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JOHN BURN-MURDOCH: If anyone says to you that the conditions we’re seeing in England’s hospitals at the moment are no different to what we get in a bad flu season, this video is what you should show them. What I’ve done is I’ve taken data on the numbers of people being admitted to ICUs in England with flu over the last few years in a typical winter. First of all, we’re going to look at the year 2013-’14.
So on the vertical axis, you’ve got the number of people admitted with flu per week per million people. To put that into more context, England has about 56 million people as a whole in the country. So when the number is 1 person per million per week, that’s about 56 people per week.
So let’s start in the winter of 2013-’14, where the flu season peaked around about 1.5 people per million per week. If we then move to the following winter, it was a bit worse, and things got up to about 2.5 per million per week. The subsequent winter was worse still. 2016-’17 was a bit more mild. But then 2017-’18 was a relative record, one of the worst flu seasons we’ve seen in about 40 years, ’18-’19 also bad, ’19-’20 not quite as bad.
But what we’ve seen this winter, in 2020-’21 with COVID is a completely different picture. It’s an order of magnitude different. Whereas the worst flu seasons in the past were peaking at about 6 people per million per week admitted to ICUs, what we’ve seen this winte– and, of course, the numbers are still developing, still, in fact, rising– we’ve seen a peak so far of about 17 people per million per week. And that translates into around 980 people admitted to ICUs in England per week with COVID.
To put that 980 new admissions into context, the total ICU capacity across all of England– that’s the number of ICU beds typically available, even in winter– is about 3,500. So that’s more than a quarter of all available ICU beds taken up just by new admissions in one week. Now, of course, not all patients admitted into ICU stay there. Some are discharged. Some unfortunately lose their lives.
But it just shows you quite how full and, in fact, overwhelmed England’s ICUs have been this winter relative even to bad flu seasons in the recent past. Now, some people will look at that last chart and say, well, we’ve not been testing everyone, including asymptomatic people, for flu in the past in the same way that we’re doing for COVID this winter. Now, there are a couple of things to say about that.
First of all, the vast majority of tests being done are on people with symptoms. So to say that the lack of asymptomatic testing in the past is different is not really true. We test for flu in normal years when people are ill. We test for COVID this year when people are ill.
But the second and perhaps more definitive response to that kind of criticism is we can look at the total numbers of people in England’s ICU for any reason. Now, if the spike in that last chart for COVID is simply due to the fact that we’re doing more testing for respiratory illnesses this year than in other years, and what we’re really seeing is people who got admitted to ICU for other reasons– perhaps a broken leg, perhaps a heart attack– and then tested positive for COVID, then the total numbers of people in England’s ICUs shouldn’t be any different. It’s just that COVID is spreading among people who are already in hospital.
So let’s see if that is, in fact, the case. The chart here looks again over the winter months from November, December through to February, March. And we’re looking here at the total numbers of people in ICU beds in London for any reason at all, doesn’t matter whether they’re in for flu, for COVID, broken ankle, anything like that.
If we look at 2013-’14, the same winter we started with last time, the numbers start rising as we come into winter. Now, that’s not unexpected. But they then level off at around 650 people in ICU beds in London. And that stays roughly the same as winter plays out.
Now let’s pan through the years again. So here’s the following winter, ’14-’15. Around 700 people in ICU beds in London all the way through, similar the year after that, similar in 2016-’17. Even in ’17-’18, that year that was especially bad for flu, the numbers never got above 750 people in ICU beds in London for the whole winter, 2018-’19, again around 700, ’19-’20 the same.
But here’s 2020-2021. And once again, just as in the last chart, we see that COVID is completely different to what we’ve seen before. Instead of the typical number of about 750 people in ICU beds, that number has shot up above 1,000. And again, the line has only been growing steeper. When the data is updated, it’s almost certain that this will have risen even further.
The peak of that red line for this winter is at 1,074 patients in critical care, in other words, ICU beds in London. That’s a 40% increase on that record-bad flu season in 2017-’18. So this is, again, a completely different scenario that we’re dealing with, putting doctors and hospitals under immense pressure.
And when you look at this, the only reason that doctors and hospitals are able to accommodate 1,074 patients in ICU beds when they typically have about 700 to 750 is they’re moving beds from elsewhere, and they’re moving staff from elsewhere to care for these patients. So the care that patients receive in this case really is a zero-sum game.
For every additional patient being treated in ICU for COVID, a patient elsewhere is receiving either a lower quantity of care or a lower quality of care. We now know that in many ICUs in London, one doctor or one nurse is having to deal with four patients in ICU. Whereas, typically, even in a bad winter, that number would be one or two patients.
So people are more stretched. Resources are more thin. And it’s likely the outcomes may become worse. Now, of course, the outcome after you see a huge surge in the number of patients in hospitals, and especially in ICUs, is that unfortunately we also see the numbers of deaths start to climb. But there have been a lot of confusing numbers bouncing around online over the last couple of weeks about whether deaths this year are indeed higher than they normally would be in a typical winter.
One piece of information that some of those who don’t think this winter is any different to normal have been using is data from the European Mortality Monitoring website, EuroMOMO. Now, what they’ll do is they’ll point to a chart that looks a bit like the one you see in front of you here, which is tracking whether or not deaths occurring in different countries in Europe are roughly normal for the time of year or above what we’d normally expect. They’ll focus on this period right at the end of the chart, where it looks like the line is going downwards, suggesting that deaths are falling back towards roughly normal levels for this time of year.
The problem is the way this data is processed means that the lines always trend downwards at the end, because there is essentially a delay between when deaths occur and when they’re registered. So if we look at the data for England, for example, if we visited this web page about a week ago, the data point for week 52, the last week of 2020, gave a value of 0.15. That means essentially deaths occurring in the last week of 2020 were no different to a normal year.
However, we come back to this page today a week later, and that value for England, for the same week, is now 5.98, almost 6. In other words, it’s considerably higher than normal and in the range that EuroMOMO says means significant excess deaths. That’s the same week. It’s just that a week later, more of that data has been processed and the line has gone back up.
Once again, the final point of the line looks like it’s tipping down. But we know from this experience, from past experience, that is a data processing issue. And once all that data is fed through, that point, like the one before it, will rise up significantly. That’s just one of the ways that we can look at excess deaths and try to add some clarity to the data here.
But another way is to compare what we’re seeing this winter, as we’ve been doing in those previous charts, with what we’ve seen in other bad flu seasons. So here’s a chart showing the total numbers of people whose deaths are registered in England and Wales over the calendar year. And we can see this figure for the years through from 2012, ’13, 2014, all the way through to the last couple of years, ’17, ’18, ’19, and then here we have the data for 2020.
Now, that huge spike that you see in March, April and into May in England and Wales is the spike that we’re all grimly familiar with. This was the huge excess that we saw in the spring, back when the virus was really out of control in England and Wales. And this peak was so high, in part, because until late March, we’d all be mixing freely with no concerns for how this might be affecting viral transmission. That led to thousands and thousands, in fact, tens of thousands of excess deaths.
What has been more contentious is whether or not the numbers we’ve been seeing in the last few weeks, in September into October, November and latterly December, have been especially abnormal for a winter. But the simple fact is they have. Just as we’ve seen ICU admissions far higher this winter than they would be even in a bad flu season, the same has been true of deaths.
So the winter of 2017-’18, as we mentioned earlier, was a record-bad flu season. And one of the statistics that is used to measure exactly how bad a flu season is this concept of excess winter deaths. Now, that terminology adds a lot of confusion when people are comparing the death tolls of different years because excess winter deaths and the general concept of excess deaths that we’ve been talking about this year are actually two completely different things.
Excess winter deaths are defined as the number of deaths in the four months from December, January, February and March compared to deaths in the four months immediately before that, so the autumn, and deaths in the four months after that, the next spring. So it’s about saying how many more deaths did we see over one year in winter than in the autumn before and the spring after that period? It’s a way of measuring the impact of seasonal winter viruses, like flu, and of freezing temperatures, which can themselves cause increased deaths.
But when we’re measuring excess deaths during the COVID-19 outbreak, what we’re doing is we’re seeing how many more deaths there have been this winter compared to previous winters. So that measure is always going to give a smaller number because it’s comparing against a winter baseline, where deaths are known to be high, rather than against a spring and autumn baseline, where deaths are known to be low, as is the case with excess winter deaths. So when people point to 2017-’18 and say, well, there were about 50,000 excess winter deaths in that year, but we’ve not seen 50,000 excess death this winter, they’re actually comparing two numbers that cannot possibly be compared, two completely different methodologies.
And the closest we can actually get to a like-for-like comparison of excess mortality this winter versus 2017-’18 is to compare deaths from September to December versus the same months in 2017. And the result? The result is that autumn in winter 2020 has seen 15,000 more deaths than the same period in 2017-’18.
The final couple of problems we have when we try and deal with excess mortality this year relate to the fact that there are very, very long delays between the occurrence of a death and that death appearing in death registration data. So if we look at the very latest data that we have from the Office for National Statistics, that was published on January the 6th, and it refers to people whose death was registered in the week ending on Christmas day, the 25th of December. That’s a lag of 12 days between when the death was registered and when it is published in the official data.
There’s then another lag between when someone dies and when their death is registered. That’s typically around five days in England and Wales. So the very latest data that we have on excess deaths in England and Wales refers to people who lost their lives around the 20th of December.
Now, we know that it was in the immediate lead up to Christmas in the UK that the virus was spreading at its fastest. It was from the 20th of December onwards that we saw case rates, positivity rates surging up higher and higher towards those April levels. And it’s only been in the last two weeks that we’ve seen hospital and ICU admissions reaching and then, in fact, breaching those spring records.
So based on that, we would expect most of the rise in deaths from this winter wave of the virus to take place long after the 20th of December. So the fact that we’ve seen considerable excess mortality over the last few months is one thing. But we actually fully expect, and the data, I’m sure, will bear out the fact that we will now see an acceleration, a steepening, of that excess deaths curve, as the data from people who lost their lives after the 20th of December philtres through into the published data that we can actually use.
We’ve been tracking these statistics and many other metrics for COVID not just in the UK, but through dozens and dozens of countries around the world. And you can find all of our data at ft.com/coronavirus-latest.
‘Their hair is on fire’: Trump fans await return to political stage
On his final day in the White House last month, Donald Trump told a small crowd of supporters at Joint Base Andrews, the military airport, that he had no intention of leaving the stage quietly.
“I will always fight for you, I will be watching,” the outgoing president said before boarding Air Force One for the last time. “We will be back in some form . . . we will see you soon.”
Now the 45th US president is set to make a splashy return to the fray on Sunday with a keynote speech at the Conservative Political Action Conference (CPAC), an annual gathering of Republican politicians and media personalities that has become a kind of rock festival for rightwing activists, especially college students.
Ford O’Connell, a Trump supporter and former Republican congressional candidate, said attendees were “dying” to hear from Trump, whom he described as the “leader of the Republican party, even if he is not in office in the traditional sense”.
“These folks are unhappy about how the 2020 elections turned out, but their hair is on fire after a month-and-a-half of the Biden administration,” O’Connell said.
“What they want to hear from Trump is: how do you move forward in 2022 and 2024,” he added, referring to the midterm elections in two years and the next presidential contest.
Trump’s speech will end an unprecedented stretch of near silence for the former reality TV star, who built his political career on regular cable television appearances and constant tweeting. After leaving Washington, he took off for Mar-a-Lago, his resort in Palm Beach, Florida, and has stayed there since, playing golf and shunning the spotlight.
Shorn of his ability to communicate with to his millions of supporters on Twitter and Facebook — which banned him for his role in the deadly January 6 siege on the US Capitol — Trump has made just two notable interventions: he called in to Fox News to eulogise the late rightwing radio host Rush Limbaugh, and released a blistering statement attacking Mitch McConnell, the top Republican in the Senate.
Advisers had encouraged Trump to keep a low profile during his impeachment trial, which ended this month with his acquittal.
Trump will be the final speaker at the four-day conference, which is being held in Orlando, Florida — a city that is just two-and-a-half hours drive from his home and that has looser Covid-19 restrictions than CPAC’s usual location of Washington, DC. The former president is expected to speak in person, although event organisers have not confirmed the details of his speech.
The list of the other CPAC speakers reads like a who’s who of his fiercest defenders, including Florida’s governor, Ron DeSantis, and Republican senators Josh Hawley and Ted Cruz — all of whom have been suggested as possible 2024 contenders that could carry Trump’s torch if he does not run again for president.
Trump has not ruled out another bid for the White House, despite mounting legal troubles, including criminal investigations in New York and Georgia.
His appearance at CPAC — an event dating back to a speech by Ronald Reagan in 1974 that has become increasing populist and Trump-centric in recent years — has also drawn attention to Republican party infighting.
Mike Pence, the former vice-president, who fell out of favour with Trump supporters after he certified Biden’s election win, is not attending the event. Nor is Nikki Haley, the former South Carolina governor who told Politico in an interview that ran earlier this month that Trump could not run for office again because “he’s fallen so far”.
The party’s divisions were laid bare in an awkward encounter on Capitol Hill this week, when reporters asked House Republican leader Kevin McCarthy whether Trump should be speaking at CPAC.
McCarthy replied, “Yes, he should,” before Liz Cheney, one of his deputies, interjected: “I’ve been clear in my views about President Trump . . . following January 6, I don’t believe he should be playing a role in the future of the party or the country.”
After Cheney contradicted him, McCarthy abruptly ended the press conference, saying: “On that high note, thank you very much.”
Cheney was one of 10 House Republicans who joined all House Democrats in voting to impeach Trump last month, and is among a handful of critics on Capitol Hill who have openly castigated the former president despite knowing they run the risk of losing the support of party voters.
While a few elected Republicans, like McConnell, have joined Cheney in rebuking the former president, CPAC will serve as a stark reminder of how popular he remains among party activists.
A Suffolk University poll out this week found 46 per cent of people who voted for Trump last November said they would abandon the GOP if the former president broke away and formed his party. Half of those polled said the Republican party should be “more loyal to Trump”, compared to one in five said the party should be less loyal.
Matt Schlapp, a Trump ally and chairman of the American Conservative Union, the group that organises CPAC, told Fox News this week the Republican establishment should recognise that it must now cater to a much broader church; one made up by the old party faithful and the supporters that Trump brought into the fold with his “Make America Great Again” movement.
“It’s Republicans, it’s conservatives — who are this big, big minority in this country — and then it is these new MAGA supporters,” Schlapp said. “This is now a coalition.”
But more moderate Republicans warn that by sticking with Trump, the party will never be able to win back the centrist conservative and independent voters who abandoned the party at the ballot box in November.
“It is important to remember there is a whole other wing of the party, and virtually no one from that . . . wing is being represented at CPAC,” said Whit Ayres, a veteran GOP pollster. “It is a gathering of the most conservative and some of the most active members of the Republican party, but it represents only a portion of the party.”
McKinsey partners sacrifice leader in ‘ritual cleansing’
The news this week that Kevin Sneader would be McKinsey’s first global managing partner since 1976 not to win a second three-year term stunned many of the consultancy’s partners and influential alumni.
Few could point to any one mis-step that had felled the 54-year-old Scot. “It added up,” one veteran said simply of the litany of reputational crises he had tried to resolve.
But nor did many think that Sven Smit or Bob Sternfels, who beat Sneader to the last round of voting, would represent a cleaner break with the past — or that whoever won the final vote in the next few weeks would face an easier task than he had.
Within days of taking over in 2018, Sneader flew to South Africa to apologise for failures that had embroiled the firm in a corruption scandal. “We came across as arrogant or unaccountable,” he admitted in a speech that began with the word “sorry”.
That set the tone for a tenure defined by the need to make up for other crises that largely predated his promotion, from damaging headlines about McKinsey’s contracts in authoritarian countries to US states’ lawsuits over its work to boost sales of highly addictive opioids.
Speaking to the Financial Times less than two weeks before senior partners voted him out, Sneader said he had focused on making the private firm more transparent, more selective about which clients it took on and better structured to avoid surprises in a global group whose rapid growth had made it more complicated.
According to people who witnessed those efforts, though, pushing them through consumed much of the political capital Sneader needed to win re-election. For some, particularly younger staff, his reforms did not go far enough. For an older group more prominent among the 650 senior partners who vote on their leadership every three years, they went too far.
Sneader’s downfall looked like a case of “the partners not wanting to take the medicine”, one former partner said. Another argued that Sneader’s push for more oversight over partners who prized their freedom had made the firm “too corporate”, while some Sneader allies saw the “protest vote” as a rejection of his reforms rather than a clear mandate for Smit or Sternfels.
Sneader was not helped by the timing of this month’s $574m opioid settlement with 49 US states, added Yale School of Management professor Jeffrey Sonnenfeld, who said that consultants outside the US did not understand why he agreed to the payout.
Sneader might have been able to reassure them in person, but with McKinsey’s frequent-flyers grounded by a pandemic, “there are limits to what you can do with Zoom”.
‘In business, as in poker, there is uncertainty’
Laura Empson, author of Leading Professionals, said one question now was whether the vote against Sneader was “a ritual sacrifice to appease the bad PR” or a sign that McKinsey’s partners were willing to take more radical action.
The run-off between Sternfels and Smit may not resolve that issue, say people who know them both, who note that they are of a similar age to Sneader and members of the leadership council that signed off on his reforms.
Sternfels, a California-born Rhodes scholar who joined McKinsey in 1994, was the runner-up to Sneader in 2018. As head of “client capabilities”, he has a role akin to that of a chief operating officer and is closely associated with the rapid expansion of the firm under Dominic Barton, Sneader’s predecessor.
Based in San Francisco after six years in Johannesburg, the former college water polo player is known as an effective operator and, the second former partner says, “the guy who built the new business models”.
But some of McKinsey’s newer activities have dragged him into controversies: last year, he was called to testify in litigation brought by the restructuring specialist Jay Alix — the founder of rival consultancy AlixPartners — over McKinsey’s disclosures while advising clients in bankruptcy.
When a frustrated judge asked whether he was dealing with “a group of people who are so educated, so arrogant, that they just can’t admit that they’re wrong”, Sternfels apologised, insisting that “we try and not foster arrogance”.
Smit, who joined in 1992 and is based in Amsterdam, is known inside McKinsey as a more cerebral figure. Now co-chairman of the McKinsey Global Institute, the consultancy’s research arm, “there’s not a university campus he couldn’t parachute into and be received as one of the smartest people in the room,” Sonnenfeld said.
The Dutch mechanical engineer earlier ran McKinsey’s western European operations and may attract less support from US peers, but the first former partner describes him as “the conscience of the firm”, who will say no to ideas with which he disagrees. The second thinks he may “take the firm back to more of an old-school McKinsey”.
Smit’s writing on topics from urbanisation to the future of work made him popular with clients and provided a glimpse into his thinking on strategy, which he likened in one report to poker. “In business, as in poker, there is uncertainty, and strategy is about how to deal with it. Accordingly, your goal is to give yourself the best possible odds,” he wrote.
Discontent runs deep
Whether the cards fall for Smit or Sternfels, colleagues past and present question whether either will reverse the reforms that seem to have triggered unrest about Sneader.
“I don’t think Kevin had any choice but to centralise,” said one Sneader ally.
One of the former partners added: “What were the alternatives? It’s a large firm to govern and you do need structures.”
What the election result has already revealed, however, is that discontent with the state McKinsey finds itself in runs deeper than had been obvious outside the firm.
Whichever candidate triumphs, they will need to listen seriously to the concerns of alumni, clients and policymakers and make clear that he plans meaningful cultural reforms, Empson says.
Sneader’s successor will also have to defy the odds in professional services firms, she adds. “Often with partnerships, when something goes wrong, they appoint someone else in reaction to the problem and that isn’t the solution either and they cycle through another round of leaders quickly,” she says: “It’s almost as though they have to go through this ritual cleansing.”
McKinsey, which does not disclose its financial performance, earned annual revenues of $10.5bn in 2019 by Forbes’ estimate. Sonnenfeld points to the irony that the firm, which charges a premium for its services, has stumbled in this way.
“It’s odd that McKinsey doesn’t create the kind of leadership that would thrive in a crisis,” he reflected. Before the succession process starts again in 2024, “they need to go into overdrive on leadership development”.
Investors look to Sunak for clarity on new UK infrastructure bank
Ever since chancellor Rishi Sunak announced the setting up of a UK government infrastructure bank last autumn, investors have wondered what its role will be. Next week, in the Budget, they will get the answer.
The Treasury has only said it will focus on supporting new technologies that are too risky for private finance and would contribute to meeting the government’s target of net zero carbon emissions by 2050. As examples, it gave carbon capture technology and the rollout of a nationwide network of electrical vehicle charging points.
The selection process has just begun for a part-time chair, working two to three days a week, and it is scheduled to open on an interim basis on April 1.
The bank’s creation has prompted a debate about how infrastructure should be funded in the UK, at a time when the government’s finances are stretched and customers are likely to resist tax or bill increases, the means by which many sectors — such as ports, airports, energy, telecoms, water, and electricity — are funded.
Many of these assets in England are owned by sovereign wealth, pension and private equity funds, and regulated by arm’s length bodies, under one of the most privatised infrastructure systems in the world.
Dieter Helm, a utilities specialist at Oxford university, said the bank was “a good idea but it needs scale — a balance sheet and capital funding from the state, in which case you’ve essentially created a new arm of the Treasury”.
“The question is whether this is going to be the primary vehicle through which the government implements infrastructure,” he said.
John Armitt, chair of the National Infrastructure Commission, a government advisory body, suggested it needed an initial £20bn over five years to make an impact and reach projects the market might be unwilling to support.
The institution, which Sunak has said will be based in the north of England as part of the government’s levelling up agenda, will partly replace the low-cost finance provided by the European Investment Bank, which is no longer available since Brexit. But it is unclear if it will be able to match the €118bn the EIB has lent to the UK since 1973.
Sunak has promised that the government, which spends much less than most European states on infrastructure, will spend £600bn over the next five years. But ministers hope that more than half their national infrastructure plan will be paid for by the private sector. However, private finance is generally more expensive than government borrowing and requires taxpayers to underwrite the construction and financial risks.
“The government wants the public to believe that the country can have this wall of private sector investment without higher bills and taxes now but investors will only come if the government will guarantee they will receive a return and it acts as a backstop,” Helm said.
The lockdowns have taken a heavy toll, for example forcing the renationalisation of rail services. At the same time the Eurostar train service, airports and airlines have called for taxpayer bailouts, while the government is also paying for some households’ broadband.
Although the prime minister has in the past year given the go-ahead to some rail and road schemes, including a tunnel under Stonehenge, other projects — including £1bn of rail improvements — have been axed.
Meanwhile, local authorities — which are responsible for urban roads and other key infrastructure — have been forced to shift their limited financial resources to care for the elderly and vulnerable during the pandemic and so want more central government help.
Despite this growing demand, some investors have questioned the need for the new bank, even though they are popular elsewhere — such as Canada, which established one in 2017.
“Given there is at least $200bn of international capital looking for projects in which they can invest, the government has to be careful it doesn’t just crowd out existing finance,” said Lawrence Slade, chief executive of the Global infrastructure Investor Association, which represents private sector investors.
He argued the new bank, which will take over the government’s guarantee scheme, should only take on projects that are “too risky” for institutional investors, pointing out that the Canada Infrastructure Bank was mandated to lose up to C$15bn (£8.45bn) over 10 years. “It’s not yet clear what question the new infrastructure bank is trying to answer,” he said.
Ted Frith, chief operating officer of GLIL Infrastructure, a £2.3bn fund backed by UK pension funds, said the EIB loaned money at competitive rates to projects that also borrowed from capital markets. “This is a global market and there are plenty of alternative sources of finance to replace the EIB,” he said. However, he added that the infrastructure bank could play a role in addressing the shortage of available projects.
While investors will put equity into existing or smaller infrastructure projects — such as an airport extension or a wind farm — they are wary of new projects, according to Richard Abadie, head of infrastructure at consultancy PwC, because the latter carry long term construction risks and do not provide an income stream for several years.
“The NIB can play a role de-risking projects but the main challenge is how we can afford and manage the cost of energy transition, not whether finance is available to bridge the cost,” he said.
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