The COVID-19 pandemic: the world reels

Within hours of the Prime Minister’s decisions to first request and then impose restrictions on the daily life of the British people, the streets of our cities and towns were almost deserted. By this past Monday even parks were emptying.

Rarely in our history has there been so graphic an illustration of the wisdom of former Labour Prime Minister Harold Wilson’s adage that ‘a week is a long time in politics.’

But much more than the physical appearance of the United Kingdom has changed this month. Fear has transformed the mood of the British public (and its politicians) to the institutions of state – most obviously, the National Health Service.

The sentiments of Robert Jenrick, Housing and Communities Minister, on the BBC’s flagship ‘Today’ programme yesterday morning, that ‘people working in the National Health Service are absolute heroes’ have been echoed by government ministers from the Prime Minister down.

In a budget statement on March 11th, rapturously received on the Tory party back benches, the Chancellor of the Exchequer, Richi Sunak said: ‘whatever extra resources our NHS needs it will get.’ Even then, given the Prime Minister’s record of promising more than he delivers, scepticism was still warranted.  

After all, this is a government that only last year was forced to deny that it was negotiating a trade deal with the United States which involved ‘selling off’ the NHS. That charge was never plausible; but discussion of a deeper involvement of private sector USA firms in the British health system was part of the negotiations.

Now, as the current COVID-19 outbreak unmasks the threadbare patchwork of a USA health system that ‘Obamacare’ ultimately failed to resolve, any appeal of the American model is vanishing.

As Robert Shrimsley, the Financial Times’ political columnist noted on Tuesday, as he dissected the shift in the political winds: ‘There will be an absolute demand to fund spare capacity in the NHS… the Tories already face a reckoning on under-funding… voters will not tolerate another NHS winter flu crisis.’

The BBC, another national institution under attack, has sniffed the wind too. Its presenters are now studiously avoiding confrontational interviews that would leave it open to charges that they are undermining the national interest because of their alleged political bias. There is, as one reporter noted on the World at One this week, a conscious effort to ensure that it is fulfilling what he described as ‘its public service mission.’

Instead, however, the BBC is going back to what some of its top executives have grown up with, solid, impartial, reporting. Ministers have been given plenty of air-time. But there has been no shortage of interviews with senior doctors and nurses revealing the dire shortages of personal protective equipment: nor of the now emerging cost of the government’s failure to heed the early warnings about what Professor Hugh Montgomery described on Channel 4  News on Wednesday as the ‘tsunmi’ of COVID-19 cases now sweeping towards hospitals.

A couple of months (at most) of data means it still too early for professional economists to predict how hard the British and world economies will be hit by the current COVID-19 outbreak. Kristalina Georgieva, Managing Director of the International Monetary Fund, is warning of a global slump far worse than in 2008/9 recession.

For the UK, given that, according to the government’s Office for Budget Responsibility, Brexit would already be hitting Britain’s economy this year, and looking at the latest indicators across Europe for business activity in March so far, a deep and protracted recession looks unavoidable.

This means that Britain is again facing a surging budget deficit and a potentially destabilising rise in the level of government debt to national output, currently an unnerving 80%. Unlike in 2008/9, however, public sector institutions like the NHS will not be in the firing line.

And, in a world reeling from a pandemic, ‘global Britain’, has lost its allure. It is not just prospective trade deals with America but also increasing immigration from far off countries like corona-ravaged India (the price of any trade deal with the sub-continent) that look like a bridge too far.

So too the risks from higher trade barriers and tariffs with the European Union, or the costs of developing and launching our own satellite-based military communications system rather than asking for re-admittance to Europe’s functioning Galileo system. The loss of our varied roles in the EU, including hosting the European Medicine Agency, are also looking a bit like shooting ourselves in the foot. There will be no move to re-join the EU, but when you are in trouble you tend rely on our neighbours and friends for help – indeed the Prime Minister is now urging us to do just that!

What are your thoughts about the political and economic ramifications of the COVID-19 emergency? Do add your comments to this blog

Stewart Fleming, journalist and previous foreign correspondent for the Financial Times in Washington. 

Comments (11) Add yours ↓
  1. Louise de Winter TUF

    I think at this point it is hard to call the future political ramifications of COVID-19. Economically, however, charities such as The Urology Foundation are already affected with our fundraising events and plans put on hold, meaning that our income targets may not be met. More importantly, however, is the impact on the wider economy and stock market, the real threat to jobs and livelihoods, that will affect the confidence of many donors. Many will feel worried and nervous about their own financial position and income and that will inevitably cause them to pause on their charitable giving. That could potentially impact on future funding for urological research and training, at least in the short term.

    At TUF we will endeavour to ensure that our programmes and grants reflect the needs of the urology profession and I am confident that, with the help and support of urologists and urology nurses, we can get through this and continue to fund important training and research.

    March 26, 2020 Reply
  2. Roger Kirby Professor of Urology

    Great comment Stewart – many thanks.
    The report below in the Lancet is relevant in this context https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30236-1/fulltext

    which is all about this report –

    file:///C:/Users/cbayn/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/The%20UK’s%20contribution%20to%20health%20globally%20–%202020%20update%20FINAL%20(1).pdf

    There is hope therefore, even if the UK’s Financial Market etc is damaged, NHS PLC for the world may still have a place, but not if we go belly-up with our current response to the crisis.

    March 26, 2020 Reply
  3. Dr Suzy Walton Vice President , Royal Society of Medicine and former head of Strategic Futures in the Prime Minister's Strategy Unit

    We can’t begin to know the political and economic ramifications. In government and in business when we don’t know something we model it – we look at different scenarios that give us different possible futures. We take account of known drivers of change and we assume some ‘wild cards’ that we can’t define precisely but we know might come into play.

    However with COVID-19 we can’t scenario plan. The data we have that is being laboriously gathered by organisations like WHO and Johns Hopkins gives us a insight into the starting chapters but we have no previous analogs to guide us. Conventional tools of analysis desert us.

    So we’re asking the wrong questions. Rather than speculating about political and economic ramifications we need – as we are doing – to mobilise the best epidemiologists, the best public health experts, the best engineers, the best planners and others. We need to work truly globally and across organisational boundaries to get the world an exit plan for the pandemic. How we do that – that is the question for now.

    March 26, 2020 Reply
  4. Simon Wessely Professor

    iI suppose the one good thing about COVID-19 is that we don’t seem to talk about Brexit anymore. Indeed, the extraordinary levels of government spending on protecting wages, supporting the NHS and so on, represent a change that makes the Labour spending promises so derided during the last election seem like pocket money. and to be fair, it is hard to see how Brexit has really impeded our public health response to the crisis – we are co operating not just with our old EU partners, but across the world as we tackle the pandemic. And our failure to join forces for a joint procurement exercise with our EU partners to provide ventilators, now in desperate need, turns out to be nothing to do with Brexit, but a communications failure. But as Stewart points out, when finally the current crisis is over, and when we actually do leave , the fundamental economic truths have not changed. Recovery from COVID is going to be harder out than in.

    March 27, 2020 Reply
  5. Roger Kirby Professor of Urology

    If as Stewart says the COVID-19 situation in the UK is pretty grim, it’s probably worse in the USA in part thanks to “the Donald”! The US now has more confirmed cases of coronavirus than any other country, with more than 85,500 positive tests. According to the latest figures collated by Johns Hopkins University, the US has overtaken China (81,782 cases) and Italy (80,589). But with almost 1,300 Covid-19-related fatalities, the US death toll lags behind China (3,291) and Italy (8,215).
    The grim milestone came as President Trump predicted the nation would get back to work “pretty quickly”!

    March 27, 2020 Reply
  6. Roger Kirby Professor of Urology

    Latest news: UK prime minister Boris Johnson has tested positive for coronavirus!
    He is recovering after coming down with the symptoms of COVID-19, Downing Street confirmed on Friday.
    “After experiencing mild symptoms yesterday, the Prime Minister was tested for coronavirus on the personal advice of England’s Chief Medical Officer, Professor Chris Whitty,” a Number 10 spokesperson said in a statement.
​
    “The test was carried out in No 10 by NHS staff and the result of the test was positive.
    “In keeping with the guidance, the Prime Minister is self-isolating in Downing Street. He is continuing to lead the government’s response to coronavirus.”


    March 27, 2020 Reply
  7. Michael Kirby Professor

    An interesting view on the state of affairs in the US with lessons to learn on how it may end

    https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/

    March 29, 2020 Reply
  8. Roger Kirby Professor of Urology

    The US and UK both have weaknesses in their healthcare systems which could trigger a collapse if the two countries experience the kind of severe coronavirus outbreak similar to Italy, a Financial Times analysis has found.

    Both countries have fewer hospital beds per capita than most other western nations, the analysis shows. While the US and UK have about 2 beds per 1,000 people, Germany, by comparison has 6, while Japan has 7.8, according to the OECD.

    The US also lags behind on the number of doctors for its population, with 2.6 per 1,000 people. That compares with 4.3 in Germany and 4 in Italy, where hospitals have had to erect inflatable tents in their grounds and patients crowd the corridors.

    March 30, 2020 Reply
  9. Brian Dye Lawyer

    I’d like to commend this very well written pre-print of a paper by the mathematical modellers at the Covid-19 working group of the Centre for Mathematical Modelling of Infectious Diseases at the London School of Hygiene and Tropical Medicine (and others) which has been circulated today:

    https://cmmid.github.io/topics/covid19/control-measures/report/uk_scenario_modelling_preprint_2020_04_01.pdf

    The whole paper is worth reading in detail but for those who want to get straight to the point, please look straight away at Tables 4 and 5 and then double back and read the whole paper; the nub of their modelling conclusions (keeping things simple and in my own words) is that:

    1. Had the Government maintained its decision just to mitigate and not suppress Covid-19, we would be looking at a median case of 370,000 deaths up to December 2021 and that, whatever we do now by way of lockdown, deaths of 51,000 are to be expected.

    2. To keep deaths just to the level of 51,000, we’d be intensifying lockdown and relaxing it at a trigger of 1000 Covid ICU bed occupancy; and the extent and duration of the lockdown needed would require school closures until August 2020, intensive measures until at least March 2021, and lockdown until August 2021. For this we’d need to spend over 70% of the period Jan 2020 – Dec 2021 in lockdown.

    3. On the other hand, if we were to manage (increasing and relaxing) the intensity of the lockdown based on a trigger of a 5000 Covid ICU bed occupancy, we would be looking at 130,000 deaths by December 2021 and, at the peak, we’d need 13,000 Covid ICU beds and 26,000 Covid non ICU beds to cater for demand. But we’d only need to spend 35% of the time from Jan 2020 – Dec 2021 in lockdown.

    4. If, as a society, we don’t fancy extensive lockdown, and if we just take an “intensive measures” but not a “lockdown” approach, we’d be looking at the same 130,000 deaths, but we’d face the obstacle that, to cater for demand in the peak week, we’d theoretically need 33,000 Covid ICU beds and 62,000 Covid non ICU beds if we were going to meet peak demand.

    These are perhaps just headlines takeaways from the paper, and, I emphasise, expressed in my words. For more details, including sophisticated statistical detail, variances, confidence intervals, details of the modelling, definitions of interventions, I refer readers to the paper itself.

    The results have already apparently been presented to the Government. It is a great tribute to CMMID and its Covid-19 working group that they have published their work in the public domain for us all to see.

    Obviously, there are other models in circulation. But these people are very distinguished and they know what they are doing so, prima facie, this is a paper for us all to evaluate very seriously.

    April 1, 2020 Reply
  10. Roger Kirby Professor of Urology

    Prime Minister Boris Johnson has been admitted to hospital for tests, 10 days after testing positive for coronavirus, Downing Street has said.
    He was taken to a London hospital on Sunday evening with “persistent symptoms” – including a temperature.
    It is said to be a “precautionary step” taken on the advice of his doctor.
    The prime minister remains in charge of the government, but the foreign secretary is expected to chair a coronavirus meeting on Monday morning.
    Mr Johnson is expected to stay overnight and is having what have been described as “routine tests”, according to BBC Political Editor Laura Kuenssberg.
    In a statement, a Downing Street spokeswoman said: “On the advice of his doctor, the prime minister has tonight been admitted to hospital for tests.
    “This is a precautionary step, as the prime minister continues to have persistent symptoms of coronavirus 10 days after testing positive for the virus.”

    April 5, 2020 Reply
  11. Nicola Stingelin Ethicist

    In situations of a public health emergency, values other than individual autonomy must in many contexts correctly take priority. The parliamentary debates surrounding the passing of the Coronavirus Bill reflect the serious nature of granting emergency powers in a public health emergency, and the high level of scrutiny taking such action requires.

    Amongst the most distressing COVID-19 events have been the reports of people – both young and old – dying without family being present because of risks of contagion. The role played by surrogate family health care professionals is truly remarkable.

    Notwithstanding the correctly must vaunted ‘science’ held as justifying not allowing loved-ones the chance to accompany the dying process, I have been concerned at who has being formulating this kind of rule, using what process, and precisely what rights, interest, risks and benefits are being draw into the analysis? Do we have a failure of moral proportionality?

    Clearly times-lines and decision making processes in a health emergency cannot follow normal democratic paths. However, this means that the importance of transparency, accountability, and scrutiny are heightened.

    I was therefore relieved to hear early on 15th April that the Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, would be relaxing such restrictions. However, the wording he actually used was very worrying. Mr Hancock said that he was “giving people the right to say goodbye.”

    This approach to ‘rights’, and who has the power to take them away, and who has the power to give basic rights in a public health emergency surely deserves transparency, accountability and debate – not only regarding the current situation, but also regarding future public health emergencies. We need action now – a question to parliament when it open? I am working on this, Please join me.

    April 16, 2020 Reply

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