According to an analysis published in the Lancet, approximately 95% of the Wuhan population remained uninfected by the virus at the end of January, after the peak of their crisis, as a result of aggressive countermeasures. These data on their own indicate that herd immunity is not an inevitable outcome, nor is the possibility that up to 80% of the UK population will be infected within the next year, as was claimed by Professor Chris Whitty.
A common rebuttal to social distancing strategies is that the policies to implement them may backfire. For example, on Thursday’s BBC Newsnight, one of the Government’s advisors claimed that shutting down schools or cancelling football matches would simply lead people to gather in other ways — such as by children infecting their parents and grandparents as they return home, or by spectators gathering to watch matches at the pub, respectively.
It is difficult to imagine a scenario in which a child would sustain more contacts while returning to and staying with their family, than if they encountered additional hundreds of children at school every day, or to imagine a scenario whereby spectators would gather in pubs and homes at an equivalent level and density as if a football match was cancelled.
Fortunately, there is substantial literature on this topic from across the world, which the government should have looked towards. It includes historical successes in pandemic control and current countermeasures across the world, such as by South Korea, Hong Kong, and Singapore. Given the way case statistics in the UK are progressing, it will increasingly include recent measures taken in Italy.
Nicholas Christakis, a professor at Yale University who specialises in research on social networks and contagion, calls school closures “one of the most beneficial ‘non-pharmaceutical interventions’ that can be employed, more effective even than reactive quarantines or banning of public gatherings,” in part because “parents also stay home as a result”. He cites evidence from six studies based on data from Japan, Italy, China, the UK and the US which converge on the conclusion that school closures, especially early ones, reduce the total number of cases and delay the peak of epidemics.
Confusingly, the Government also appeared to admit that social distancing policies would be effective, according to their own models, despite not recommending them. They stated that school closures for at least 13 weeks would reduce the peak of COVID-19 by 10-15%, that self-isolation would reduce it by up to 20%, and that restricting mass gatherings would reduce it by 5%.
To be clear, in any field of research, these would be considered massive effects individually, and if they are insufficient on their own, it was unclear why the government had not considered implementing them all together — as many other European countries had already done – aside from increasing the strain on healthcare workers with children.
In addition, the government initially claimed that the population would encounter “fatigue” if countermeasures are implemented early, and would get tired of self-quarantining, and that “nudges” to encourage people to wash their hands more frequently were sufficient. At the time this piece was published, over 500 behavioural scientists had signed an open letter urging the government to publish their evidence for this claim, stating that they are “not convinced that enough is known about ‘behavioural fatigue’ or to what extent these insights apply to the current exceptional circumstances.”
The evidence that emerged was surprising. On Friday, one of the government’s advisors explained that the idea of social fatigue, which was used as a rationale to delay quarantine, was based on a literature review of the psychological impacts of quarantine.
But crucially, the literature review made no mention or recommendations of how early quarantines should be implemented. It also stated explicitly that only a few of the papers it included directly compared quarantined versus unquarantined patients, which makes it difficult to establish whether quarantine would cause more panic and social fatigue in an epidemic than the absence of quarantine.
The other paper cited as “influential” in the government’s strategy was in fact a working paper that was published a single day before the government’s delays to quarantines were announced. As with the previous paper, it made no recommendations as to when quarantines should be implemented.
There may be real and substantial psychological, medical and economic side effects of quarantine measures, and of a pandemic more generally, regardless of whether individuals are quarantined or not. But given the exponential nature of the disease’s spread, these effects should be mitigated alongside countermeasures, not traded off for them. If the government believed that individuals would feel fatigued by taking self-isolation procedures and social distancing measures, they should have provided top-down assistance and coordination to alleviate this.
And if these papers represent the basis for the government’s strategy to delay quarantine, they should be seriously questioned. Substantial social distancing measures are recommended by WHO and the CDC to be implemented as soon as possible if there is evidence for local community transmission of COVID-19.
The government’s unsubstantiated claims did not end there, however, as the question remains of whether acquired “herd immunity” from infection was feasible or even desirable. Some further background may help to judge the justification for those claims.
Vaccination (the prototypical source of herd immunity) reduces the number of people who are susceptible to a pathogen, which reduces its effective reproduction number. The R0 value can also be used to estimate the proportion of the population that would have to be immunised to prevent further spread of the virus. In general, this proportion is estimated using the formula: 1 – 1/R0. Immunised in this sense refers to being unsusceptible to infection, which can result from acquired immunity (which may develop from a previous infection by a pathogen) or by active immunity (which may develop from a vaccine).
Using this as a guide, the government suggested that its strategy was to allow the virus to spread until “herd immunity” was achieved by the population getting infected, rather than by vaccination. David Halpern, an adviser to the government, indicated that vulnerable groups will be “cocooned” until the population has “acquired immunity” to the virus (comments that were reflected by the Chief Scientific Officer) and the spread of the virus would supposedly be slowed down to reduce the strain on hospitals, as part of a long-term strategy that predicts the epidemic will substantially return several months from now, during the winter.
What does this entail, practically? Using an R0 estimate of 2.5 and the formula mentioned above, the government has said that this means at least 60% of the population would have to be infected and acquire immunity to the virus. That was an estimated 40 million individuals that government advisors claimed would “inevitably” be required to succumb to the virus, in order to protect the remaining vulnerable groups.
This was perhaps the most egregious claim made by the Government, and it is important to understand the many reasons why.
One reason is our understanding of the grave severity of the disease: statistics from WHO indicate that the global case fatality rate (CFR) is approximately 3.8%, meaning that 3.8% of globally confirmed cases eventually died from the disease. This rate varies by age group: 0.2% between the ages of 20-39, 0.4% between the ages of 40-49, and 1.3% between the ages of 50-59. The rate increases rapidly with age, reaching 14.8% above the age of 80.
The fatality rates for young to middle-aged cases may sound low at first, but they are over a hundred times greater than those of influenza, and the CFR alone may obscure the seriousness of the illness in the patients who survive. Patient data from China indicates that apart from the 2.3% of cases in China who died, 5% of cases were critical (meaning that they suffered from “respiratory failure, septic shock, and/or multiple organ dysfunction or failure”), 14% of cases were severe (meaning that they suffered from “shortness of breath, respiratory frequency ≥ 30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300,30 and/or lung infiltrates >50% within 24–48 hours.”) and 81% of cases were mild.
What does “mild” mean here, exactly? As a WHO expert explained, it includes anything short of requiring supplemental oxygen: ranging from asymptomatic cases to fever and coughing to mild pneumonia – that is, the definition of a “mild” case of COVID-19 is not equivalent to that of a mild cold. And if you thought that was all, it isn’t: case report data shows that some patients who fully recover from the disease still exhibit weakened lung capacity and organ damage.
Part of the Government’s strategy was to “flatten the curve” of new cases to reduce the strain on the NHS, and relied on an assumption that just 5% of symptomatic cases will require hospitalisation. Given the numbers above and the initial lack of aggressive social distancing measures to achieve such a “flattening,” it was unclear how that figure could be possible. Instead of increasing the amount of testing, the government said that they would restrict testing to serious cases and would turn away mild cases from hospitals for self-quarantining even if they have tested positive for the virus.
Perhaps most surprisingly, until yesterday the policy was that confirmed cases were required to self-quarantine at home, but household members of these confirmed cases (such as their spouses and flatmates) were still not required to quarantine themselves in hospitals or even at home, despite being at risk of acquiring the virus from their cohabitants and subsequently spreading it to others in society. In addition, government advice was to self-quarantine for 7 days if relevant symptoms arise, even though research shows that individuals are infectious for between 2-14 days and recommends 14 days as the length of quarantine. That, as well, was changed yesterday.
Four epidemiologists from Harvard and Boston University’s schools of public health modelled the number of ICU beds that would be required by the population during the peak of the crisis, assuming the government’s strategy is achieved.
Even while these researchers use highly generous assumptions to the government’s plan (e.g. if full cocooning is achieved), at the peak of the crisis, twice as many ICU beds would be required than are available in the NHS, even if the proportion of detected cases was only 8%, and even if we only considered 20-40 year olds. In total, the degree of failure is expected to be far greater than this, considering individuals of all ages.
The epidemiologists title their paper: “The direction of the UK Government strategy on the COVID-19 pandemic must change immediately to prevent catastrophe.” In an article published in the Observer on Sunday, one of the authors of the same paper, Harvard epidemiologist William Hanage, states plainly that he “assumed that reports of the UK policy were satire” and explains his alarm to the government’s strategy in much greater detail. Note that the report from the response team at Imperial predicted much of the same.
Meanwhile, reports had arisen on the weekend that hospitals were already being overwhelmed by the crisis, that the virus was spreading far quicker than the government’s models predicted, and that Boris Johnson was already considering an acceleration in aggressive measures.
The media coverage regarding “flattening the curve” (delaying its peak) may be misleading. Hospitals would quickly be overwhelmed by severe cases, which would spiral exponentially out of control, to say nothing of the damage that would have been unleashed when patients with unrelated chronic diseases who require ICU beds and hospital care were displaced by the coronavirus crisis.
As Timothy Gowers, a Royal Society Research Professor, explains: “flattening the peak to the point where the health service can cope is approximately as hard as trying to stop the spread altogether.” The evidence and guidance from WHO is clear – soft measures to flatten the curve and delay its peak are not a viable long-term strategy, containment must be the goal: “Not testing alone. Not contact tracing alone. Not quarantine alone. Not social distancing alone. Do it all.”
One question you may be wondering about at this point is how the Government’s models diverged from the estimates made by epidemiologists and reality so quickly.
Part of the reason may be that these (as-of-yet unpublished) models were rumoured to be built on assumptions from influenza pandemics: that a second peak would arise due to its seasonal nature and that the population would experience social fatigue from the countermeasures. This, as well, was indicated by reports yesterday.
There are many differences between influenza viruses and coronaviruses that are relevant here. One is that the case fatality rate of COVID-19 is over a hundred and fifty times higher than influenza fatalities in a typical year, as mentioned previously. Another is that the influenza virus mutates rapidly, which is why WHO recommends three vaccine formulations that are produced every year, each containing vaccines for 3-4 strains. In comparison, COVID-19 and coronaviruses in general mutate relatively slowly, explains Trevor Bedford, scientist-developer of the platform Nextstrain, which has tracked mutations in the virus since the first genomes were published.
Another difference is that the influenza virus exhibits clear evidence of seasonality, while evidence shows only a weak relationship for coronaviruses. An analysis by Harvard epidemiologists uses data from provinces across China and finds “a slight negative relationship” between temperature and the R0 of COVID-19. It concludes that “weather alone (i.e., increase of temperature and humidity as spring and summer months arrive in the North Hemisphere) will not necessarily lead to declines in case counts without the implementation of extensive public health interventions.”
Finally, there is a lack of evidence that lasting herd immunity to COVID-19 was possible in humans when acquired by infection, and that recovered cases would be prevented from reinfection. “Typically coronaviruses don’t make long-lasting antibody responses,” tweeted Brian Ferguson, an immunologist at Cambridge University, adding, “if this is a deliberate approach it’s not scientifically based and irresponsible.”
Research based on the previous SARS virus supports this conclusion: the quantity of SARS-specific antibodies declines substantially after around 6 months of infection, until it is undetectable 2-3 years after disease onset. Several additional things must be considered: we don’t know how similar the antibody responses to this virus will be compared to the SARS virus; there is scant research on whether these antibody responses will prevent re-infection in practice; we simply don’t know how the immune system would respond to a reinfection.
The initial report used by the Imperial team assumed lifetime immunity to re-infection, and deviations from the assumption would mean that an even greater proportion of the population would need to be infected than their strategy assumed (which was already 60%).
The Government’s chief medical advisor claimed that part of the reason he believed cases in China had declined was because 20% of the Wuhan population had been infected by the virus and had acquired herd immunity and because a large proportion of cases were asymptomatic.
But as mentioned previously, evidence from researchers at the London School of Hygiene & Tropical Medicine estimated that 94.8% of the Wuhan population were still susceptible to infection at the end of January (i.e. had not been infected by the virus) and that “there was evidence that the majority of cases were symptomatic.” Daniel Falush, a statistical geneticist at the University of Bath, tweeted that these claims were contradictory, adding that “unfortunately, tragically, this error is driving UK policy right now.”
Much of the damage could have been avoided if aggressive countermeasures had been taken earlier: the longer the inaction, the greater the spread of the virus and the greater the response required. Given the evidence outlined above, it is perplexing why the government preferred softer and delayed measures, which would have continued to exponentially increase the number of cases, compared to aggressive and immediate ones that would force the new number of cases down.
Aggressive measures would buy time to acquire and scale up diagnostic tests from other countries that could be rolled out more widely, time to continue identifying existing antivirals that may be effective against the virus,” against the virus, and time to test vaccines.
The evidence was not conflicted, it was clear: the Government’s strategy of delaying the peak and inducing herd immunity was unscientific, unfeasible and dangerous. It is hugely unfortunate that the Government delayed aggressive social distancing measures, which will have already caused avoidable deaths and suffering, but it is encouraging that they quickly reconsidered many of their initial plans — for the damage must be mitigated swiftly. Countries around the world considering the British strategy should seriously reconsider. Containment is possible. Containment is necessary. Containment must be the goal.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeYes, if the Chinese had have taken appropriate measures when the disease appeared in Wuhan, they could have stamped it out at source.
But instead they elected to cover it up for 3 months so as not to make the communist party look bad.
But lets not criticise them, right?
While your comment isn’t incorrect, I have to vehemently disagree. I’ll give you an apology. Suppose your neighbour had a fire smoldering in their basement and did nothing to put it out until it reached their kitchen…at which point it spread to your house. You now have two choices: You can choose to let your own house burn to the ground, or fight like Hell to save your house and everyone in it.
Just so, other governments have had plenty of warning and are making decisions between allowing a minimum of 2 percent of their population to die or to minimize the spread of the virus by reducing their R0 to less than 1. Countries like the UK following the theory of herd immunity suggest that draconian measures can’t be taken, that it’s just easier to only minimize the strain on the health care system. I think that underestimates the social and psychological effects on the populace of having so many die in such a short time, not to mention the prolonged economic effects of such policies.
When it comes down to it, we all need to determine which side we stand on. You can either put out the fire or give up. For me, it’s a simple decision because there are many problems in the current world order that aren’t worth protecting…some of which led to the globalization of this virus. I would rather fight and establish a better world order that protects people in their own countries.
Rose, your analogy is unsound, but in the case of Covid-19 I totally agree we should fight like Hell. Our “experts” disagree unfortunately.
Yes, and likewise if the UK Government had taken appropriate measures at the start, instead of experimenting with dangerous untested theories, we might have reduced the spread. Now it may be too late.
(Moderators are not allowing me to comment – I’m not ‘on board’ with the blind faith brigade. So only ‘reply’ works to post at all now. So apologies.)
All forums are now moderating strictly, and consequently all hope of introducing any narrative into the debate that is not officially sanctioned and approved is nil. You know how bad things really are when the obvious increasing suspicion, as this crisis drags on and on, that it’s really all up with us is an unwelcome intuition that must be suppressed in order that what amount to panic measures continue to go unchallenged, maintaining the pious hope that, against all the odds, we will still squeak through. You can’t blame them of course; we’ve got nothing else left but our secular faith in medicine and the police. God help us.
So there are still as many opinions as experts. Perhaps because we don’t yet have enough data to draw reliable testable conclusions or the situation is too complex to be subject to sound test methods. Regardless of this its not helpful to say “the government will have already caused avoidable deaths”. This detracts from the more sensible parts of this piece. Would the author like to tell the CPS which of the 53 deaths so far attributed to Covid-19 they think were caused by the Government?
What is very noticeable so far is how vested interests dictate the so called “scientific” response. The anti business lobby want to shut down everything and set the controls for the 13th century. Businesses from restaurants to airlines want to avoid bankruptcy. Macron wants you to go to work but not the pub. Spain has closed schools but you can still go to mass. Unfortunately its the nature of disease to evolve and it may be the case that sometimes the diseases evolve faster than the cures. Politicising this just makes the situation worse and todays blame chuckers may find themselves on the receiving end in due course.
exactly what I would like to have said 🙂
End of the day the government have the country’s top scientists on board and a world of (admittedly little at this stage) public and confidential information along with meticulous modelling and research to work with. With the greatest of respect how can the author of this article (who I note is a student) possibly have a better handle on this issue than them? …Really?….Come on now…
Or possibly two of our top scientists have a better handle on it than most of the World’s top scientists?
The modelling is meticulous I’m sure, but I doubt if the inputs are.
‘It may be the case that sometimes the diseases evolve faster than the cures’
Of course everyone is in good faith desperately trying to propitiate this unpredictable and sinister new plague with all means at our disposal. But there are no guarantees that any response or any combination of responses will save us; nor can there be – it is an entirely new and very nasty viral challenge. So we can only hope, or pray, indeed, since only good luck, or the Grace of God if one prefers, stands between humanity on this afflicted globe and the very real possibility that civilisation itself may rapidly be overturned by a random vagary of nature we may – quite realistically – ultimately fail to resist or overcome.
We are being forcibly reminded just how dangerous and indifferent to our human welfare the Earth really is. It seems alarmingly possible that, whatever we try to do now, our beautiful illusion of human imperviousness to the nightmare that life has been for most living things for most of Earth’s history has been shattered for ever. This sense of immunity from the world’s lurking horrors seems like a lovely dream from which we have been rudely awakened. Nature from now on will never be our embracing Mother again, but is revealed in her true guise as a shrieking hellcat whose insane vagaries we cannot escape.
The passing bell is tolling for humanity. Weep, children of man, for your joy is gone forever.
I am not a scientist or biologist or a trained mathematician but over 4 weeks ago I created a simple excel model of the virus based on the somewhat dubious Chinese data and then updated with SKorea, HK & Singapore data. Basically a child’s spreadsheet that anyone with half a brain could understand and it chilled me to the bone. I tried to talk about it on social media and elsewhere but was branded a fear mongering idiot. In this instance I truly hate to be vindicated……
Very good piece, Saloni. I am an economist and Visiting Prof in computer science at UCL btw.
I rarely post comments, but your piece, quite correctly, doesnt pull any punches
I was in despair about the UK’s strategy, now it is only half-despair!
I remain astonished that so much weight was given to the views of the “Nudge Unit”
Sorry, but this is an appalling article. I’d have been here a bit earlier but was delayed by the search for evidence of Saloni’s “dramatically slowing down“ of new cases in Italy.
The actual figures:
March 2nd 335
March 16th 3233
Though the March 16th figure is lower than 3590 on March 15th (over 3.5k to-day).
The ‘expert’ team who produced the recent report have been reporting to the advisory team from the start. Neil Ferguson (Imperial) is a member of SAGE which is the government’s Scientific Advisory team.
Chris Whitty’s 80% figure is an absolutely worst case scenario figure. I have a crude S-I-R model on a spreadsheet and get close to this figure. It’s a pretty easy figure to pin down. Planning often involves starting with the worst case figure and then working to bring it down. That’s basically what was being done.
I don’t believe full “herd immunity” was ever a policy. If individuals implied it was they were mistaken. However a degree of “herd immunity” is a consequence of an epidemic. Remember this could go on for 12 months. We may have to put tight controls on the spread between December and March because of other pressures on the NHS. With no vaccine, it would be helpful if we had pockets of herd immunity around the country by the end of the year.
Finally, Saloni fails to understand that the figures cannot be used to infer anything very much at this stage. Countries are using different criteria and methods to record cases. Actually the Diamond Princess probably gives the best ball park figures as things stand.
Saloni writes “that 94.8% of the Wuhan population were still susceptible to infection at the end of January (i.e. had not been infected by the virus)“. This would suggest that 5% were infected. In a city of 11 million people ““ that’s over 500k that were infected. The official number of cases for the whole of China is around 80k.
The rest of the article appears to be a regurgitation of tabloid headlines. Poor.
If one starts with the age break down for preponderance to hospitalisation, intensive care and fatality for infected individuals in the report from Imperial, which I believe informed the government’s position (p5, https://www.imperial.ac.uk/…, it’s pretty clear that the critical issue is to prevent the elderly from catching the virus and to accelerate the younger cohorts through to herd immunity as quickly as possible. If it’s the case that the nhs can quadruple its number of ICU beds, as reported, then, even if only the extra ones are used for covid 19, there’s a peak capacity of 12k beds.
Using the ICU bed rates for 30-39, and 40-49 and 50-59, scaled by the sizes of these cohorts, the total required beds is only 19,996 ; 48,609 and 144,540 respectively. Clearly, it would take a few months to complete the 50-59 group, but by that time, 78% of the population would be covered and we’d be approaching herd immunity without excessive deaths flattening the nhs or hitting the headlines.
Maybe a QALYs based approach would be more appropriate, though.
It’s a sobering article, but leaves me with a big question.
Does Ms Dattani, PhD student, know more than Prof Chris Whitty?
Why isn’t she the Chief Medical Officer?
Perhaps Chris Whitty isn’t as much of an expert on this subject as he is supposed to be if a PhD student can so convincingly debunk his recommended strategy.
Given that this article by PhD student in psychiatric genetics is riddled with falsehoods and misunderstanding, I think Prof Whitty’s status is safe.
It was never the government strategy to induce herd immunity. The strategy has always been to delay the spread of the virus.
Given that this premise of the article is wrong, the rest of it is as worthless as the daily bloviating of Piers Morgan.
The government’s strategy was to allow herd immunity:
Patrick Vallance: “Our aim is to try and reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it. Those are the key things we need to do.”
https://www.theguardian.com…
So far that’s one error by you and none by the PhD student so far.
No it wasn’t strategy to go for FULL herd immunity. “Some kind of herd immunity” is not a final objective.The strategy was to use the quiet (for the NHS) summer months to manage a steady flow of patients while allowing the rest of the country to carry on more or less as normal. They could then slam on the brakes as winter approached. A consequence of this policy would be that some herd immunity would have developed which could have helped with research as well as further pandemic management.
This might have worked if the virus had behaved itself and spread in a uniform way across the country but we now have a situation in which London hospitals are starting to buckle while our local Trust is taking care of the 3 patients who were admitted a week or so back.
“This might have worked if the virus had behaved itself and spread in a uniform” .
Well nobody could have predicted that could they? How dare the virus not behave itself!
‘FULL herd immunity’. There’s a phrase that wasn’t coined when this was first raised. ”Well minister, when we said herd immunity, we didn’t mean FULL herd immunity”. Please accept the Sir Humphrey Appleby award for weasle words in 2020. Partial herd immunity makes about as much sense as partial pregnancy.
Full herd immunity means just that. With CovId-19 it is estimated that FULL herd immunity would be achieved when 60% of the population are immune (plug a R0 value of 2.5 into Saloni’s formula above). This is where these numbers come from. That was never the policy.
However ‘partial’ herd immunity can be achieved which will act to slow transmission of the virus through the population. It ‘s not like Pregnancy so you’re not correct here.
Whitty has said essentially the same thing. The UK government is still experimenting with Herd Immunity, although they are bending to common sense (nt a factor in statistical analysis).
The government’s strategy is to try to achieve herd immunity. This has been clearly proven in documents obtained by Channel 4, as well as an interview with the Scottish Health Minister yesterday. They’re operating under the assumption that 80 percent of people will be infected. They see no reason to test unless a patient is in serious condition in hospital. They assume most people will have a mild case of the virus and should go back to work in a week.
Maybe, but if students know more than professors then where does a PM turn for his advice?
Quite. He could try the Far Eastern countries who have had the most comparable pandemic (Sars), whose approach has been radically from that advised in the UK, although our ‘experts’ are now advising many of the measures other countries have implemented.
My comments exactly – as posted above.
“All models are wrong, some models are useful”.
This article lapses into some really poor conclusions and adds to the general fear, which is a great shame.
To quote the Imperial College Paper: “Analyses of data from China as well as data from those returning on repatriation flights suggest that 40-50% of infections were not identified as cases This may include asymptomatic infections, mild disease and a level of under-ascertainment” So please don’t raise the scare levels on this one.
Also, the Imperial College paper has a breakdown on the hospitalisation rates and Critical Care rates by age range. These are much much lower than the Boston/Harvard estimates. (CC = 0.06% rather than 2.4%) Even so, the conclusion of the IC report agrees with the BU/Harvard report that it is Critical Care capacity that will be overwhelmed. However, this is not by the 20-40s, it is by the 70+ age range. At which point, we should do some QALY analysis because resources are always finite and the impact is enormous.
I contend that the BU/Harvard model is both wrong and highly misleading.
The IC report acknowledges that “We do not consider the ethical or economic implications …. here, except to note that there is no easy policy decision to be made. Suppression, while successful to date in China and South Korea, carries with it enormous social and economic costs which may themselves have significant impact on health and
well-being in the short and longer-term.”
This is a major gap of the IC report.
So aggressive countermeasures should have been taken earlier. How much earlier? Surely blind obeisance to the EU open borders shibboleth with its free movement of people needs investigation.
Thank you for the article that underlines the danger to us that our Government represents.
After weeks of boasting of our resilience the facts are now clear as to how badly the Government has let us down by a failure of containment policy,of ventilator and test component procurement and failed assessment of NHS capacity. This is not the result of a science led policy but political failure.
I cannot believe that the full responsibility for establishing the facts relating to how to deal with Coved 19 will have been left to one man. Surely a range of options with projected outcomes will have been considered for their medical,social and economic impacts so that a political decision was made.
This has been concealed by the labelling of the Government decisions as scientific and to compound the deceit this morning Laura K. advised us that the science had changed. Science does not change man’s understanding of science changes!
Some very interesting points. My feeling is that many if not most of the governments in Europe plus Canada and the US had agreed to try to achieve herd immunity. The messaging from the Canadian government is nearly verbatim what is being stated by the UK e.g. that they are following a “science based approach”. They have been talking as if they were taking action when they have actually done nothing. All attempts at containment have been made by provincial health authorities. The UK has just been more outspoken in their position. President Trump’s statements were confusing at best but clearly coming from the same position…”everybody is going to be immune”.
In the past week, Italian doctors have been speaking out, warning other countries that this virus is overwhelming their health care system. It has only been in the past few days that their government has seemed to agree that the virus has to be stopped. Even after Northern Italy was locked down, they were welcoming tourists.
It’s fairly easy to see which countries were not in on the scheme. Peru, for example, closed its borders yesterday and they have very few cases compared to Europe and North America.
An opinion piece posing as a researched argument of academic rigour . I am a refugee from the Spectator, for this very reason.
It has nothing to do with the author’s qualifications, she is simply reporting, not challenging the statisticians. However she could have quoted more contrary theories from countries that have taken an opposing approach, China, S.Korea, France.
And what UK Hard Data are the statisticians entering into their models? The only UK Data is for those hospitalised. What is the weighting for UK Data compared with Chinese Data?
I have only school statistical knowledge, but I know that models can be highly sensitive to input changes ie even a small change in input data can give a totally different output. What if they ran a model with less than 75 and over 75 inputs? The results would be quite different, if only because those 75+ will have a higher rate of underlying problems.
If there is anyone on this forum that knows how to run models, please do so and publish the results.
Well, here we are at the beginning of May and, yes, hindsight is 20/20. The article largely pinned it’s flag on the high death rate of 3.8%, which we now know was way over-estimated. Studies that involve testing for the antibodies have been carried out in other countries, including the U.S. are showing cv-19 is a lot more widespread than first thought – ie. people who had the virus but were either asymptomatic or just had mild symptoms. In the U.S., employers are also getting their employees tested and this is another great source of information. As a result of the higher numbers of people who have the antibodies, the death rate is of course lower. Some experts are saying as low as 0.03%. Let’s also remind ourselves that a large proportion of the ‘cv-19 >>associated<< deaths are not directly attributable to cv-19. In the UK for example, the over 85 age group accounts for only 2.4% of the population but over 33% of the reported CV-19 deaths – but we can assume that nearly all of those were people with one ore more comorbidities. It depends whether we want to believe the scary worst case headline numbers or the lower death count relating to deaths directly attributable to CV-19. In Italy, for example, one study found that only 1% of ‘cv-19 deaths’ were directly attributable to cv-19. Well, as I said, hindsight is 20/20 but it’s looking clear that the Government should have stuck to its guns and not enforced a draconian lockdown as Sweden has done. Sweden was getting a lot of hate for its policy from strange people in the UK but even the WHO is now saying they are ‘a model’ for how to manage the pandemic.
On a related but slightly separate subject you can see why Dattani is wigging out. I’ve just read online that Rishi Sunak is going to give £330 billion or £20 billion (depending on which national newspaper you read) to those affected by CV19. I think these are lies on top of more lies… i run a business that has 10 PAYE and 30 self employed workers in construction – we will not get a penny of these promised funds because they are false promises. Based on our cashflow forecast as of today we will be 40k in the red by 30th May.So after 26 years of profitable trading we have no choice but to close the company and lay off all staff. Boris campaigned on the motto “f*** business”. He could not have done a better job if he’d hired Corbyn or McDonnell as advisors.
That a PhD student (no offence) can poke so many holes in the strategy of supposed experts should make us questions on reliance on them. What was it Michael Gove said about experts?
But there are still gaps, most notably the matter of the seasonality of Covid19. The paper referenced as evidence that temperature may not be a factor has not been peer reviewed and itself has a disclaimer that it should not be used in the formulation of public policy. Reading the paper, it seems to draw a conclusion it can’t support as it cannot distinguish between the importance of weather and China’s lockdown policy in Wuhan/Hubei in preventing the spread of Covid19. As there is substantial agreement that Covid 19 is spread by either large respiratory droplets, and small particle droplet nuclei (aerosols) – like cold and flu viruses – a seasonality to infection rates should be expected. We’ll find out in the UK in about one month.
‘China’s lockdown policy in Wuhan/Hubei in preventing the spread of Covid19.’
But why would anyone believe in China’s remarkable success in containing the virus? They’re claiming no more onward transmission; only an imported case.
If you’re cynical enough to dismiss our CMO, you can’t just believe what Beijing tells you, Iliya.
I don’t believe anything the Chinese government says but I observe their actions, which are to re-open business. Through a lockdown only a communist dictatorship could put in place, they seemed to have controlled Covid 19 spread. Of course, only a communist dictatorship would have allowed the thing to spread in the first case by locking up those reporting early cases.
The whole thing is gaps – based on articles in the Guardian/Observer – not a trustworthy source – Twitter, and a misreporting of what the government strategy actually is.
I am not an expert but I can poke many holes in this article:
– effect of temperature on the spread of coronavirus – it’s only been around since November, so no-one knows, but it isn’t spreading in hot countries at the moment.
– mutation rates – also unknown – maybe it will mutate more once it is in the general population than in a few bats.
– death rates. We still don’t know the death rate because we do not have a good idea how many people are actually infected. What we do know:
– not a single child 0-9 has died of coronavirus.
– the estimate of death rates of the whole range 0-39 is 0.2% – higher than basic flu, but much much lower than spanish flu, smallpox, SARS, basically any previous major pandemic, and those did not lead to the complete shut down of the economy and education system.
– countries that have more widespread testing – so pick up more mild cases, show lower death rates.
You’re strawmanning the article eg. there is no definative statement on the relationship between temperature and virus spread, just a reporting of a research paper.
The change in government strategy over recent days validates the core argument in this article that UK advisors have under estimated the size of the threat.
Saloni’s piece is so misleading it should really be taken down.
Yup. Take it she was on that list of 229 scientists who wrote the open letter criticizing the government’s response:
“Many of the scientists are drawn from mathematics rather than medicine with very few specialists in infection control and no leading experts in the spread of disease.
Not all of the academics who have signed the letter are scientists and there are also a number of PHD students on the list of signatories.”
Maybe you would also like to silence the opinions of the W.H.O. and experts from other places who might just disagree with the Herd Immunity experiement.