COVID-19: TALKING ABOUT THE NEW NHS COVID-19 APP

This morning I was interviewed by David Prever on BBC Radio Oxford, talking about why I won't be downloading the new NHS COVID-19 app.  This was raising some of the key points from this blogpost about the app.

The whole feature started 3hr6:15 and I was the second speaker after 3hr10.

As I said on air, "I am supportive of the app in principle" hoping the app had been well written, and be a very useful contribution to the fight against COVID-19.  That is because people are infectious before they develop symptoms, and the app could help identify individuals who ought to self-isolate before showing symptoms, thereby reducing transmission of the virus.

But having tested many far more sophisticated systems over the years, the app does not appear to be fit for purpose.  There is one aspect of the design that is apparently a 'showstopper', plus a number of othe significant issues.  Unlike the Bake Off creations, this type of 'showstopper' is a reason for the app not to have been released.

On further investigation, there is a subtle difference between how alerts to self-isolate are issued to users depending whether the user has 'encountered' (my term) someone subsequently proven infected:

• Automatically using the proximity algorithm and Bluetooth:
  
• This is an instruction to self-isolate for 14 days
  
• For venues check-ins, manually triggered by the local health protection team:
• "it will not usually tell you to self-isolate, just to be aware and to get a test if you develop symptoms". The latter part is no different from what you would do anyway, so adds little if any value
• There is also the possibility that the alert will be a request to self-isolate 
  

In that context, would I download the app? 

Update 3/10/20: There are a couple of reasons why I might download it, discussed here.  Mainly as there is less chance of incurring a £1000 fine by using the QR code scanning in the app rather than providing my details separately to the venue.

THE CONSEQUENCES OF SELF-ISOLATION

Many people on receiving a self-isolation instruction will have major problems with self-isolation, for example:

• Those on zero-hour contracts will lose earnings, and possibly lose the job completely
• Self-employed will potentially lose income, depending whether they can work at home, and again risk losing a contract
• Single parents would have difficulty with child care
• Those caring for older relatives will not be able to do so.  So who will provide the care?
• Everyone will be inconvenienced, unless already shielding
  

There is also the prospect of a £1000 fine for breaking a self-isolation request. Although it has been confirmed that alerts issued on the app mean a fine is not enforceable, presumably because the de-centralised architecture of the system means the authorities have no knowledge of alerts, nor sufficient proof to issue fines.

Nonetheless, people will want to 'do the right thing'.  It is therefore vital that the vast majority of alerts are correct, with 'false alerts' ('false positives') being negligible.

 

THE POTENTIAL SHOWSTOPPER

The potential showstopper is that the app lets you check-in to venues, but doesn't let you check out.  

Let's say you leave the venue at 2pm and go to work rather than another venue, and someone arrives at the venue at 6pm who subsequently proves positive for COVID-19.

The system will assume you were there at the same time, and could result in you receiving an alert.  As described above, that may be just a warning, or could ask you to self-isolate for 14 days.  Given the de-centralised architecture of the system, it is unlikely you would be provided with sufficient information to know whether that alert was a 'false alert' or was correct.

Experience of the beta test of the first version of the app in the Isle of Wight was people started deleting the app when they got fed up with it.  Thereby defeating the purpose.  

I'm prepared to accept alerts and self-isolate if they are far more likely to be correct than false.  But this design is inherently likely to produce more false alerts than correct ones.  The question is whether those alerts would be merely a warning, or an instruction to self-isolate.  Either way, I'd soon get fed up!

So maybe not as bad as I first was led to believe.  But in any case no thank you.  Until there is much more clarity and experience, I won't be putting myself in the position of receiving false self-isolation alerts by downloading and using the app.

 

BUT WHAT ABOUT MY CIVIC DUTY?

Primary purpose

David raised two very important points:

• Have you got any evidence of false alerts ("false positives")?
  
• Isn't it socially irresponsible not to download and use the app?

I said that it was too early to have evidence of false alerts, as it was too early for people to tell whether they have received false alerts.  This is because the app gives the user little or no information as to where or when the contact with the positive person was thought by the system to have occurred.  It can't, because the key information is only held on individual mobile phones. It is only after some time of multiple alerts, especially when they don't result in developing symptoms, that people will twig that alerts are unreliable.  

The central system appears to have no way of knowing whether alerts are correct either.

As to being socially irresponsible by not using the app, I said that it was socially irresponsible to worry people unnecessarily, especially if that was an instruction to self-isolate.  That is because the design on venues looks as if it could create more false alerts than correct ones.

Update 4/10/20: Here is a real life example of the distress caused by an unclear and potentially false alert, where this man's wife is high risk and panicing, n hsi step-daughter is having to live elsewhere as a key worker.  As he says, echoing my view, "...damn it, this is basic beta stuff that should be ironed out".  He is no longer self-isolating, defeating the object.

WHAT IF THE VENUES ISSUE WAS FIXED?

Let's say the app developers fix the venues issue by allowing a checkout.  Would I then download and use the app?

Firstly I'd have to remember to manually do the checkout.  Unlikely to be 100%. But putting that aside, we then have to consider the second league of deficiencies identified.  Are they serious enough not to use the app?:

• The other cause of 'false alerts', proximity, where two people are actually either side of a party wall or ceiling.  The FAQs state that if someone is 2 metres apart for 15 minutes, an alert to self-isolate would be sent to one person if the other person is proven positive.  Two examples:
• If chairs are positioned either side of the party wall, then two people will be within proximity.  
• Then there's public transport, where everyone should be wearing a mask.  The app cannot distinguish whether a mask is being worn or not
• The app is not cognisant as to whether the contact is outdoors or indoors, two completely different risk scenarios
• The Police force has been told not to download the app to work phones, and to ignore self-isolation alerts, or preferably switch off the app.  Presumably because of concerns about false alerts.
  
• Not being able to record test results when carried out by NHS labs.  That probably won't affect me, and is being fixed
  
• Battery drain, given my phone can die without switching Bluetooth on
  

This leaves me with three problems:

1. My concern is that the venues issue and the NHS labs issue suggests bad design and inadequate testing.  What else have they overlooked in rushing the app out?  Here's a critique of the QR code coding, which is another issue which doesn't inspire confidence in the app's development
   
2. Is the proximity issue either side of a party wall a major problem?  Or use on public transport?  I just don't know.  I have no faith in the testing.
3. I don't want to drain my phone battery
   

I really wanted to download the app and use it.  But after testing many systems over the years, this is coming across as not being fit for purpose as it is.  Fixing the most significant issue would still not give me sufficient confidence in its design and validity.

What a crying shame!

So sorry, David.  I won't be downloading it until my confidence in it is significantly improved.   That's going to require some significant improvements.

Update 3/10/20: I strongly suggest that people do not use the Bluetooth proximity function, but the app might be worth using for some limited purposes.

My concern is people will in any case lose trust in the app over the next few weeks.  That will undermine the value not only of this app, but also any subsequent improved iteration.

 

 

COVID-19: APPEARANCES ON BBC

In the last few weeks I have appeared live on BBC Radio Oxford's "Breakfast Club", interviewed by Sony Award-winning presenter David Prever.

You can listen to these broadcasts for 29 days after the day of each broadcast, as follows:

(1) TODAY WEDNESDAY 30 SEPTEMBER 2020

Talking about 'false alerts' using the new NHS COVID-19 App. The whole feature started 3hr6:15 and I was the second speaker after 3hr10. 

This was raising points in this subsequent blogpost:

COVID-19: TALKING ABOUT THE NEW NHS COVID-19 APP

(2) WEDNESDAY 23 SEPTEMBER 2020

Talking about whether PM Johnson had done enough in the measures announced the day before, starting 3hr20

This was then discussed further in this blogpost:

COVID-19: HAS PM JOHNSON DONE ENOUGH?    

The discussion on 'what I would do if I was PM' was unexpected, and my response was what I would have suggested over the summer when daily "new confirmed cases" were below 1000.  

Now the rate is far higher, a more aggressive approach would be needed to get to #NearZero.  The approach came to me a few days after this broadcast.  But this idea has the advantage that it should require an even shorter "Mass Self-Isolation" explained in this blogpost:

COVID-19: NOW HERE'S AN IDEA

  

(3) FRIDAY 11 SEPTEMBER 2020

Talking about the impending "Rule of 6", and its impact on families with four children and amateur musical groups, starting at 3:25:30

Here's the relevant blogpost:

COVID-19: 'RULE OF 6', 'OPERATION MOONSHOT' AND MORE

COVID-19: THE NEED FOR SIMPLICITY

The new restrictions for North-East England, coming into effect at midnight tonight, have caused confusion today.

People are looking back at the original lockdown, and saying that "Stay at Home" with a few exceptions such as a daily walk was a clear and relatively simple message.  "Kiss it Simple Stupid".

One advantage of the Mass Self-Isolation proposal is that it too would be simple. Not just a lockdown like we had in March/April, it would need to be tougher as near to a true "Circuit Break" as possible.  The idea is to get to #NearZero to provide these benefits of being better for:

• Lives
• Livelihoods
• Life in general
• And the economy

It would apply nationally throughout England and potentally Scotland and Wales.  Ideally with Ireland and Northern Ireland too to cover the entire British isles.

It would only need to be for two weeks, or maybe a little longer, to correspond to the time it takes for someone to display symptoms.

Letting us get back to near-nomal.  Wouldn't that be good?

Read all about it.

COVID-19: THE NEW APP AND SOLVING THE CHANCELLOR'S FUNDING PROBLEM

Update 1/10/20:  Additional detail here that 'softens' the criticism a little but does not change the conclusions.

AS ORIGINALLY WRITTEN

By noon today, Monday 28th, 12.5 million people had downloaded the new NHS COVID-19 app to their phones.  The app has several functions, but it's main purpose is to send out alerts that the user of the phone has been in contact with someone who has tested positive.  The phone's user then needs to self-isolate.

Today also saw the start of the law that anyone who doesn't self-isolate when requested could be subject to a £1000 fine in the first instance, rising on subsequent occasions.

Let's assume that every user breaks an isolation alert once, and gets fined once and learns their lesson   That would be 12.5 billion pounds.  Kerching.

Real life isn't like that.  I jest.  But there are some real concerns about the app, and there's a better way to minimise the drain on the nation's finances.   

With the black cloud of a potential £1000 fine if you don't self-isolate when alerted by the app.  

Let me explain.


FALSE ALERTS

People are likely to break an isolation instruction if they do not believe they are infectious, such as would happen if they received a false alert telling them to self-isolate.

Some weeks ago, a friend I had met at an outdoor gig contacted me with the message that they might have caught COVID-19.  Disconcerting.  Should I self-isolate?  It didn't feel necessary, and indeed turned out to be a false alert.  I'm imagining receivng an alert through this app.  Just not fun.

I have been the IT Audit Manager at a Big4, and helped develop and test a multitude of bespoke systems over the years. Often at the bleeding edge, and far more sophisticated than this app.  That included Sony UK's main STN trading system and ecommerce apps.  I have seen some excellent systems, but also seen other systems that are not fit for purpose.  I can spot a dog's breakfast of a system a mile off.

Indeed it looks almost as if the NHS COVID-19 app has been designed specifically to create ghastly false alerts:

• You log into a venue, but can't log out.  If you go straight to another venue and log in there, fine.  But if you go from the venue to work or go home, the system believes you are still at the venue until midnight.  If that visit is for breakfast, say, you could overlap according to the system with anyone visiting the venue over the remainder of the day and evening.  As Paul Bernal, Associate Professor in Law at the University of East Anglia, says "This means there could potentially be a great many false alerts"

• The Bluetooth mechanism can see through walls and ceilings, such as between flats, terraced houses, semi-detached houses, rooms in university halls of residence, and hotels.  Which is where a majority of the people in this country live.  There is some form of proximity sensing in the app, according to strength of the signal.  But if you are sitting 'next to' someone the other side of the wall or ceiling, is that enough to avoid an alert if one of the people is tested positive? 

• The alert that is sent out does not tell you where or when the contact took place.  So you can't identify alerts that are clearly nonsense. Self-isolating when totally unnecessary. 
  

SECURITY CONCERNS

Actually the central system does not store your details, so nobody central can identify you and follow up whether you are self-isolating when requested.  That's an improvement on the privacy of the previous attempt at an app, but somewhat defeats the purpose.

How long is that going to last?  If Chancellor Sunak is to get his money, that 'flaw' will need to be fixed.


TALKING OF DESIGN AND TESTING FLAWS

The app allows you to record when you have had a positive test, so that your contacts can be alerted.  Unfortunately the app only allows the "pillar 2" tests carried out outside the NHS.  The "pillar 1" tests carried out within the NHS cannot yet be recorded.

All these issues implies:

• Poor design
• And/or inadequate alpha testing by the development team
• Plus inadequate beta testing with users.  Which is effectively what we are doing now.  

Though a beta test in Isle of Wight of this second iteration of the app was started in mid-August without fanfare.  For the first iteration of the app, a lot of Isle of Wight users deleted the app when they found it was more trouble than it was worth.  No news of how they found the second iteration.

I could go on.  But the flaws identified above are sufficient of themselves to show that this app is not fit for purpose.  Showstoppers of the wrong type.  As a software tester, I would pass it back with no question that it would be released.  Not something I would use in real life.

"You need to self-isolate"

Here's Paul Bernal, Associate Professor in Law at the University of East Anglia, talking about the app from these and other angles.  He echoes my analysis above, in saying "What’s more, though they’ve built it around checking in, for some reason they’ve not included a function to check out. That means you remain checked in at the venue until you check in somewhere else or midnight comes, whichever happens first. If you go for a coffee at 7am but spend the rest of the day working from home, the app considers you checked in at the café for the whole day. And so, if anything happens to trigger an alert at that café, you’ll be alerted even if it’s been 12 hours since you’d left. This means there could potentially be a great many false alerts – which brings us to the biggest problem of all..." Worth a read of his whole article.  I won't spoil his thunder as to what that problem is, but can confirm that I have mentioned it above.

LIVING WITHOUT THE APP

The app requires either:

• Operating system iOS 13.5 or higher for Apple iPhones (but not iPads)
• Android 6.0 or higher for an Android phone. 

Older smartphones are not compatible, and some people do not have a smartphone at all. 

Go to a venue without an app, then either:

• Use a smartphone to register contact details, and then order drinks/food, or
• The venue takes contact details and order at the table manually, much like they were doing before the app

I've done both since the app has been available, at venues geared up for the app, so you don't need the app to visit venues.

The app does a number of other things, but none of them are essential:

• Symptoms: check if you have coronavirus symptoms and see if you need to order a test.
• Test: helps you order a COVID-19 test if you need to, and record the result.
• Isolate: keep track of your self-isolation countdown and access relevant advice.
• Check the Infection Level in the local area, according to the first half 'outward' portion of the postcode optionally entered, e.g. SL3 

You can do those things outside the app, so you don't need the app.


DRAIN ON BATTERY

Many phone batteries die during the evening if it is not possible to recharge them.  That is how I ended up needing to check in and order manually.

I don't usually have Bluetooth switched on, so this would be necessary.  The app consumes at least an extra 5% of battery drain, we are told.  But I hear of experience suggesting that it is higher given Bluetooth has to be switched on.

I could switch Bluetooth on to just check in to venues, and then turn it off.  But that would mean losing the proximity functions.

Battery drain is another reason not to use the app.



IN CONCLUSION ABOUT THE APP

I had hoped the app would help the fight against COVID-19.  But it seems to be more trouble than it is worth, as a combination of functionality flaws and battery drain.

The app is not fit for its primary purpose, and I will not be downloading it.  For those who have already downloaded it, they should seriously consider deleting it.


SO HOW WILL CHANCELLOR SUNAK FILL THE FUNDING GAP?

We have seen that getting infections down to a very low level would substantially reduce the funding requirement.

Here's an idea for how to get there.

COVID-19: NOW HERE'S AN IDEA

You heard it here first

Do we really want to carry on living like this?

What would you be prepared to do to get back to normal?

Here's an idea.  Not ideal, but nothing is.  Better than continuing as we are.

Indeed we can't carry on as we are.  Over a quarter of the UK population are now under stricter measures than the others, with significant (but different) restrictions in each of the four UK nations.

Nobody can plan ahead.  Not businesses nor families.  Christmas is now three months away, and nobody knows what restrictions might need to be in place.  

We're going to have to live with the virus at least until there's a mass vaccine or medicine, perhaps in early 2021.  But we still have to live with 'flu despite a vaccine, so realistically we have to plan to live with COVID-19 for the foreseeable future.  There must be a better way of doing so.

Indeed there is.  We have seen that the #NearZero strategy is far superior to the current UK Government approach by being:

• Better for lives
• Better for livelihoods
• Better for life in general
• And better for the economy

#NearZero is also better than 

• The full "elimination" strategy implemented by New Zealand
• The Swedish approach of a light official lockdown, with a public-led lockdown (which is not herd immunity)
• Full 'herd immunity' as that would take years, and with countless deaths

So our best option is to get to #NearZero and then keep infections very low.


HOW TO STAY AT #NearZero

Whilst any reduction in the infection rate is welcome, there is no great point getting to #NearZero unless the country can stay there without repeated lockdowns.  Keeping infection rates very low isn't easy.  It needs:

1. Strategy and policy:  Commitment from the Government for #NearZero
2. Public Attitude: The public's voluntary commitment to keeping infections very low.
3. Immigration Arrangements: Effective quarantine and testing procedure for people and goods, but expecting some 'leakage' of virus into the country
4. Tackling Outbreaks:  Ability to spot individual outbreaks early and deal with them rapidly
5. Financial support: As necessary for individuals, businesses and other organisations during any lockdown

HOW TO GET TO #NearZero


In the summer, official "new confirmed cases" were under 1000 a day.  It would have been possible to get to #NearZero at around 200 cases a day in 3-4 weeks with a second lockdown similar to the first.  But the infection rate has risen substantially, to at least 5,800 a day and rising.  A very low level of infections consistent with #NearZero is no longer attainable with a standard lockdown like started in March/April.   There needs to be some different action.  But what?

People develop symptoms in 2-14 days, but typically 5.  So in two weeks anyone infectious who will develop symptoms will have done so, and should self-isolate. Asymptomatic people can also be assumed to be no longer infectious after two weeks. Any outbreak after the two weeks would need to be dealt with as if it was an imported case.

So the idea is to have a complete "circuit break" with a full Mass Self-Isolation for 2 weeks.  Exceptions only where essential, and very limited.  Not just a lockdown, and not what's been discussed as a light circuit break so far.

After that time COVID-19 will be best part eliminated. This can be timed to coincide with the school half-term at the end of October, as long as it is announced this coming week to give people time to prepare.

I now hear an epidemiologist suggested a Mass Self-Isolation back in February as the first wave took off.  It is not an alien concept.

No doubt there will be lots of reasons raised as to why we can't adopt this strategy.  But gut feel is every single one of them can be overcome.  Where there's a will there's a way.

Indeed effectively we have a choice:

• Carry on as we are for six months or more, not being able to plan and see death figures steadily rise, or
• Do a short, sharp 2-week Mass Self-Isolation, and then carry on with life almost like normal

What would you prefer?


THE DETAIL

Here you can see the idea and the benefits discussed in more detail.

COVID-19: WHEN THE GOING GETS TOUGH...

Professor Shock

The summary "Now Here's An Idea" worth reading first.

Something's been bothering me so far this weekend.  If it could have taken just 3-4 weeks to get to #NearZero in the summer, how long would it take now the infection rate is so much higher?

We know #NearZero is not only better for lives, livelihoods and life, but also better for the economy:

• Lives
• Fewer deaths
• Fewer cases of LongCOVID

•  Livelihoods
• More work for the employed
• More work for the self-employed

• Life
• Get on with what we like to do
• Better for education
• Less strain on the NHS, our health service, and the people who work in it
• Less strain on NHS Test system

• Economy

• Better for business
• Better for the nation's finances

But how do we get there?   

Professionally, I advise the senior executives of FTSE, AIM and private businesses, typically the CFO (Chief Financial Officer) and the CEO (Chief Executive Officer).  That has on occasions meant coming up with solutions to problems that other people have not solved.  A little madness helps.  Thinking the unthinkable.  Asking the questions others haven't thought to ask.  The impact can be significant.

So what of this problem?  How do we unlock the significant benefits of #NearZero?

Now, there's a useful fact.  People develop COVID-19 symptoms within two weeks of infection.  Hence the two weeks for self-isolation and quarantine.

We've heard the term "circuit break".  But what does it mean?  What if it meant cutting off literally all routes of infection for two weeks? 

A mass self-isolation. 

It might sound mad, but that is the only answer.



THE PRACTICALITIES OF A MASS SELF-ISOLATION

A mass self-isolation may be fine in theory, but how about in practice?

Firstly, everybody would have to be ready to self-isolate for a fortnight:

• Enough food in stock
• Enough medicines
• Enough of anything else

Let's say it would take two weeks preparation for those who are not ready to get ready.  Most people have freezers and cupboards with enough already in place.  There should be enough tins and other provisions in the shops and their supply chains for everyone else.  

All shops, business, schools and higher education would then close down for two weeks. 

There's been talk of a "circuit break" for the October half-term.  The timescales could tie in with that ideally.  Provided a decision to do this is made promptly.  Minimising the impact on education.

There's then public attitude.  The "Mass Self-Isolation" has to be sold. And the public need to respond not only with support for the mass self-isolation but also keeping the infection level very low thereafter.  

Indeed there are these pre-conditions identified in an earlier blogpost:

1. Strategy and policy: The Government must commit to keeping the infection rate very low, #NearZero
2. Financial support: This must be provided to individuals, businesses and other organisations during lockdown.  It only needs to be for a very short time.
3. Public Attitude: The public's voluntary commitment to keeping infections very low must be gained, through much improved communications with the public.  That must include explaining the 'whys' as much as the 'whats'.  Like any sales exercise, all the contrary "objection" viewpoints need to be tackled and overcome.  Fines very much as a last resort.
4. Immigration Arrangements: A more effective quarantine and release procedure needs to be in place to suitably control not just people, but also things coming into the country. Last I heard chilled food packaging was still suspected as being a source of New Zealand's outbreaks.
5. Local Outbreaks:  Ability to spot individual outbreaks early and bring them under control

In the meantime the public should be encouraged to self-isolate as best they can.


IN CONCLUSION

The infection rate in the UK has risen too high to get to #NearZero with a light lockdown, or even a lockdown as draconian as the first.

The only answer is a full and proper "circuit break".  It will need a "Mass Self-Isolation".  With only minimal exceptions, such as for those people needing daily care.

Achievable by the end of October if the proper steps are put in place this coming week. 

Save Christmas.  Save our lives.  Save our livelihoods.  Save the economy.

I put this statement to the House for debate.

COVID-19: THE PRACTICAL AND FINANCIAL BENEFITS OF #NEARZERO

Just before PM Johnson's speech last week, we saw how a #NearZero strategy, with very low levels of infection, would be substantially better in a whole host of ways than the UK Government's current strategy for England.

The following day the Chancellor, Rishi Sunak, outlined the financial support.  Reduced to a level that will be of little use to employers, employees or the self-employed.  Which is why there is concern about unemployment and the hit to the economy, which would produce significant income losses for the Treasury, and significant extra costs.

So let's pull these two aspects together:

• The benefits to lives, livelihoods and life for individuals, with
• Impact on the Treasury

So we've shown that a very low level of infections, #NearZero, is not only better for lives, livelihoods and life, but also better for the economy:

• Lives
• Fewer deaths
• Fewer cases of LongCOVID

•  Livelihoods
• More work for the employed
• More work for the self-employed

• Life
• Get on with what we like to do
• Better for education
• Less strain on the NHS, our health service, and the people who work in it
• Less strain on NHS Test system

• Economy

• Better for business
• Better for the nation's finances

Which leaves one unanswered question. Why isn't the government following a #NearZero strategy?

The answer may lie in what is needed to get there.  A fresh day produced a fresh idea.

COVID-19: THE SUNAK "WINTER ECONOMY PLAN"

Rishi Sunak and his Winter Economy Plan

When I was interviewed by David Prever live on BBC Radio Oxford yesterday, Wednesday, we went well beyond his original question.  "How do these changes announced yesterday [by PM Johnson] affect you and your family?"

We talked about the six months of restrictions in prospect.  Having identified that being "in limbo" for this length of time is a problem, he 'appointed' me PM, and asked what I would do.  "One-month lockdown" was my reply.  He then 'appointed' me Chancellor "How are you going to pay for it?" My response was "Put it the other way, how are you going to pay for six months' support?"

Six months.  Six.  Months.  And that won't be the end of it.  Nor are the support measures the only costs.

This afternoon Rishi Sunak, the Chancellor, announced the support he has chosen to provide for those six months, the "Winter Economy Plan", including:

• The "Job Support Scheme" replacing Furlough with a Government subsidy significantly lower than before
• An extention to the "Self-Employed income Support Scheme" (SEISS), but at 20% of average taxable earnings instead of the original 80%.  Reducing cost to the Treasury, but virtually useless to those receiving it, and with a significant number of people again not being eligible
• Deferral of VAT payments by businesses, and income tax deferral for people subject to Self-Assessment
• Extention of loan scheme repayments

Yet Rishi is still expecting significant job losses, which will:

• Become a burden on Universal Credit
• In addition to a loss of PAYE and National Insurance receipts.

IMPACT ON THE EXCHEQUER

That means there are four types of 'cost' to the Exchequer which will hit the deficit and cash flow:

• The costs of this support, which is clearly being withdrawn compared to earlier support
• Reduction in tax receipts
• Increase in unemployment support costs
• The extra costs of running the NHS and 'Test and Trace' with a high infection level

Let's look at those in some greater detail.


TAXATION AND OTHER INCOME

Imagine being the Chancellor.  Tax revenues are like this, according to the 2020 budget:

• 24% / £208 billion from Income Tax
• 17% / £150 billion from National Insurance Contributions
• 18% / £161 billion from VAT
• 7% /£58 for Corporation Tax
• £296 billion all other taxes and receipts
• £873 billion in total

EXPENDITURE

For expenditure, again there are some dominant categories:

• £285 billion for Social Protection
• £178 billion for Health
• £116 billion for Education
• £55 bilion for Defence
• £56 for Debt Interest, which increases with any additional borrowing

So when Sunak talked about spending £12 billion on Test and Trace as part of the COVID-19 defence plan, that's nearly a quarter of the entire traditional Defence budget added to costs.



THE EFFECT OF HIS PROPOSALS ON THE ECONOMY

In summary, a reduction in employment, self-employment and business levels would result in these key revenue losses and cost increases in the general economy:

As we have seen these categories of income and expenditure are the largest, the impact on the Government's cash flow, deficit and borrowing needs will be highly significant.  That Magic Money Tree had better be good!

Add in the costs of the support and the extra costs of running the health service, and no wonder the Conservative ranks are balking at the cost. But whereas they are inclined to be more libertarian, by loosening the restrictions, the better answer (or at least least worst) is a short, sharp lockdown to get to #NearZero.


SO WHAT'S THE ALTERNATIVE?

Getting to #NearZero would have required around 3-4 weeks lockdown in the summer. But the higher the infection level rises, the larger the reduction in infections needed, and the longer it will take.

In financial terms that's a one-month or so cost of support to get to a position that will allow the economy to flourish.  In contrast, the Government's plan to run a higher level of infection will not only kill more people but it will kill jobs and cost a fortune, over a longer period:

We've also seen that #NearZero produces a better outcome for lives, livelihoods and life. So with the higher financial cost of its strategy, the Government's choice looks nowhere as good as #NearZero.


I'm not saying getting to #NearZero would be easy.  There are some critical pre-conditions to a lockdown, especially to avoid a subsequent resurgence.  But what would you rather happen:

• Spend a fortune hobbling along in limbo with a high death count? or
• Investing in a short sharp lockdown so we can get back to near-normal, with a thriving economy and a much lower cost in deaths?

COVID-19: HOW COULD A LIGHT SECOND LOCKDOWN WORK?

When I was on air this morning I avoided saying the word "lockdown" for as long as I could.  Apart from the fact that the word is poison, there are some practical matters that must be considered for another national lockdown to work:

• The need for the lightest possible lockdown
• Pre-conditions
• Experience with local lockdowns in Leicester and elsewhere
• Crucially, keeping infection rate very low thereafter
• Level of infection when lockdown started

So here's the analysis.


THE NEED FOR A LIGHT LOCKDOWN

It may surprise you that back in March I first favoured a light lockdown, similar as it turned out to Sweden's approach.  Accepting a low level of deaths, like we do for 'flu, so that we could continue with everyday life. That is because of the significant 'side-effects' of a lockdown, which were predictable and we have now experienced.

Balancing lives, livelihoods and life.

But with no vaccine or effective treatment for COVID-19, the level of deaths and serious illness requiring hospital attention was simply too high.  The same applies now, with the added issue of far higher numbers of people suffering from LongCOVID.

So just like treating any medical problem, as long as the medicine is better than what is being treated, it is worth doing.  That has proved to be the case, back in March and now.  A lockdown, as light as possible, being imperative.

In the case of COVID-19, we need to look from two perspectives:

• The six risks to individuals are such that action is needed.  
• From society's and the Government's perspective, there is also the need to avoid over-running the NHS.  That was the key reason the Swedish approach could not be adopted in the UK, and still couldn't.

TIMING OF A SECOND LOCKDOWN

Doing a lockdown back in the summer would have had three distinct advantages:

• It was more practical to do activities outdoors, which is considerably safer than indoors.  That includes all hospitality, such as pubs, cafes and restaurants
• Schools were on holiday
• Universities were on holiday

Any lockdown should do four things if at all possible:

1. Measures: Be somewhat stricter than the measures announced this week
2. Outdoor activities: Allow activities such as sports and hospitality outdoors or in very well ventilated areas (such as open-sided marquees)
3. Schools: Keep schools open if at all possible. Sweden only closed schools for over 16s
4. Universities: Keep universities open, with tuition provided without students needing to congregate

PRE-CONDITIONS

There are four pre-conditions to doing a national lockdown, only one of which I had chance to mention on air:

1. Strategy and policy: The Government must commit to keeping the infection rate very low, #NearZero
2. Financial support: This must be provided to individuals, businesses and other organisations during lockdown
3. Public Attitude: The public's voluntary commitment to keeping infections very low must be gained, through much improved communications with the public.  That must include explaining the 'whys' as much as the 'whats'.  Like any sales exercise, all the contrary "objection" viewpoints need to be tackled and overcome.  Fines very much as a last resort.
4. Immigration Arrangements: A more effective quarantine and release procedure needs to be in place to suitably control not just people, but also things coming into the country. Last I heard chilled food packaging was still suspected as being a source of New Zealand's outbreaks.

EXPERIENCE WITH LOCAL LOCKDOWNS

One of the advantages of Sweden's approach was anticipating that people would get fed up with enforced lockdowns, whilst realising that COVID-19 would be around for a considerable time.  It is a pity that we cannot follow their lead.

So how have the local lockdowns worked?  As effectively as the first national lockdown?

Here is Leicester's experience:

It was possible to get daily infections down to around a fifth of the peak, before they began increasing again.  Similar results were achieved in Oldham, Wigan and other parts of the north west.

My belief is that even better results could be achieved with improvement in communications, at least as good as the first lockdown.

KEEPING INFECTION RATES VERY LOW THEREAFTER

Keeping infection rates very low after a lockdown is absolutely critical, otherwise any lockdown is a waste of effort.  I'm not suggesting regular lockdowns as a matter of expectation or policy.

The sad thing is that as soon as an infections reduction has been achieved, it's then shot up again.  This has been seen in Leicester, Madrid and many other places.

How can the infection rate be kept very low, so further lockdowns can be avoided?

The basic anti-transmission measures (Space, Face, Hands in that priority order) must become second nature.  For all age groups.  That includes young adults, for reasons explained by the senior scientists.  That requires:

• Clear communication of the 'whys' as well as the 'whats'
• Establishing a social pressure, just as drink-driving has become socially unacceptable
• Wardens to help educate, encourage and chide.  These could be the "COVID marshals", perhaps combining their role with 'boots on the ground' contact tracing

LEVEL OF INFECTION WHEN LOCKDOWN STARTED

In the summer "confirmed new cases" were under 1000 a day.  We know these are only the tip of the iceberg, with total new cases around five times that number, at the testing levels since July.  This is because:

• Not everyone with symptoms gets tested
• Swabbing can result in 30% or more false negatives
• Asymptomatic people are not tested, who can nonetheless be carriers

A 'very low' rate of infections is under 1000 per day across the country, or 200 official new confirmed new cases.  That's 0.3 per hundred thousand a day, around 2 per hundred thousand a week in official terms.

The first lockdown took new infections down to a sixth of the peak level in three weeks, plus the time it took before the level peaked:

The higher infections are let to rise, the higher the starting point, and the higher the level achieved after 3-4 weeks.  So on a rising curve, the sooner a lockdown is started, the less time it would take to get to a specific lower level.

In the summer a rate of under 1000 a day nationally could have been reduced to 200 official "new confirmed cases" comfortably in three weeks.  Now official rates are 4500 a day, but could already be much higher as:

• This figure could be as much as two weeks out of date given that people take some time to develop symptoms and get tested.  
• Recently people have had symptoms and not been able to get tested.

There is no time to lose!  Let's get the pre-conditions in place and get into lockdown.  Before it's too late.

Update 28/9/20:  Daily infections have now risen to over 5700.  A lockdown similar to the first would not be sufficient to get infections down to very low levels.  A more robust "circuit break" in the form of a Mass Self-Isolation would be needed.  But the good news is it could be as short as 2 weeks.


AREN'T PM JOHNSON'S MEASURES ENOUGH?

The headline from Wednesday's "i" newspaper makes it clear that scientists do not believe the new measures go far enough.

Indeed the paper quotes Paul Hunter, professor of medicine at the University of East Anglia, as saying "It is doubtful that the measures currently being enacted will be sufficient to reduce the R value to below one much before this side of Christmas".  That's daily infection rates continuing to grow, albeit at a slower pace.  Not reduce, as is needed.

Over recent months the measures introduced in Scotland have tended to be stricter than England's, and this week is no exception.  Scotland's First Minister,  Nicola Sturgeon, is quoted as saying she had been advised by Scotland's Chief Medical Officer that PM Jphnson's proposals "will not be sufficient to bring the R number down".


IN CONCLUSION

There is no doubt that the infection rate cannot be left to rise.  The Government was right to introduce new national measures, but they do not appear to go anywhere near far enough.  Too little, and frankly too late.

The right balance between lives, livelihoods and life, as explained here, is at a far lower level of infection.  An investment in a tougher lockdown, whilst preferably light enough to keep schools and universities open, would be well worthwhile.  Provided it is conducted in accordance with the necessary pre-conditions.