Explaining the Leicester COVID-19 Outbreak

Full playlist of BBC Interviews here

The Home Secretary, when questioned on the BBC Andrew Marr show announced on Sunday 28 June

‘there is going to be a Leicester lockdown?’
‘So, there will be support going into Leicester … with local flare-ups, it’s right that we have a local solution’

But looking at the public data from coronavirus.data.gov on Covid infections, Leicester does not have a significant problem:

It is only when you look at the Public Health England surveillance report, you notice something awry.

(Leicester is the red area inside the orange Leicestershire at the centre of the country.) Source:
National COVID-19 surveillance report: 25 June 2020 (week 26)

https://www.gov.uk/government/publications/national-covid-19-surveillance-reports

Why the dispartity? This comes from the difference in how tests are reported. Coronavirus.data.gov only reveals so-called ‘Pillar 1’ tests (those in the NHS), wheres the PHE maps include both Pillar 1 and Pillar 2, the latter being conducted under the auspices of NHS Test and Trace and other commercial partners.

Data from Pillar 2 tests is only just getting through to Directors of Public Health. And the number of people tested is still not disclosed (the number of people tested is still ‘unavailable’).

As of 9am 28 June, there have been 9,195,132 tests, with 127,709 tests on 27 June. 

311,151 people have tested positive. 

As of 5pm on 27 June, of those tested positive for coronavirus, across all settings, 43,550 have sadly died.

Test data are as of 9am, 28 June. Deaths data are as of 5pm, 27 June.

Notes: Reporting on the number of people tested has been temporarily paused to ensure consistent reporting across all pillars. Due to revisions to historical data, the cumulative total for tests is 154 lower than if you added the daily figure to yesterday’s total.

Public Health England only report publicly the level of outbreaks at the Upper Tier Local Authority level (mostly county councils, unless there are large cities such as Leicester where the are unitary authorities).

So, how do we know that there isn’t an outbreak in our local area? Basically, we don’t. But the PHE surveillance report is the best we have for now. Also worth examining the cluster of outbreaks around Manchester (which may be outbreaks in schools or hospitals)

PHE Surveillance Report week 26

What appears to be unusual about the Leicester outbreak is that it does not appear to have been traced back to care homes, hospitals, or schools. It appears to be community transmission, and is the first real test of the Government’s policy of preventing a resurgence of COVID-19

Beware of the Survivorship Bias of Politicians: COVID-19 Letter Published in The Financial Times


The news that UK business secretary Alok Sharma has been tested for Covid-19 highlighted the issue of survivorship bias, that is the systematic overestimation of performance and underestimation of risk by ignoring non-survivors.

In the early stages of the epidemic, the risk perception of politicians broadly matched that of the general population. However, if the proportion of decision makes that have been infected by the virus and survived exceeds that of the population, the executive’s risk appetite could surpass that of the people they represent.

Politicians need to ensure that they make decisions in such a way that suvivorship bias does not affect their judgment.

Dr Duncan Robertson

School of Business and Economics, Loughborough University

Simulation Modelling Community Response to COVID-19

Our paper in Journal of Simulation ‘How simulation modelling can help reduce the impact of COVID-19‘ setting out how simulation modelling can help in the fight against COVID-19 and subsequent epidemics and pandemics. Click here to access the paper.

ABSTRACT

Modelling has been used extensively by all national governments and the World Health Organisation in deciding on the best strategies to pursue in mitigating the effects of COVID-19. Principally these have been epidemiological models aimed at understanding the spread of the disease and the impacts of different interventions. But a global pandemic generates a large number of problems and questions, not just those related to disease transmission, and each requires a different model to find the best solution. In this article we identify challenges resulting from the COVID-19 pandemic and discuss how simulation modelling could help to support decision-makers in making the most informed decisions. Modellers should see the article as a call to arms and decision-makers as a guide to what support is available from the simulation community.

Muddling Through Does Not Work for Pandemics: COVID-19 Letter Published in The Financial Times

In 1959, Charles Lindblom wrote The Science of “Muddling Through”, advocating an incremental approach to public policy and management. “Muddling through” does not work for pandemics. The science of pandemics is dominated by epidemiology, not behavioral science. The delay between policy decisions (or indecisions) and the resultant high UK death rate needs tracing back from the prime minister and his advisers to Cobra, the chief scientific adviser, and the Scientific Advisory Group for Emergencies. However, this is one form of contact tracing that can be delayed until the inevitable public inquiry.

Dr Duncan Robertson
Fellow in Management Studies,
St Catherine’s College,
University of Oxford, UK

Charley Says Social Distancing

Charley was a character in UK Public Information Films in the 1970s. Here he is in ‘Charley Says Social Distancing’


“Treat everyone else as if they’re about to catch fire and you’re a lit match.”


Charley: Miaoweeaawwwoa [I can’t believe I’m writing this]

Narrator: This is you. You’re a match. And these are your friends. You catch the virus and you’re on fire. You’re too close – now all your friends are alight – you’ve infected them with the virus.

Tony, the Boy: Charley says that if ever you see a box of matches lying around, tell mummy because they can hurt you.

Narrator: We’d like the virus to spread slowly so to match the capacity of the health service. It takes a few days before your friends get ill, so you can’t see it spreading.

The virus is spreading rapidly so we need to slow it down. If you’re older or have an underlying medical condition, you need to stay apart.

That’s better. Keep apart. Treat everyone else as if they’re about to catch fire and you’re a lit match.

Charley: Awoooarwah.

SOCIAL DISTANCING. DON’T GET TOO CLOSE

For advice on COVID-19, see:HM Government NHS (UK National Health Service) WHO (World Health Organization) US CDC (Centers for Disease Control and Prevention) US NIH (National Institutes of Health)

YouTube Link: https://www.youtube.com/watch?v=4YmN0iV3f0I

Twitter Link: https://twitter.com/Dr_D_Robertson/status/1241307225626423296

I am concerned about the UK Government’s approach to social distancing

The real problem with Coronavirus Covid-19 is that when the health service becomes overloaded, the death rate goes up significantly. So, it is imperative that we keep the number of cases at any one time below or as near as possible to NHS capacity.

The Government’s model relies on shifting the peak. I am not clear that we are doing this fast enough. We are an outlier compared to other countries in our social distancing policy response.

There is a tension between epidemiologists – those who study how diseases spread (a very established science started around the time of the Spanish Flu 100 years ago), and behavioural scientists who study how people behave and react.

Epidemiologists have models validated against past pandemics. Behavioral scientists do not.

There are economic and social costs of social distancing. But if you delay social distancing too much, there are potentially very real human costs in increased mortality. Doctors will need to make very difficult moral decisions on who to treat and who not to treat.

I do not understand why, if the intention is to create herd immunity, why we are not isolating our vulnerable population, especially those in care homes.

Behavioral insights are great when you are trying to get people to pay their tax bills on time. And if people don’t, it doesn’t really matter. With a pandemic, if you get the timing wrong, more people die unnecessarily. Then you look back from your computer and say, yes, we got that behavioral model wrong while doctors and nurses on the front line are exposed to extra cases that could put their own lives at risk.

Here’s a video to show what we should be trying to do:

Social Distancing using Play-Doh and Matches

There has been much talk about using social distancing as a response to the Coronavirus outbreak. Here’s a video of how social distancing can be used:

  • Close Contact, where the population is infected very rapidly. This is not A Good Thing – the national health service is overwhelmed, and the death rate goes up as a result
  • Extreme Distancing, where the viral spread takes too long. This is not A Good Thing – the social and economic costs are huge
  • Optimal Distancing, where the spread is controlled and the human, social, and economic costs are optimized. This is A Good Thing. It is also very tricky to get right.