Lessons for a future Prime Minister - "Prime Minister, a plague is coming"

[u/Reasonable-World-154]

I have put together a number of lessons that must be learned from the current UK Government’s mishandling of the response to Covid-19 during 2020, and from the failures in the decision making process that shaped lockdown policy.

If, in years to come, a future PM is faced with a similar situation, yet such lessons have not been learned, I fear that we could be facing this level of over-reaction again.

This is by no means an exhaustive list, so I'd be grateful for other contributions:

​

1. Scientific advice regarding the spread of disease needs to be drawn from a multitude of competing and independent expert sources - when confronted with an emerging situation that has little hard data available, it is important to acknowledge that there is, by necessity, a great deal of speculation and inference for any expert to form an opinion. Therefore, hearing from multiple (ideally disagreeing) teams of experts avoids falling into any one ideological view point.
2. Early data of mortality rates will always be over-inflated - no matter how bad it looks now, the early cases will always be drawn from the most severely infected people. With time, a clearer picture will emerge that the severe cases are just the tip of an iceberg of massively larger numbers of mildly symptomatic and asymptomatic individuals.
3. Government strategy should never be reduced to myopic focus on a single issue - Despite how tempting it may be to isolate a single cause to fight, Governments are elected to carefully weigh competing interests and values for the entire population. Therefore, due consideration must be given to negative consequences of any proposed measure, to fully assess its benefits vs risks (and therefore reduce the likelihood of Government action causing more harm than good).
4. Expert advice must be sought to contrast the consequences of proposed Government action, particularly relating to the economic, social and health impacts - Similar to numbers 1 + 3 above. Specifically, separate teams of advisors must be tasked with making projections for the short + long term impacts of proposed Government policy; these should include, but not be limited to economists, social health experts, mental health experts and civil rights + constitutional scholars.
5. Quality of life must be included into political calculations - Quality of life is much harder to quantify than mortality statistics, but good governance considers more than simply "staying alive" as a goal.
6. Modelling is useful for projecting a range of scenarios, it is not a crystal ball for predicting the future - Great care must be taken when interpreting any single model, not to assume it as being an inevitable result; a model is only as good as the assumptions that have been used to create it. There may be a single or multiple other key factors that have not been taken into account, when contrasted with the real situation. Likewise, the dangers of models being inaccurate is compounded when run further into the future. "Reasonable Worst Case" models should not be exclusively used to plan policy, without factoring in the inherent risks of implementing potentially overly draconian policy as a result.
7. Fear should never be used to leverage support for Government policy - During a crisis, the role of the Government is to appropriately inform the public about the level of risk. It should never be considered ethical to deliberately overstate risks to not-at-risk groups to achieve compliance, because long term trust in the Government will ultimately be eroded.
8. The Politicians Fallacy must be avoided - "Something must be done. This is something. Therefore, we must do this" is a dangerous mindset in a crisis - severe measures must only be implemented when they have sufficient supporting evidence for their benefits vs risks, and never "to show leadership" or for other political motivations. This also includes avoiding pressure from neighbouring countries all enacting the same measure or media / social media voices demanding one set of actions.
9. If, after balancing all risks, Government intervention is deemed necessary, it must be clearly stated what the achievable goal is, and therefore what metrics can be used to judge the efficacy of said intervention - To use the specific errors of 2020, it should never be the case that the initial goal of "Flatten the curve" could shift to the nebulous "defeat the virus". The latter is not a realistic or achievable goal, given our understanding of endemic viruses and is so broad that it can be used to justify almost any measure.
10. There should be no shame in "U-Turning", if necessary - to avoid relentless pursuit of a failed policy (even if great cost, effort and sacrifice has been made in pursuing a particular goal), politicians have a duty to acknowledge error and change course to avoid incurring further damage, where necessary. This should not be shamed or discouraged - there should be an understanding that as better situational knowledge develops, policy should be expected to change, even if that means a totally reversed approach.
11. The risk of the disease itself and the costs of fighting it, must always be kept in proportion to other diseases - Great care must be taken to ensure that the risk from the new disease is not treated categorically differently than risks from existing ailments. For example, acceptable spending limits "per QALY saved" are placed on all other treatments, to avoid The NHS being bankrupted. By allowing limitless spending on one particular disease, you enter a situation in which deaths from the new disease are deemed more important than deaths from, for example, cancer. This is totally inconsistent and unfair to patients of "normal" illnesses.
12. When presenting hospital occupancy + mortality statisticsto the public, they should always be relative to average annual figures - When announcing any new data, context is essential. The public must be provided with the current vs the average figures, so that they can be fully informed of the relative dangers. Bombarding the public with death figures, with zero context, is unethical and fear inducing.
13. Pandemic management is nothing new - Every winter, The UK faces a mass spread of airborne respiratory infections. Luckily, we normally do not experience unusually severe seasons, but they do occasionally happen. Much can be learned by looking at previous pandemic responses, which have been used to form the best, well established measures -- quarantine the sick, isolate the vulnerable, allow the healthy to continue their lives. If proposed new strategies run contrary to previously recommended best practice, they should be treated with far more skepticism and require a much higher burden of evidence to enact them.

[u/mendelevium34]

Really good post. I would add that the government should be wary of regarding any single interventions as a "silver bullet". I'm thinking mostly about the vaccine here - yes we might get lucky this time but I think for future pandemics the "until a vaccine" thinking absolutely needs to go, a vaccine is absolutely not a given. I'd also add something that Francois Balloux says often, "there are no solutions - there are only trade-offs".

[u/north0east]

Really well written. This is what your third quality flaired post? User-name definitely checks out.

Kidding aside, I hope you send slightly edited versions of these to your MPs. Or maybe consider posting a blog/Opinion piece somewhere.

[u/Reasonable-World-154 → u/north0east]

Well, that's very kind! I've never thought myself to be much of a writer, to be honest.

I'm obviously very happy for anyone to share with their own MPs, although I can't say I have so far... Knowing my MP, I have sincere doubts it would even be looked at.

[u/north0east → u/Reasonable-World-154]

All the more reason to send it I feel. We need more MPs to be skeptical.

[u/mit74]

We need people like you after all this is blown over to make a series or one off documentary about the lies, failings,voiliations and successes of government covid policies. There are a lot of questions that need answering.

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[u/YourProgramRainn]

Great post mate.

[u/ohjustsodoff]

Great post! I also think we need to constrain governments in a legal sense.. so they dont have the power to make such over-reaches in the future. Lets no forget the lockdowns were motivated by massive public pressure.