The Lessons SAGE Needs to Learn from Sweden’s Anders Tegnell

There follows a guest post by a reader, who wishes to remain anonymous, who has spotted another important difference between the U.K. and Sweden.

The Prime Minister will be given another crucial SAGE briefing at the start of the New Year, when, once more, he will presumably be steered towards a decision on more restrictions for businesses and the general public by the use of models.

If Professor Graham Medley, the chair of SAGE’s modelling committee, takes part, we can, of course, expect that he will only present a worst-case scenario.

In stark contrast, the Swedish state epidemiologist, Dr Anders Tegnell, known for his aversion to lockdowns from the beginning of the pandemic, routinely produces models with several scenarios and I have yet to see evidence that they are presented to his Government with all scenarios expunged, barring the worst one. 

I’ve applied, below, the ‘SAGE’ presentation principle to Tegnell’s latest Covid models, created last week for the Swedish government.

It’s striking that even the worst ICU forecast is only for a peak of around 50 new patients in mid-January, which would equate to around 280 in England, if the difference in population size is taken into account, whereas the best is little more than the current figure of barely 10, equating to 56 in England.

As of December 29th there were 771 patients in ICU units in England who have tested positive for Covid, with no forecasts for future numbers made public. This is numbers in ICU, however, not new admissions. While new ICU admissions are not published on the Government dashboard, recently numbers in ICU have been declining rather than rising.

Daily Case Numbers Are Not Correlated With Mobility in Sweden

Throughout the pandemic, those in favour of more restrictions have argued there is a straightforward relationship between restrictions and case numbers. When the government imposes restrictions, the number of face-to-face interactions goes down, meaning there are less opportunities for transmission.

A week or so later, you should see case numbers start to fall. Or so the argument goes. Yet as David Paton noted in my recent interview with him, the assumption that “governments can turn infections on or off like a tap” simply isn’t true.

Last spring, almost every country around the world saw a large drop in mobility – as measured by indexes that track people’s smartphones. In most countries, this drop not only coincided with the start of lockdown, but also preceded a fall in case numbers by one or two weeks.

It was therefore widely assumed that mobility could serve as a proxy for the kind of behaviour change that causes infections to go up or down. However, examples like South Dakota – where infections fell rapidly without much change in overall mobility – cast serious doubt on this assumption.

In other words, just because mobility has fallen, doesn’t mean case numbers will go down; and just because mobility has risen, doesn’t mean case numbers will go up. This suggests the relationship between restrictions and case numbers is far from straightforward.

I plotted mobility alongside new daily cases for Sweden – one of the countries where restrictions have been least stringent. If mobility were closely related to infections, we’d be able to pinpoint precisely when restrictions should have been made more stringent, in order to get case numbers down. But that simply isn’t possible, as you can see below.

Both Right and Left-Wing Authoritarianism Predict Support for Lockdown

The pandemic has seen unprecedented infringements in our civil liberties. Policies that would have been regarded with suspicion or even outrage if implemented by Britain’s ‘enemies’ – like confining people in their homes – have been par for the course.

Interestingly, in both Britain and the United States, support for lockdown measures has been greater on the political left, even though right-wing voters tend to be older (and hence at greater risk from Covid).

In a paper published this July, researchers found that Labour and SNP voters were much more likely than Conservatives to support closing schools and shops, and making people stay at home. Likewise, Democrat voters in the U.S. have been more supportive of lockdowns than Republicans.

There are several factors behind the left’s enthusiasm for lockdowns: skewed risk perceptions; the ideology of safetyism; a preference for prioritising health over the economy (including ‘our NHS’). However, one reason that hasn’t received much attention is the growing strain of left-wing authoritarianism.

In a paper published last December, Joseph Manson explored the influence of left and right-wing authoritarianism on people’s attitudes to lockdowns and other restrictions. ‘Right-wing authoritarianism’ is a well-known construct in psychology, but ‘left-wing authoritarianism’ is relatively new.

The latter phenomenon had not received much attention in psychology until recently, most likely because of the discipline’s left-wing skew.

Right-wing authoritarianism is measured via agreement with items such as, “What our country really needs is a strong, determined leader,” and “God’s laws about abortion, pornography and marriage must be strictly followed”.

By contrast, left-wing authoritarianism is measured via agreement with items such as, “This country would work a lot better if certain groups of Christian troublemakers would just shut up and accept their group’s proper place in society.”

Manson found that both of these constructs were positively associated with support for lockdowns and other restrictions. Those who scored high on right-wing authoritarianism were particularly likely to say that foreigners should be banned from entering the country.

Those who scored high on left-wing authoritarianism were particularly likely to say that governments should have the power to prohibit misinformation, and that politicians should be able to introduce new restrictions without consulting legislative bodies.

There were also areas of agreement. As Manson notes, both right and left-wing authoritarians favoured “restrictions on the right to protest, punishment without the right to trial by jury, and surveillance via a mandatory tracking app”.

Regardless of one’s view on the pandemic restrictions, there can be no doubt that many of them have an authoritarian character. And even if their impact in the short run was positive (something of which I am doubtful), the possibility that they will be misused by governments in the future remains troubling.

Leaked NHS Report Claims London Hospitals “Likely to Be Overwhelmed” Within Three Weeks. We’ve Heard That Before

An internal NHS report leaked to the Health Service Journal claims that hospitals and ambulances in London are “likely to become overwhelmed due to rising Covid demand in the next two to three weeks”.

This is despite the fact that, as NHS Providers Chief Chris Hopson points out: “The overall numbers remain relatively low compared to the January 2021 peak – 1,819 Covid patients currently in London versus 7,917 on January 18th 2021.”

Let’s bear in mind also that last winter an internal NHS briefing, again leaked to the Health Service Journal, claimed that under the “best” scenario London would have a shortfall of 1,515 general and acute beds by January 19th. Yet the briefing also stated London has 15,600 general and acute beds, which is almost double what turned out to be the peak Covid winter occupancy of 7,917 beds on January 18th.

Nationally, at the winter peak on January 18th there were 8,696 unoccupied beds, 26,902 beds occupied by Covid patients and 50,204 beds occupied by non-Covid patients.

It’s also worth remembering that the NHS has a beds crisis every winter, as this selection of Guardian headlines illustrates. (See also the image at the top of headlines from the 2017-18 winter crisis.)

SAGE Modeller Says They Don’t Model Good Outcomes Because “It Doesn’t Add Any Further Information”

As SAGE minutes released with the Government’s approval make the case for new restrictions and even the cancellation of Christmas, Spectator Editor Fraser Nelson probed SAGE modeller Graham Medley on Twitter on why SAGE’s models were so often pessimistic and wrong.

The exchange, reproduced in full below, is illuminating because Graham says they do not include more benign scenarios because “it doesn’t add any further information” and “decision-makers are generally on [sic] only interested in situations where decisions have to be made”.

“Decision-makers don’t have to decide if nothing happens,” he argues. This is wrong, of course: not imposing restrictions because the threat doesn’t warrant it is itself a decision, a very important one.

Fraser asks: “So you exclusively model bad outcomes that require restrictions and omit just-as-likely outcomes that would not require restrictions?”

Graham replies that “we generally model what we are asked to model”.

Fraser asks: “Okay, so you were asked to model bad Omicron outcomes and make no comment as to the probability?”

Graham’s reply: “We model the scenarios that are useful to decisions.”

Ladies and gentleman: The Science.

Finally! YouGov Poll Finds Public Opposed to Lockdown

A YouGov poll for the Times, has revealed that a majority of the British population are opposed to further Covid restrictions. Guido Fawkes has more.

Guido can’t remember the last time a poll on Covid saw the public really reject any proposed restrictions on civil liberties, however a new one in today’s Times demonstrates just that. According to a poll of 1,714 people between the 14th and 15th, the arrival in Omicron saw very little movement on the public’s opposition to:

– Shutting pubs and restaurants: 60% opposition
– Shutting non-essential shops: 65% opposition
– Banning indoor meetings with people from other households: 62% opposition
– Banning indoor meeting people from other households on Christmas Day: 68%
– Pubs, bars and restaurants not being allowed to open on New Year’s Eve: 53%

According to YouGov’s polling, the government has already maxed out its support for anti-Covid measures – facemasks and passports – while leaving very little room for further restrictions if, as predicted, a wave of Omicron sweeps the land. For potentially the first time during this pandemic, civil liberties defenders have the overwhelming backing of the public…

Is there Any Evidence that the New Lockdown Measures will Work?

There follows a guest post in which ‘George Santayana’, the pseudonym of a senior executive in a pharmaceutical company, asks if there is there any evidence that the new lockdown measures will work? After examining the impact of similar measures in Scotland and Wales in the last six months, he concludes that they will not.

Last week, the Prime Minister announced that England would be moving to implement stricter mask mandates, work from home orders and vaccine passports in certain situations to try and do something to limit the rise of the Omicron variant. This is the so-called ‘Plan B’ and, although nowhere near a full Lockdown, involves the U.K. Government flexing its authoritarian muscles and imposing a range of restrictions on England in the name of saving us from viral Armageddon. But is there any evidence that these measures will help?

Effectively since ‘Freedom Day’ (July 19th, 2021), we’ve been doing a real-world experiment in England, Scotland, and Wales because, while England dropped mask requirements and had never implemented vaccine passports, the other two nations maintained the requirement for face coverings and introduced vaccine passports in some settings. In effect, Scotland and Wales all went to versions of ‘Plan B’ and, as a result, we can compare the effect that these extra restrictions have had on SARS-CoV-2 infection and Covid-related deaths to those in England as a way of understanding the potential impact of ‘Plan B’ in England.

Let’s start by thinking about what we might predict would have happened if ‘Plan B’ measures had had any significant effect in preventing the spread of SARS-CoV-2 in Scotland and Wales. Firstly, we would predict that, looking at levels of infection within the general population, we should see a clear difference between England, as the control group, and Wales and Scotland, with England performing worse with respect to the number of infections per head of population or perhaps showing worse trends in things such as more rapid increases in rates of infection or slower recovery from a ‘wave’ of infections. Similarly, if we consider Covid-related deaths, we’d expect that ‘Plan B’ would help Scotland and Wales avoid a larger number of Covid related death compared to England, which would again be at the bottom of the league table. Finally, as the non-pharmaceutical interventions (NPIs) implemented by Wales and Scotland in their ‘Plan Bs’ are similar, we might expect that any trends we observe in looking at infections and deaths in these two countries are more similar to each other than to England, corroborating the idea that these improvements are due to ‘Plan B’.

Let’s first look at the infection data, which we can pull directly from the latest ONS survey that can be found here.

In Figure One, I’ve reproduced the results from the ONS coronavirus infection survey for England, Wales, and Scotland. The arrows on the graphs on the left-hand side indicate the approximate position of July 19th (‘Freedom Day’).

Alcohol Deaths Increased at Record Rate Over Lockdown

Over the course of 2020, the number of deaths caused by alcohol increased by almost 19% according to the Office for National Statistics, with last year witnessing the biggest rise in alcohol deaths since records began. In addition, Public Health England (PHE) reported that, during the first lockdown, there was a noticeable increase in the number of people consuming more than 14 units a week, with the Head of Health Analysis pointing out that “loneliness, depression, and anxiety” may have been key factors fostering this trend. The Guardian has the story.

There were 8,974 deaths from alcohol specific causes registered in the 12 month period, up from 7,565 deaths in 2019 – the highest year-on-year increase since the data series began in 2001. It bucks a trend in which fatalities from alcohol remained stable for the previous seven years.

In England, the number of people drinking more than 14 units a week increased after the first national lockdown, according to surveys by PHE, and has remained at similar levels since. As pubs shut, drinking at home soared, with off-licence sales of beer rising 31% and spirits 26% compared with 2019.

Dr. James Tucker, the Head of Health Analysis, said: “There will be many complex factors behind the elevated risk since spring 2020.

“For instance, Public Health England analysis has shown consumption patterns have changed since the onset of the Covid pandemic, which could have led to hospital admissions and ultimately deaths. We’ve seen increases in loneliness, depression and anxiety during the pandemic and these could also be factors. However, it will be some time before we fully understand the impact of all of these.”

Close to eight out of 10 of the deaths were from alcoholic liver disease and although alcohol-related cirrhosis can take a decade or more to develop, most deaths occur as a result of acute-on-chronic liver failure owing to recent alcohol intake, a PHE study in July found.

Scotland and Northern Ireland continued to have the highest rates of alcohol deaths, but the fastest rises were in Wales and England. The sharpest rise in deaths in England was in the West Midlands, followed by the south-west and London. Nearly twice as many men died as women, which is consistent with previous years.

Worth reading in full.

Studies “Consistently” Find That Costs of Lockdown Outweigh Benefits, Say Researchers

Notable by its absence from the House of Commons’ pro-lockdown report was any mention of cost-benefit analysis. Indeed, the authors sidestepped the single most important question – was the lockdown worth it? – and went straight to saying that we should have locked down sooner!

Had they attempted to weigh up the costs and benefits, their report’s conclusions might have looked very different – assuming, of course, that they didn’t bungle the analysis. Remember: there are things to consider other than Covid outcomes.

Cost-benefit analyses published since the summer of 2020 have not been kind to lockdowns (which may explain their lack of inclusion in the House of Commons’ report). In a new paper, Ari Joffe and David Redman review 11 studies, each of which estimated impact using a common metric (e.g., the QALY).

Their results are shown in the table below. Each study’s main finding is given in the right-hand column.

All 11 studies found evidence that lockdowns do more harm than good. Among the nine that directly compared costs and benefits, the smallest ratio of costs to benefits was 2.5, and the largest was 26.

What’s more, the studies generally made assumptions favourable to lockdowns (e.g., that they have a large impact on the epidemic’s trajectory). Hence, in the authors’ words, their results “strongly suggest that lockdowns do not have a favorable cost-benefit balance”.

Joffe and Redman’s paper not only reviews cost-benefit analyses of lockdown, but also sets out an alternative plan for dealing with Covid (or, perhaps, with a similar pandemic virus in the future). Their plan specifies that the goal should be minimising harm to society “as a whole”, rather than – say – minimising the total number of Covid deaths.

It contains a number of appealing elements: increasing surge capacity; providing focused protection for the elderly; and reporting relevant information with context (e.g., number of deaths from all causes alongside the number of Covid deaths).

The paper by Joffe and Redman contains a lot of useful insights, and is worth reading in full.

Lockdown Has Led To Vulnerable Children Being Abandoned, Says Former Children’s Commissioner

Anne Longfield, the Chair of the Commission for Young Lives, has said that “very vulnerable children have continued to slip from view”, with the pandemic restrictions leading to vulnerable and abused children being isolated from support networks. Drawing on the case of six year-old Arthur Labinjo-Hughes, who was abused and murdered by his step-mother, Longfield mentioned that the young boy was not present in school during the months before his death due to ongoing lockdown restrictions. The Guardian has the story.

The neglect and murder of six year-old Arthur Labinjo-Hughes was possible because vulnerable children “slipped from view” during the pandemic, the former Children’s Commissioner for England has said.

Anne Longfield told the BBC she was “just heartbroken and totally sickened” by the case, in which Arthur was subjected to a what prosecutors called a “campaign of appalling cruelty” and murdered two months after social workers found no evidence of safeguarding concerns.

A court heard that Arthur was violently shaken and suffered an “unsurvivable brain injury” when his head was banged against a wall by his stepmother, Emma Tustin. After his death in June 2020, he was found to have 130 injuries.

Tustin was found guilty of murder and 29 year-old Thomas Hughes was found guilty of manslaughter on Thursday. They were due to be sentenced at Coventry crown court on Friday.

Longfield, now Chair of the Commission on Young Lives, said the case suggested a failure to put in place lessons from past failures such as the death of Victoria Climbie. “Very vulnerable children have continued to slip from view, and for anyone who looks at the serious case reviews, or hears about them that come after a child’s death, you will see the same things coming up,” she said.

“Time and time again, missed opportunities, lack of coordination, lack of data sharing, the things that professionals need to have at hand to be able to protect these children, still aren’t in place. But whilst there is learning from the serious case reviews, it’s not enough to change what happens to protect these children.”

She said Arthur was particularly vulnerable because of the Covid lockdown in place in the months leading up to his death. Noting that a high caseload and inexperienced staff could also be factors, she said: “What of course was also the case here was that it was a pandemic.

“So a lot of the services went on to the screens for children, and this child in particular, Arthur, wasn’t in school. And it’s much easier for families who want to evade view to do that when they haven’t got someone in the room. So there’s a big lesson there, instantly about if there is a crisis, there are children who are going to slip from view and we have to make sure they have the protection which does need face to face contact.”

She said the best way to keep children like Arthur safe was to intervene early when warning signs were visible to social workers. But she said that cuts to funding made that harder to do. “Long-term help is what needed, and again that’s something that’s been there less and less over recent years, and that means that more children are falling into crisis,” she said.

Worth reading in full.