COVID-19: TAKING TONY BLAIR APART

A week ago an opinion piece was published in the Financial Times by Tony Blair, former Prime Minister of the UK.  This blogpost is a review from a practical business angle, based on many years advising FTSE250 and other boards, not political.

Love him or loathe him, Blair has substantial experience of the global scene and you would hope has learnt from his mistakes. 

If you have never read a transcript of his maiden speech in the Commons, displaying his background in the coal mining of County Durham, it's worth a read to understand his foundations.  Whether you would agree with them or not.



The FT piece was titled "Three Priorities for the Developing World to beat COVID-19" (behind paywall).  This has been written alongside a paper published a week later by his "Institute for Global Change" called "Taking the UK’s Testing Strategy to the Next Level", signed by Blair and former Conservative leader William Hague and Jeremy Hunt, who was Health Secretary for many years.

Though much of the article is a critique of the UK's reaction to COVID-19, and so raises lessons for us and the developed world too. 

His introduction is spot on "COVID-19 is the toughest practical challenge for government I have ever seen", affecting every country in the world.


THE POINTS TONY BLAIR RAISED ABOUT THE UK RESPONSE

He then makes several points about the UK, with the links being my own relevant blogposts:

1. "Eradication" (or more correctly "Elimination" in an individual territory) is not possible.  "Containment" has been the chosen strategy, at least until if or when a vaccine becomes available                                                             
2. "Herd immunity" is too costly in lives (it would also take many years)                                                                                                                        
3. The way to pick up asymptomatic cases, which we know to be at least 50%, is a programme of mass testing, as his Institute's latest paper proposes                                                            
4. UK was too slow at the beginning of the crisis, but understandable

MY REACTION

Vaccines

We are all hoping that one or more safe and effective vaccines will be developed in 2020 or early 2021.  Initial indications are positive, but anyone who works in clinical studies knows nothing is guaranteed until the tests are complete.  Safety is especially important if mass vaccination is proposed, not just in the UK but globally, and to persuade the anti-vaxxers. 

I support vaccination, but will need some persuading to take this vaccine early.


Strategy Options

Until then I believe we should aim for Eradication, with an expectation of #NearZero .  An assessment of alternative strategies England could follow is given here.


Herd Immunity

Herd immunity from COVID-19 alone would take far too long, but cross-immunity for anyone who has a common cold type of coronavirus might reduce the 60% of population threshold to less than half that.  That should make vaccination more effective, and already appears to be having an effect in reducing infection rates in countries that have had a higher infection level such as Sweden.  Fingers crossed.


Testing Strategy

With my business hat on, I don't believe that a national mass testing programme is affordable nor sensible.  There's a better way.

The big issue with COVID-19 is the combination of asymptomatic people carrying the virus who can still be infectious (who may have had COVID-19 befiore), and pre-symptomatic people who can be infectious for some days before displaying symptoms.  In both cases they don't know they are infectious, and carry on life without self-isolating.  How can we identify them and get them self-isolating?  A mass testing programme would ideally need to test all adults and children, even if they have had COVID-19, every 5 days.  With a population of 55 million, that's 11 million a day.  Mind-boggling!

My view is a mass testing programme as proposed by Blair, Hague and Hunt is therefore far too costly to set up and run, and impractical.  Instead something at least as effective could be achieved at lower cost.

The central planks to the Institute's Mass Testing proposals are that many businesses would not survive a second lockdown, and other anti-transmission measures are not sufficient to keep COVID-19 suppressed.  This is false for three reasons:

• The first UK lockdown brought the infection rate down to a sixth of its peak.  Current estimates are that infection rates overall in England are about 5 times too high.  A 3-4 week national lockdown is potentially enough to get new cases down across much of England, leaving just a few hotspots for further action.

• The rise in daily cases around Europe [link to follow] since lockdown means anti-transmission measures are indeed weak.  But that's a matter of poor compliance, such as people holding mass gatherings when forbidden.  Better education, 'wardening' and voluntary compliance would make simple measures far more effective.

• If businesses need extra support to survive, then that ought to be provided.  The cost to these businesses of not getting infection rates to #NearZero is in any case likely to be far higher over a prolonged  period if customers are not confident to go out.  That's especially relevant to the live entertainment industry.   The cost to the Exchequer in lost revenue and extra social security would similarly be reduced if action is taken.  

So from everybody's point of view, a short national lockdown would be a great investment to keep schools open, open the economy and get entertainment venues open. Despite the 'side effects', which mean I only suggest a lockdown when there is no realistic alternative.

With this in mind, I would suggest an alternative approach to testing that is at least as effective and would cost far less::

• National infection rates must be down to #NearZero, using a short national lockdown if necessary

• That would allow testing to be two-pronged:
• The ONS Infection Survey sampling, recently expanded, and other techniques to identify hotspots around England and the UK
• Focus on testing of these hotspots, literally wheeling in lab capacity to test as many people as possible every 5 days.  A town like Swindon with 222,000 population would still need a mind-boggling 45,000 "Got it" RNA tests a day.

• There needs to be a far better public education programme.  Common sense is only useful if people have experienced something like COVID-19 before, but they haven't

• Contact tracers nationwide can also act as 'wardens' helping to educate, encourage and chide people to comply with any restrictions

• People being asked to self-isolate must be given practical and financial support.  No extra help is currently provided in England, though it is in Scotland which has long had a "Test, Trace, Isolate and Support" policy

• There are also testing capacity constraints.  Reagents for "Got it" viral RNA testing are in short supply, restricting the growth of testing procedures.  The trend in new tests to move from RT-PCR technology to RT-LAMP will change the reagents, but still require massive quantities.  That's unrealistic for the UK, let alone globally

• Until we understand immunity better, and whether people who have had COVID-19 can carry it again and be infectious, "Had it" antibody testing is of lower value.  Such testing does not yet need to be scaled up beyond the ONS sampling

Looking around Europe, this approach is relevant elsewhere too.

We also need to improve the testing and isolation arrangements for inbound travellers, be they returning citizens, tourists or business visitors.  A complex subject, with no easy answers.


Was the UK too slow in responding?

This is a big question.  In a nutshell the answer is yes, though the complexity of the situation meant a careful response from the UK government was understandable.

I personally realised by Friday 13th March that infection rates were rising too fast and a national lockdown was needed, despite the 'side-effects'.  This conclusion was based on publicly available information, and no doubt the government had information earlier.

A full lockdown should have been put in place for 16 March, not left until 23 March.  Whether it should have been earlier needs more of a discussion.



THE POINTS TONY BLAIR RAISED ABOUT THE INTERNATIONAL SITUATION

Blair acknowledges that confirmed cases across the world are in the millions and rising in territories such as India, Brazil and Africa.

Hospitals are being overrun, compounded by the sort of problems the UK experienced with a lack of PPE (Personal Protective Equipment), health care workers going off sick, and people avoiding hospitals for other serious conditions for fear of catching COVID-19.  Plus many developing countries do not have as good health care facilities as developed countries.  An unenviable position.

The danger is that not only will COVID-19 deaths and the bigger problem of LongCOVID go through the roof, but there would likely be a resurgence of issues such as "HIV, tuberculosis, malaria, and maternal/child health".

Blair therefore makes three recommendations each government should follow, supported by the richer nations:

• "Healthcare workers and services must be protected"

• Public engagement", being:
• Shielding the vulnerable
• Education so people follow anti-transmission measures such as social distancing  
• Mobilise community action like was successful in beating Ebola

• "Build up surge capacity in hospitals", including beds, equipment, staff and supplies

He also points out "If low and middle-income countries cannot deal with the crisis, we can not control the disease globally".  It is therefore in the developed world's self-interest to support developing countries.


MY REACTION

All three recommendations make sense, as is the worth of developed countries supporting the developing.

The UK has been very good at building up surge capacity with the Nightingale hospitals, which might still be needed.  Though it is not yet clear that there's sufficient equipment or staff available.

Protecting the UK's frontline workers was a major problem in the early stages of the crisis, and the world's supply of PPE is still limited. 

This will remain a major problem for both developed and developing countries.

Where the UK has been particularly poor is Community Engagement, where improvements can still be made as suggested above under "Testing Strategy".

Indeed Sweden is blaming their lack of attention for care homes, which account for half of their deaths, as being a significant issue in their response.  In the UK, the way care homes were used and abused will no doubt be a dominant scandal when the public enquiry takes place to the UK's COVID-19 response.


IN CONCLUSION

I have approached this review in a business-like manner, with an open mind, together with much experience of advising FTSE250 and other boards in business, and months of studyng the issues around COVID-19.

In formulating recommendations, the first stages are to compile one's findings and recommendations.  I haven't been able to cover Blair's detail here, but his article displays a good understanding of the issues and their implications.

I certainly agree with the three recommendations for the governments of developing countries, which are still relevant for developed countries such as England and the wider UK.  It is also sensible for developed countries to support the developing, for our own self-interest in controlling the disease globally as much as being humane.

For as long as there is infection in the world, there is a risk of COVID-19 reappearing in the UK despite our efforts for elimination.  Just as New Zealand is now finding. 

But for England and the UK, I do not believe the call for a mass testing programme across the country is business-like, being both unaffordable and impractical.

Instead, we need to keep schools open, strengthen the economy and open entertainment venues by:

• Getting infections in England and the wider UK down to #NearZero, by investing in a short national lockdown if necessary, with suitable support for businesses and others affected
• Boosting public engagement including a far better public education programme
• Using contact tracers as 'wardens' to help educate, encourage and chide the public
• Providing better support for people asked to self-isolate
• Improving the testing and isolation arrangements for inbound travellers, be they returning citizens, tourists or business visitors
• Using the ONS Infection Survey testing and other techniques to cover infection rates across the country
• Focussing testing attention on 'hot spots', which would need to be set at lower infection rates than currently

The future won't be easy.  But if we want to get back to anything like 'normal', we have got to be prepared to make these investments.



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