Like it or not, every country is pursuing a herd immunity strategy, all they are doing is trying to manage the speed at which it happens.
– Perry de Havilland
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Samizdata quote of the dayApril 4th, 2020 |
 24 comments to Samizdata quote of the day |
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The so-called UK government ‘momentary’ (English English) policy of “herd immunity” was a silly thing. I can only interpret it as a desire to keep the population somewhat positive, with ‘good news’. This along the lines: “Something must be done (said); this is something; let’s do (say) it.”
Herd immunity is only relevant within a policy of vaccination. The purpose is to reduce the number of infections (and their downstream effects on mortality, morbidity, etc). You cannot directly reduce mortality and morbidity by infection (at least unless you can guarantee to partition it against those who will suffer most severely – and do you trust any government on that?). All other things being equal, you cannot reduce ETC (and indirect effects of mortality and morbidity) by increasing infection in the short-term.
Perry’s point is surely that (prior to any of vaccination, effective treatment or prophylactics), the direct effects of mortality and morbidity over the longer-term cannot be improved by human action. In that, I agree with him.
However (and surely not concerning Perry’s point, so not against his point), reducing short-term mortality, morbidity, etc gives more time for effective treatment and/or prophylactics to be discovered – and applied for greater benefit. And reducing short-term higher infection is exactly the opposite of action to increases pre-vaccination herd immunity.
Best regards
“(at least unless you can guarantee to partition it against those who will suffer most severely – and do you trust any government on that?)”
The government did.
At the present rate say 50% of the population will get this Chinese Flu, half of these will not develop symptoms, and a small proportion say 5-10% will become seriously ill.
Waiting for a vaccine is pointless, while we have 30+ efforts many overlap. and a good few are using a process that has never worked before! It usually takes at least 5+ years to produce a vaccine. Now we have bent the rules to speed things up but we are looking at 1 year for a vaccine, that may not work as the virus like the common cold and influenza mutate each year!
If the present panic continues we will destroy the economy and that could knock over 3 months off everyones life span. Letting the virus continue ‘slightly’ slowly through the population means the over 75’s are the only ones losing 3 months of their lifespan.
“At the present rate say 50% of the population will get this Chinese Flu, half of these will not develop symptoms, and a small proportion say 5-10% will become seriously ill.”
Maybe. We don’t know the exact percentages, yet.
“Now we have bent the rules to speed things up but we are looking at 1 year for a vaccine, that may not work as the virus like the common cold and influenza mutate each year!”
Coronaviruses in general are known to be unusually stable against mutations. Influenza works differently – having multiple strands of RNA which can be switched around instead of a single strand as coronaviruses do. We’re not certain with the current one, but so far as I’ve heard it doesn’t appear to be mutating.
“Letting the virus continue ‘slightly’ slowly through the population means the over 75’s are the only ones losing 3 months of their lifespan.”
Depends what you mean by ‘slightly’. In a sense, that *is* the current plan.
There are a number of options.
A. Take no protective measures at all, the hospitals get overloaded, the 10-15% who become seriously ill can’t get treatment and die in large numbers, possibly millions dead, including many of the young.
B. Take limited measures to isolate the elderly and vulnerable from the rest of the population, but otherwise let it rip. The hospitals get overloaded again, the 5-10% of the young and healthy who get seriously ill can’t get treatment and die in large numbers, maybe around a million dead, maybe more, including many of the young.
C. Lock-down the population to stop it spreading totally. The ones currently in the pipeline should hopefully not overload the health service, maybe 20,000 dead, mainly the elderly and already ill. Keep the lock-down in place until a cure is available, which may be a year or more away. This option saves the most lives, but wrecks the economy.
D. Turn the lock-down on and off, so as to keep numbers within the capacity of the health service, but aim for herd immunity. The current pulse may kill 20,000, mainly the ill and elderly, and may reach a level of 5% of the population infected. To get to 50% and herd immunity we would need to pass through about 10 pulses like that. Damages the economy, but maybe a half or a quarter as much.
E. Lock-down for now, to play for time. Invent a cure or treatment, such as the hydroxychloroquine currently on trial. This would then enable us to release all the restrictions, without millions of deaths.
We’re on plan D.
Plan E is a political gamble. Either you could lock-down for the long term and then find no cure appears. (We’re still waiting for a vaccine for HIV/AIDS 40 years later, for example.) Or you could turn the restrictions on and off, letting lots of people die, and then somebody invents a cure that could have saved them all, and that would be embarassing.
If you want to confine the deaths to the over-75s, then plans A and B are out. If you want to aim for early herd immunity rather than permanent lock-down, plan C is out. So we’re on plan D, hoping for a switch later to plan E but making no promises. You just have to stretch the meaning of ‘slightly’ a bit.
There are existing medicines that have been shown to be of some use against COVID 19 – and there are other medicines that are being developed.
A possible justification for the “shut down” in various countries is to give TIME for these medicines(existing ones and new ones) to be ready.
However, it is impossible to know for sure what is going on in the United Kingdom – as there is endless slogan chanting, rather than rational discussion.
Of course, many countries are not practicing a “shut down” – if the factories and other forms of PRODUCTION (as opposed to consumption) are shut down for a long period of time, there will be economic collapse.
And that would lead to mass death.
For the record some of the countries that have not followed a policy of “shut down” have had vastly FEWER deaths from COVID 19 than the United Kingdom has.
Hi NiV
Regarding the graph you’ve linked to with the phrase “including many of the young”.
Whilst the graph shows high numbers of hospitalisations at younger ages, to my eye it looks like small numbers of young in the deaths (and none in the under 20 age bracket). The lack of any indication on the graph as to what the numbers on the y axis mean – 20: is that twenty thousand, twenty million? What is the source of the graph?
“Whilst the graph shows high numbers of hospitalisations at younger ages, to my eye it looks like small numbers of young in the deaths”
Exactly right. People of all ages require hospital treatment, but so long as they get that treatment, very few of the young die.
The question you need to think about is: what happens when the hospitals are full, and all those people currently hospitalised can no longer get treatment? Presumably, significantly more would die without treatment, and it wouldn’t just be the elderly. Exactly how many, we don’t know. Nobody has had to find out yet.
“What is the source of the graph?”
Sorry, I should have linked it again. (I’ve been putting it up repeatedly for the last week – I’m afraid I assumed people would have already seen it.) The US CDC reported on the number of people hospitalised in each age bracket up to March 16th, where that information was known. Unfortunately, data on a lot of people is missing.
Ultimately it is the only course. Without worldwide herd immunity the disease will keep recurring took a lot of work to do that for smallpox!
Of course until it is near achieved there will be deaths, and it is the general inability to face that fact that creates panic amongst people who expect never to have to go through a problem but always have government solve it for them.
The pity is that when government fails they assume that a different government would have succeeded – again and again over many problems.
Paul:
Well … that is true for Samizdata 🙂 Not everywhere on the web.
You’ve got it the wrong way around:
For the record, Western countries that have had vastly fewer deaths than the UK have not imposed a shutdown.
I wonder why??
As for the PdH quote, that is exactly right.
(Well, make that: about right.)
Michael van der Galien, a Dutch journalist, reported on PJMedia during the failed coup in Turkey, where he was living at the time. (Maybe he still is.) He wrote that, when he heard of the coup, he immediately ran to buy some food, because the Turkish military have a tradition of imposing a curfew after a coup, and some people died of starvation as a result.
Now, such a curfew, if imposed for a couple of weeks, would no doubt slow down the spread of the virus dramatically, but would also result in even more casualties.
Not yours truly, though. I started stocking up on long-lasting food weeks before there was a run on toilet paper. As long as there is running water and electricity for the fridge and the cooking range, i am safe.
NiV, the death disparities between your “plans” are BS.
We don’t have a cure, so everyone gets better or doesn’t off their own bat. Hospitals might keep people alive longer for them to fight it off themselves, but they aren’t curing them yet. Anyone already sick getting CV19 is in big trouble.
Overloading the hospitals won’t cause “a million” otherwise preventable deaths compared to twenty thousand then. That would imply that modern treatments are currently preventing death in 980,000 / 1,000,000 = 98% of the serious cases that go to hospital — including the more than 2% of the population who are already seriously ill. I don’t see anything to suggest that is the case, because the death rate for those hospitalised in places not close to overloading suggests totally otherwise.
We can’t even save 98% of many patients for many diseases where we have cures, let alone one where we don’t.
Not true. New Zealand went into lockdown before our first, and so far only, death.
US states that barely have any cases are in various stages of lockdown.
There seems very little relationship between the severity of the restrictions and the amount of deaths. Places with lockdowns are often struggling (Italy, New York) and other places are getting by with far less restriction.
If at the end of this Sweden and Portugal come out with very similar death tolls to Denmark and Spain, the case for the effectiveness of lockdowns will be very, very poor. Yeah, yeah, we know they should work. But it doesn’t seem to be helping Italy at all.
Plan D =DUMB NiV.
Short burst lockdowns?
If this one doesn’t end soon the mess will be unstoppable let alone re-runs on a regular basis.
Chester–MOST people with coro are NOT in serious trouble. Unless they might suffer emot pain by infecting someone vulnerable that they love.
“We don’t have a cure, so everyone gets better or doesn’t off their own bat. Hospitals might keep people alive longer for them to fight it off themselves, but they aren’t curing them yet.”
The distinction escapes me. Keeping somebody alive long enough for their own immune system to fight it off, when otherwise they would have died, *is* ‘curing’ it, in the sense of enabling people to live.
“That would imply that modern treatments are currently preventing death in 980,000 / 1,000,000 = 98% of the serious cases that go to hospital”
No. About 10-15% go to hospital, about 1% die, so they’re potentially preventing death in 90-93% of the serious cases who would have died. If you suppose about half of the hospitalised cases would have lived anyway, 80%. You get another factor of 10 or more from the reduction in the number of people infected, and hence the number of cases. Instead of 80% of the population going through in one two-month surge, the lock-down measures reduce that to about 4% of the population being infected, and isolation of the elderly further reduces the rate of serious illness. The whole point of the lock-down is to limit the number of new infections, so as not to overload the health system. Fewer infections, fewer serious cases going to hospital, fewer deaths.
“There seems very little relationship between the severity of the restrictions and the amount of deaths.”
You shouldn’t expect any. People only put the lock-downs in place when they realise they’re going to struggle. And because there is a 4-week delay between putting a lock-down in place and it having any effect on the death rate, and because in many places the epidemic is increasing 10-fold in between 1 and 2 weeks, that means the actuality is potentially already between 100 and 10,000 times worse than it appears. Different nations have different rates of spread, and different levels of political blindness to what’s coming, and so take action at different times. And as Perry said, everyone is pursuing the herd immunity strategy, which means waiting until you’re about to hit the limit before locking down, so as to get people through the bottleneck faster. Different countries have different limits, depending on the state of their health service.
Nobody as yet has tried plans A or B. Places like South Korea (and as you say, New Zealand) seem to be going for plan C at the moment. Most other Western countries now look like they’re aiming for plan D, although I think Trump is having a go at plan E, holding out hope of an early exit with the aid of fast-tracked drugs.
But all the numbers are uncertain, and nobody knows what’s going to happen, and we possibly never will know what would have happened if we had followed a different policy. You can only work with the information and understanding you have got at the time.
There is also Plan B++:
* close the borders, except for citizens and permanent residents (who must self-quarantine for 2 weeks under penalty of jail time);
* cordon off the most afflicted parts of the country;
* close down the places where you are most likely to catch the virus, unless they provide essential services;
* allow access to places providing essential services only with PPE — at least, gloves and a scarf over nose+mouth;
* demand that people keep at a safe distance from other people at all times, with fines for people who do not comply after a warning;
* offer round-the-clock daycare for free to children of people providing essential services.
“Now we have bent the rules to speed things up but we are looking at 1 year for a vaccine, that may not work as the virus like the common cold and influenza mutate each year!”
I read an interesting discussion about the “common cold” and vaccines for it. What we call the “common cold” is in fact a collection of about a dozen or so different viruses which cause similar symptoms, so this makes vaccine development very difficult. The article also discussed the cost of ‘speculative lawsuits’ against vaccines – say someone dies of something a week after having the vaccine. They may have died from it anyway, and it probably was completely unconnected to the vaccine, but courts are happy to pay out anyway, and often huge sums.
So much of the reason we have no vaccine is the reward doesn’t match the risk (we all get the reward, one pharmaceutical company gets shafted with the risk) and it is hard anyway.
If the coronavirus doesn’t mutate frequently, and there is only one version of it, and the legal obstacles are removed/waived/reduced, that should mean much more chance of developing one. But still, probably a year away at least.
“There is also Plan B++”
Indeed. There are lots of possible variations. I saw a paper discussing an interesting proposal for ending the lockdown, that they should lift the restrictions in one small geographical area at a time. The large number of cases from that region are distributed across the entire country, until you get local herd immunity. Then that region goes back to normal, and you move on to the next region. It still takes a long time, but it means that for much of that time large parts of the country and economy are operating normally again, and can better support the rest.
https://www.medrxiv.org/content/10.1101/2020.03.29.20046011v1
NiV writes: “I saw a paper discussing an interesting proposal for ending the lockdown, that they should lift the restrictions in one small geographical area at a time. …”
I am reminded about UK WW2 rationing:
Nine years: not exactly a good example of how things should be done.
And UK WW2 national identity cards were only phased out in 1952.
Best regards
NiV & Co. All this alphabet spaghetti of plans assumes lockdowns are 100% hermetic. They can’t be; there is going to be some leakage and eventually the whole population will be exposed, including the most vulnerable. All who are susceptible are going to be infected. What we can do is slow down the rate of infection to the level ghat hospitals can cope and possibly delay infection of the vulnerable until some treatments have been found.
“All this alphabet spaghetti of plans assumes lockdowns are 100% hermetic. They can’t be; there is going to be some leakage and eventually the whole population will be exposed, including the most vulnerable.”
The theory is based on what they call ‘herd immunity’. Contacts between people normally result in each infected person potentially infecting about 2-4 new people. This number, called Rt (the time-varying version of R0, which is the multiplier with no measures in place), determines whether the epidemic expands or contracts. If Rt is greater than 1, each generation of the virus increases by a factor Rt. If Rt is less than 1, then each generation of virus still infects new people, but fewer, so the number newly infected shrinks and the virus dies out. If Rt equals 1, the level stays constant, neither growing nor shrinking.
If you can reduce the number of contacts between people by a factor of more than R0, the virus is still spreading, but with each generation smaller than the last. Eventually it disappears. That’s what the lockdown is intended to do. It doesn’t stop contacts and infections completely, but it does (hopefully) drop it to below the critical number. But the other way to do it is to ensure more than 1-1/R0 of the population have already had it, and are immune. If R0 is 3.5, we need more than 72% to have had it to get herd immunity. Then even though people are still making contact at a rate of 3.5 infectious contacts per person, 72% of those contacts have no result, only 28% of the usual number lead to new infections. 28% of 3.5 is 0.98, so the infected infect a smaller and smaller number each time round.
This is helpful, as it means that as time goes on, less stringent measures will be needed to achieve the same effect. The combination of reduced social contact and growing herd immunity can keep Rt well below 1. On the other hand, it also slows progress towards herd immunity down as the final stages are reached.
Eventually, when significantly more than 72% have already had it, any new infected people introduced from outside will run into masses of already immune people, and the virus dies out before it can spread to the vulnerable. That’s the hope, anyway.
See panel K in the figure on page 9 of Imperial College’s report 13. This shows the estimate of Rt over time, as different levels of restriction have been introduced. It starts off at about 3.5 (R0), but drops. We need to get it below the black line to get the numbers to shrink. As you can see, it’s quite uncertain whether we’ve done enough.
“What we can do is slow down the rate of infection to the level that hospitals can cope and possibly delay infection of the vulnerable until some treatments have been found.”
Agreed.
NiV. I hope you’ve right, but I’m very wary of models when lives are at stake (especially computer projections from a source with a problematic record). I fear that long before we reach 72%, peripatetic care workers will have carried infection to care homes and care in the community clients.
As I have said before on other threads – the government has not concentrated its attention on curing the disease.
I would like to make clear I do NOT believe this is because the government are evil – they are NOT. It is a matter of a mistaken policy of thinking that if people just hide the disease will go away on its own.
Mistaken – NOT evil.
What South Korea, and Taiwan, have done is attack their COVID-19 epidemics from the top and bottom. From the top they aimed to make Rt < 1 by lockdowns and social distancing to control the initial clusters, then use widespread testing with aggressive contact tracing with enforced quarantines to prevent the formation of additional clusters. This is the other option, but it requires you to have the infrastructure to test like crazy and do the contact tracing.