Monthly Archives: October 2020

Dr No wrote this post (starting at paragraph 2) yesterday — and what a difference a day makes in covid. Overnight, news has broken of catastrophic worst case scenario predictions from the government’s pandemic modelling group SPI-M for the coming winter, with [enter your own choice of a large number here] deaths possible unless radical measures are taken immediately. Headlines vary in their degree of certainty, but the general message is that Boris Johnson is set to announce a national four week lockdown on Monday. Dr No takes a dim view of these hysterical worst case scenario predictions, viewing them as nothing more than Ferguson Reloaded. Though not yet fully in the public domain, some un-referenced blurry details have emerged, along with a completely unintelligible ‘surge capacity is burnt through’ Cabinet Office ‘timeline’ chart of hospital overload based on the SPI-M modelling, which once again suggest yet more modelling on steroids. Despite the appearance of these dire predictions this morning, Dr No continues to believe the NHS is not at risk of imploding by what the Cabinet Office calls ‘Xmas week’, and so publishes the post now as it was written yesterday.        

One of the most exciting and at the same time frightening developments of recent years has been our ability to collect and analyse vast amounts of data. Something of the sort has always been possible, but it was only with the arrival of cheap personal computers that ologies like epidemiology have been able to move from pencilled clustered tally marks ‘ ‘ analysed with back of the envelop chi-squared tests via the hidden 1s and 0s of computers to massive data sets probed in ways quite unfathomable even only a few decades ago. Back in 1982, the year Dr No qualified, no one had heard of logistic regression or data modelling. Google’s Ngram Viewer — itself a wonderful example of data collection and analysis — shows that both logistic regression and data modelling took off in the mid nineteen eighties. Add the discrete citizen surveillance device more commonly known as the smart phone, and the explosion in social media use, which have together enabled  the collection of personal data on a huge scale, and we now find ourselves living in a world where data is everything, and everything is data; a world in which once unique individuals have become transformed into numbers, to be probed, analysed and described at will, not as individuals, but as data.

The recent brisk treatment of Professor Allyson Pollock on twitter by fellow medics reminds us of how polarised views about covid–19 have become. Pollock’s chief point, that a positive PCR test for covid RNA doesn’t on its own prove infectiousness is perfectly reasonable, and Dr No agrees. Finding a broken fragment of a needle in a haystack doesn’t mean you can conclude the haystack is a working sewing machine. Yet an army of contrarians queued up, expressing views ranging from astonishment that she ‘would be willing to risk lives like this’ (argumentum ad homicide), and admonition ‘we have been screening pre-op cases for six months – it’s the accepted standard of care…the position of all four surgical colleges is clear’ (argumentum ad authority and populum), through incredulity ‘the whole thread is wrongheaded’ (argumentum ad bonehead) to imploration ‘loved your book but you are absolutely supporting some nonsense here’ (absolutely argumentum ad incredulum). There was, in short, argumentum ad nauseam, but what was conspicuous by its absence was even a single reference to any evidence that a bald positive covid PCR test confirms infectiousness.

One of the most potent core beliefs of the covid activists — those who want to see more done on a grand scale to control the virus — is that, one way or another, we can manage our way out of covid. Whether the action is sharper and harder lockdowns, or bigger and better mandatory masks, or more frequent and wider ranging testing, the core belief is the same: it is by concerted managed effort that we will control the virus. Dr No, ever the sceptic, has his doubts. Might it be that while all this action makes the activists feel better in themselves, the stark reality is that they are blind hamsters running ever faster in their wheels, oblivious to the fact that however hard or fast they run, they will never get anywhere? Could it simply be that there is no grand scale managed solution to covid, and the pretence that there is lies somewhere between foolish folly and reckless hubris?

Along with social distancing, which includes that commedia dell’malarkey that is masking, given a mask is a barrier, covid–19 testing is one of the three bendy prongs of our rubber trident against SARS-CoV-2. The third is immunity, howsoever gained, which may yet turn out to be the only prong with a real tip. Testing, the way it’s supposed to be, serves three aims. The first, where n = 1, is to make a diagnosis in an individual patient. The second, where n = up to a few dozen, is to identify cases, for contact tracing. The third, where n = up to 67 million or so, is to carry out mass screening, or surveillance. It is hugely expensive, and may, as we shall see, come to be the most expensive covid–19 monetary cost of all, and yet, on the face of it, covid–19 testing is a broken arrow. How shall we count the failures? Let us see.