Estimating Indian Deaths due to Covid

 

Goodhart’s law comes back to haunt the UK’s Covid strategy

Chris Giles in The Financial Times 


Every so often, public policy provides a reason to discover or remember the value of Goodhart’s law. The UK’s response to coronavirus is a powerful and tragic example.  

Named after Charles Goodhart, a financial guru, former chief economist of the Bank of England and a sheep farmer, the maxim is about the dangers of setting targets. When a useful measure becomes a target, the law states, it often ceases to be a good measure.  

Mr Goodhart developed the law after observing how Margaret Thatcher’s government in the 1980s targeted the supply of money to control inflation but then found the monetary aggregates lost their previously strong relationship with inflation. Inflation ran out of control even when the government held a tight grip on the money supply.  

What was true in 1980s UK economic policy is regularly experienced in the private sector. Far too often companies hit their top-down targets without improving underlying performance.  

In the current crisis, target-setting is altogether more important. Early in March, Italy’s government strove to protect the nation’s health by locking down the Lombardy region. Initially, this led to a mini exodus that probably increased the spread of the disease to other parts of the country.  

But it is in the UK where Goodhart’s law was most obviously overlooked. Throughout the crisis, “protect the NHS” has been the government’s core target. Along with “stay at home” it was the slogan repeated daily to “save lives”.  

At first sight, nothing seemed amiss. Ensuring hospitals would not be overwhelmed seems so obviously necessary. Who would have wanted to see them starved of funds in a public health crisis? And their staff needed to be given all necessary equipment to battle the pandemic. With many weeks of experience, however, the slogan and associated numerical targets for making hospital beds available have been nothing short of a disaster. The evidence is overwhelming that instead of saving lives, they have cost them. 

While the government focused on hospitals, care homes were given much less priority. Over the past five years between mid-March and the end of April, an average of 17,700 people have died in England and Wales’s care homes. This year, the total is just above 37,600. There is a debate over whether coronavirus was recklessly seeded into care homes when patients were moved there from hospitals. But there can be no doubt that relegating care homes to second division status contributed to the 19,900 excess deaths in the care sector.  

Far more people than normal have also been dying at home and most of the excess deaths have not been classified as related to Covid-19 on death certificates. We do not yet know precisely why, but at the height of the crisis local doctors were asking their elderly patients to think hard about whether they really wanted to go to hospital or use the emergency services. A fit and sharp relative of mine received two of these calls.  

The exact causal links will take time to establish. But 29,874 people have died at home since mid-March in England and Wales, 10,800 more than normal. 

No one should think the government’s ambitions deliberately cost lives. But it was a deadly example of Goodhart’s law. The moment “protect the NHS” became the mantra, people dying elsewhere or without being tested didn’t count. 

By comparison, the much criticised target of performing 100,000 coronavirus tests a day by the end of April was better conceived. Although the health department fiddled definitions to hit the goal for one day, earning a rebuke from the statistical regulator, the effort has left the UK better positioned for its ultimate objective of testing, tracking and isolating those with the virus. 

Goodhart’s law always pops up in unexpected places. The failure in this crisis to think through the incentives created by the “protect the NHS” slogan will haunt Britain for many years.

American gun use is out of control. Shouldn't the world intervene?

The death toll from firearms in the US suggests that the country is gripped by civil war

• 
• • Henry Porter
  • The Observer, Saturday 21 September 2013 22.12 BST

A man on a rifle range: 'More Americans lost their lives from firearms in the past 45 years than in all wars involving the US.' Photograph: Scott Olson/Getty Images

Last week, Starbucks asked its American customers to please not bring their guns into the coffee shop. This is part of the company's concern about customer safety and follows a ban in the summer on smoking within 25 feet of a coffee shop entrance and an earlier ruling about scalding hot coffee. After the celebrated Liebeck v McDonald's case in 1994, involving a woman who suffered third-degree burns to her thighs, Starbucks complies with the Specialty Coffee Association of America's recommendation that drinks should be served at a maximum temperature of 82C.

Although it was brave of Howard Schultz, the company's chief executive, to go even this far in a country where people are better armed and only slightly less nervy than rebel fighters in Syria, we should note that dealing with the risks of scalding and secondary smoke came well before addressing the problem of people who go armed to buy a latte. There can be no weirder order of priorities on this planet.

That's America, we say, as news of the latest massacre breaks – last week it was the slaughter of 12 people by Aaron Alexis at Washington DC's navy yard – and move on. But what if we no longer thought of this as just a problem for America and, instead, viewed it as an international humanitarian crisis – a quasi civil war, if you like, that calls for outside intervention? As citizens of the world, perhaps we should demand an end to the unimaginable suffering of victims and their families – the maiming and killing of children – just as America does in every new civil conflict around the globe.

The annual toll from firearms in the US is running at 32,000 deaths and climbing, even though the general crime rate is on a downward path (it is 40% lower than in 1980). If this perennial slaughter doesn't qualify for intercession by the UN and all relevant NGOs, it is hard to know what does.

To absorb the scale of the mayhem, it's worth trying to guess the death toll of all the wars in American history since the War of Independence began in 1775, and follow that by estimating the number killed by firearms in the US since the day that Robert F. Kennedy was shot in 1968 by a .22 Iver-Johnson handgun, wielded by Sirhan Sirhan. The figures from Congressional Research Service, plus recent statistics fromicasualties.org, tell us that from the first casualties in the battle of Lexington to recent operations in Afghanistan, the toll is 1,171,177. By contrast, the number killed by firearms, including suicides, since 1968, according to the Centres for Disease Control and Prevention and the FBI, is 1,384,171.

That 212,994 more Americans lost their lives from firearms in the last 45 years than in all wars involving the US is a staggering fact, particularly when you place it in the context of the safety-conscious, "secondary smoke" obsessions that characterise so much of American life.

Everywhere you look in America, people are trying to make life safer. On roads, for example, there has been a huge effort in the past 50 years to enforce speed limits, crack down on drink/drug driving and build safety features into highways, as well as vehicles. The result is a steadily improving record; by 2015, forecasters predict that for first time road deaths will be fewer than those caused by firearms (32,036 to 32,929).

Plainly, there's no equivalent effort in the area of privately owned firearms. Indeed, most politicians do everything they can to make the country less safe. Recently, a Democrat senator from Arkansas named Mark Pryor ran a TV ad against the gun-control campaign funded by NY mayor Michael Bloomberg – one of the few politicians to stand up to the NRA lobby – explaining why he was against enhanced background checks on gun owners yet was committed to "finding real solutions to violence".

About their own safety, Americans often have an unusual ability to hold two utterly opposed ideas in their heads simultaneously. That can only explain the past decade in which the fear of terror has cost the country hundreds of billions of dollars in wars, surveillance and intelligence programmes and homeland security. Ten years after 9/11, homeland security spending doubled to $69bn . The total bill since the attacks is more than $649bn.

One more figure. There have been fewer than 20 terror-related deaths on American soil since 9/11 and about 364,000 deaths caused by privately owned firearms. If any European nation had such a record and persisted in addressing only the first figure, while ignoring the second, you can bet your last pound that the State Department would be warning against travel to that country and no American would set foot in it without body armour.

But no nation sees itself as outsiders do. Half the country is sane and rational while the other half simply doesn't grasp the inconsistencies and historic lunacy of its position, which springs from the second amendment right to keep and bear arms, and is derived from English common law and our 1689 Bill of Rights. We dispensed with these rights long ago, but American gun owners cleave to them with the tenacity that previous generations fought to continue slavery. Astonishingly, when owning a gun is not about ludicrous macho fantasy, it is mostly seen as a matter of personal safety, like the airbag in the new Ford pick-up or avoiding secondary smoke, despite conclusive evidence that people become less safe as gun ownership rises.

Last week, I happened to be in New York for the 9/11 anniversary: it occurs to me now that the city that suffered most dreadfully in the attacks and has the greatest reason for jumpiness is also among the places where you find most sense on the gun issue in America. New Yorkers understand that fear breeds peril and, regardless of tragedies such as Sandy Hook and the DC naval yard, the NRA, the gun manufacturers, conservative-inclined politicians and parts of the media will continue to advocate a right, which, at base, is as archaic as a witch trial.

Talking to American friends, I always sense a kind of despair that the gun lobby is too powerful to challenge and that nothing will ever change. The same resignation was evident in President Obama's rather lifeless reaction to the Washington shooting last week. There is absolutely nothing he can do, which underscores the fact that America is in a jam and that international pressure may be one way of reducing the slaughter over the next generation. This has reached the point where it has ceased to be a domestic issue. The world cannot stand idly by.

Iraq War: 'we have to face the truth and admit we failed'

Andrew Gilligan, who reported from Baghdad throughout the invasion of Iraq, highlights the failures of the British military as well as those of the politicians.

British forces transfer authority over Basra to the Americans in 2009 Photo: AFP/GETTY

By Andrew Gilligan

10:00PM GMT 09 Mar 2013

On the last day of Britain’s combat mission to Iraq, 30 April 2009, we lowered the flag with characteristic verve and style. In the morning, at our base in Basra, there was a deeply affecting service in honour of our military dead. It took 29 minutes to read out all the names.

In the afternoon came a more upbeat ceremony. Air Chief Marshal Sir Jock Stirrup, chief of the defence staff, said British forces had made an “outstanding contribution to the transition of Iraq.” They pulled out, he said, with “their reputation intact.”

Brigadier Tom Beckett, commander of 20th Armoured Brigade, the British formation, said: “We leave knowing we have done our job, and done it well. We leave with our heads held high.”

Gordon Brown, the prime minister (though sadly too busy to make it down himself) had earlier said that British troops remained “the best in the world” and had made Iraq “a success story”. The leaders’ very need, of course, to say such things showed that they were no longer quite true.

The Basra event was telling in one other way. Newspapers and broadcasters had known about it for some time, but were strictly forbidden from even mentioning that it would take place until afterwards. If the victory ceremony has to be kept secret on security grounds, what does that tell you about the victory? 

Iraq was a huge blow to the moral and international standing of this country. It changed, probably permanently, the relationship between the people of Britain and their leaders. I, for one, can never see our government – or our feeble democratic institutions, which did so little to prevent the disaster – in quite the same light again.

But, less widely understood, Iraq was also a military humiliation for the UK. In the debacle that was the war, and above all the occupation which followed, one group of people – Britain’s military leadership — got off far too lightly. And because we never faced up to this, the humiliation continues, right now, in Afghanistan and in Whitehall. One cherished part of the country’s self-image – the power and reputation of our armed forces — is now at serious risk.

For years, the top brass has been essentially exempt from the kind of criticism dished out to other public-sector leaders. All the failings of Iraq and Afghanistan are blamed on conniving politicians or cheese-paring bureaucrats. But evidence from those conflicts shows some of our generals, admirals and air marshals to be rather too much like, say, NHS managers for comfort.

Iraq’s greatest disaster was not the deceit beforehand, or the brief phase of “major combat operations” which began 10 years ago next week. It was the occupation which followed. That was when the vast majority of victims — perhaps 190,000 of them – died. If the occupation had gone better, the politicians’ lies would have been forgiven by now. And it was during the occupation that Britain’s brass fell down on the job.

The key evidence is hundreds of pages of official interviews, conducted by the Army itself with those in charge of the operation. A full set of classified transcripts, leaked to The Sunday Telegraph in 2009, painted a disturbing picture of complacency and misjudgment at senior levels.

Major-General Graeme Lamb, commander of 3 Division in the first months of the occupation, told his interlocutors: “It is easy to become fixated by the enemy. Securing military victory over the enemy is probably not a reality.”

Instead, Lamb favoured “soft effects,” such as improving the lives of the local people, which “really wasn’t that difficult and didn’t require that many experts. Once you knew what you needed to do, you then dispatched the nearest captain with the 'find me 100 trucks’ order and it all worked.”

With apologies to Lamb — who went on to high command in Afghanistan — the enemy surely was quite important. And sending out a captain with a hundred trucks did not “all work”. Basra’s infrastructure remained in ruins, partly because there were not “that many experts” — indeed any at all – and because security was never satisfactorily tackled by the British.

Instead, the British preferred to make deals with the enemy, the Iranian-backed Mahdi Army militia commanded by Muqtada Sadr. In the classified interviews, Major-General Andrew Stewart, the overall British commander, described how he “evaded” and “refused” American orders to confront Sadr, saying: “I was trying to achieve the same result through different means – trying to neutralise Sadr through the use of local Iraqis and succeeding.”

He did not succeed. Sadr was not a solution to the insecurity, but its key source. By 2006, Basra was in anarchy. By the following year, the policy of negotiation had led Britain to what was essentially a surrender. To the intense frustration of many British officers, we secretly signed a deal that we would not enter Basra in return for a promise that Sadr’s forces would stop attacking us.

It kept the body count down, which was all that mattered in London. But it also abandoned Basra to the Mahdi Army, who swaggered through the streets closing down video shops and enforcing headscarves on women.

The tragedy — as many of the classified interviewees recognised – was that Britain’s part of Iraq, the Shia south, was not like the centre of the country. Brutalised by Saddam, Iraqi Shias supported the invasion and might have been prepared to back the occupation. But Britain’s failure to improve infrastructure and security alienated them.

It is true that, by the time we left, the situation in Basra had dramatically improved. But that was due to an Iraqi- and US-led military offensive, Charge of the Knights, in which we took virtually no part.

Constrained by their surrender agreement, the British, theoretical guardians of Basra, stayed in their secure base on the outskirts until the closing moments, as the Iraqis and Americans drove the Mahdi Army out of town. By that stage, such was both nations’ contempt for Britain that they didn’t even tell us they were coming until the last minute.

Of course, you could say that without enough troops, and without enough political commitment, the British Army made the only choice it could. That is one of the reasons why Mr Blair’s deceits beforehand ended up mattering so much: because he could not admit he was planning a war, the forces could not prepare properly for either it or the aftermath. And afterwards, public disgust at the lies sapped will to resource the occupation.

As it happens, the military leadership was culpable there, too. In the run-up to the war, top-level figures in the defence establishment privately told journalists, including me, of their scepticism that Saddam was a serious threat. None was ever prepared to go on the record. Only in their memoirs — or at the Chilcot inquiry, when a stampede of brass wore out the carpets to dump on Blair – did the public learn of these brave warriors’ doubts.

Nor, with one or two exceptions, did they speak out against the years of disastrous procurement and kit that contributed to Britain’s Basra reckoning. Some soldiers only had five rounds of ammunition. The very first British casualty of the war, Sergeant Steven Roberts, died because his unit didn’t have enough body armour.

^{Sergeant Steven Roberts from Bradford, West Yorkshire, who was the first British armed forces personnel to be killed in the Gulf War in 2003.}

Underlying the failed Basra strategy, too, was a flawed British assumption that they were good at counter-insurgency. We understand the natives, the generals would tell you — unlike those brutal, clumsy Americans. But smiles and handshakes could never alone have worked. Even previous peace support operations, such as Bosnia, had only been resolved by the use, or threat, of sufficient force.

The Americans were indeed appallingly brutal, to begin with, but they learned, and they changed — and, unlike us, they didn’t give up. They did surge men and resources; and in the end, helped by the overreach of their enemies, they did at least in part prevail. Both countries suffered political humiliation in Iraq. But only Britain was defeated militarily.

The clear lesson from Iraq was that you should do something properly, or not at all. But in Afghanistan, Britain’s generals repeated the same half-baked, penny-packet approach, the same self-delusion about their rapport with the locals, and drew the same contempt from their American allies.

General Benjamin Freakley, the main US commander in southern and eastern Afghanistan at the beginning of Britain’s campaign, admits that he was “scathing” to the British about their efforts in Helmand province. He said he warned especially strongly against Britain’s “disastrous” tactic of sending small groups of soldiers to far-flung “platoon houses,” sitting ducks for the Taliban. The practice was finally changed, but not before dozens of British lives were needlessly lost. These were operational decisions, nothing to do with British politicians — some of whom, indeed, were aghast at their generals’ recklessness.

The irony of Iraq is that an operation intended to strengthen the Anglo-US “special relationship,” the bar to which the British diplomatic and military establishment so desperately clings, did the exact opposite.

Basra cost us much respect in the Pentagon. In the leaked Iraq interview transcripts, the British brass complain that the overall US commander, General Rick Sanchez, never visited and never called: he didn’t, they complained, even install a secure phone link with them. Britain’s chief of staff, Colonel JK Tanner, likened the Americans to “a group of Martians”, saying: “Despite our so-called 'special relationship,’ I reckon we were treated no differently to the Portuguese.”

Soon, in Afghanistan, we will declare victory and leave. But it seems unlikely that we will leave much lasting trace of our presence, or much in return for the 440 British lives so far sacrificed there. And unlike the politicians of Iraq, the generals have moved on, reputations unsullied, to more lucrative work.

General Lamb, for instance, has recently taken to the media, extravagantly praising a dictatorial Arab regime which paid his lobbying company £1.5 million to “support [its] stance before the international community”. The Iraq war sandblasted the credibility of the British government, the intelligence agencies, and the diplomatic corps. But with the forces there is still, perhaps, an unwillingness among the media and public to confront reality; still a strong wish to believe that Britain is the best, the undefeated.

But for the sake of the self-respect and the very future of those forces, still among the proudest assets of this country, it is essential that they, and we, face the truth and learn the lessons.