Living Under the Rule of Six

Last Monday, as a result of Coronavirus case increases across the UK, new rules went into effect that are both simpler and stricter than the rules they replace. They are also different in England, Wales, Scotland, and Northern Ireland. If this difference were due to differing COVID numbers, this might make sense, but it’s due to the individual governments’ drawing different conclusions about what the best course of action is, health being a “devolved responsibility,” much as we’re seeing in the US with the states. Fortunately, we don’t see any of the governments ignoring the need to do something, as some US states have done. Unfortunately, these differing rules are broadcast all over the UK, once again making what was supposed to be simple more complicated. In Scotland, a maximum of six people may meet, inside or outside, but those six people must be from no more than two households. Children under the age of twelve are not included in the total. Wales’s rules are quite similar to Scotland’s, but the group must be from the same “extended household” group. This extended household may not be made up of any more than four households. This seems quite complicated, given the maximum of six, but it’s designed, one assumes, to allow situations when, for example, two sets of grandparents wish to meet with parents and their under-age-twelve children. In Northern Ireland, no more than fifteen people may meet outdoors, but indoors, the maximum is six from no more than two households.

In England, the main new rule is that people may not gather, inside or out, in a group of more than six people, unless their immediate cohabitating family consists of more than six people. In a departure from the other devolved nations, this includes children. The rule of six replaces more complicated guidelines that involved how many families made up the group, presumably because it’s a lot easier for the police to enforce the new rule. This is important because up until now, unless there were a truly egregious breach of the rules, the police have mostly been inclined to do nothing, not even saying, “You know, you’re supposed to….” This means everyone was doing what British people seem to love to do—decide for themselves which rules “make sense,” or are the least inconvenient, and follow them.

Every day, meanwhile, there is more bad news about testing. This is exacerbated by health minister Matt Hancock’s refusal to acknowledge that any problems exist—and then, when forced to recognize the very serious problems, blaming the public for “unnecessary testing.” People who go onto the government website to book a test are sometimes told to travel halfway across the country to get tested—and can then be turned down for a test because Matt Hancock believes it is unnecessary. The problem, other than the epidemiological nightmare of sending sick people across the country for tests, is that many people are caught in an economic nightmare of not being able to go back to work until they are tested. Here’s how it works (or doesn’t): Following the government’s exhortation to “get Britain back to work,” you are back at your job as a server at a local pub. The pub is following the government’s guidelines (which last week became rules—I had no idea they were just guidelines before) to take contact details for all the customers in the pub. One of your customers, lucky enough to snag one of those elusive tests, tests positive for COVID-19. When the customer is asked, by the government’s supposedly “world beating” tracing system, where he has been, he names the pub in which you were working at the time you were working. Although you feel fine, you are told by your manager that you may not come back to work until you have a negative result on a COVID test, so you go onto the government’s crackerjack test-booking system to schedule a test. You are in London, but the closest test is in Portsmouth, a 1 ½-hour drive away, but, like many Londoners, you don’t have a car. You need the job so you take the two-hour bus and train journey to the testing location. You are wearing a mask, but still, if it turns out you  are positive, you have now come into contact with two busloads and one train car of people that will have to be traced. You get to the testing center where they ask you a series of questions about your symptoms and then turn you away because you are not eligible for a test. You return to London without having taken a test. You’re £40 out of pocket (train travel isn’t cheap and you had to book quickly once you got the testing appointment). Your boss can’t reimburse you—she’s still trying to recoup the losses of three months of lockdown. And you can’t go back to work. How did we get to this point? Boris Johnson promised us in March and April that we would have a testing and tracing system second to none. Well, to be fair, I guess he didn’t specify second best or second worst. According to  Sky News and many of the experts I’ve seen interviewed over the past couple of months, it’s a problem of a lack of preparedness going in and the administrative mistake of trying to centralize testing rather than leaving it to the local NHS trusts. I’d add to this a general unwillingness on the part of the government, and certainly Hancock, to ever admit they got anything wrong. “We messed up, capacity isn’t what it should be, but we’re trying to address the problem.” Hancock seems to be charging ahead without altering course, and both Johnson and Hancock are misrepresenting the numbers. Johnson, for example, in the September 10th Coronavirus briefing, asserted that there were now 350,000 tests per day. It turned out that this was “capacity” rather than processed tests and included 100,000 antibody tests. Moreover, this was theoretical capacity and the experts put actual delivered tests (not including the antibody tests) at somewhere around 190,000 tests per day. What did the government do to address this problem? Promised 500,000 tests per day would be achieved shortly and instant results were on the horizon! Never mind that they haven’t met their existing targets—increase the promises!

Now, Johnson has claimed that Britain is testing more people than its European neighbours. Is he right? Surprisingly, yes, according to Oxford’s Our World in Data site, both in per capita and absolute terms. As  matter of fact, if we look at the per capita numbers, the UK is doing significantly better than even the US:

Why is there such a problem in the UK, then? Does this include the antibody tests that the government is including in press conference numbers? The good news is no. The Oxford dataset splits out PCR (polymerase chain reaction) tests from the antibody tests. Could it be that most of the other countries had higher earlier testing rates so that if we look at cumulative tests, the picture is different? Again, the answer is no. In cumulative per capita tests, the US overtakes the UK, but the UK is still doing better than a lot of other countries that don’t seem to be having the bottleneck currently in evidence in the UK:

What is going on, then? What is the UK doing differently? Or perhaps we’re just not hearing about problems with testing in other countries? Could it be, as Hancock implies, that the UK is performing more “unnecessary” tests? It’s impossible to tell with any degree of certainty. If we look at the number of tests per positive case, which would seem to be a good indicator of “overtesting,” the UK is in the middle of the pack there, too, and well below New Zealand. But it’s difficult to compare because information isn’t complete and the numbers change quite a bit from day to day:

Part of the problem may be the mismatch between who is required to get a test and who is allowed to get a test. The hapless server in my opening example would not be one of the people allowed to get a test in England, according to NHS guidelines. Probably at this point, at least in London, he or she would be better off getting a private test, but that would cost between £100 and £200, which, given the length of time they’ve been off work during lockdown, the average server probably can’t afford. And legitimate PCR tests are not available everywhere in the country. So people are faced with unfortunate choices: Stay in isolation, off work with no government support for another two weeks, pay money you don’t have for a test (if you can get one), or lie about your symptoms and try to snag one of those scarce testing appointments. I’m guessing people are doing the last in at least some cases, which just increases the difficulty of getting a test. Part of the problem seems to be the government’s lack of planning for the reopening of schools. Children, of course, get all kinds of colds and viruses. Now they, and their siblings, are being told to stay home from school until they get a test if they have any kinds of symptoms of illness. Other children in their classroom “bubbles” are also instructed to stay home in some cases, even though they can’t get tests. Schools that are already short-staffed due to smaller class sizes are stretched even further when teachers are out because of cold symptoms and can’t get tested—or can’t get the results of tests. School officials are also not being allowed, either by their unions or by the government, depending on whom you talk to, to make their own decisions depending on the individual circumstances.

In one case featured on BBC news this morning, a child was sent home with a cough and her mother couldn’t get a COVID test after trying to book online for 3 days. The girl’s brother had been home sick with bronchitis, so in all likelihood, she, too, had bronchitis, but the school still required a COVID test—proof of another source of the cough was not enough. There was no indication that the girl had been or was planning to go to the GP for her cough, so it’s not clear whether a positive diagnosis of bronchitis for her, once she was better, would be enough proof for the school. I assume they are still following the two-week isolation guideline, so if she’s sick, there would probably be at least a couple of days she should be staying home anyway, so we may be talking about an additional week if, during that time, her mother cannot report a COVID diagnosis. But the story was presented as much more dire than it actually was. I am not minimizing the effects to education if teachers are required to stay home in large numbers or the effects to parents if they are required to keep their children home for an extra week because of testing problems. But if you’d watched the BBC, you’d be left with the impression that the child was in a worse position than if the schools had remained closed, which, of course, is absurd. This, I believe, is the third part of the problem. Yes, the government over-promises and under-delivers—or promises things so far into the future that they can’t make anything better now. But the news services are culpable of sensationalizing everything, using a few statistics and a lot of “human interest” stories, generally featuring people who don’t really have a full grasp of the story they are telling and may not be at all representative of the general state of things. The effect many times is to heighten a sense that things will never be right and increase anxiety that the government is not up to handling the crisis. I was as surprised as anyone to see the numbers I’ve presented here. I really thought Boris Johnson was again using fake or misleading numbers to pretend that testing was better than it was. Yet it does not seem like the UK has a real testing shortage—although they certainly need to coordinate the programs much better than they are.

With all of this happening, and with local restrictions currently being experienced in Leicester, Birmingham, and other cities because of spikes in cases, how is the UK faring overall? Will we be subjected to the dreaded second wave and end up closing businesses, or isolating “vulnerable” people to allow businesses to stay open? If testing is really the shambles news stories would have you believe, you’d expect the number of hospitalisations and deaths to be on the rise—and the number of new positive test results to be artificially low because of the inability of people to be tested.

So how are the UK numbers now? I’d written an entire answer to that question last week using Oxford numbers but then saw that the government’s numbers were different—and higher—and I couldn’t immediately figure out why. I thought I’d research the numbers this week and then post. Unfortunately, every day brings a new story, and the story right now is that the UK government is threatening a second nationwide lockdown. Therefore, I will leave it here and devote my entire next post to figuring out where we actually stand—today.

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