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Anders Tegnell, the face of Sweden's response to Covid-19. Credit JONATHAN NACKSTRAND/AFP via Getty
The argument around UK Coronavirus policy looks like it’s over before it even got started. The “hawks” in the Conservative Party might have preferred a more rapid lifting of restrictions, but no-one serious on the Left or Right is contesting the principle of a cautious and phased approach to releasing the lockdown.
The new, ongoing serology study by the ONS and Oxford University — the first phase of which is released tomorrow — will settle the argument even more definitively. It is expected to show that under 10% of the UK population have had Covid-19: still a lot of people, but not enough to be confident about much of an immunity effect. Hopes of widespread symptomless infections and 50% infection rates will be dashed. Ongoing suppression is the plan — Ferguson 1, Giesecke 0.
Meanwhile all the political pressure on the Prime Minister is pushing him towards a slower and more cautious path towards lifting the lockdown. Even the superlatively tentative first steps he took on Sunday, wading through ifs and buts, were leapt on by the SNP and trade unions as proof of a reckless Tory Party pushing workers into the workplace before it was safe.
As for the voters, polls show that the British public has fully signed up to lockdown life. A survey released at the weekend showed that 73% of Brits think protecting lives should take precedence over the economy, compared to just 49% of Germans and 44% of Swedes. Polling since Sunday‘s announcement suggests that voters are split almost exactly evenly on whether or not even those tiny relaxations were too much, too soon. On that evidence, it looks like the Prime Minister went about as far as he could go.
And yet, despite all this, in time we may find ourselves tacking back to something closer to the Swedish model anyway. Here’s how.
First, public opinion will change, and despite their current popularity, attitudes to the restrictions will eventually sour. While 82% of voters say they could put up with lockdown-style measures until the beginning of June, that drops to 69% for the beginning of July and 44% for the beginning of August. Data from YouGov shows that support for individual lockdown measures has already been drifting down from its peak at the end of March.
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SubscribeThere are a number of key points to consider:
1. The lockdown does not stop Covid 19, as the article rightly says it only suppresses transmission. Lockdown is only effective as a policy if a vaccine can be developed, manufactured and injected into the population inside the lockdown period. If it can’t be done suppression becomes a sticking plaster and once it is lifted the spread will continue as before
2. The lockdown was originally intended to “flatten the curve” of infections. It appears to have moved well beyond that, suggesting that the policy is actually a long term policy to stop the spread.
3. Regardless of (2) above, lockdown cannot be a long term policy because the policy itself has a cost in human lives. People not going to the GP or A&E with serious illness, people not getting treatment for serious preexisting conditions, the mental health effects of lockdown (including suicide), the destruction of families both though abuse and financial hardship, etc. The policy choice is not between lockdown saving lives and releasing it costing lives. Lockdown costs lives and if it goes on for to long it will end up costing more lives than it will save. Every policy has a “cost/benefit”. It may be harsh but it exists and we need to understand one policy is not “good” and the other “bad”!
4. Just imagine the search for a vaccine fails. Considering that we have never developed a successful Coronavirus vaccine before that is a very likely outcome. That means we will have to accept this virus is here to stay and we need to find a way to live with it. That means developing antivirals to mitigate it’s effect along with other treatments for it’s side effects. These may take years to develop. Can we live in lockdown for 4 or 5 years, not letting our children go to school or see their friends and grandparents? What sort of generation will we be raising?
The problem we are in is the cost of lockdown is being ignored. We need a cold calculation because we run the risk of lockdown being worse than Covid 19 simply because we refuse the analysis for fear of the backlash Johnson has been subject to for trying to move us beyond the current policy.
Further to your second point above, this is a classic example of mission creep. This is why you must never ever tolerate such a brazen power grab by the authorities. Once they have it, they are loathe to give it back. The last of the “temporary” measures introduced during World War 2 were not lifted until 1964.
Or the emergency income tax introduced in as a temporary measure in 1799
Abolished in 1816. (on conclusion of the Napoleonic Wars).
Reintroduced by Sir Robert Peel in 1842.
Lowering/slowing infection rate has become a fetish to the point nobody is considering why. Why bother if infection is not an issue for 99% of the population who either will not get the disease or only in a mild form.
The number of those for whom the disease will be serious or fatal are not spread evenly throughout the population, many of them have had it, recovered, therefore immune or have been culled.
Nobody knows the infection rate anyway or how many are/have been. What is being noted is reported cases of disease, this is not the same as number of infections which will be higher.
Pandemic means everywhere. Trying to control one is like playing whack-a-mole with invisible moles.
Absolutely correct.
“73% of Brits think protecting lives should take precedence over the economy”. If only the equation were that simple. The health of a nation is closely related to the wealth of the nation, and the wealth of the UK is heading south at a rate of knots. I suspect the 73% figure may change rapidly when the sun stops shinning, the furlough money starts drying up and insolvencies rise. At the moment it is a bit like an extended holiday for some but, when the credit cards are all maxed out, the reality of paying for that holiday will hit home.
I completely agree – but it is the phrasing of the equation as such, by the government and the media that is causing such panic and anxiety at the mere suggestion of lifting the lockdown. My local FB page is full of comments from people refusing to send their children back to school – who are disgusted at the government for – in their eyes – putting profit before lives.
We need to be more honest about the cost of the lockdown – how many lives have been lost to the Lockdown (not Covid) so far? 18,000 extra cancer deaths as been suggested: What percentage of those will be children and young people – disproportionately more than would be affected by Covid, I would imagine. Is that acceptable? Everyone is loathe to ‘put a price’ on a life or to put one life higher than another, but as anyone who has worked in the health service knows resources are not limited and choices need to be made. These need to be informed choices.
Well that 73% can be the first to lose their jobs as far as I’m concerned. As part of the 27% (assuming the poll is even correct), I wish we had followed the Swedish model from the start.
The Swedish model will work for Sweden because it was better prepared & it’s health service is unlikely to be overwhelmed. It is suffering a relatively high number of deaths now but that is likely to even out in coming months and, given that a vaccine is likely to be some way off, Sweden will probably be in a stronger position than most countries who locked down.
The Swedish death rate I would argue is not relatively high per capita (the sprint) and I agree that the marathon will be won be Sweden, hands down. They do have a soft lockdown of the elderly, which allowed its health service to cope.
Hear, hear. This Chinese Death ‘Flu’ disproportionately slaughters the old and, to use the vernacular the
“Knackered “.
That the financial of the future of the Nation could be sacrificed on such flimsy grounds is truly pathetic.
Ancient Rome took centuries to decline due to decadence. We have managed it in sixty years. Bravo!
Vae victis.
The problem is summarised by the fact that UK opinion polls always present a choice between saving lives and saving the economy. The idea of saving lives by saving the economy has been edited out.
I am not sure Ferguson has really taken an early 1-0 lead over Giesecke if the match is one of epidemiological analysis and data interpretation, as distinct from political and practical responses by governments. So far, international studies seem to be pointing to case fatality rates closer to those estimated by Giesecke than those assumed by Ferguson. We should not exclude the possible conclusion that Ferguson’s analysis is more appropriate for the UK and Giesecke’s is better for Sweden – one size may not fit all societies and economies. As you suggest, we are still in the first half and the match could go to penalties.
I think you are on the money here Freddie. Once people realise that we have an exit gamble (vaccine) not a strategy and that the time horizons are distant the people will look for more pragmatism. I favour “Shield”, “Distance”, “Live” as the nomenclature for the 3 lanes concept. Everyone to be given a risk grade by their GP of 1-9. 3 low Risk groups to “Live”, 3 medium risk groups to “Distance”, 3 high Risk groups to “Shield”. Total economy re-opens and people participate according to their risk grouping. The aim is to get community immunity concentrated in the low risk groups within 4 months. Maximise R0 in the low risk group, suppress it in the Medium risk group and minimise it in the high risk group.
That’s very good.
It may be that you can pay the Grim Reaper now or pay him later. As the lockdown is not perpetually sustainable it will have to be ended, with the resulting deaths, sooner or later, in subsequent infectious flare-ups. Different models suggest that herd immunity may be reached at levels far below Ferguson’s estimates: https://judithcurry.com/202…. and
http://www.rationaloptimist…
Postponing deaths from Covid-19 based on Ferguson’s criticized models, while accelerating a growing number of deaths from other causes (cancer surgery postponed, etc.) is also unsustainable. Only time will tell, say a year from now, whether following Ferguson or Giesecke reduced the harm the most.
Support for the lockdown will last as long as Furlough is in place.
Spot on. And when the government’s communication machine starts to properly explain risk by reference to the statistics.
‘ Germany’s R rate has shot up back above 1 after just four days of relaxing measures,’
Isn’t there an up to 15 day incubation period from infection to disease, in which case the new cases result from infection prior to relaxing restrictions… but anyway, so what?
Incubation is 2-14 days.
They had mainly very localised infections, eg. 100 cases in a residence for Eastern European slaughterhouse workers. This is included in the calculation, but when you look closer at the facts, it is not a threat to 60 Million other people living 100s km away. Sadly, all the British press reporting on this do not state these facts.
It is wrong to describe this as a “looser lockdown”, given the introduction of an economically destructive 14 day quarantine on air travellers, and that far from a mere one month lockdown we now have months and months with no obvious end in sight. A better description would be “a prolonged and increased destruction of the economy, done on the basis of a hopelessly poor measure of ‘R’, in the face of a death rate barely worse than for flu in a bad year, when at least one country with looser restrictions (Sweden) is doing better.”
My guess on “collective immunity” based on IFR of 0.25% was around 20%, but I think we need to look at collective immunity in the working age population separate to the over working age and under working age, each of which have markedly different IFRs and different opportunities to manage their own risk levels and different choices regarding quality vs quantity of life.
I always expected Germany to struggle because it was too effective in the first stage at reducing the collective immunity it acquired and it has not immunised its population to uncomfortable daily death figures quite the way we have. At what level will Germany bottle it and lockdown again? Its very good health service was so embarrassed by how unstressed it was it took a few dozen Italians to be seen as the good guys helping a sick neighbour. Are the Germans prepared to properly test their health service this time?
Sweden predicted 26% in Stockholm (its only real epicentre) but I have not seen the results of the serology. The only serology I saw was from New York, which had achieved around 20% if I recall correctly.
Knowing our own serology results might help or might hinder depending on what they are and how they get spun. I remain of the view regardless of the result that we need to use the summer months to get to around 60% immunity in the working age population by Oct. We cannot cower in our homes until there is a vaccine. The lockdown is breaking anyway – try to find out how many people were in A&E following drunken brawls as VE day street parties.
Trying to manage high levels of Covid infection, because there still is not the natural moderator to R provided by collective immunity, alongside a return of seasonal flu will cause the meltdown of the NHS that was narrowly avoided at the last peak.
I agreed with everything Prof G said especially “you should manage infection levels as high as possible WITHOUT overloading your health system”. We can debate whether having NHS workers in the trenches for 3 weeks and denying treatment to all elective plus self denial by patients with of other life threatening conditions (I have a relative on a ventilator now for a non covid condition who would not be there had she sought and got the right help earlier) counts as not overloading it last time.
Interesting. If only the organisation of care homes in Sweden hadn’t been so bad, thus leading to all the deaths in these facilities (by the way, not the fault of Tegnell and his ministry! as these have been privatized recently with profit weighing more than safety or staff continuity), the Swedish response would have been quite OK. As Sweden is coming to grips with this particular problem – a little too late for all the dead – their/our handling of the crisis will probably be more successful and absolutely more sustainable than for instance the UK:s. It is definitely based on the science as the Health ministry sees it. They don’t bat an eyelid until there is a peer reviewed paper on anything! Ergo Sweden has been sloth to recommend face masks in crowded places, even proclaiming that they could have adverse spread properties since people don’t know how to use them properly. They say there is no convincing evidence that face masks have any positive effect. But you have to give Tegnell (and Giesecke) top marks for consistency. It gets a bit boring! Oh, and by the way, I don’t think many people here in Sweden would go with the acceptance of a high rate of deaths. I certainly don’t know of anyone whatsoever who would go with that!
We may as a nation be very cautious right now. But we are a couple of weeks behind the European curve. Look at the rapidly falling infections in most countries there – now down well below 1000 a day in most places. This changes the debate. Countries are moving out of lockdown quickly & the pace is increasing. Dentists have been open in Denmark for weeks now, & in Switzerland & I believe Netherlands. The threat from the virus has been exaggerated ( though real ) & as each country sees from the most relaxed regime that it is not such a threat as feared….it will be a race to get back to normal.
Prevalence according to Matteo Villa @ ISPI
https://www.ispionline.it/e…
Surely a key difference between the UK and Swedish approaches is that if you delay as per UK you give time for the virus to be better understood and treatments developed (and perhaps a vaccine) to reduce the death rate rather than accept more deaths upfront as with the Swedish approach?
Or you maybe just make damn sure you really do protect the elderly properly, plus all the other reasonable precautions obviously. (Sweden didn’t manage this in the beginning sadly.)
The oxford study looks odd it shows a much lower infection rate than any other wide spread testing I suspect it is down to incompetent testing or multiple retests of the same people to get the test numbers up
The very good “More or Less” programme on BBC R4 asked exactly that and even got an honest answer from the Health Ministry. A lot of people in hospital get tested 2 or 3 times. every test is added to the published number of tests carried out. The positive result is only counted once (at least they get that right)
When these antibody results are published be careful to look at the dates when estimating IFR and population immunity.
It takes about 5 weeks for antibodies to appear after infection. In the middle of the epidemic immunity grows very rapidly and you get from 10% to 50% in a very short space of time (probably less time than it takes to get from 0% to 5%). You also may be at a point in the epidemic where the number of deaths is doubling in the space of a week. This can make the results very sensitive to estimates both of how many weeks it takes to die and how many it takes for antibodies to appear.
I have often seen the same antibody study used in the media to justify claims of high IFR/low immunity and low IFR/high immunity.
All countries has to go the same way as Sweden, without any doubt. The only question is if it was the right thing to start with a lockdown to buy time, maybe control the virus after and hope for a vaccine soon or seek protection by herd immunity. Time will tell.
“Despite the R number going above 1 in Germany this week”
The current estimate of the R number in Germany is 0.81 (Robert Koch Institute https://www.rki.de/DE/Conte….
The number of new cases has fallen every day since 2nd April, except one single day (30th April).
The more I think about this, the more it seems trying to ‘contain’ COVID is utterly absurd. Especially in the kind of environment we have in the UK, with a public health system in desperate need of reform and a government trailing its feet in terms of a coherent strategy.
The Swedish ‘fatalist’ model seems to be the only solution. The only question is whether we arrive at that slowly and on accident, after years of the government trying to pursue ‘containment’, with the population living a semi-lockdown life – lost years both in terms of the economic devastation and personal – or the second option is; do we open up and let nature do it’s work. It’s getting to the point where the latter option seems to be the most humane of a an inhumane set of choices.
As others have pointed out, the only question mark is the use of buying time for a treatment or a vaccine, but given that may be years out, I think we have go for a fatalist model – a model that still considers our vulnerable and elderly – and may mean a longer stint in isolation for them until the horizon has changed. But that decision should be left to them.
I have just watched a very good lecture on vitamin D and its role in strengthening the immune system. Especially effective for people with asthma.
The body can form Vit D by exposure to sunshine.
And here is our government telling everyone, especially people with asthma, to stay indoors!
Prof Joerg Spitz from the Akademie for menschliche Medizin. German YouTube
Please do an interview with Dr Knut Wittkowski
An interesting article, although I would love to have had a reference for the ONS/Oxford Uni serological study so that I can keep up to date. I can’t find it through a google search and yet the importance of the ‘denominator’ number for IFRs I would have thought is crucial for our assessment of risk. So Freddie, if you can reference this somewhere I’d be grateful.
As a dual national, Swedish/British, living in Sweden I’ve been following both countries pretty closely, with the weight on Sweden. I have some reservations about Sweden’s response (see my comment further down) but agree with it in most ways. For one thing, we don’t need to bother with the discussion of when and how to ease a lock down. The big thing this last week is should the students have their customary “finishing carnival”. (It’s a Swedish thing!) Oh, and everyone’s pissed off because the football probably won’t be allowed to get going again as thought. But in general the restrictions/regulations are fairly logical and sustainable over time. After this depressing lock down in the UK I hope any lock-down-let-downs will be logical, reasonable, sustainable, based on science and easy to understand and follow. Good luck UK!
Part of the problem with the UK lockdown is the sheer heavy-handedness. Japan, where I live, is every bit as crowded and interconnected as the UK, and has had a lockdown in place. This is in the process of being lifted. The lockdown appears to have worked. The police weren’t stopping people in the street and fining them, people outside minding their own business were not being harassed by the state or its avatars. People showed good old-fashioned common sense (Japanese not British). The state here has largely treated people as adults. And that’s how people have behaved. The obsessive detail with what you can and can’t do that’s made such a laughing stock of the UK prime minister ought to be entirely unnecessary in the first place. What you need to do to reduce risk of catching or spreading coronavirus isn’t rocket science – people really ought to be able to cope themselves without the government having to spell everything out. I am so, so glad I spent lockdown in Japan and not the UK, and it really pains me to say that.
“And yet, despite all this, in time we may find ourselves tacking back to something closer to the Swedish model anyway.” – This is incorrect. The Swedes decided on one model and the Brits, after a bit of to-ing and fro-ing, decided on another. The two pathways are mutually exclusive. To say the Brits will “follow” the Swedes is a bit like a woman with one child deciding that she wants to be like her friend with twins. She gives birth to a second child and decides she will call them twins regardless. Please, for the love of god, be smarter than this and apply some simple logic.
As a Swede: Obviously the Swedish way has been approved earlier from the more science driven German government than the fear driven governments of our Nordic neighbours…. Our borders to Germany reopened today and no 14-day quarantine!
“10% of the UK population have had Covid-19”? That’s not what has been reported. 10% in London maybe. Early reports seem to suggest 3 point something percent of the UK have been infected.
I think that puts the estimates of IFR in Ferguson’s range, not the order of magnitude lower predicted by Giesecke.
It’s not that simple, as the IFR needs to be weighted by the demographics of those infected. For exmaple, if more infections took place in care homes and the eldery/vulnerable than their representation in the population you need to adjust for those as they have a much higher IFR than say under 50s with no health issues.
Some places seem remote and test more?
https://www.theguardian.com…
The problem is, without *massively* increased testing (particularly serology/for antibodies) we really haven’t the faintest idea how many UK residents have had the disease and the same goes for (nearly) everywhere else. It is almost pointless discussing it until we have a much better and more accurate picture of this. I have very much had my fill of so-called ‘experts’ as well as our government’s (predictably) slavish reliance on them (despite the utter hypocrisy shown by … well, you know who). Why is our government not spending even a tiny fraction (ie an awful lot of money) of what the lockdown-related damage is doing to our economy on (as the WHO boss entreated *3 months ago*) ‘testing, testing, testing’?!!
No, it doesn’t. Most fatalities were in London area where infection is high anyway.
Second, if the infection rate is that low, it means that covid19 isn’t much infectious after all.
The early snippets from the report suggest that the national Infection Fatality Ratio is about twice as high as Ferguson assumed. So Covid19 is correspondingly much harder to get. Outside London, which seems to be on the Ferguson ratio of 0.89, fatalities must be running at a significantly higher rate. But, correspondingly, very few are getting it, and the crowds of asymptomatic carriers (later human iimmune shield carriers) do not exist. Alternatively, for whatever reasons, few of those sampled outside London developed antibodies, although more may have recovered from the disease than appears from the serology. Altogether, it is a mess, since Britain is either anomalously more susceptible to death by Covid, or the ONS study has kicked off on the wrong foot.
It does seem anomalous. Other studies have been finding loads of young asymptomatic carriers (prison and aircraft carriers). It’d be good to know if they’re doing serological tests on them.
It’s possible our government has been absolutely useless at stopping the spread in care homes and hospitals though, and it’s been predominantly a nosocomial infection and much less in the community, I’d imagine the IFR would be higher then.
Britain has a higher rate of Black and Asian men at a certain age, who are more at risk, than other Europ countries. I am sure when they start comparing data in detail across Europe, this will be one explanation for the high death rate…and the British have an unhealthy lifestyle.
We’ll find out tomorrow when the first wave of the government’s study is published. Early leaks suggest high single figures or low teens….
Has those figures been corrected for the previous assessment that it takes 21 days from recovery for the test to work? The IFR would need to be calculated from deaths up to 21 days ago. Daily death rates have been falling at about half the rate they rose and that seems to be a ratio which holds for other European countries: Spain and Belgium which rose faster falling faster and UK and Italy directly overlaid on each other with UK a few weeks behind when per capita adjusted.
https://ourworldindata.org/…
Yeah it’s strange, it’s almost as if it’s a completely different disease here.
I worked out the average IFR for London to be about 0.8% and the average for the rest of the country (at 3% infection) to be about 1.2%, which is really odd, as literally everywhere else urban areas have had higher IFRs.
It could be because we’ve got a much more elderly population getting it outside of London. This might be best considered as a disease of 2 populations, if you’re under 70 and healthy the risks seem negligible – IFR around 0.01% If you’re over, it’s deadly – IFR around 3-5%.
I’m somewhat skeptical; the Kings College lot have a lot more suspected infections than the ONS, they’re doing some testing too I believe.
Why would the IFR be so much higher than Sweden though?
The most accurate samples to me are the Diamond Princess and the US Navy Ship where you had approximately 50% asymptomatic and the remaining majority with mild symptoms and suggest the IFR to be closer to 0.1%. These were contained cases which meant that we had a full look through and are more accurate case studies compared to antibody testing in the community which may very depending on the antibody test and also mean not include those who had it but did not need to develop antibodies due to some other parts of the immune system doing the job for them.
Anyway, at this point, the jury is fully out.
What do we expect of a nation who values the life of a cat higher than lives of people in developing countries?
“Rascals, do you wish to live forever?”