Exit strategies

Iraq, Afghanistan, Syria, COVID-19… we seem to have developed a penchant for embedding ourselves deeply into situations without fully considering how to get out of them.

This piece is prompted by the very high death rates now predicted for Sweden by IHME modelling, which I find hard to square with what we know, or are told, about the SARS-Corona-2 virus. The virus is a highly contagious one, with a relatively long pre-symptom infective phase, and a high (though as yet undetermined) rate of sub-clinical infection – Dr Anjeanette Roberts, a research virologist whom I know from the Peaceful Science site, estimates the current best-guess of asymptomatic infection at 80%.

The death rate is relatively low, though again this cannot be absolutely determined until widespread antibody monitoring can be performed. However, it is probably less than 1%, targeting overwhelmingly the elderly infirm (the reasons for the sporadic younger cases perhaps including initial virus load and stress levels amongst health workers). The virus’s USP is the lung disease it causes even in some asymptomatic patients, which limits oxygen absorbtion and, worse, often provokes a damaging auto-immune response. It is now apparent that perhaps 40-50% of ventilated patients will die nevertheless from this.

Because of these features, and because of criminal misinformation from China and the WHO, the world was caught off guard by exponential increases in numbers of cases at an early stage. This led to the UK’s initial strategy – and here’s where the meat of my argument begins – of trying to slow the initial increase in cases to give time for the NHS to tool up ITUs to treat the severe cases adequately, whilst also hoping milder cases would develop herd immunity sufficient to inhibit the spread, and eventually end the epidemic.

The latter hope was dashed as cases increased dramatically, leading to the lockdown we now have. But it should be remembered that the real purpose of lockdown was to avoid an Italian situation where health services were overwhelmed early on, leading to potentially salvageable cases not being offered ventilation. That purpose appears to have been achieved, even if a second wave of cases occurs at a later date.

With the benefit of hindsight, the deaths this policy would or could prevent were (a) the “salvageable” 50-60% of severe COVID-19 cases and (b) the non-COVID patients who would die unnecessarily in the event of an NHS meltdown.

But here’s the rub – this “delay the peak” policy could only save this limited number of deaths, and no more. Given the ongoing spread of the virus, and its untreatability, the total number of susceptible individuals will develop severe respiratory problems, and 40-50% of them will die despite the best medical attention. As things stand, these future deaths are all inevitable at some stage, and UK policy was intended to stagger the cases so as to save as many of them as could be saved by a functioning NHS. So far the policy has succeeded, but the public is being allowed to assume that their efforts are “preventing deaths” rather than as is the case, spreading them out over the weeks. This impression, in my view, is dangerous.

There are only three ways, as far as I am aware, that any of these “necessary” deaths can be averted.

  • (1) By the development of an effective vaccine, which even the most rosily optimistic estimates put in the autumn, and more sober voices as a year or two, or even never, given the variability of Coronaviruses in general. There is no realistic possibility of locking down society for that long.
  • (2) By the development of herd immunity sufficient to give the virus “nowhere to go” so that it dies out, or largely so. But the lockdown policy, if it works, is the most effective way of preventing the development of herd immunity. If A. J. Roberts’s high estimate of asymptomatic infection is correct, then conceivably populations may be developing infections and immunity despite health policy, but that may be wishful thinking. Herd immunity develops because viruses spread freely – there is a sound reason why nature has developed immune systems, despite their limitations, rather than social distancing.
  • (3) By locking society down so effectively, long-term, that the virus cannot spread at all. This kind of thinking explains Dr Fauci in the USA suggesting that handshakes may become a thing of the past, and similarly draconian social changes being suggested by some “experts” here. With a worldwide pandemic such total isolation is impossible, even if looming economic catastrophe did not make it impracticable. But given the absence of (1) and (2) the present restrictions can only be lifted – unless you can inform me better – by accepting that those destined to die will die, perhaps somewhat sooner than they would if lockdown persists. That seems to be a communication dilemma that politicians and experts are avoiding, and which uninformed journalists are failing to press (though given their desire to blame governments for every death as if governments were God, that may be a good thing).

Let me return, though, to that Swedish “projected death rate.” Unless I have misunderstood the whole epidemiological situation (which is entirely possible, though I have more of a grasp of the subject than most non-medics) that figure is either meaningless, or refers only to the “first wave” of deaths, the unstated belief being that Sweden will pay up-front for its policy whilst the other nations will make themselves look better by pushing the inevitable mortality a few months into the future – much like their “tax the future” policy in recent middle-eastern wars.

But I question whether even this is correct, given the way that the data is developing.

This daily graph from Watts Up With That? has the advantage of standardising each nation’s cases to begin at a death-rate of 10 per million. What is intriguing is how the deaths are all following similar paths, after allowing for the differences in testing policy, diagnostic criteria and so on. They nearly all look as if they’re heading for a broadly similar death rate, a little above the projection for Italy.

Compare particularly the UK (just about keeping within health provision, major lockdown), Italy (initial collapse of health care and consolidation of lockdown too late) and Sweden (very little quarantine, and very adequate health provision). The latter’s curve, despite the red line at the top predicting a uniquely high death-rate, is actually crossing the UK’s as the rate of increase slows. Why is it not still rising exponentially? Meanwhile headlines today suggest the UK’s death rate may prove even higher than Italy’s, despite the initial breakdown of Italy’s health service, and its older population: is this suggestion of any real significance?

To me, the similarities across three very differently-managed countries look less like the successful effects of a common policy (lockdown) and more like a reflection of the virus’s natural history. If that is the case, then any claim that “the lockdown has worked” is likely to result in any relaxation of it being blamed for the deaths that will, inevitably, follow. And that leads to the danger of the re-imposition of even harsher restrictions, with all the social and economic problems associated, or else to the government being to fearful to ease restrictions sufficiently to get things moving again. The new command-control society could persist through political fear rather than through totalitarian intention.

Of course, politicians might have an “out” in saying the models were wrong, that Sweden got it right, and that the virus is, for the most part, running its natural course whilst thumbing its nose at human policy-makers. But to do that they’d have to backtrack not only on a policy that has hurt millions and cost billions , but also on their much-vaunted “reliance on the best science.”

The trouble with asserting the ability to control nature better than God is that it gets harder and harder to admit to being mere men.

Jon Garvey

About Jon Garvey

Training in medicine (which was my career), social psychology and theology. Interests in most things, but especially the science-faith interface. The rest of my time, though, is spent writing, playing and recording music.
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6 Responses to Exit strategies

  1. Jon Garvey Jon Garvey says:

    Well, today’s news is that there is a spike in UK deaths much bigger than is to be realistically accounted for by COVID-19 pneumonia. And simultaneously there has been an assessment by the Office for Budget Responsibility (the official UK body set up as a check on governments making unrealistic budget goals for political purposes) that the current costs of lockdown will put Britain’s economy in the worst state since 1700. My March 13th fears are, indeed, being realised.

    Here’s one sobering thought: whilst COVID-19 is not just “a flu epidemic,” it is far from the worst kind of pandemic that can be imagined, even before the final death toll is known. The Swedish politician who said that it is not Sweden that is conducting an untested experiment, but the rest of Europe is right. If we mess up the global economy for the next many years by the false belief that we can control viral pandemics by shutting down society, then what will we do when there is another viral scare in a decade or so, perhaps far more deadly?

    Remember the scares of only this young century (which the WHO and world community also united to misjudge) – SARS in 2002, bird flu in 2003, swine flu in 2009, Ebola in 2013-16… novel infections are part of life – but can we afford to combat them as we are now? And even if we can (somehow) afford this one, how could we ever afford to repeat it – perhaps next year, with the same organism?

  2. Robert Byers says:

    good summery. I still question this is a notable epidemic relative to numbers. the big point being the complete lack of cases/deaths amongst children and few in the teens. why are they so immune to getting it? or why so easily beating it? i think its only a flu outbreak, as i said before, that is affecting the elderly and this only noticed because of modern stats professionals. its not dangerous to non elderly people. i think its the same people who think they can win in the casino because they here noises of people winning.
    If one did the british stats relative to the black pl;ague starting at year one in pop of 3 million people would the black plague be called a epidemic? No! Too little impact.
    I suspect its very hard for non elderly people to pick up much less be hurt.
    Its not catchy. Social distancing is useless as, I think, some of your stats say.
    people forget how many people there are.

    • Jon Garvey Jon Garvey says:

      “If one did the british stats relative to the black pl;ague starting at year one in pop of 3 million people would the black plague be called a epidemic? No! Too little impact.”

      The annual figures for the Black Death in Britain are a little less precise than elsewhere. Around its origin in Kyrgyzstan 300 tribes were wiped out in a three month period. 85,000 dieed in Crimea the year it reached there. In Sicily 1/3 of the population died in the first year. 56,000 died in Marseille in the first month: 50,000 in Paris in the first 6 months. Towards the end of the first year it reached London, 290 people were dying daily (in a population of only 60-100K).

      So SARS-CoV-2 is nothing like the Black Death in scale. The young are not immune to getting it – they’re just very unlikely to get it badly, and given the nature of the severe form that probably has to do with altered immunity in the sick and elderly.

      Quarantine is more likely to have little effect because it is very infectious, not because it isn’t infectious: in Switzerland, testing of random people consistently shows 15-25% infection rates, with very little change (just a small increase) after lockdown. For this reason it’s believed that anything up to 80% of cases have no symptoms – the studies to show how many in populations have actually unknowingly had it are not yet in.

      It isn’t flu, by definition (a coronavirus, not an influenza virus). Nevertheless the mortality rates are looking on a par with flu, only they are occurring on a shorter time-scale because of the novelty (and so lack of population immunity) and the characteristics of the virus.

      For those interested there’s an excellent, and frequently updated, independent fact-sheet from Switzerland here.

      • Jon Garvey Jon Garvey says:

        And another good, full length, presentation (which seems to show that I picked up most of the relevant factors correctly) is this one with David Katz.

        Towards the end he includes a very sensible bit on the permanent risk to civil liberties, which I didn’t cover in my OP.

      • Robert Byers says:

        the Swiss thing was excellent but not the video. It makes my suspicions increase about the competence behind the noise of this.
        It said in countries without lock downs etc there was no difference. I’m not sure the young get it. i’m unsure about the SEVERE form. Does that mean two? more likely its just a curve showing the eldrly can’t fight it. thus it gets worse but is not a diffeent strain. Just one.
        We need sampling of youth to prove points.
        Something is wrong with all the stats the gov’t gives. The threat fears don’t add up. Indeed would there be more or less deaths among the elderly with this new virus or do they cancell each other out. I guess we need stats for viros/flu deths among elderly from last year.

        • Jon Garvey Jon Garvey says:

          “…more likely its just a curve showing the eldrly can’t fight it. thus it gets worse but is not a diffeent strain. Just one.”

          That’s the case. Though the paradox is that, as in many other conditions, an inappropriate immune response to infection makes it worse. That is, it’s fighting it that kills you.

          One researcher suggested that exposure to a similar virus decades ago might have primed the immune system to such a reaction, and that would be one reason for the elderly to bear the brunt. But also you don’t usually make it to old age without picking up diabetes, coronary artery disease or other things that make you susceptible – which is why thousands of elderly die every winter from flu and other viruses.

          There definitely needs to be more population-level sampling, both of active infection and antibodies. The problem is that it’s too soon to have reliable tests, and pressure of cases tends to concentrate their use to those sick or “at risk,” whereas sensible policy depends on knowing what the virus is doing “out there.”

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