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The beginning of the middle

The beginning of the middle

The vaccine provides humanity with a dose of much-needed hope in the face of the pandemic, but it’s unlikely to be a silver bullet. There’s still a lot we don’t know – about the jabs, the economic impact, and the disease itself


transcript

The coronavirus death toll in the UK has passed the 100,000 mark, the first country in Europe to register so many deaths from the disease. Deaths in the UK, a country with one 20th of China’s population, are 20 times that of China.

At the end of last year, at Tortoise we held the Covid Inquiry. It was an attempt to understand how and why Britain has got it so exceptionally wrong, and the answers were clear: optimism bias. Optimism bias in Downing Street that, as a result, led again and again to delays to lockdown, delays to getting test and trace up and running, delays to closing the borders. But also we found sickness in the system; the long-term neglect of obesity and housing; negligence in sending patients back into care homes.

By the end of this month, more than eight million people in the UK will have been vaccinated. It’s the fastest rollout of a vaccine programme in Europe by far. It’s not as fast as Israel, but it’s well ahead of the US.

And the combination of these numbers is indelible. They explain the erratic run of the news this month and the mixed feelings of optimism and endurance, grief, fear and anger. They’ve also contributed to a certain clarity about the pandemic, the simple narrative of a race between the vaccine and the virus.

But the fact is that things are far from clear. Once again, you can’t help feeling that we are underestimating uncertainty. I’m James Harding, editor and co-founder of Tortoise, and in this week’s Editor’s Voicemail, I want to run through just some of the things that we don’t know now.

Let’s start with this. What is the ferocity of new variants of Covid-19? We don’t yet know how much more lethal the Kent variant might be. Nor do we understand what prompted the variants that have emerged in Kent, but also in South Africa and Brazil. And without knowing that, it’s hard to know how many more variants we will see, and how infectious, fatal and resistant to vaccines they might be.

The vaccines, of course, are the best news to date. But are they beginning to look oversold? People might be forgiven for thinking that they protect you from the virus. But the extent of the protection itself is unclear. On the one hand, hospitalisations among vaccinated people – particularly elderly people who’ve had the vaccine – are seen to be falling fast. On the other, there’s early evidence that some vaccinated people can still get coronavirus – in those cases, the vaccine doesn’t prevent infection; it mitigates the illness, so that, as one medical researcher put it to me, you won’t be hospitalised or die. But, still, we don’t know the extent to which vaccines will limit transmission. We don’t know how long the vaccine is effective for. We don’t know the impact of delaying the second jab from three weeks up to 12. We don’t know when or whether we will need to develop second, third, fourth generation vaccines as the virus mutates.

Variants and vaccines – these are the biggest variables. We don’t know – given the variations of the virus, the unknown rate of vaccine refusals and, beyond the pharmaceutical trials, the unproven efficacy of the vaccine itself – if herd immunity is a realistic prospect.

But there’s more we don’t know. We have so much to learn about the disease itself. The wonder of warp-speed vaccine development has rather masked the slow progress in developing targeted, effective treatments for acute Covid-19 patients in hospital. And meanwhile, post-Covid syndrome is going to be a bigger and bigger problem given the infection rates, but, again, it’s barely understood.

Nearly a year into lockdowns and social distancing, there’s still so much we don’t know about non-pharmaceutical interventions. The test and trace regime is far more effective than it was. But what about the third, crucial element? It was always supposed to be test, trace and isolate – so what about isolate? Well we’re told that not quite 60 per cent of people contacted say they comply with self-isolation rules, and even that’s subject to interpretation. But the implication of course is that nearly half of people who are contacted don’t isolate. Likewise, the contact-tracing regime is reaching 90 per cent plus of people, but, we’re also told, only one third of people with symptoms go in for a test.

With infection rates so high these days, it’s been hard to discern where people are catching the virus. So, when we begin to come out of this lockdown, what’s going to be the best pattern for future tiering? Is it by geography (i.e. region by region) or should it be by activity; by places within those geographies (university, bars and restaurants)?

On those NPIs – non-pharmaceutical interventions – these are just some of the things we don’t know. Who’s not isolating? Who’s not testing? What elements of social distancing are really working?

And we are yet to know our tolerance for this pandemic. We don’t know how much the financial markets will tolerate government debt. We don’t know how much individuals will tolerate repeated bouts of isolation. We don’t know how much longer the government’s own backbenchers will tolerate lockdowns and rule-making by executive fiat. We don’t know how many infections and deaths the government is willing to tolerate as the price of reopening.

Consider this. In the fight against terrorism, we have zero tolerance: the machinery of state strives to ensure no murders by terrorists. But what’s the number of Covid-19 deaths that the government expects of the NHS, social care and public health? We just don’t know. And to be fair, nor do they. The uncertainty isn’t just confined to Covid-19 itself; it’s economic, social, political and governmental, too.

Journalists generally pride themselves on telling you things you need to know, and the 100,000 death toll tells you a good deal about Britain’s failure. The rising number of vaccinations signals the country’s best hope.

But in this past long year we’ve been reminded how important it is to recognise what we don’t know.

Because, if we can take that uncertainty to heart, it might better prepare us for the months ahead.

The return to normality is probably further off than we like to think. Forward planning in business and a fundamental reorganisation in government is needed now, not for the post-Covid world, but for the long haul of the with-Covid world. This was not just the pandemic of 2020. It feels very much like the beginning of the middle.