Seems like Covid "Plan A" still locked and loaded
https://uk.yahoo.com/news/britons-cite-shocking-lack-testing-112814713.html
Don’t listen to what the Government are saying, observe their actions
https://uk.yahoo.com/news/britons-cite-shocking-lack-testing-112814713.html
To me, this is working towards Herd Immunity. They just keep protesting that this IS NOT Plan A
Comments
Anon
April 3, 2020 at 4:38 pmI think aiming for herd immunity is a very high risk approach, this virus is killing a number of ‘healthy’ young people and debilitating a lot more.
However, (warning – dangerous ill-informed speculation) there is a suggestion that viral load is very significant for COVID 19. If this is true, is it possible that a very very low dose to the healthy population might be beneficial? Is it better to get 2 day old Covid 19 from your amazon delivery than to risk getting a full dose? (end of dangerous speculation)
Don
April 3, 2020 at 4:37 pmThere is one organisation that I blame for all this hysteria and anxiety. Its not the government, they can only work with the tools that they have at the time. An argument could be made for the amount of tools at their disposal but we are, where we are and just got to get on with it.
I blame the various media outlets and the need to over hype or sensationalise something that literally does not need any sensationalisation because its a Pandemic of global proportions that no government alone can fix.
Hopefully when this is all brought down to manageable levels then the spotlight of scrutinisation will focus on what role the media played in f*cking with people’s mental health.
Achieving herd immunity never went away as “the plan” – it’s the only obvious way to stop this, and the way many epidemics end up limiting themselves naturally.
The thing that the government changed was the rate at which they were going to let people get infected, as it became clear we were likely to be heading for a catastrophe, with services overwhelmed (and we may still be). Also maybe who they are going to let get infected.
Achieving herd immunity through properly tested, safe, vaccination would be much better than through infection, as it should kill far fewer people. However, that simply isn’t going to be ready in time for most people (and rushing it, using poorly tested vaccine, would risk both killing a lot more people, and having a vaccine that really wasn’t very effective). It’s probably more of a hope for the higher risk individuals that have to shelter away for many months until it’s ready.
The huge worry is that we don’t know how long immunity lasts after infection or a hypothetical vaccine (or how likely a new strain is to appear that can bypass such immunity) – if it isn’t long, herd immunity won’t be achieved at all. This is where I think it gets pretty frightening.
The thing I find most hopeful is improvements in the way we treat it, especially the medicines used – this could greatly improve survival rates and hopefully reduce serious illness and long-term damage.
There are also hopes that we can’t control – it remains possible that the disease is far less dangerous than feared, with a much larger number of people having it asymptomatically, and there’s also the hope that it will evolve to become less dangerous as time passes. But these may simply not be the case.
It seems that Sweden are more openly heading in a “Plan A” direction. There’s a lot to be said for it as a plan, though I guess we won’t fully know for a year or so which strategy was better.
This is an overview of the Swedish approach: https://unherd.com/2020/03/all-eyes-on-the-swedish-coronavirus-experiment/
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My gut instinct is that the Swedish policy might work OK in Sweden – but that it would be a complete and utter disaster if applied in the UK. I have no evidence for this!
Interesting point about the left and right views on severity of lockdown being reversed over there.
It’s not plan A but it’s not much of a plan either, it’s just panic and mistakes and obfuscation.
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Or a vaccine? There are trials starting I believe. Here’s hoping they get something effective soon
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Getting to human trials is the easy bit. A vaccine will be 12 months at least 18 is more likely, and 18 months would be an amazing result. We have only just started human trials for the coronavirus MERS-Cov which first appeared in 2012. Obviously more resources will be used on a SARS-Cov-2 vaccine but there’s only so much you can do.
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They were talking about human trials starting in early summer about 3 weeks ago actually they started about a week or two ago. If it gets as bad as predicted in America especially I reckon there will be a vaccine out much quicker than that.
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A vaccine affords herd immunity, you end up with the same thing really. Enough of the population have become immune that the virus can no longer spread so it dies out. Everything I’ve read suggests at least a year and probably longer before a vaccine is available. You’ve got make sure the vaccine works and it doesn’t kill more people than it saves and the side effects may not reveal themselves for some time, you won’t necessarily keel over the moment the needle is withdrawn from your arm..
In the meantime I suspect we’ll see a series of lockdowns. Certainly that seems like the sensible approach, when a certain number of people end up in intensive care the government impose a lockdown, once it drops below a certain number they relax restrictions and so on. No doubt a certain amount of flexibility can be added but at the moment one must bear in mind that this is a completely new virus and a lot is unknown about it so any plan we come up with now is only going to be based on best guesses and will necessarily change. That’s not incompetence but reacting to a changing and uncertain set of circumstances.
I’d also imagine that once you’ve had it and recovered you’ll be able to resume a more normal life. I think there’s been talk of issuing Covid passports, obviously getting a test that proves you’ve had it will be very valuable.
This is the best article I’ve read so far and the Technology Review website has a lot of other good articles albeit with a US slant but gives an idea how the next year or so might unfold.
https://www.technologyreview.com/s/615370/coronavirus-pandemic-social-distancing-18-months/
There are such a range of ideas as to how long immunity will last that it seems like too much of a gamble! There are estimates as short as 3-6 months! I guess as long as China are testing, we should start to get some results soon if it is the shorter end of estimates. Fingers crossed it’s longer, but either way, basing things on herd immunity alone seems a crazy way to go!
Ultimately, until enough of us have had it and are effectively immune (or a vaccine is released) then we’re at risk of an outbreak aren’t we?
Staying home helps slow that rate, hopefully to a level where we don’t overwhelm the medical services with too many severe/life threatening cases.
The original “crack on, save the economy and get it over with” strategy seemed to bite the dust when they realised that the 250,000 old people it would kill were, most likely, tory voters. But that, and the dithering, shouldn’t be forgotten
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“Ultimately, until enough of us have had it and are effectively immune (or a vaccine is released) then we’re at risk of an outbreak aren’t we?”
Correct. This severely limits our ability to exchange people with other infected countries. However, when cases crop up in the future, the population will be much more aware of the risks and will understand the need for apparently disproportionate control measures, and we’ll have a high quality testing and contact tracing infrastructure (you there at the back, stop laughing). All this should make future outbreaks more controllable.
“The original “crack on, save the economy and get it over with” strategy seemed to bite the dust when they realised that the 250,000 old people it would kill were, most likely, tory voters.”
So, here is my take… I’m not an expert in this and I could be totally and utterly wrong. This is my estimate of the masterplan.
Now however there are efforts going on to “cocoon” the old and otherwise vulnerable individuals away with volunteers being trained in supplying them relatively safely. This changes everything.
Once you have the most vulnerable 5m or so people cocooned away, you can relax the lockdown to the point infection rates are ~ 10x higher than now, still without overwhelming the health service (including 20k extra field hospital beds), as the fraction of the less vulnerable people needing intensive care is so much lower. Detected and reported infection rates today are ~4k/day. We could be under-detecting at a factor of ~ 8x (sources: comparing numbers of deaths vs detected for Germany for example, CMOs estimates from a few weeks ago etc.). So, with cocooning in full force, we could tolerate 320k people getting infected per day in a reduced lockdown. Allow that slow fuse to burn until ~ 10m people have been infected/recovered (takes about 30 days) and you hit a point where ~1/6th of the non-cocooned population are immune. That’s a tipping point; with no lock down but good social distancing from this point on, the infection fizzles out in another 90 days or so through a growing herd immunity of ~ 70% of free ranging population being recovered/immune. I say “fizzles” as there’s a second peak of infection after the lockdown is ended, but the 10m and growing infected/recovered people take the sting out of it and it doesn’t overwhelm the new healthcare capacity.
The key to making this work on a reasonable timescale is to completely “cocoon” the people most likely to end up in intensive care away until the herd immunity in the rest of the population beats the virus. As soon as there are antibody tests to identify the recovered/immune they can be used to improve cocooning. Any cocooned person who needs to go to hospital is in for a very rough time however, unless a dedicated hospital and patient transport system is built staffed only with the recovered/immune.
When it comes to dealing with an out of control pandemic there are no good options. Arguably this plan is one of the best of a bad bunch – it protects the vulnerable and it protects the health service – despite the falsely binary choice of “lives/economy” some right wing posters present, it seems that protecting the vulnerable and the health service is also necessary to protect the economy. Once the infection is wrapped up it has a herd immunity component strong enough that outbreaks from travellers etc can be contained without going critical. It does rely on ~ 70% of the non-vulnerable becoming spreading agents in chains that will go on to kill people. I feel intense discomfort at the idea of me being (statistically) used to do this, and would appreciate the government levelling with us all if that’s the plan.
Or – and it’s a very valid point – I could be totally of my rocker with paranoia and a bad understanding of the progress of this pandemic and spouting absolute shite.
Edit: This is a “Plan B” with “Plan A” involving a deep, wide and responsive test/trace architecture. Every day that this fails to come together increases the size of the problem by ~10%; it’s hard to overcome that kinds of scaling once you pass a certain point.
“But that, and the dithering, shouldn’t be forgotten”
Quite.
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doesnt matter
April 3, 2020 at 4:23 pmWhat struck me as wrong about the original strategy was that they didn’t stress the need to cocoon the vulnerable (or if they did it didn’t come across strongly to me).
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Stewart
April 3, 2020 at 4:24 pmI think that’s close to where we’re going. I’m not convinced it’s the plan in so much as there is one or that the resources will be in place in time to keep the ‘less-vulnerable’ population losses down in the 10K’s. Also supplying and caring for the shielded through the peak without infecting a very significant number looks distinctly non trivial and not yet solved with perhaps 2 weeks left to figure it out very completely.
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Indeed. The antibody test has got to be a key part of this, but best case it’s going to be cut far too close for comfort.
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Jon
April 3, 2020 at 4:25 pmVery interesting!
I think one thing to bear in mind when thinking about this is the limit to how much planning can actually achieve. If anyone has come up with a masterplan, I’ll bet my arse it won’t work. People won’t do what you want them to (or they’ll do it more than you’d expected); the virus will turn out to be different to what we thought; something non-virus related that’s completely unexpected will occur that’ll turn the whole plan to shit; or some other category of unexpected thing will occur that I didn’t think of.
While there my be some masterplan I think that air of general panic is probably totally transparent and perfectly justified. What can we do in the next 48h? Try to keep people out of the hospitals, build some more hospital capacity, and try to get testing started. And repeat. And repeat.
As for the “dither and delay”… As much as I know intellectually that trying to stop the thing before it started would have been the right thing to do, I also can’t see how that fits into our way of life and psychology. It’s a very difficult policy to implement because it’s massively expensive/inconvenient for individuals (catastrophically in many cases) and you’ve got to get it in place before people can see the need for it. One good thing about having Chinese-style state control of the population is that you can get an epidemic under control…
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“If anyone has come up with a masterplan, I’ll bet my arse it won’t work.”
Totally agree. We’ve not had a situation like this in modern times. Erring heavily on the side of caution limits how catastrophic it gets if any of your unexpected things come to pass. Any attempt to “thread the needle” and get a desired infection rate is very difficult with the time delays between cause and measurable effect and the exponential behaviour. The problem would give a sentient computer a nervous breakdown but it’ll give a modeller a perfectly sensible looking output.
“As much as I know intellectually that trying to stop the thing before it started would have been the right thing to do, I also can’t see how that fits into our way of life and psychology.”
An archeologist friend of mine suggested a month ago that if we’d called it “The Wuhan Plague” people would have responded better. A lot of the public response is guided by government and media, and neither of them were on board with preparing people for what had to happen, so instead of a short sharp shock we get something a lot worse.
“and you’ve got to get it in place before people can see the need for it”
Spot on, and exactly why Taiwan and Singapore are following such a different course to us. If nothing else perhaps Europe will learn from its lumps this time…
‘Our way of life and psychology.’ I’m going to be a bit of a devil’s advocate and suggest that this ‘way of life and psychology’ is not something that’s always been with us, at least in the same way. We Brits have always prided ourselves on our individualism, in so far as it’s led to initiative and inventiveness, but it used to be combined with a greater collective discipline, I think, combined with sheer hard work. Now society is much more divided between the very hard workers and those who are quite comfortably off and go through life, cutting corners, seeing just how little they can do.
Perhaps the discipline imposed by the lockdown might have some long-term benefits? Coupled with a {Nietzschean } revaluation of our values? Certainly I have never felt such a sense of warm togetherness with the street I live in than when we all came out at 8 o’clock in the evening and clapped, and cheered, and clashed pans, etc.
Strangely, the idea that discipline is so awful is something I’ve never agreed with. I was sent to some truly draconian schools, which were really awful in lots of ways, but the overall disciplined routine was not one of them. It really helped you work and use the day well. The rules of silence meant you could really concentrate, without distraction. It also taught you how to structure your day and use your time well, in ‘slots’ as it were, in the periods when the rules were strict. The quite extraordinary draconian religious nutter of a headmaster at my Prep school was a complete paradox. Because there were quite a few huge periods in the week, perhaps each day, I can’t quite remember, when we were all just allowed to let our hair down, play pop music full blast and ‘twist and shout’ etc. etc. and do more or less whatever we liked. But during lessons, you could hear a pin drop.
Just throwing out a few randomish ideas, food for thought, not an argument.
Carl
April 3, 2020 at 4:13 pmI’m not sure how lack of testing leads you to that conclusion. Or even what your conclusion is for that matter. In fact is it even a conclusion?
nope
April 3, 2020 at 4:44 pmA point worth noting (as highlighted in M.D.s excellent article in the current edition of P.E.) – this idea of getting 70% of the population infected for herd immunity relies on an assumption that 70% of the population are fit and healthy and able to deal with the virus. This is optimistic to say the least and we have large numbers of people even in young or middle age who are riddled with health problems. This is a website based around an outdoor activity and as such we probably all associate generally with fit active people or we will certainly have a bias towards this in our associates. Don’t let our individual perception skew the facts.
bob
April 3, 2020 at 4:42 pmWhat percentage need to catch it for it to die out? If we assume that it dies out when r0 is < 1 then we can estimate it. If x is the fraction of the population who have not caught it and recovered, then the r0 is effectively multiplied by x? To me this is intuitive because, let's say half the population are immune then the virus has half as many targets so each infected person will infect half as many.
So if r0_effective is r0*x, and we take r0=2.6, which I think is the current best estimate, then we can say:
2.6*x < 1
x < 0.38
So when more than 62 % of the population have recovered we should be OK? The above might be nonsense I'm just thinking aloud.
James
April 3, 2020 at 4:39 pmThe fact that the virus is spread so easily and before/without symptoms makes it virtually impossible to retain control in a free-reign situation. As an example, a care home here had an outbreak of the virus this week, 16 residents and 11 staff. This is somewhere that’s been on lockdown because they know how bad things will be if it gets into the home, yet it’s still got in. You’d have to have the staff living in the home to prevent them mixing with the wild world outside to have any chance of control, plus quarantine / sanitisation of everything coming in and out the home.
You also have the risk of high viral load from mass infection causing mass hospitalisations of fit and healthy people beyond what the hospitals can cope with – New York has 50% of it’s admissions under the age of 45 apparently. The healthcare system ‘red line’ (as per the graphs in the Imperial college report) are simply too low to cope with mass infection in any form – even the flattened curve can’t be dealt with. Perhaps the only solution is to compartmentalise an area e.g. a town or city and go for the mass infection where the unknowns become much more known.
The sad thing is I can’t see any ‘exit plans’ being feasible without mass testing and/or a wonder treatment or vaccine. Without mass testing governments simply don’t know what the scale of the problem really is. Decisions based upon bad information are bad decisions!
coronavirus sucks!
April 3, 2020 at 4:40 pmI don’t see that we have much choice over exit strategy. This is anecdotal so feel free to ignore it but I know quite a few friends who have the virus (or a bad dose of flu at coincidental timing), either because they have to go out and work or because they are ignoring the lockdown and travelling to visit people and go out for a weekend etc.
So we might not have the luxury of wondering how to un-lockdown a non-infected population, I think we may reach herd immunity anyway before a vaccine and all we can do is try and flatten the curve.