Dr No first came across Stanley Milgram’s now infamous but fascinating obedience to authority experiments as a disobedient undergraduate keen to understand why so many of his fellow students seemed willing to toe the line to authority, even when authority had got things wrong. The Great Secret, it turned out, was for authority to dress things up as being for the greater good, add some cuckoo science, and ideally put the public facing authoritarians in uniform. Faced with this diabolic trident, ‘normal’ — Dr No uses quotes because one of the criticism’s of Milgram’s work was that his sample was small and in no way representative — Americans would, despite most showing evident anguish, and even great distress, and occasionally infantile giggling, administer what they believed to be dangerous electric shocks to fellow citizens, because they wanted to do the right thing.
The Big Question about covid–19, of immense historical and future importance, is whether hard lockdowns work. No one of sound mind can be in any doubt that soft, or voluntary, lockdown makes sense. Hard, or legally enforced, lockdown, with its far more stringent measures, is entirely another matter, chiefly because it comes at a very significant cost. These costs are not only highly significant, they are also wide-ranging, and include social, ethical, economic and health costs. Put bluntly, because of these costs, hard lockdown can only ever be justified if it can be shown that its benefits, measured in deaths deferred, because that is all it can ever achieve, outweigh its inevitable and catastrophic harms.
In the 1961 Walt Disney film 101 Dalmatians, Cruella de Vil locks down 99 dalmatian pups (the 101 includes the parents of the original litter). In a roundabout way, this got Dr No wondering if there might be 101 lockdown damnations. There surely are, but after fifty items, Dr No felt the point was sufficiently made. Already the mother of all dossiers of despair, reining in another fifty items risked permanent damage to Dr No’s sense and sensibilities.
Back in the 1980s, John Naughton, The Listener’s TV critic at the time cracked Norwegian after hearing a recording in English being played backwards and forwards. Norwegian, he realised in an instant, is merely English spoken backwards. On forwards, clear English could be heard, but in reverse, the machine delivered perfect Norwegian. Recalling Naughton’s discovery 35 years later, Dr No realised that must also mean that English is merely Norwegian spoken backwards, and that this might be the way to get at the contents of a promising covid–19 report published in Norwegian by Norway’s official Public Health Institute. Alas, the Folkehelseinstituttet report spoken backwards doesn’t come out as English, but on another level it is ‘English spoken backwards’, insofar as it’s main conclusion is the reverse of English lockdown dogma. The Norwegians, after due analysis, have all but concluded that the science, to date (and that is an important caveat), does not back hard lockdowns.
This last week, another rapid covid–19 test hit the fan. The story is becoming boringly familiar. A company announces a new covid–19 test, and puts a high gloss on the test’s performance. Ministers respond by placing large orders. Later, it turns out the company has been polishing a turd, as real world studies show the test’s performance is, err, crap, and ministers find that instead of getting more bang for their buck, they have got more crap for their cash. Such are the rewards for ministers who admire their reflections on the faces of polished turds. What made this particular turd/fan disintegration situation more notable than some is the suggestion, made by the BMJ and denied by the DHSC, that the government had known all along it was buying a polished turd, but deliberately suppressed the information, because it would get in the way of procurement.
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.