Dr No has never been much of a ‘stand back, I’m a doctor’ sort of doctor. In his first house job, asked by excitable relatives whether a patient was on the Danger List, Dr No replied that he didn’t have a Danger List, but if he did, he supposed the patient might be on it. By far the greatest clinical teacher Dr No came across in his early formative years was a surgeon who taught Dr No, at the time hell bent on a career in obstetrics, a red shirt and brown trousers specialty if ever there was one, that the most important skill for a surgeon, given basic competence, was to know when to operate. Any fool can dive in right away, but the better surgeon knows when to operate: maybe now, maybe in a few hours days or weeks, maybe never.
The back of a fag packet account of the rise of a totalitarian state goes something like this. First, atomise a preferably already disenfranchised people, then fill the void with a spell binding myth that is at the same time under constant threat from a deadly enemy that must be eliminated, whatever the cost. These steps achieved, the tyrant can walk though an already open door. The ancillaries of totalitarianism — the eradication of free thought and spontaneity to be replaced by the normalisation of uncritical uniformity, the apparatuses of decree, surveillance, propaganda and terror, and the unswerving adulation of the supreme leader — can then all click into place, like a latch in a door frame. The alibi for these hideous intrusions is, as Camus noted, the welfare of the people, and the people, as Franklin noted, willingly trade in essential liberty to gain temporary safety, each and every one hoping, as Churchill noted, that if he feeds the crocodile enough, the crocodile will eat him last.
You might be forgiven for thinking the new discipline of maskonomics was created by government to facilitate to masking of awkward and tiresome economic results. In fact, it is a close cousin of economics, the field of study that makes astrology look rigorous, and its purpose is to mask, or silence, mask dissenters by providing a barrage of argument in favour of wearing face masks, or coverings, in public to reduce covid–19 spread. Its high priestess in England is none other than the utterly formidable Prof Trisha Greenhalgh, a medical OBE whose gaze alone is sufficient to curdle fresh milk at twenty paces. Lesser prelates include Dr Venki Ramakrishnan, a more benign but no less mask committed Nobel Prize winning structural biologist who is for the time being Chief Pongo at the Royal Society, where he has found applying structural social engineering to promote mask wearing very much to his liking.
The biggest fact about face masks and covid–19 is there are no facts. This should not surprise us one bit. Covid–19 is a new disease, and research takes time to conduct. Furthermore, the sort of research that would give us a definitive answer, a randomised controlled trial, is burdened with almost — but not totally — insurmountable difficulties, from ethical concerns to procedural obstacles. One solution, attempted by the three authors of the Royal Society report covered by Dr No in his last post, is not to let the best be the enemy of the good, a pragmatic wheeze that says that the absence of the great (RCT evidence) doesn’t mean we should ignore the good (lower quality but, one hopes, tolerable evidence). The danger is that following Voltaire can all to easily turn into ‘no need to bother with that sort of nonsense round here’, where ‘that sort of nonsense’ is good quality evidence. This is what the Royal Society report authors did. Having found no reliable clinical evidence, they turned instead to an in vitro, laboratory based physics experiment, and came to a clinical conclusion. Dr No regrets to say that simply won’t wash. But then again, you hire demographers, you get pyramids.
As the buns continue to fly back and forth across Hadrian’s wall in a mock war of independence, cheeky commentators south of the border have dubbed face masks, now compulsory when out and about north of the border, jock straps, on the basis that they are indeed straps of cloth fitted to all Jocks, of either sex. Inevitably, the Scottish compulsion, which came into effect last week, has prompted a frenzy of hand wringing and bed wetting in England as to why we aren’t doing the same thing. More moderate minds wonder what the evidence is for the effectiveness of masks, given that any compulsion is also inevitably an infringement of liberty, and that, as such, any compulsion must be proportionate, insofar as the benefits outweigh the harms.
Dr No is not sure whether Sarah Montague on yesterday’s WATO almost had a Harry Commentator is your Carpenter moment. Alluding to the Secretary of State for Health, something sounding (at 14m 20s) rather like Hat Mancock got stiffled in a slew of splutters. Whether Montague said it or not, it is a fitting name for a man seen by many as a bit of a knob, a man who would rather pop cherries on cakes than deliver an effective test and trace system, and who happens, for the time being, to be the man with overall responsibility for covid–19 surveillance in England. This surveillance covers both how many people currently have covid–19 (swab tests for the virus), and the crucial question of how many people have had covid–19, with or without symptoms, in the community since the pandemic started (blood tests for antibodies).
That Trump gets it but Halfcock Hancock doesn’t is a long way south of bizarre, but there it is. A trumpdemic is an artefactual spike in covid-19 cases caused simply by doing more tests. You do more tests, you get more cases, or, as the eponymous president would have it, you do no tests, you have no outbreak. ‘That’s great, you know. I’ll have my people stop testing. No tests, no covid. No tests, no way. Yes, sir, that’s my baby. Mahmood Indigo. Sheik Rattle’n’Roll. Celine Dion.’ Or, to get an outbreak, take a city with a constant prevalence of covid–19, say 5%, from one week to the next. In the first week do 2,000 tests, and you have 100 cases. In the next week do 10,000 tests, and you have 500 cases. Cripes! Houston, we have an outbreak! Only we don’t: the underlying prevalence remains the same. We just did more tests.
The last 24 hours has been a wake up call for Dr No. A natural sceptic when it comes to government statistics, he has nonetheless been lulled into a false sense of confidence over the availability of covid–19 data, by the widespread online publication of data. Crucially, he made the naive assumption that, if data was existed, then it would be published. This assumption — and we should recall that assumption is none other than the mother of all f*ck ups — was it seems badly wrong. Allegations are rife in the press that the government has wilfully held back crucial local authority level data on Pillar 2 covid–19 testing, hampering local attempts to manage spikes. This discovery has led to an orgy of data mining and sharing, led by the FT, and tarted up using deeper red data gloss by the Guardian. The inevitable caring and sharing so much it hurts explosion on twitter is now in full swing.
Now that Boris the Builder has failed in his attempts to achieve greatness, first as the New Churchill, and then as the Noo Roosevelt, one hardly dare contemplate who is next in line for emulation. Perhaps there will be clues – denied reports of the summary execution in the Rose Garden of the first minister to stop clapping in cabinet? Or maybe the BBC’s melodious Lorna Squawksberg will report that sources close to Number Ten have confirmed the Prame Miniature will soon make a progress announcement on tractor production? Or, Heaven forbid, that we hear leaks of alleged Cummings’ mutterings, that a single death is a tragedy, fifty thousand is a statistic? Only time will tell which hapless figure from history will next be reduced to one whackamoled dimension, but of one thing we can be sure, the Minister for Metaphors and Clichés will bear down at warp speed to double up on levelling down.