’ – the study of general and fundamental questions about existence, knowledge, values, reason, mind, and language) orientated in the west. I don’t think you mean that we, in the west, had a monopoly over the ‘love of wisdom’ until we spread it to the east! The historical evidence doesn’t really support this 🙂
What I understood from my Prof friend is that in the west, traditionally, the approach to developing and exploring “wisdom” (the nature of existence etc) has been through conceptual and linguistic means, where as in the east the focus has tended to be on developing techniques for enabling direct experiential exploration, with a recognition of the limitation of the conceptual thought and language.
PS. I think a much more useful term than “meaningless” is the translation often used by eastern practitioners: “emptiness”. It is much less value-laden and does a better job of pointing to the non-dualistic nature that it is pertaining to.
Yep, though the West has its mystical traditions as well; and the respective values in Greek and Sanskrit that we appropriate through translation as ‘wisdom’ are different; the cultural values we lump together under our ‘wisdom’ are ‘sound judgement’ and ‘self-awareness’ respectively. This conflation, incidentally, leads to all kinds of confusion.
PS Perhaps ‘colonised’ is a better term than ‘appropriated’.
And I agree: ’emptiness’ and ‘meaningless’ certainly convey different connotative values.
It doesn’t really help you escape dualism, though. ‘Emptiness’ itself still only has differential meaning; that is, it has meaning only in contrast to a binary opposite.
Yes, I agree. Hence the need to eventually do away with a conceptual approach. Though a supportive conceptual framework is necessary.
And re wisdom… point taken. Wisdom is not the word I would have used but it is the word often used in the definitions..
‘A conceptual approach’ to what?
Pandemics do not offer cost-free solutions. They bring only difficulty and suffering, of one kind of another. It is a matter of selecting the least worst priorities from difficult choices. You have not demonstrated that there are not huge risks in following the Great Barrington Declaration. If all you can hang on the 65,000 deaths is that it is a correlation, then what you offer is frankly insufficient. You offer less reliable information than we already have; and you do not answer the challenge of protecting the vulnerable. Few in the care sector appear to believe in the Declaration case. I do not wish to change anything I have said.
I think the case you make is slight and unconvincing. Why you need anonymity to make your point I neither know, nor frankly much care; but it is scarcely a compelling advertisement for your conviction in your own case. If you are not even prepared to stand openly behind your own opinion, why should I give it much credence?
I will add this, from the Guardian: “In a paper last month, the Scientific Advisory Group for Emergencies (Sage) told ministers that most people in the UK who had Covid-19 or who had been exposed to somebody who had tested positive fail to fully self-isolate. A lack of financial support and the erosion of public trust had contributed to these findings, scientists interviewed by the Guardian said. It was becoming clear that Covid-19 was a disease of poverty and vulnerability, Prof Mckee [the professor of European public health at the London School of Hygiene and Tropical Medicine] said, adding that years of austerity had taken their toll on the UK’s ability to absorb shocks in comparison with Nordic countries.”
No doubt you do not rate this scientific-medical advice, but it seems to me a great deal more persuasive than the sources on which you rely.
I’d agree with that analysis about money, or lack of it, being a factor.
My daughter , who lost two (zero-hours) jobs and then her own flat to Covid measures, is now forced to work in a pub three nights a week and then return to the parental home. Us oldies are fearful of catching the illness, but should we tell her to give up her only income in return for a roof over her head?
Your personal example underscores and important point. There is too much pressure on people least able to observe the public health restrictions to ignore or bend the rules, simply to retain an income, or to rely on people who are themselves at risk. We have a public policy in the UK that is big on the aspirations of Government demanding onerous rules of people without the resources to deliver, but a Government that fails to deliver on the required resources to ensure they are achieved. It is grotesque that this failure is deemed acceptable to defend a wholly discredited neoliberal theory of money and debt. Governments always have the capacity to use all means to defend the security and well-being of the people they govern. It is not only war that requires the Government to rise to the occasion. This is a national crisis, and the Government is failing in its fundamental duty to protect its people.
Dear Mr J.S. Warren, thank you for your considered reply. However you missed the aim of my comment. It was not my aim to make an argument and provide any evidence. This should have been obvious. Regrading you barbs about anonymity, I find your position deeply unthought through. Trying to make an issue out of how I choose to identify here is essentially an example of attacking the man rather than focusing on the issue. There are many people who might require anonymity to be able to speak freely online – I can think of many legitimate scenarios. But you use it as a mechanism to try and discredit my comments – ridiculous. Even if you knew my last name it would not make me any less anonymous to you. Anyway, due to some technical and social reasons I am probably one of the least anonymous people posting here. But if it bothers you so much, please provide your postal address here and I will be happy to correspond by mail.
You raised the issue of trolling, remember? I didn’t; I merely responded to your attempt to start this argument by suggesting you would be considered a troll; reluctantly in fact, but I am frankly tired of this kind of miserable guff on social media. This is a standard method of trolls,even if you are not. You have, indeed merely demonstrated that you are much more eager to talk about this than the real matter at hand; your comments are mere low-grade disruption, and a complete waste of everybody’s time: “It was not my aim to make an argument and provide any evidence”: that is what you wrote. Well, you are right about that. No argument, and no evidence. You provided precisely nothing, save rhetorical waffle.
As for those who require anonymity to comment online? Indeed there are whistleblowers in critical areas of life who have powerful reasons both to speak out and remain anonymous. Usually they make their predicament clear, and it is quite understandable. You have presented no evidence whatsoever to suggest that there is any good reason for your anonymity. It is not as if you are revealing a scandal to the world, you are merely commenting on a public matter that is widely contested. So what? Lacking a serious reason to remain anonymous, I have no idea and less interest why you wish to be anonymous; but you have so little of genuine interest to say on the matter at hand, I think I can understand that you do not care to acknowledge ownership: because who cares about argumentative guff?
There is really no more to be said. By all means go on venting your opinion here, I have lost interest.
Our current strategy seems eminently sensible: we can’t stop the infection spreading, so we need to slow the rate at which it spreads in order to reduce the risk of our health services and other functional aspects of our society being overwhelmed. This is the tried and tested strategy we already follow as a matter of course with other viral infections, like flu.
The way we slow the spread is by erecting physical barriers to impede the virus’ progress through the population; that is, by practising good hygiene, including physical distancing, and by using PPE where physical distancing can’t be maintained.
This isn’t an alternative to developing herd immunity; it’s a means of developing herd immunity through infection in a controlled way. The infection will still spread through the population, building immunity on the way (we hope! – we still don’t know whether people who’ve had the infection are thereby immune from further infection or how the virus might mutate and thereby become immune to any immunity we might develop), but the level of illness that results from its slower spread through the population will be more manageable economically than the level that would ensue from its rapid spread.
Neither is the development of herd immunity an alternative to slowing the spread of the infection. Herd immunity occurs when a large portion of a population (the ‘herd’) becomes immune to a disease, making the spread of disease from person to person less likely. As a result, the whole herd becomes protected, including those who remain vulnerable to illness, and not just those who are immune.
We need to stop thinking about the management of the pandemic as an ‘either/or’ between slowing the rate of the virus’ spread and developing herd immunity. The former is a means of developing herd immunity in a controlled way; the latter is a means of minimising the rate of the virus’ spread through the population. It seems that this virus, and/or subsequent mutations thereof, is going away any time soon. We need to stop engaging in manufactured disputes and learn instead how to live with it as safely as we can.
I agree with most of what you say.
Other than: “The problem here in the UK that makes this especially difficult, is the end of furlough and the lack of adequate financial support; combined with a Test and Trace system that is fit for purpose. Test and Trace should never have been privatised.”
‘Test and Trace’ is not the system here in Scotland; we have ‘Test and Protect’ which has not been privatised. Also, I’m sure you mean ‘NOT fit for purpose.’
Read it again Nancy. He said; “The problem here in the UK …is…the lack of… a Test and Trace system that is fit for purpose.”
( I had to read it twice too)
Perhaps I should have phrased it differently. The problem is that the privatised UK national Test and Trace system, on which Scotland partly depends (because we are still in the Union and the UK has the bulk of the financial resources – by which I mean the capacity to issue money or borrow – because Scotland is not independent) does not work. Evetybody knows it has catastrophically failed. It is based on a far worse privatisation than the railways; and the rail franchises have failed so badly the Government has step in; constantly.
Ten years of austerity has destroyed much of the public health capacity we had in Britain to fight pandemics; and coronavirus demonstrates the disastrous nature of neoliberalism when it is actually faced with a crisis; an expensive privatisation fiasco. Neoliberalism is a fair-weather concept used principally to further the interests of rentierism; it is so weak and uncompetitive, it is scarcely even capitalism. There is no competition involved, not even to tender for the fat Government contracts. It is a scandal.
It seems I can no longer spell my own name……..
Sorry, Nancy! But the ‘testing’ part of NHS Scotland’s Test and Protect service is conducted through the UK government’s ‘privatised’ testing programme. The ‘protecting’ part is conducted through a tracing app that has been developed by a private company in the Republic of Ireland, in partnership with Amazon Web Services, using tools provided by Google and Apple.
Thank you Anndrais. My understanding is that the Test and Protect system in Scotland is overseen by Public Health Scotland, which might make a difference. It certainly seems to be running more efficiently than that in England.
Thank you also, John S Warren. I think the ‘fit for purpose’ sentence is a bit ambiguous; I see it can be read the way you meant it. In any case – a good article, thanks!
I hear that, as with NHS England’s Test and Trace programme, it’s currently at breaking point and is struggling to cope with the recent spike in demand.
Still, both governments are throwing cash at the staffing shortages in an attempt to increase tracing capacity. That’s reassuring!
I tend not to trust institutions that lie about what they are, what they want, who funds them and who profits from their policies.
These parasitic vermin will never come up with any plan that benefits public health.
If you work in education you might want to see this:
https://skwawkbox.org/2020/10/10/breaking-proof-govt-has-told-track-and-trace-agents-not-to-trace-contacts-of-school-staff-or-pupils-or-pass-details-to-local-health-teams/
Good article. Mr Warren always writes with clarity and produces well-reasoned arguments backed by evidence.
Wow, that is such a passive aggressive response. My joke about trolling was obviously a joke. There are many more reasons than being a whistleblower for wishing for anonymity – though, as I said, I’m not. And you don’t address any of my other points regarding your ridiculous attempt to discredit. Your use of your last name has not stopped you from being aggressive and avoiding useful discuss. Are you aware of the psychological concept of “projection”? My conclusion from my interactions with you are that you easily revert to personal attacks instead of entering in debate. You seem to be a very humourless and dogmatic individual. But that is, of course, your prerogative.
Yawwwwnnnnn !!!
I have not returned here in order to participate in further discussion. If your remark was a joke then I with draw my comment, since it appears to have been unwarranted; but the context is that I detest anonymity because I believe it has ruined social media. I have taken this up several times on other threads. Trolls could only survive under the invisibility cloak of anonymity. Anonymity has destroyed open, honest discussion on social media. Pre-social media editors of newspapers would rarely publish anonymous letters; rightly in my view. I have already explained the exceptions.
Generally I attempt to write considered articles and make the extra effort to participate with commenters in below-the-line discussion; it is what social media is for. I do not expect everyone to agree with me, and frankly I do not much care whether people notice the writer at all, or what people think of me; the matter at hand is why I am here. The issues, generally are serious and I have limited time to scan the comments: I seek comments that attempt to engage, and respond in robust discussion. I think your expectations of my close reading of your remarks (no argument, no evidence), but demanding I notice your “obvious” joke (that was a joke?), suggests over-sensitivity, if not borderline narcissism. Do I have a sense of humour? Well I made a joke at my own expense, as I mistyped my own name. Was it funny? Probably not. The issue at hand, however was a serious one, and I was assuming serious engagement.
I think if I am to learn a lesson from this exchange it is that I should write the article, and leave below-the-line comments entirely to themselves in future.
As a final comment… to be clear I have no feelings about your reading or not reading my comments. But you started on the personal attacks and I felt a responsibility to respond. Your accusation that I have “borderline narcissism” demonstrates well your strange way of engaging with readers – you claim to value debate, but in reality resort to personal insults. I’m interested in breaking out of my information bubble. But you seem highly sensitive when it comes to people offering up different views. Your position on anonymity is ridiculous and would seem to reflect your sheltered existence, rather than the reality of public debate. Mr J.S. Warren, I bid you good day.
Interesting… The appropriateness of anonymity seems to be dependent on the context in which it occurs. You shouldn’t write it off altogether, John.
The essential purpose of anonymity is that a nameless person remains non-identifiable. Anonymity can thus be a way of realising certain other values, such as privacy or liberty.
Anonymity is required by free elections. It’s also customarily accepted in transactions, such as casual conversations between strangers, buying/selling some product or service, or formal argument, where the identities of the agents are of no significance to the matter being transacted. Acts of charity can be performed anonymously when benefactors do not wish to detract from the selfless nature of the act. People who feel threatened might attempt to mitigate that perceived threat through anonymity, such as when we call helplines or commit punishable acts. In such contexts, the perception of threat might be well-founded, but it might equally be a product of fantasy or paranoia or the famous ‘invisible man’ syndrome, in which presenting oneself as invisible is a way of drawing attention to oneself and making oneself feel more important than one objectively is.
Psychologically, by mitigating the threat of punishment, anonymity can also reduce the accountability one perceives to have for one’s actions. This can have dramatic effects, both useful and harmful, on the various parties involved. It can foster a reckless sense of invulnerability; on the other hand, it can liberate one from disabling feelings of guilt.
The pathology of this ‘escape’ is explored most perceptively by Dostoevsky in his great psychological novel, Notes from the Underground. In many respects, its anonymous narrator is psychologically the archetypal ‘troll’.
Sorry! That should read, ‘The pathology of this ‘escape’ from accountability is explored…’
It is striking that suddenly; not in Scotland, but in North West England there is serious resistance to the lockdown from the Mayors of Manchester and Liverpool. This provides unexpectedly tough political resistance within England, which we know is determined because the PM is reduced to claiming that he is “negotiating”. This also underscores the degree of anger in the country with Government inadequacy. The resistance is not to the principle of lockdown, as I understand it, but because the appropriate resources to carry out the lockdown are not being supplied by the British Government, in the areas of economics and Test and Trace. This last point is too conveniently lost in the hasty political point-scoring by critics of the resistance.
This unhappy situation in the north of England, in fact provides a critical insight into the gap between a Britsh government driven solely by neoliberal ideology in everything it does, and its collision with hard realities in a crisis it does not understand, and for which neoliberalism provides no answers. I tried to highlight the hard realities the British Government had failed to face in the article, covering the two key policy failures of the British government during the pandemic: first, the failure to supply the required economic resources (finance) to allow lockdowns the best opportunity to be followed scrupulously, and successfully; worse, the Government actually proposed to end Furlough, the only mechanism they had provided that had even half-worked to this date. Second, the catastrophic privatisation of Test and Trace, from efficient local instrument of public health, into a hapless chaos of ‘private’ enterprise feeding off public contracts, has simply failed wholesale to provide the vital working (which means local public health managed) Test and Trace system required for a lockdown to succeed, or in order to execute the Government’s own expectations effectively.
The British Government is clearly out of its depth.
Our national governments are indeed clearly out of their depth! Imagine how much worse the performance of our test and trace/protect systems would be if they weren’t ‘privatised’. We need to take this opportunity to develop a less nationalised public health infrastructure on both sides of the putative border.
What is your evidence for this conclusion? There is not a single Public Health specialist I can think of who has commented on the matter, who agrees with you.
Precisely! I’ve no evidence for it. It’s a counterfactual claim, just like the claim that the system would have been better had its design and implementation not been ‘privatised’. There’s no way of proving whether it would or it wouldn’t.
Forgive me, but that is just sophistry. Evidence does not come with a guarantee; we rely on best available evidence. It is what we have in a crisis. This was an article about a difficult, serious public health, practical issue with major political implications; I think the thread has completely lost a sense of both focus and proportion.
From my perspective, you now have the floor, and the thread to yourself; good luck.
It’s not, you know; sophistry, that is. You’ve based your argument on a counterfactual claim. Counterfactual claims can’t be made good. That’s just a fact. The clue’s in the name: ‘counterfactual’.
It’s not a question of appealing to the ‘best available’ evidence. There’s simply no evidence to which one can appeal in justification of a counterfactual claim. That’s just a consequence of its counterfactuality. Because it’s counterfactual, you can no more produce any evidence in support of your claim than I could in support of its contrary.
This was indeed ‘an article about a difficult, serious public health, practical issue with major political implications’. We’ve examined the arguments you’ve presented in that article and discovered that one of its conclusions depends on the truth of a counterfactual claim; that is, a claim the truth or falsity of which can’t be determined. That’s a problem with the content of the article.
The standard philospohical text on counterfactuals, if I recall correctly is probably David Lewis, ‘Causation’ (1973). I am amazed you think your observation is relevant to the kind of claim I made. Indeed in the almost fifty years since Lewis, am I not correct in thinking the current prevailing view in philosophy is that counterfactuals probably do not provide a satisfactory analysis of causation? I confess I have not followed the development of the topic. I assume you have, since you write with such authority (you must be one); so you can explain the issue, and the technical philosophical problems counterfactuals face, at length. Please do so.
Speaking for myself, and remaining unconvinced by your ‘philosophical’ interpolation, without evidence; I currently think the very fact we are discussing this here, as if it adds anything of interest to the matter actually at hand shows that this thread has completely lost its way. That is my last word; but make yourself at home, I am sure you can make this thread your own with a full critical exposition of counterfactuals.
Incidentally, you wrote earlier in this thread, on current pandemic measures: “This isn’t an alternative to developing herd immunity; it’s a means of developing herd immunity through infection in a controlled way.” Yesterday the Guardian quoted the Head of the WHO, Tedros Adhanom Ghebreyesus: “Herd immunity is achieved by protecting people from a virus, not by exposing them to it,” Tedros said. “Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic.”
You will understand if I am more persuaded by the WHO.
Well, the last time I had anything to do with counterfactuals was before 1983, but I’ll see what I can remember.
Counterfactuals are conditional sentences that express propositions about things as they might have been but aren’t so in fact: e.g. ‘If the design and implementation of our test and trace/protect systems hadn’t been privatised, they would have worked better.’
The formal problem with counterfactuals is that they can’t be evaluated as truth-functional conditionals. This is because a counterfactual can be true regardless of whether its antecedent is true or false. Thus, a counterfactual and its contrary can both be true, which violates the law of non-contradiction, one of the three fundamental axiomatic rules upon which rational discourse is based.
This formal problem was first identified by Nelson Goodman in the 1940s and further clarified by Willard Quine in the 1960s. David Lewis offered a formal solution to the problem in the 1970s by inventing the logical device of ‘possible worlds’. I believe the jury’s still out on Lewis’ proposed solution, but my studies led me elsewhere and I never followed the dispute.
The material problem with counterfactuals (which is the one on which I based my criticism of your article) is that there is no possible evidence against which the truth or falsity of a counterfactual could be tested. The fact is that the design and implementation of our test and trace/protect systems WERE privatised, and there’s in fact no world in which we could gather evidence of what the consequences would have been if they HADN’T been privatised, even if there might be (following Lewis) in logical principle.
There, that’s not bad, I think. The auld memory isn’t quite shot yet.
“The fact is that the design and implementation of our test and trace/protect systems WERE privatised, and there’s in fact no world in which we could gather evidence of what the consequences would have been if they HADN’T been privatised, even if there might be (following Lewis) in logical principle.”
Public health in Scotland has been operating both the national UK Test and Trace system and its local Test and Protect system, which was never privatised. The Test and Protect system works much better because there is long established Public Health management and control, and local tracing system in operation. That disparity in performance is at least is the consensus professional view. The comparison, is therefore between a new and unproven privatised system that everybody knows has failed to perform, against the whole history of public health operations which produced the local system of Public Health throughout the UK in order, inter alia, to fight pandemics, and which was dismantled from around 2007-8 in England for reasons solely of austerity. There is virtually nobody in the Public Health field, in England or Scotland who does not believe it would be much better if Test and Trace operated as a local network; based on experience of Public Health that is long established and proved. This is nothing like the examples of counterfactuals in philosophical texts, which are either expressed in the form of formal logic, without context, or examples like nuclear war (where there is virtually no consequential evidence available, save Japan in 1945 – I am fairly sure nuclear war was a Lewis example).
Your argument does not apply. As I pointed out the world has a long history of Public Health responses on which to draw sound conclusions; there is a comparison to be made; and privatisation has been found wanting.
Okay, let’s leave aside the fact that your counterfactual claim can’t be truth-functional.
You’re also saying a) that the English test and trace system has performed poorly, in comparison to the Scottish test and protect system and b) that the reason for this is that the English system is ‘privatised’ while the Scottish system is not.
Let’s consider b) first.
As I pointed out to Nancy above, the English system is no more or less ‘privatised’ than the Scottish system is. Both have been developed and implemented in partnership with commercial testing laboratories and tech companies; both rely on local Public Health health protection teams to manage those systems. Local authorities in England developed COVID-19 outbreak control plans back in June, supported by an additional £300m in public funding.
The problems that arose within the system in England weren’t due to the inclusion of the capacity of the commercial sector in our collective response to the public health emergency per se; they arose mainly because local directors of public health were initially unable to implement much of their plans because they were unable to access the necessary case-level data from commercial laboratories due to concerns surrounding data governance. This issue was resolved in July, when the UK government clarified the responsibilities of local government to control local outbreaks and devolved specific powers to support the development of local responses to rising case numbers or outbreaks.
(As I said to Michael: for my own part, in relation to the defence of our liberty and democracy as well as that of our biosecurity, this dispersal of power doesn’t go far enough, but it’s a start. However, this is by-the-by…)
There have been other problems too, on both sides of the political border: inadequate mass testing capacity, even with the mobilisation of commercial testing labs and the repurposing of other non-commercial facilities; technical shortcomings in the tracing tools our governments have commissioned; inadequate public compliance with the test and trace/protect regimes; etc.
But whether or not these problems have let to the system performing more poorly in England than in Scotland is a moot point and depends on the performance measures you employ. And at the end of the day, in the midst of a global public health crisis, does it really matter who’s got the bigger willie, us or the English?
We all need to increase our testing capacity, improve our tracing efficiency, and maintain physical barriers to slow the spread of the virus.
You have demonstrably been wrong on herd immunity, you tried to use counterfactuals where they do not apply and you are wrong about privatisation. Test and Trace is not run by a Public Health specialist, but Dido Harding – a management consultant, who does not appear either to have public health qualifications or medical experience. Private companies were brought in with no background in public health, still less in pandemics. Huge expenditure was wasted on botched Apps. This is an irresponsible way for any government to conduct Public Health in a crisis when there is a long established and proven Public Health system, based on a century of experience. Privatisation was done because the UK Government had dismantled the existing Public Health operations for reason of austerity. Local Public Health operations should never have been run down, and the new finacial resources could have been applied directly to them, because that is where the professional knowledge, the command and control capacity is to be found – and unlike privatised Test and Trace, they know what they are doing. Instead a completely privatised system was begun (without the required Public Health leadership), from scratch in the middle of a crisis. It is a shambles.
The failure of the privatised Test and Trace is well documented (not least by Hancock’s painful responses under questioning on the floor of the House of Commons). Let me quote from a Government favouring organ, ‘The Telegraph’ 7th October, on just the most recent blunders, among many: “Research by Imperial College London shows that 20 per cent of people who have been in close contact with an infected person are also infected, meaning around 10,000 contacts of the original cases may now have contracted the virus. Mr Hancock insisted the Government’s assessment of the scale of the epidemic had ‘not substantially changed’ as a result of mistakes in the data. He placed the blame with a ‘legacy’ computer system run by Public Health England (PHE), which was identified as in need of replacement in July. Mr Hancock admitted the incident ‘should never have happened’ but stopped short of offering an apology, blaming technical errors. While those who tested positive had been informed, their close contacts – who should have been tracked down within 48 hours – were not. Mr Hancock told the Commons that efforts were ‘ongoing’ to obtain details of such contacts”. Contact tracing is only properly working when in the hands of local Public Health professionals. Everyone knows this; everyone, except, it appears you. There is a mass of further examples of the privatised disaster available – I could go on and on with real evidence, but that would turn a comment into an article.
Local Public Health have no choice in having to make the best of it, because they do not have the resources to do otherwise. The Scottish Government had had to operate a hybrid system with the private part working inefficiently because the Scottish government does not have the financial resources to build up Test and Protect to do the whole task, and Scotland remains part of the UK. The whole UK experience has simply demonstrated the flaws in the over-centralised Test and Trace system. The real Public Health professionals know the system is unsatisfactory, and would be far better and more reliable wholly in their hands. The fact that you cannot see it is not my problem.
You are setting yourself up as an authority, on a matter on which you are quite wrong. The scale of the pandemic has required the ramping up of Public Health responses in a sector that has been left badly shorn of resources in order to service neoliberal ideology. There really is nothing more to be said. I am quite happy to leave readers – if they are any left to read your attempt to justify the unjustifiable – weigh the value of what each of us have written. I rest my case. If you have a real case, write a proper article, and submit it.
I should note that your reference to how well Scotland or England is doing as a competition, is becoming a typical, gratuitous, evasive red herring. My Scottish example was a simple contrast between the separate Test and Trace and Test and Protect systems, and their performance. The example was because devolution meant part of the system in Scotland was protected from being run down; a happenstance, of which I made nothing of the politics because it was irrelevant. The issue I made abundantly clear was UK wide; between a new, hastily cobbled, unproven, inefficient, failing, centralised Test and Trace system not run by Public Health specialists, but flooded with financial resources; and a local, Public Health system with a long history of success and reliability, run by expert professionals in Public Health that has been starved of resources and given inadequate input into policy.
Jings! There are so many ad hominems here that it’s difficult to see where to start.
First of all, it’s not all Diana Harding’s fault. The new National Institute for Health Protection, which was set up to bring together under a single leadership structure bringing together the analytical capability of the Joint Biosecurity Centre, NHS Test and Trace, and Public Health England when the latter’s incapacity to deal with the pandemic in England became apparent, reports directly to the Secretary of State for Health and Social Care; Diana’s just the executive chair of the Institute and, appropriately enough, a manager rather than a clinician.
Moreover, the quango-change from Public Health England to the National Institute for Health Protection doesn’t come into effect until the spring of 2021; so, it’s a bit too soon to evaluate the latter’s performance in its oversight of testing and tracing in local communities. In fact, Diana, as the current chair of NHS Improvement, is only acting as the interim chair of the impending Institute while a full recruitment process to the post is carried out. Who knows: maybe they’ll wheech a doctor out of doctoring to manage the governance of the operation.
The public health establishment is characteristically unhappy with the bureaucratic change; a lot of wee professional fiefdoms will be crumbling and it’ll be a mad-scatter to transit these powerbases to the new regime. But that regime isn’t a ‘private’ company; it’s still a publicly owned government agency; so, there’s no ‘privatisation’ there.
You’re right to this extent, however: the failure of Public Health England is due to the diversion of funding to other parts of the NHS over many years. Chickens coming home to roost, and all that. But to scapegoat Baroness Hardup for our public failings is the stuff of pantomime.
“Diana’s just the executive chair of the Institute”. An extraordinary statement to make. Executive chair;responsible for nothing. Not me guv. You then propose that “Who knows: maybe they’ll wheech a doctor out of doctoring to manage the governance of the operation.” Oh, well sometime, never; no rush. Nor am I clear what you mean by “governance”; too much imprecision sliding around your exposition. PHE was not perhaps the happiest solution, but that is a sobering part of the multiple government blunders over many years. You acknowledge that ‘chickens are coming home to roost’, but the privatisation was a thoroughly bad move to cap the worst management of public health anyone could imagine. Your best defence seems to be accuse Public Health of having “wee professional fiefdoms”; there may well be, but given where we are it is a cheap shot at the professionals who are the only people we can depend on. As for “scapegoating” the executive chair, that is rich; and risible.
We clearly fundamentally disagree; but candidly I have now wasted sufficient time on what I consider to be indefensible. Stay safe and take care; but do not rely on anything the British Government is doing in Public Health.
Sorry, but this is so apt. I have constantly said that there is endless evidence of the failure of Test and Trace as an operation. Here is the latest. Ed conway, Sky News on Twitter: “Exclusive: UK govt is paying management consultants the equivalent of million and a half pound salaries to work on Test & Trace.
I’ve seen documents showing senior staff from Boston Consulting Group are being paid day rates of around £7k, equivalent to £1.5m on an annual basis.”
Local Public Health operations never, ever sees this kind of money thrown around; and they know what to do with it. QED.
‘[T]he privatisation was a thoroughly bad move to cap the worst management of public health anyone could imagine.’
What ‘privatisation’? (I refer you to my foregoing remarks.)
‘…the professionals who are the only people we can depend on.’
If we aspire to democracy, rather than governo tecnico, we should be depending on ourselves.
‘Governance’ = ‘the systems and processes concerned with ensuring the overall direction, effectiveness, supervision, and accountability of an organisation’.
The use of management consultants and other external contractors within by public sector organisations has been common practice for a long while. It is expensive, but it’s still less costly to hire external contractors with specialised skills for specific projects than to hire permanent ‘in-house’ expertise, which lies redundant for most of the time. Clinicians are notoriously bad at management, since they rarely have the relevant skillsets, and would much rather be delivering clinical services than managing the governance of an operation. It’s also a poor use of their time. (I’ve sat in several boardrooms with clinicians; believe me, they’d much rather have been elsewhere.) Professional managers are much more dependable in the role (though I myself prefer more democratic governance).
(By the way, for someone who’s never done announcing that they’re leaving a discussion, you show an admirable capacity for lingering.)
Ah, you could still mean either a CEO, or a Chair(man/woman); you are drifting between a legal and management definition. It is a rather late for tinkering of this kind. “If we aspire to democracy, rather than governo tecnico, we should be depending on ourselves.” This is guff. When a democracy suffers a pandemic it expects salvation from its elected representatives and executive, not rhetorical flourishes. It is Public Health that holds the knowledge of the community to fight pandemics.
Oh, boy: “[S]pecialised skills”. The specialised skills for a pandemic are in Public Health, not in Management Consultancies. Your proposition is staggeringly naive and amateurish; utterly ridiculous. I find it hard to believe that you actually believe it. You write like someone who has picked this up from the mission statement, or PR video for a Management Consultancy. You reference to ‘clinicians’ is conveniently capacious, but Public Health is a specialism and has the experience and knowledge that has actually fought pandemics for the last century. They have acquired the skill-set to do this; built up over long period and from actual experience throughout the world of fighting virulent outbreaks and pandemics. They do not have to re-invent the wheel at vast cost, and then bungle it because you cannot do this from the ground floor, with no time, no experience and in the middle of a pandemic. Give Public Health the resources and they will do the best job that can be done.
I do not know how many boardrooms you sat in, or for what kind of institutions; but you have a bizarre perspective on the nature of management. No, don’t tell me; you are a self-appointed authority on management.
‘It is Public Health that holds the knowledge of the community to fight pandemics.’
It is indeed: and public health (as a body of expertise) hasn’t disappeared; it’s just under new management.
But you clearly disagree with how pubic health is currently being organised and deployed.
So do I, by the way. I’d like to see it managed more democratically, by local health boards that are more directly accountable to the communities they serve.
You seem to want to pull clinicians out of their clinical roles to carry out the management function. I’d see that as a poor use of resources; i.e. bad management.
We had a Public Health system before the Conservative Government wrecked it in the name of austerity. This is a wheel I do not wish to re-invent when the wheel we have is proven, and actually works – and that is how wisdom works in management, when to innovate, when not; not in the middle of a pandemic, and in Public Health, by Public Health specialists. All it wish is for Public Health to be properly resourced to do the job, not private enterprise to reinvent it solely for ideological reasons. Our knowledge how to tackle Public Health crises has been built up over the long term; and from bitter experience. Like Dr Elizabeth Ness McBean Ross, who died in a Serbian field hospital in Kragujevac, along with two nurses; fighting a sudden, brutal typhus epidemic, WWI 1915. She is remembered as a heroine of Serbia to this day.
Everybody knows Test and Trace is a Turkey. It is an exercise in neoliberal ideology, and it is privatisation. What is Serco (and other corporates, there is no need to single one out – after all, they are effectively and merely invitees of Government, a select band simply because of the entry fee scale to play this game); what is a Serco doing in the middle of a public health pandemic? I checked the 2018 annual accounts of Serco. Nowhere could I, at least even find the words “public health”. Here is what Serco is; “Serco Group plc is a leading provider of public services. Our purpose is to be a trusted partner of governments, delivering superb services that transform outcomes and make a positive difference to our fellow citizens.” What sort of services? In the 2018 trading review items highlighted included Asylum accomodation and Brexit. In 2018 underlying EPS growth was 63%.
As far as I can see Management Consultancy driven Test and Trace has effectively torn up the Public Health manual for fighting pandemics. It has replaced it with a private enterprise model that is deliberately scaled; it is digitised, highly centralised (against authoritative Public Health opinion), with very high set-up costs, funded by the State (all these Saville Row suited, Jermyn Street shirted Management Consultants in John Lobb shoes to fund), and the desperate urge to digitise through supposed breakthrough innovation by command. I hypothesise that the neoliberal theory underlying the objective is that eventually running on-costs, principally digital with a small command and control, and a diffuse army of zero-hour contract labour will produce a low cost structure, ensuring the appropriate ROI for shareholders from the Government contracts. You can call it what you like;I call it the privatisation of public health.
I do not consider neoliberalism any longer even to be capitalism. It is state funded rentierism.
You seem to be saliva-spittingly opposed to the state mobilising the resources of the private sector in our response to the current crisis (‘privatisation’?).
To take up your example of Serco: I did a quick survey of the contribution Serco has made to our response so far in controlling the spread of the virus. As far as I can see, this contribution has been in the fulfilment of ancillary roles, supporting the deployment of our fund of public health services’ expertise.
In the United Kingdom, Serco was commissioned to support Public Health England’s NHS Test & Trace programme, initially recruiting and training 10,500 people as Tier 3 call handlers in just five weeks. These call handlers are responsible for calling the contacts of confirmed cases, which are identified by the medical contact tracers at Tiers 1 and 2, who interview confirmed cases and are employed directly by local health authorities or NHS Professionals.
Serco has also been commissioned by the public sector to deliver new mobile and drive-through centres across the country, to help increase our testing capacity. Serco now manages about a quarter of the UK’s testing sites.
Serco is only providing support for NHS Track and Trace in these two areas and isn’t involved in other elements of the operation, including the design or management of the processes, sizing the capacity, running the booking system, developing or managing the IT systems, supplying the tests, running the laboratories, developing the App, or identifying contacts. These are either delivered ‘in-house’ or commissioned from other public and private sector providers.
Specifically in Scotland, Serco was a key partner in setting up the new Louisa Jordan Hospital at the Scottish Events Campus in Glasgow, where it’s been contracted by NHS Scotland to deliver cleaning, catering, portering, and linen and waste management.
It has also supported citizen and clinical services more indirectly through its transport and prison services; e.g. by adapting the timetabling of its Northlink Ferries to help ensure essential services between mainland Scotland and the Northern Isles throughout the pandemic.
Refusing to countenance the mobilisation of private sector resources through commissioning as part of our public response to the current crisis is, I suspect, a case of wishing to excise our noses for ideological reasons.
You read like a Public Relations representative for Test and Trace. You simply refuse to countenance the quite obvious fact, to the whole world that Test and Trace has consumed enormous public resources and failed dismally to perform; which at the same time has deprived Public Health from accessing both the resources and ear of Policy to do the job as it needs to be done. The whole world knows this basic fact. It is not about ideology on my side, it is about performance. All of this could have been done within the skill-set we had, by giving Public Health the resources to produce local operations as standard protocols dictate; which would have been much, much more effective. I suggest that if you really believe what you say, stop slouching around in semi-hiding, in a fast decaying below the line comment section in response to an article by a critic of Test and Trace declaring that ‘Humanity is not a Herd’; (you just keep repeating the official dogma like some low-grade neoliberal gopher), and take it up with the Public Health critics of the current Test and Trace regime and in a wider forum out there in the world; or as I said before, try writing your own articles, and see how that goes.
And before you say – what are you dong here: it was my article, I know why I am here; I have a good reason to be here, and even I wish I was anywhere else.
Give it a chance. John! Test and Trace/Protect has been a gargantuan project to develop (I don’t think there’s been a system like this developed on such a scale in the entire history of public health), and it’s only been up and running for a few weeks. Anyone would think you wanted it to fail.
Here is a suggestion. Zarah Sultana MP has just tweeted this: “Serco’s CEO is the brother of a former Tory MP. His partner is a Tory Party donor. And Serco’s former top spin doctor is the Tory Minister for Health. In Parliament, I just voted for Test and Trace funding to go to local public health teams, not Serco. The Tories voted it down.”
Tweet her right now and explain how good Test and Trace has been. She has circa 88,000 followers.
Sorry, I don’t have a Twitter account. Otherwise, I might have offered a critique.
Test and Trace launched on 28th May, I think; more than ‘a few’ weeks: ” Test and Trace/Protect has been a gargantuan project to develop (I don’t think there’s been a system like this developed on such a scale in the entire history of public health)”. You really think that is an exemplar of policy at the height of a crisis; throw the public health protocols out and do just what you have enthused over. Really? I think the technical term for this procedure is ‘crackers’.
Test and Trace was launched 28th May. I say ‘launch’ because it is indeed the ‘Mary Rose’ of projects; most famous for being sunk, and rescued at enormous expense to be revered as a wonder of the world. In the case of the Mary Rose, at least there is real historic interest. Test and Trace is just another Government dud.
How does this kind of blunder happen? Just let “the eye wink at the hand” (Macbeth, Act 1, Scene 4).
Incidentally the advocate of a ‘gargantuan’ project, gratuitously and radically rewriting the rules of public health, in the middle of a pandemic – cannot handle Twitter; you do see that is a pathetic response?
I’d hardly describe the Test and Trace/Protect systems as ‘exemplary’. There’s certainly (and always) room for improvement. I’ve already indicated what I think their shortcomings are.
But, tell me, what public health protocols have been thrown out by those systems?
Or rules rewritten?
WHO interim Guidelines on COVID-19 contact tracing, from which you will find this extract:
“Engagement with communities and their leaders should help identify potential challenges for contact tracing including language and literacy, access to food and medical care for other illnesses, education, information, as well as stigma and marginalization. Special consideration should be given to planning contact tracing for at-risk and vulnerable groups, including, but not limited to, minority groups, homeless persons, migrant workers, refugees, and others.
Communication about contact tracing should emphasize solidarity, reciprocity, and the common good. By participating in contact tracing, communities will contribute to controlling local spread of COVID-19, vulnerable people will be protected, and more restrictive measures, such as general stay-at-home orders, might be avoided or minimized. All communities are likely to express concerns about privacy and confidentiality of their personal health information. Public health agencies implementing contact tracing for COVID-19 should be prepared to communicate how information will be used, stored, and accessed, and how individuals will be protected from harmful disclosure or identification.
It is critical that contact tracing and associated steps, such as quarantine of contacts and isolation of cases, not be used punitively or associated with security measures, immigration issues, or other concerns outside the realm of public health. Contact tracing activities should be available to all communities. As such, WHO recommends voluntary participation by cases and their contacts.”
Notice the deep stress on local involvement and by implication, managment. There are numerous features of the centralisation process of Test and Trace that makes these provisions difficult; combined with over-emphasis on breakthrough Apps and digitisation. The complex local requirements of the above guidelines (such as the homeless, just as an example) becomes difficult or impossible as a practical proposition. The capacity for face-to-face tracking; door knocking, is obvious. Door knocking takes local knowledge and the local framework of command and control. The whole emphasis of the guidelines is on local involvement, management, and personal direct contact. The over-centralised, over digitised solutions being set up by Test and Trace are hard to reconcile with this. In addition note the remarks about immigration issues. I suspect there are at least potential conflicts of interest here. Whether deliberately or not the rules are changed, and change too much.
But you must know this; so why are you asking?
You have written as if you were an advertising strategist for Test and Trace. Please do not pretend the bland acknowledgements that we can always improve amounts to meaningful criticism. You are an apologist for a bad solution; nothing more.
I note that this extract is from WHO’s interim Guidelines on COVID-19 contact tracing. I didn’t realise that WHO had also thrown out the tried-and-tested public health experience and protocols that have served us well for so long and produced new ones. Is the middle of a pandemic really the best time for it to be doing this?
Also, I don’t see the word ‘local’ at all in the extract you’ve posted. While I agree that decision-making powers in relation to controlling the spread of the virus through the population (‘herd’) should be dispersed rather than centralised, to achieve the optimal balance between social security and individual liberty (which is where we started this conversation – remember?), I don’t see any reference to this principle in WHO’s new guidelines.
Were traditional public health protocols in relation to pandemic really based on going around chapping on doors? How did the door-chappers prevent themselves from becoming superspreaders? This is all fascinating stuff. Did people really live that way? Isn’t it more efficient to gather and disperse test and contact information to local decision-makers digitally than physically via armies of door-chappers?
Anyway, I’m away to clean the lavvy.
You do love making smoke. The WHO is a critical part of the conventional, established, well-proven system. When they move something it is well-founded, well-understood round the world in Public Health and evolutionary; as an approach to knowledge we may think of it in Public health as rather like a version of Whewell’s pyramid; not a hack revolution by neoliberal privatisers ad-hoccing their way to whatever sub-optimal bumble toward an over-priced solution, for which we are supposed to congratulate them.
Please do not hurry back from the lavvy cleaning. It is an apt task however; you have the labour of Sisyphus here; I trust not there as well.
Done! It gets a squirt of bleach once a week, whether it needs it or not.
So, with reference to the extract of the WHO’s interim guidance that you quote, which of the well-established public health protocols rehearsed therein have our test and trace/protect systems thrown out?
I do not think you read what I wrote; or rather you are trying to evade the problem. The principles are easy to recite and are sufficiently generalisable even to suggest that ‘nothing has changed’; for example to claim to maintain all the principles of contact identifying, listing and follow-up in standard, traditional contact tracing can easily be made for the new Test and Trace, but the fact is that whenever there is an ‘outbreak’ of communicable disease the protocols actually assume direct local solutions. It still remains the case that something like, for example an ‘outbreak control team’ at the locality is best practice, and best practice still stresses people-powered solutions on the ground. These are however expensive, time-consuming, and require substantial resources.
I notice you complained about the cost. If austerity had not destroyed our established public health system (right down to almost £1Bn of PPE stocks allowed to decay), it would have been cheap at the price. The objection to Test and Trace I have already explained. See above. The over-reliance on technology (e.g., Apps) has wasted resources and the attempt follows the desire to over-centralise. Technology and digitisation also raise serious privacy and ethical issues, which add to the requirement for local and direct contact to meet the problems; while, the introduction of corporate entities with interests beyond pure public health potentially compromises the independence of public health, and also in my opinion raises ethical, if not legal issues. Taken in sum the traditional protocols are, de facto, compromised.
Now it is be about time that you stopped playing games.
So, basically, your argument is that, while the same test, trace, and isolate protocols are followed by the new systems, because the administration of those systems is centralised rather than localised, they are necessarily less effective than the systems they have superseded. And the evidence for their being less effective is that ‘everybody knows’. Am I right?
The problem with this argument is that the administration of the new systems is a blend of localism supported by the centralisation of information gathering and sharing that digital technology enables (I’m sure I’ve made this point before). The centralisation of information gathering and sharing works in parallel with Public Health England’s local health protection teams, who in turn work with local authority health and social care staff.
Cases involving institutions such as hospitals, care homes, and prisons are automatically passed to the local teams, who give advice to the institution rather than the affected individuals.
Cases involving infected individuals are handled centrally by NHS Test and Trace: the infected person is contacted by text, email or phone, instructed to isolate, and asked to give details of their recent close contacts. That person may either enter these contact details into the Test and Trace website or give them over the phone to a contact tracer, who then alerts the person’s contacts of the risk of infection and directs them to get tested.
If the infected person or their contacts don’t respond, NHS Test and Trace passes their details to the appropriate local health protection team, which makes further attempts by phone or text and, if necessary, by chapping on their door.
Because these informational transactions are digital, they’re made in seconds. The information is also automatically routed to a national database for analytical purposes. No time is wasted, few (if any efforts) are duplicated across local public health teams.
Now, why would the administration of those systems be better without the centralised information gathering and sharing element, which is what you seem to be objecting to? Especially given the scale and virulence of the pandemic, both of which are unprecedented in the history of modern public health?
More waffle from the Test and Trace advertising blurb. The reality is nothing like it. The gap between your fantasy Test and Trace and reality is stark. C4 News reported tonight that Test and Trace contact tracing is running below 40%. The Test and Trace system is a failure.
But I have allowed you to ask questions and answered them. Now it is my turn, and I am perfectly entitled to ask; it goes to purpose. Do you have any interest, direct or indirect, of any kind in Test and Trace, or any institution that uses Test and Trace?
No, you haven’t answered them, John. But no matter.
In what respect is my account of the Test and Trace/Protect systems inaccurate?
Why would the administration of those systems be better without the centralised information gathering and sharing element?
See you in the morning!
I somehow thought you would duck the question. I hoped my intuition was wrong, but there you are. Pathetic, but not unexpected. After all, you ducked every awkward fact that did not fit your ideas. No wonder you hide in fading comments below the line. I recall you were eager to defend anonymity, so it should be no surprise. A sad insight, but no surprise.
You asked me why I had said I was leaving the thread, but never departed. The reason was my article was on page one of Bella Caledonia, so there was always the possibility that new readers would arrive, and find your guff being promoted below the line because you hang around endlessly, and I did not want my argument unrepresented among your comments. I thought we would be on page two long before now, when it was unlikely new readers would notice an old thread; save for those readers foolish enough to have requested new comments: they will be regretting that now. I will not make the same mistake again.
Well, suddenly ‘Humanity is not a Herd’ is almost on page three, so I can thankfully leave. I rejoice! Tumbleweed will drift across the thread, which I am sure you will appreciate as a denizon of the lower depths of decayed threads. I have spent too long here wasting my time in discussion with you; time I have lost forever, for no good purpose and from which I gleaned virtually nothing.
So it is adieu from me. Free at last! I shall try to remember your name, so that should our paths cross on a thread in future, I will know to pass on hastily without delay. Stay safe and take care.
Cheerio!
Sorry to prolong the agony, but I just thought of a snappy answer to your ad hominem (which, qua ad hominins, I was taught to ignore as impertinent to any argument – water off a duck’s back, and all that) that would steer you back to the nub of the critique of your article.
Here it is:
I must confess that I do have an interest in Test and Trace and institutions that use it, insofar as I have a shared interest in slowing the spread of the virus through the population to an economically sustainable rate and maintaining it at or beneath that rate until sufficient numbers in the population become, naturally and/or through vaccination, immune to the disease it causes that the disease ceases to be epidemical.
I have in interest in our cultivating community/population/social/‘herd’ immunity, in other words, and test, trace, and isolate is a tried and tested method of so containing the spread of harmful viruses.
I just remembered the tale of Eskimo tribes who would abandon their elderly on an iceberg rather than look after them. I understand other “primitive ” tribes had similar customs.
It would seem the Barrington declaration is designed to push us back to the status of Eskimo.
Except that what the Great Barrington Declaration proposes is not senicide but focused protection.
The objection to this proposal is that it would be impossible to shield all those who are medically vulnerable while the rest of us are left to continue living normally, leading to a large number of avoidable deaths among the older generation and younger people with underlying health conditions, especially when the long-term effects of COVID-19 are still not fully understood.
Really? And the authors do not know that isolating old people often hastens their decline and death?
The difference between abandoning them on an iceberg or abandoning them in care hoes or their own homes seems to me to be academic.
But the proposal isn’t to abandon those who are more vulnerable to the virus to social isolation; it’s rather to focus protection on them while allowing the virus to spread among those who are less vulnerable.
Do you really think that shielding vulnerable people during a pandemic is akin to senicide by exposure?