The COVID Chronicles – 9

Geneva, 19 December, 2020

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Attenborough (on the left) during his famous 1978 encounter with gorillas. Source BBC

David Attenborough has been involved in nature broadcasting for more than 70 years. He is a truly remarkable and inspirational man who, at 94 years-old, has written a truly remarkable and inspirational book “A Life on Our Planet.” I have just finished reading it. Attenborough wags a very authoritative finger at homo sapiens for how, through a perceived need for continual economic growth, we have pretty much destroyed our habitat and that of millions of other species. He provides ample evidence of a looming catastrophe. Given this, he nevertheless offers solutions and even hope. He neatly draws together what needs to be done from an ecological point of view (including an argument for a more plant-based diet,) the imperative for a total shift in how we think of the economy (looking beyond GDP as the sole value of the well-being of a nation) and a human future that is equitable and sustainable. If I were a wannabe politician eyeing the long term, this book would leave me with three words to work into speeches. People, Planet and (not only) Profit.  

The boost to our spirits on hearing that COVID-19 vaccines are soon coming on line has been short-lived. The pandemic news has just got a whole lot more complicated and, I fear, worrying. Burgeoning case numbers with associated deaths continue in the US. In the UK and Germany there has been a sudden rise in cases despite lockdown measures. School closures are fiercely debated. We hear that the virus responsible has mutated and may be even more transmissible than before. (Apparently, this is what coronaviruses do. In evolutionary terms, such a virus is much more interested in transmission between its hosts than killing them.) On top, the WHO and China have agreed that an international investigation team will be sent to Wuhan where, supposedly, the virus responsible for COVID-19 first emerged.

And of course, it’s getting to that time of the year. I detest the rampant consumerism that traditionally takes over our lives at this period. Otherwise, I neither like christmas nor dislike it. I just go with the flow. I’m always baffled by how much importance we put on Jesus’s birthday. Christmas in the time of COVID-19 is lining up to be more baffling still. It seems that politicians want to curry favour by allowing us to go shopping and get together with our families in full knowledge that these activities are likely to compound the spread of the COVID-19 virus. Predictions of a new year resurgence are both believable and serious given that case numbers surged in the US as a result of family gatherings for Thanksgiving in November. 

I realise that this may all be just too gloomy. So just for grins and giggles, why don’t I populate this black scenario with some online snippets that I’ve found about the economic impact of the pandemic to date. I do not present this material with any expertise in economics.

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Source: US Bureau of Labor Statistics
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Source: UK Office for National Statistics

These unemployment figures are heart-breaking. Unemployment has spiked like never before in the US and the UK. By contrast, here in Switzerland, it is reported that those claiming unemployment benefit rose from 2.5% to only 3.2% in the 2nd quarter of the year. 

Are the stock markets holding their own? 

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Source: The Motley Fool
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FTSE100 2020 Source: Bloomberg (Last upward trend follows news of COVID-2019 vaccine development)

The markets took quite a hit in March but seem to be getting back on track. Apparently, I am not the only person mystified by this recovery. My friend Tom, who knows about these things, is not sure that this market confidence is sustainable. He’s convinced that the world of high finance is yet to be truly tested by the economic impact of the pandemic.

The most sobering of all is a World Bank graph I found yesterday.

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Source: World Bank

This shows that the proportion of countries that will be in recession in 2021 as a result of the pandemic will be over 90%. This is higher than any past recession including the great recession of the 1930s.

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US Dollar v. Swiss Franc Source: XE converter
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2020 Gold Prices USD /oz. Source: Trading Economics

In a global financial crisis, I’ve heard it said that two traditional financial refuges are the Swiss Franc (yay!) and gold. The US dollar has tumbled in relation to the Swiss Franc. (The US now accuses Switzerland of manipulating currency markets.) Gold dipped when the pandemic first hit but in August this year, dollars per ounce of gold hit an all-time high.

This morning, I listened to the third 2020 Reith Lecture “From COVID crisis to Renaissance” delivered by Mark Carney, former Governor of the Bank of England. His theme for this series of lectures is that leaders should reassess “value” beyond pure economic terms. Other more subjective values should be taken into consideration such as fairness, the health and wellbeing of people and the ecological impact of all our activities and lifestyles. He describes the impact of COVID-19 pandemic as the “bill arriving” for lack of resilience preparation, propagating inequities within society and failure to recognise that essential workers are exactly that: essential. The economy was put on “life support” whilst a public health response was mounted. This response has required an unprecedented intrusion into our lives by government. However, Carney points out that this does not indicate that a trade-off exists between the public health response and maintaining a strong economy. Our health, wellbeing and health services should be considered as one set of values and that the economy – another set of values – will not improve until an effective public health response has been put in place. The value to the nation of health workers and, it follows, deaths avoided does not readily translate into economic figures and so should not be sublimated to GDP as a result.

Carney also underlines how the pandemic has hit certain socio-economic groups harder than others. Therefore our ultimate response must engender effective public health measures, addressing societal inequities especially with respect to living standards and education together with plans for an economic recovery. Finally, Carney claims that a similar approach must be adopted by leaders with respect to climate change; something he will be talking about next week.

It seems that Mr Attenborough and Mr Carney are heralds singing off very similar song sheets. If the challenge of addressing COVID-19 helps us face the challenge of climate change then the mantra of any political “renaissance” has to be People, Planet and (not only) Profit.

The COVID Chronicles – 8

Geneva, 10 December, 2020

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We recently dug out a long-forgotten chess set and gave it a go. Chess is a truly wonderful thing. It may be the only board game that does not carry an element of luck; to win or to lose is totally determined by mental abilities.  

In the first lockdown, I noticed that the corner of a nearby park normally dedicated to open air chess was deserted and commented that, over the years, I had only ever seen men playing there. I had a stab at why the game holds less attraction for women. 

Many have turned to chess this year. The evidence is that eBay has seen chess sales going up by 60% after the onset of the pandemic. According to a spokesman for the International Chess Federation, on-line chess was already booming due to the confluence of live streaming technology and video game culture. At the beginning of the year, as many as 11 million chess games were played on-line every day; when the pandemic hit, this grew to more than 16 million games per day.

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Like many others, I first subscribed to Netflix this year. Forbes has reported that the television streaming giant gained 26 million new customers in the first half of this year. The pandemic has precipitated the company’s biggest ever growth spurt. One its most successful productions is a screen adaptation of Walter Tevis’s 1983 chess novel, the Queen’s Gambit. The October debut of this absorbing miniseries came hard on the heels of the lockdown chess revival. The spokesperson for eBay reported another 215% increase in sales of chess sets and accessories since the first episode.

The story of the Queens Gambit is about a young American girl, Beth Harmon, born with a natural gift for chess. As a teenager, she goes on to beat the Soviet Union’s World Champion, Vasily Borgov. However, it is not the against-all-odds-feel-good watching that one would expect. The story encompasses grief, loneliness, drug addiction and alcoholism on the part of the main protagonist. 

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Another Netflix blockbuster is The Crown. Its success rides on the endless and world-wide (and for me inexplicable) fascination for the British royal family. It must be the first TV or film production in which, at every stage, the viewer is constantly asking themselves “Blimey, did she really say that? Nah, he wouldn’t have done that, would he?” Basically, it is one great lavish very entertaining soap based on some facts and with characters who happen to be royal, instantly recognisable, privileged and rich beyond imagination. Unfortunately, by watching, the viewer becomes complicit in the passing off of many fabricated scenes as history. The Crown should carry a fiction warning.

The issue of mental health is upfront in this series as well. It turns out that two distant cousins of Prince Philipp were incarcerated in an asylum from a young age. Princess Margaret’s drinking and suicide attempt are highlighted along with Diana, Princess of Wales’s bulimia. Warnings of scenes relating to an eating disorder precede some episodes.

These two series make for great television for when one has to stay at home. They prompted me to search around for any valid information about the mental health impact of having to stay at home because of the pandemic. 

The BBC has spoken to experts who predict that those already subject to obsessive-compulsive disorders may become chronic “germaphobes.” Anxiety will be exacerbated among those who already suffer high anxiety levels.

Antonis Kousoulis and colleagues published a review of existing evidence of the mental health impact from past epidemics and pandemics. They emphasise that the many mental health issues likely to arise from this pandemic must not be ignored. They warn that isolation and social distancing may increase the likelihood of alcohol and drug misuse and online gambling. They predict “a higher concentration of social determinants” associated with self-harm and suicidal ideation; these determinants include stress, financial worries and relationship discord.

Ann John and colleagues have recently reviewed all studies with respect to suicide rates during the pandemic. Whilst many predictions of increased rates of suicide have been published, it turns out that in high income countries, the suicide rate is unchanged and might even have fallen.

A British law firm, Stewarts, who specialise in divorce, logged a 122% increase in enquiries between July and October, compared with the same period last year. A charity, Citizen’s Advice, reported a spike in online enquiries about how to end a relationship. In the US, a major legal contract-creation site, Legal Templates, recently announced a 34% rise in sales of its basic divorce agreement as compared with last year. Couples married in the previous five months are responsible for 20% of sales. 

There have been a number of articles predicting an increase of domestic abuse, mostly of women, during lockdown. Those already vulnerable to domestic abuse are, apparently, likely to suffer further because of living in isolation with their potential abuser. The data confirming these common sense warnings seem to have two sources. The first is a study in one hospital in Massachussets, USA that reported a doubling of radiologically confirmed domestic abuse cases as compared with previous years. The second is a massive surge in calls to Refuge, a dedicated UK charity helpline. There are multiple on-line references to a UN report of a 20% global increase in domestic abuse during the pandemic. I cannot find the source of this. To arrive at this figure reliably would involve a huge, complex and time consuming study. 

With respect to drinking habits, all data point to increased on-line and carry-out sales of alcohol during the lockdown. Obviously, because people are not going out, they are drinking more at home. I got nowhere in researching how this might eventually translate into heavier drinking or alcoholism. For me, it’s best summed up by a conversation with two friends during the lockdown. We recognised that the question “Shall we open a bottle of wine this evening?” had given way to “Which bottle of wine shall we open this evening?” 

All to say, whilst we battle this extraordinary global emergency, we can predict and should all be aware of its mental health implications. As yet, though, we have barely any quantifying data.

In January this year, Netflix streamed a series of documentaries entitles “Pandemic: How to Prevent an Outbreak.” Yes, in January! Wow! Now that we’ve finished the Queen’s Gambit and the Crown, we might watch Pandemic. It’ll be fascinating to see if they predict the need for lockdown and a risk of accompanying mental health issues. 

I hope all readers of these Chronicles are as healthy and happy as possible under the circumstances. Go well. Be wise.

The COVID Chronicles – 7

Geneva, 5 December, 2020

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Anti-lockdown protests in Melbourne, Australia in early November. Source: Noosanews

We all have a bit of the “don’t mess with me” mentality. We are intolerant of people in our space or causing us the slightest inconvenience. We get stroppy; some more than others. Political parties feed off “don’t mess with me;” some more than others. However, if it serves a greater good, we tolerate being messed with; some more than others. What has surprised me is how the pandemic has brought out the “don’t mss with me” in so many people who seem unable to comprehend that the greater good of an effective public health approach must engender collective measures. The lockdowns and other social distancing measures are seen as an attack by government on individual freedoms, a personal affront and, it follows, ineffective.

In the COVID Chronicles 6, I described the no-nonsense, calm approach of the Swiss to the main issue for all of us: that is, the big balance that weighs an effective public health response against the social and economic impact of lockdown and other social distancing measures. Quite a contrast to the political and “don’t mess with me” argy-bargy in the UK about how, where and when anti-COVID-19 measures should be imposed. If I could show that the first UK lockdown avoided two million COVID-19 cases with their inevitable burden on the health services and 70,000 deaths, would the on-going imposition of lockdown and / or other social distancing measures be more digestible and less contentious? Could we not work towards a cooler judgement of weather such measures are “worth it”? You may well wonder how I’ve arrived at these figures. With some trepidation…. here goes….!

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UK cases per day. Source: Johns Hopkins
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UK deaths. Source: Johns Hopkins

Above are the UK stats for COVID-19 cases and deaths per day according to Johns Hopkins (who collate each countries own reported stats.) To date, the UK has reported a total of 1,633,744 COVID-19 cases and 58,545 related deaths largely distributed between two peaks. Similarly, other western Europe countries, Australia and Canada show two peaks. Current declining cases and deaths are due to re-imposition of a variety of measures all of which curtail our lives to an extent.

Given the graphs for the global cases and deaths per day (see below,) it would be reasonable to assume that in the UK, without the first lockdown beginning in March, the epidemic curve for daily cases would have continued to rise through April and beyond. The curve for daily deaths would have risen but disproportionally less so for reasons that remain unclear. The same assumption could be made for other countries with two peaks.

In the UK, the first peak of cases per day is on 10 April and the second on 17 November. This gives a “inter-peak” period of 191 days. A line drawn between the first and second peaks of these curves would represent a minimum of cases and deaths without the first lockdown. If we assume that the below-the-line average for those 191 inter-peak days would have been around 1,200 cases per day and around 400 deaths per day, we arrive at 2,292,000 cases and 76,4000 deaths. Therefore, the minimum number of cases and deaths avoided in this 191 day period are given by the 2,292,000 cases and 76,4000 deaths minus the reported 1,303,000 cases  and 42,000 deaths respectively for the same period. This gives us 989,000 cases avoided and 34,400 deaths avoided. The same calculation can be made for any other country showing two peaks.

But, of course, epidemic stats follow curves and not straight lines. This means that the reality of what would have happened over the 191 day inter-peak period without lockdown would have been represented by a curve in the form of one bigger peak. We will never know the full height or width of this bigger peak. Nevertheless, the figure of the below-the-line cases and deaths avoided as calculated above must represent only a fraction of the cases and deaths that would have been. In reality, double this would be a good shot. Maybe we’re looking at two million cases and 70,000 deaths avoided by the first lockdown? So there!

Politely worded disagreements based on existing data and reasonable assumptions are welcome. 

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Global cases. Source: Johns Hopkins
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Global deaths. Source: Johns Hopkins

The COVID Chronicles could also chronicle the more bizarre opinions I’ve read about anti-COVID-19 measures. How about this one? In several locations in nearby France: “Slaves and their children are masked and vaccinated!”

The COVID Chronicles – 6

Geneva, 30 November, 2020

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There is quite a COVID-19 storm brewing on the other side of the planet. The 53-strong Pakistan cricket squad flew into Christchurch, New Zealand for a series of international matches. Whilst doing time in their isolation facility, six of the visitors have tested positive. They were caught on CCTV breaking distancing protocols by givin’ the tea bags heaps outside their own single rooms. They are being threatened with a return flight having not bowled a single ball. There is outrage on both sides. Former Pakistan fast bowler Shoaib Akhtar youtubed “I want to give a message to New Zealand cricket board that this is not a club team, it’s Pakistan national cricket team. We don’t need you. You are talking about Pakistan – the greatest country on the planet – so behave yourself…. Be careful next time.” Well, that’s telling ‘em! New Zealand has shone bright throughout the COVID-19 pandemic by being one of the few countries to have controlled transmission of the virus. Since mid-May, they have had only a scattering of cases exclusively among isolated international arrivals. So I am totally baffled as to why – just in the name of sport – this number of people are permitted to enter NZ from a country with patchy public health infrastructure that is reporting nearly four thousand cases per day and rising. Yes, indeed! Be careful next time!

The international news is currently dominated by COVID-19 vaccines and pre-christmas relaxation of social distancing measures. The debate about the origin of the virus in Wuhan, China seems to be on a back burner. It (the debate) will come back at some stage.

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COVID-19 cases per day: Italy. Source: Johns Hopkins

Italy was the first European country to be hit hard by the pandemic. As lawyers place the best understanding of facts in the context of law, so science places new findings in the context of the best understanding of facts. Enter a study that drew brief attention in April but is now published for review. Giovanni Apalone and colleagues have reported that people in northern Italy were exposed to the virus responsible for COVID-19 as early as September 2019. More than a little surprising! If true, emergence of the virus in Italy predates the presumed beginning of the Wuhan outbreak by at least two months. These findings do not fit easily into “the context of the best understanding of facts.” Can this really be correct? Can this be explained by laboratory error or – somehow unlikely – are we looking at fabrication of facts? The scientific community seems to be doing the stunned mullet on this one. As I said in the Lockdown Diary on 12 April, getting to the bottom of the origins of the virus in and its spread outside China will require a neutral stance, a ton of diplomacy, the best of science, the coolest of heads and time. In all things COVID-19 – related, there’s a message here for trigger-happy journalists, political opportunists, social media cheap-shots, conspiracy theorists, antivaxers and Dunning-Kruger positives. Good science takes time and the truth will out in good time.

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Living in Switzerland can lack excitement. Everyone here just gets on with things in a democratic no-fuss way. For the expat, the Swiss respect for law and order brings advantages beyond living in a clean, safe and exceptionally beautiful country. The weekend before this second lockdown, my wife and I rented a campervan and spent an autumnal rainy weekend near the charming town of Interlaken. When the clouds cleared, the Alps towered above us. The lakeside camp site was immaculate.

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It was also very, very quiet. No wonder given the site’s rules that constitute local by-law. I just love it… especially indeed the prohibition whatsoever of any particularly annoying games and the like!

So, despite clocking up some of the worst COVID-19 stats per capita in Europe, the Swiss have dealt with the pandemic in their own way. The first lockdown was accepted. To my knowledge, there was little disagreement; we saw no anti-lockdown demonstrations. With the current resurgence, the national authorities have decided that a second lockdown must be avoided. They have imposed a rule on the number of people who can meet socially, made masks mandatory in any enclosed public space and appealed to the weight of citizens own responsibility. This approach seems to be respected and, looking at the stats, effective. The feeling is that, yes, worrying and inconvenient as it all is, we are in safe hands.

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And here are the safe hands. The ultimate decision-making body in Switzerland is the elected seven-member Federal Council. (Note: they are hardly household names.) Each member is responsible for one ministry and decisions are usually arrived at by consensus. The Council’s Presidency rotates on a yearly basis. That’s right, there is no Head of State in the usual sense. It’s not a political system that naturally selects the alpha male personality and to cite the late Ruth Bader Ginsberg, “Wherever decisions are made, there has to be women.” I have the utmost respect for this system. It means that the Swiss response to the COVID-19 pandemic has not become mired by party politics or yobbobabbled into wibblewobbleland by one clueless male leader as we’ve seen elsewhere (well… in the US.)

The sudden spike in cases here in Geneva four weeks ago meant “non-essential” businesses in town have closed temporarily; a measure permitted by the Federal Council. Whilst those affected are obviously unhappy, they accept this has to be done. A local feature in this week’s Tribune de Geneve is that a rugby team (I didn’t know they had one!) is helping out by doing the shopping for the elderly.

The other day, I heard about a Swiss couple who had concerns about their apparently normal and happy five year-old boy because he had never uttered a word. They took the boy to a paediatrician who, after a battery of sophisticated tests, asked him directly why he had never spoken. “Because,” replied the boy “Until now, everything has been perfectly satisfactory!”

The COVID Chronicles – 5

Geneva, 23 November, 2020

In 1797, an English physician named Edward Jenner reflected on the widespread observation that milkmaids were generally immune to smallpox. He undertook an inoculation or “variolation” (later to be termed  “vaccination”) from a cowpox pustule on a milkmaid’s hand into the arm of a young boy called Phipps (the son of Jenner’s gardener.) This prevented Phipps from contracting smallpox later when Jenner exposed him on multiple occasions to the much-feared disease. The experiment proved successful in a further 23 cases. And all this with no understanding of microbes! Jenner sent a paper to the Royal Society that was never published. But word was out. 

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James Gillray’s 1802 caricature of Jenner administering his cow pox vaccine also depicting the rumours that anyone so vaccinated would develop cow-like features. Copyright: Getty images

The practice spread rapidly around the world despite criticism that included sanitary, religious, scientific, and political objections. By 1802, an active Anti-vaccine Society stoked fears – rational and irrational – about the smallpox vaccination. The UK government would later pass the Vaccination Act of 1853 making compulsory the vaccination of children aged less than three months; this spawned the Anti Compulsory Vaccination League. Serious outbreaks of smallpox in the USA toward the end of the 19th century were tackled by vaccination campaigns that were in turn opposed by activists. The Anti-Vaccination Society of America was founded in 1879. Needless to say, a global coordinated vaccination campaign eventually allowed the World Health Organisation to declare the eradication of smallpox in 1980. 

The Financial Times reported last week that on the day that Pfizer and BioNTech announced the development of a vaccine that effectively protects against COVID-19, shares in Pfizer rose by 7% and Pfizer’s Chief Executive, Albert Bourla, sold US$5.6 million of his own stock. In trying to understand whether this was legal, whether this indicated Mr Bourla’s lack of faith in the product or whether he was expecting imminent emergence of competition – that would then drop the value of Pfizer’s shares – I found myself sliding down a rabbit hole into the kaleido-warren of high finance.

It’s obvious where I’m going with this. In the months to come, the world news in relation to the COVID-19 pandemic will be dominated by the development, production, distribution, administration and effect of the vaccine and opposition to it. This media hot topic will inevitably coincide with and be linked to an ever-increasing number of COVID-19 cases in the USA and how the outcome of the extraordinary election there plays out.

The bases of reservations about or total opposition to COVID-19 vaccines are many and varied. The vaccine is not safe. The vaccine is not needed. The vaccine is not effective. The whole exercise is too expensive. You can’t trust doctors and scientists. Vaccination is one big scam run by pharmaceutical companies. Vaccination should not be compulsory. Governments can’t be trusted. The WHO is corrupt. Vaccination is not natural. Vaccination runs against God’s order. Vaccination is the means for governments to insert microchips into our bodies. There are others more competent than me WHO have ready answers to all the above. 

The voices of those against the vaccine will become all the more powerful via blogs, on-line news and social media. Disinformation and conspiracy theories spread and can take on a life of their own and so become credible. Here we arrive at what I want to say in this blog. Be very careful with respect to what you read, hear and believe about COVID-19 vaccines. Knowing about the Dunning-Kruger effect may help you.

We all like to read stuff that resonates with what we already believe but most of us have the capacity to put our own beliefs into question when presented with reasonable counter-arguments. The Dunning-Kruger effect is when people with low ability tend overestimate their ability. Thus, some people may believe they are superior because they are unable to recognise their lack of ability. Dunning summed it up as “If you’re incompetent, you can’t know you’re incompetent … The skills you need to produce a right answer are exactly the skills you need to recognize what a right answer is.” It follows that intelligent people have the ability to question whether they have the right answer. Those who do NOT ask themselves whether they have the right answer are susceptible to having their self-overestimation reinforced by interacting with others who also have not asked themselves whether they have the right answer. Think extremist politics, devotion to ultra-religious creeds, biker gangs etc. (If you’ve read this far you are probably not subject to the Dunning-Kruger effect!) It goes without saying that the internet in all its forms unleashes one great accelerator of the Dunning-Kruger effect. In relation to the subject at hand, it potentially allows equal voice to the leading public health scientists of the day and Elvis-says-NO-to-vaccines. This is just one example of what Barack Obama recently referred to as “truth decay.”

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Donald Trump blasted his way into the MMR vaccine / autism debate. On 4 September 2014, he tweeted “So many people who have children with autism have thanked me – amazing response. They know far better than fudged up reports!” Just before the 2016 US election, I flew to my hometown, Norwich, in the UK. I jumped into a taxi. The driver seemed like a nice guy. We got talking. It was soon apparent that he admired Mr Trump. The soon-to-be-President Elect’s intelligence was, apparently, evident by what he had to say about vaccines. I nodded. The subject turned to Brexit. Unsurprisingly, my driver was all for it. Fair enough. Just before we got to my destination, he said, “I see it like this… Britain ruled the world before we were part of the European Union. Britain won’t rule the world again until we leave the European Union!” I paid my fare and got out of the taxi. I stood by the roadside, stunned. How, I asked myself, do people come up with ideas like that and feel comfortable voicing them to strangers? I know now: the Dunning-Kruger effect.