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Boris Johnson’s push for mass testing is set for failure before it even gets off the grounds

Boris Johnson’s push for mass testing is set for failure before it even gets off the grounds

The campaign for regular, mass Covid testing has begun in earnest. From last Friday, everyone in England has been eligible to access lateral flow tests for free. The government would like people to test themselves twice a week.

Under the slogan “Hands, Face, Space, Fresh Air”, the public is being urged to use the NHS COVID-19 app when checking into outdoor hospitality, hairdressers and the like.

But just how effective will either of these be?

The NHS app does not have a good track record. True, it was downloaded some 21 million times last year, but the majority of these took place very shortly after its launch and it never obtained real traction.

The number of downloads seems impressive, but it is only around 40 per cent of the adult population. The low proportion has been driven by both social norms and deliberate choices by individuals.

The percentage of the population with the app never quite reached the critical point at which people felt obliged by peer pressure to download it themselves. Definite improvements have been made to it over time and there is little doubt the government is hoping that many more will take it up to facilitate entry into leisure and retail outlets.

However, the government’s own website makes clear that the option of simply leaving your details manually remains valid. Last year, there were a great deal of examples of people taking creative license with their name and contact details.

For many people, there was a positive disincentive to register on the app. You might have been on the other side of the pub or restaurant from an infected person, with very little chance of picking up the virus, but the app could still tell you to self-isolate by virtue of being in the same premises.

This disincentive still remains with the free lateral flow tests. Of course, the tests tell you not whether you merely might have it but that you probably do. But for those who are self-employed or who need to actually turn up to work to get paid, the immediate risk of losing out on a pay-cheque can feel greater than the reward.

The very success of the vaccines means there is much less incentive to have a test done. Even amongst the very elderly, the hospitalisation rate amongst those vaccinated appears, in real-life data not just in small-scale trials, to be essentially zero.

It also seems possible for people to fraudulently enter negative results in the app without ever taking a test. For some desperate to return to normality, the temptation might prove to great. There may be ways of checking up on this, but rather like the speed limit on unrestricted motorways, the chances of being caught seem slim.

The same system this time last year would have been introduced with massive popular relief and approval. Now, it seems unnecessary and costly. Cases, hospitalisations and deaths are so low, and vaccines so effective, the government would do better to follow the data and open up the country quickly.

As published in City AM Wednesday 14th April 2021
Image: Gustave.iii, CC BY-SA 4.0 via Wikimedia Commons
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Government scientists must be transparent about flawed Covid models

Government scientists must be transparent about flawed Covid models

The strength of the economic recovery as Britain emerges from lockdown is a hotly contested subject among economists. Some believe there will be a massive surge in demand as consumers celebrate their freedom, others argue it will take time to claw back confidence.

Economic forecasts are subject to the same faults as any projections, as we have seen over the pandemic, and will differ for two main reasons. The same model will give different outcomes depending on what assumptions are made about key variables, for example, how long it will take trade patterns with the EU to return to normal.

The other point of discrepancy is more fundamental: assumptions about how the economy actually works. Even with the same assumptions, different models will give different results.

At the moment, those who think inflation is primarily a monetary phenomenon are projecting quite sharp upturns in inflation not just in the UK but across the West as a whole.  Other economists place less weight on money as a cause of inflation and so see less of an increase.

Economists have appreciated this for a long time.  A substantial amount of research effort has been devoted to comparing different models so that the differences between them can be better understood. The first systematic steps on this were taken as long ago as the 1970s.

In just the same way that economic forecasts differ, the pandemic has revealed that different groups of epidemiological modellers also produce varying forecasts about how many cases of Covid there will be, the rate of hospitalisations, and the number of deaths.

What is missing in the countless scientific models used to justify decision making during the pandemic is transparency over how heavily ministers are relying on any particular model.

For example, at the end of October 2020 Patrick Vallance, the government’s chief scientist, predicted there would be 4,000 deaths a day by the end of the year.  At the same time, other modelling groups were projecting daily numbers of between 1,000 and 2,000.

As it happens, they were all too pessimistic. Even though the new virulent Kent variant had taken hold, which the forecasts made in October may well have not taken into account, the highest rate was observed on New Year’s Eve itself, with some 750 deaths.

This is by no means the only example of substantially inaccurate forecasts made by epidemiologists during the pandemic.

But the point here is not the forecasting errors made by epidemiologists.  It is that their forecasts differ for exactly the same reasons as economic ones.  Different groups both have different models and make different assumptions, such as the effectiveness of vaccines.

Epidemiology is not like Newtonian physics applied to straightforward everyday problems.  With the latter, all physicists will give the same answer to a question. The model is agreed upon, and has been subjected to stringent empirical tests of validation.  This is not the case with epidemiological models.

There is an important policy implication which follows from this.  When politicians say they will “follow the science”, the question is: which science. Which model, and which set of assumptions will be followed?

Economists have already set the example. We need a proper audit of the epidemiological models. Their black boxes need to be opened so that the “science” behind which they have sheltered can be made public.

As published in City AM Wednesday 31th March 2021
Image: Chris Whitty via Flickr
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The curious case of Boris Johnson’s popularity after a year of lockdowns

The curious case of Boris Johnson’s popularity after a year of lockdowns

In 1993, economics Nobel Laureate Daniel Kahneman published a paper with the enigmatic title “When More Pain Is Preferred to Less”.

He and his colleagues conducted two experiments with the same group of people.  In the first, the participants had to hold their hand in cold water for a specified time.

They had to keep it under cold water for longer in the second experiment. But towards the end the water was gradually warmed up.

Which would they prefer to repeat? The subjects were, rather surprisingly, much more inclined to choose the second, even though the bad part of the  experience lasted for longer.

Kahneman rapidly thought up a series of similarly imaginative experiments.  He organised interviews of patients who had undergone painful medical procedures. The evidence led him to formulate the “peak-end” rule.

Many of our experiences have well-defined beginnings and ends.  We set off on holiday and then come back to normal life. We go into a restaurant, eat our meal and leave.

In such circumstances, Kahneman argued that our memories of them are not driven by how we feel about them on average over their entire duration.  Rather, we judge them by a combination of how we felt when the experience was at its most intense, the peak, and right at the end.

This peak-end rule explains the otherwise puzzling current popularity of Boris Johnson and his government. Over 125,000 people have died from Covid, giving the UK one of the highest per capita death rates in the world.  Billions of pounds have been wasted on useless test and trace schemes and defective PPE equipment.

But the government has surged ahead in the polls. The Prime Minister’s personal ratings eclipse those of the Leader of the Opposition. The peak experience was in the novel circumstances of the first lockdown which started a year ago.  We faced an unknown and dangerous threat.

Policy advisors worried that we would soon get fed up of lockdown. Instead, it created a feeling of national solidarity. As during the Second World War, we were all in this together.  Perceived breaches, such as those ascribed to Dominic Cummings, were greeted with huge outrage, regardless of the justification.

The end is of course not quite here yet. Just over half the adult population has been vaccinated.  But this is by far the most vulnerable half, and there is a palpable feeling that the end is here. Not just that, but Britain has performed exceptionally well in creating and delivering vaccines.

The government needs to tread carefully and it could still fall victim to boasting and over-promising. There is, however, a handy scapegoat in the form of the grossly incompetent EU. For those wanting a quick end to lockdown, the peak-end rule has a sting in the tail.

The evidence from real-life events when people experience pain from surgery, for example, suggests that they prefer pain to gradually disappear rather than vanish abruptly.

Perhaps Boris is a secret devotee of the scientific work of Kahneman.  Either way, he is the beneficiary of its discoveries.

As published in City AM Wednesday 24th March 2021
Image: Boris Johnson via Flickr
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Calorie counting gimmicks and sugar taxes won’t solve obesity crisis

Calorie counting gimmicks and sugar taxes won’t solve obesity crisis

In the early days of the pandemic obesity was identified as a key factor behind hospitalisation rates and deaths from Covid.  The Prime Minister knew this personally, from his own brush with mortality last April.

This is on top of the already well-established links between obesity and other life-threatening conditions such as Type 2 diabetes, cancer and heart disease.

The government’s strategy to combat obesity, published at the end of July last year, is full of earnest intentions.

Weight management services by the NHS will be expanded, with evidence-based tools and apps being made available. Calorie labels are being added to food and drink in more and more situations.

Yet the sheer scale of the problem is not really grasped.  It is not just the numbers. Nearly 30 per cent of all adults are obese and some 33 per cent of school children.

The phenomenon is without precedent in human history.

Indeed, for most of the existence of humanity, most people lived close to starvation levels.  Only the very rich could ever get fat.

Historically, and even today in poor countries, there is a strong positive correlation between obesity and income.

In the last three decades, this has been dramatically reversed.  It is the poor who are fat.

In America, for example, in 1990, Mississippi  had the highest obesity rate of any state, at 15 per cent of the population.

The inhabitants of any such state now would look exceptionally svelte.  The lowest obesity rate is in Colorado, at 24 per cent of the population.  In no fewer than 12 states, more than 35 per cent of all adults are obese, and all of them are poor by American standards.

Simply providing more information about the dangers of being obese is unlikely to prove very effective.

A fundamental challenge to reducing obesity arises from what economists call hyperbolic discounting. The concept was initially developed by David Laibson of Harvard in the 1990s and has strong empirical support.

The issue is straightforward. You do something you enjoy today, but which has costs in the future. How do you compare future costs to current benefits?

Hyperbolic discounting simply means that you place huge emphasis on the present and the immediate future. You discount any costs beyond this short horizon heavily.  It does not mean you are unaware of them. Even if you know, you just do not pay much attention to them.

The same problem arises with climate change policies. Yes, you know the risks.  But they are in the future and right now it is cold, so turn up the central heating.

From the decades long campaign against smoking, it seems that promoting the idea that peer groups are giving up can be effective.

Whatever route is chosen, obesity will not be solved by gimmicks such as NHS apps and sugar taxes.

It is a problem without precedent and needs serious scientific study in just the same way that monies have been poured into Covid vaccines.

As published in City AM Wednesday 17th March 2021
Image: Leon Brooks on Pixnio
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Vaccine passports: a free market and plentiful pubs mean they won’t work in the UK

Vaccine passports: a free market and plentiful pubs mean they won’t work in the UK

As the country emerges slowly from lockdown, the debate over so-called vaccine passports gathers pace.

Yesterday, Matt Hancock confirmed Britain was looking into the proposition for international travel.

Countries such as Greece and Spain have a strong incentive to develop a system with us. Each attracts large numbers of British tourists in a normal year.

Whatever the details of the system might be, they would be monitored and enforced by officials at borders.  Despite potential bureaucratic inefficiencies and delays, it would work.

Could the idea be applied with the UK itself?

The Israelis are opening up their economy with vaccine passports.  But already almost half the population has been jabbed

Last spring, the idea of allowing the young to move about freely gained some traction at a high level in the UK.  Then, the argument was that there is very little health risk to them from the virus.  A key reason it was dropped was the obvious discrimination against older people.

The reverse argument applies now.  Younger people would feel justifiably aggrieved if regulations prevented them from enjoying freedom of movement granted to older, vaccinated people.

Mass testing, which the government is keen on, appears to resolve this age-related problem.  Freedom could be granted to anyone with either proof of vaccination or of a recent negative test.

The problem here is that the tests would have to be done so frequently that many would soon come to see them as an imposition.

Perhaps, as we move through the year and the vaccination numbers rise, the free market will do the job of regulation.

Already, some leisure and retail outlets are raising the idea of barring those without proof of negative status. This would give an incentive to bear the inconvenience of frequent testing and avoid being discriminated against in this way.

However, Milton Friedman argued many years ago that the free market would prevent this from working.

Quite simply, he thought that companies which discriminate impose avoidable costs upon themselves. As a result they will be driven out of business by their competitors.

As ever in economics, the strength of the argument depends upon how well its assumptions correspond to reality.  The key one here is of a “competitive market”, one with many companies, none of which can exercise any real power over the market as a whole.

Expensive restaurants in affluent areas do not need to put in their adverts, as Basil Fawlty once memorably did in Fawlty Towers, “no riff-raff”. They do have a degree of localised monopoly power over a specialised part of the market.  Discrimination would work here.

But for many hospitality and leisure outlets in towns and cities, Friedman’s assumption seems reasonable.  If a pub keeps you out because of a lack of certification, there is another reasonable one not far away.  The situation is not quite the same in rural areas.

But why leave it to either the regulators or the pubs themselves to say who can and cannot go into a pub?

Just let individuals decide for themselves which outlets to use, like they have always done.  That will be true normality.

As published in City AM Wednesday 24th February 2021
Image: Restaurant via Pixabay
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Beware those who’d lock us down and throw away the key

Beware those who’d lock us down and throw away the key

Rather like dedicated Remainers, pro-lockdown enthusiasts never seem to give up.

Their ardour will have been fuelled by leaks over the weekend of results from the epidemiological models.

Apparently, even though quite soon all the over-70s will have been jabbed, lifting restrictions before the summer would lead to a massive third wave of the virus.  Daily death rates would once again soar over 1,000.

The SAGE modellers seem to have arrived at a totally different view to that of the Chief Executive of the NHS, Simon Stephens.  He told a House of Commons committee last week that Covid would soon become a much more treatable disease.  We can look forward, he said, to a “much more normal future” over the course of the next year.

Instead of wallowing in gloom, we might usefully look at Sweden.  The country has not just the prospect of a normal future but the actual reality of a normal past and present.  In Stockholm today, for example, you can walk up to the bar and order a beer.

In terms of economic outcomes, Sweden has performed better.  In 2020, output in the UK fell by over 10 per cent, and by just over 3 per cent in Sweden. The UK is running a public sector deficit of over 13 per cent of GDP, getting on for £400 billion. The comparable figure in Sweden is 4 per cent.

The Covid death rate in Sweden is rather high, at 1144 per million people.  But in the UK, it is 35 per cent higher, at 1550.

Currently, and adjusting both rates to the UK population size, the daily death rate in Sweden is around 100, and more than 1000 here.

Could a policy of very few restrictions have worked in the UK?

The virus spreads more easily in dense populations.

Much of Sweden is essentially completely uninhabited. In fact, slightly more Swedes live in urban areas than do Brits, 87 per cent compared to 83. So no difference there.

The Swedes are definitely less fat. Just under 20 per cent of them are clinically obese compared to 28 per cent of the UK population. Obesity is a key determinant of serious illness and death in Covid cases. But even adjusting for this, Swedish death rates are hardly likely to have exceeded those of the UK.

No politician would dare as to even hint at this. But could it be that the Swedes are, well, more sensible than we are?

They could be trusted to behave in ways which did not lead to the virus getting out of control.  The epidemiological models do not in general include the possibility of people adjusting behaviour in the face of a pandemic.

Overall, compared to the UK and many other Western European countries, Sweden, with virtually no lockdown restrictions, has had a good crisis.  Behavioural changes can make a massive and sustained difference to outcomes.

With only minor modifications of behaviour and armed with the new vaccines, it seems that Simon Stephens’ vision of a return to normality is close to being realised.

As published in City AM Wednesday 3rd February 2021
Image: Socialising in Sweden by Johan Anglemark  via Wikimedia CC BY-SA 2.0
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