I’ve already posted some specific points I put in the form of a letter to the Prime Minister on 28th February. This post complements that one, since my letter to the PM didn’t attempt to outline an overall plan since I (foolishly) assumed that we would follow something similar to the approach adopted by China and now Iran and Italy.
On 9th March I felt I needed to clarify the overall strategy and wrote again by email to my (Labour) MP:
“Sorry to write again on the same issue, but I haven’t felt such a sense of despair that the country is making an enormous mistake for, ooh, 3 months, now!
Since I first wrote to you on 4th February the coronavirus outbreak has developed into a pandemic. The disease is spreading unchecked in many countries, but China has demonstrated that a Covid-19 epidemic can be rolled back and even eliminated by strict “lockdown” measures. The UK needs to stop pussyfooting about and adopt similar measures immediately.
Labour needs to call an emergency debate on the government’s plans. The following points need to be discussed:
1. The UK’s plan (as documented in the “Coronavirus: Action Plan” published on 3rd March) explicitly proposes a policy of attempting to manage the UK Covid-19 epidemic, e.g. it states (para 4.42) that: “Based on experience with previous outbreaks, it may be that widespread exposure in the UK is inevitable; but slowing it down would nonetheless be beneficial.” But we know from the Chinese experience that it is possible to do more than slow it down. Our aim should be to eradicate Covid-19 in the UK.
2. The World Health Organisation (WHO) seems to think it is still possible to contain Covid-19 by controlling the current epidemics. That seems to be one reason why they haven’t yet officially termed the situation a “pandemic”.
3. An eradication strategy modelled on China’s would avoid many early deaths compared to the UK’s strategy of trying to manage an epidemic. China has limited at least the first wave of an epidemic to around 3,000 fatalities in a country of well over a billion people. The current figure being bandied about for the UK is up to 100,000 of a population of less than 70 million, that is, a mortality rate around 600 times higher than in China!
4. The current plan will also not work, principally for the reason you highlight [in your reply to my email of 4th February], i.e. that the health service will be very quickly overwhelmed, probably when the infection rate reaches about 1% of the population (implying, in the UK, a few tens of thousands of serious cases – estimated at 5% of the total number – requiring intensive care, or as close to it as we are able to deliver). This would necessitate drastic lockdown measures to reduce the rate of infection. But because so few people had been exposed (so that they presumably couldn’t become ill a second time), we wouldn’t have developed “herd immunity” and the epidemic would simply pick up again as soon as the lockdown measures were lifted after say a month. We’d have to go into lockdown several times before the epidemic ran its course, which could take years! It would be far cheaper to have a single, longer period (say 2 months) of even more drastic lockdown aimed at eradicating the virus entirely from the UK.
5. My claim that the health service would be overwhelmed before the infection rate reaches much more than 1% of the population is supported by the Italian experience. As of today, 9th March, they have detected around 9,000 cases (with 463 deaths) in the now locked-down population of around 16 million in northern Italy. If this represents just the serious 5% of the total number of cases (and it’s probably more, because the Italians are carrying out a lot of tests), that implies an infection rate of around 1% of the affected population of 16 million. Their problem, of course, is that there are likely many other cases yet to experience symptoms. If the north Italian epidemic isn’t kept to a low single figure percentage of the population they are simply not going to be able to treat the victims.
6. Likewise China ground to a halt when a very small percentage of the total population became infected with the virus. The Chief Medical Officer, Professor Chris Whitty, has stated that 20% of the population of Wuhan (which is in excess of 10 million) have been infected (perhaps based on the reported 80,000 cases being 5% of the total number of cases) and even this is disputed – the WHO don’t believe there are such large numbers of unreported cases. But even if China has already experienced as many as 2 million cases, this is still less than 0.2% of the total population of the country. And the resources of the whole country were dedicated to containing the outbreak.
7. There is a long timelag between infection and case diagnosis. It takes up to 14 days for symptoms to develop and perhaps longer for them to become serious. There is also a wait of up to a week for tests to be carried out and of up to 48 hours for the results. With the number of cases doubling every few days the current 300 or so active cases that have actually been diagnosed in the UK so far are the tip of the iceberg.
8. Particularly concerning are the 30 cases reported last Friday (6th March) with no known connection with travel (e.g. from Italy), because we may be picking up only the most serious of these (say 5%), and at a late stage (up to a fortnight or more after infection). Each case, serious or not, will have unwittingly spread the disease to, on average, several other individuals. By now, there will have been several “generations” of infections since these 30 patients caught the disease. As a result, there are likely now thousands of individuals in the UK who can’t easily be found by contact-tracing and who are spreading the virus. Statistically, there are now likely to be infected individuals in any large crowd, such as watching a sporting event, where it could be spread to who knows how many others, mostly difficult to trace, even if the original case is detected (because it is serious).
9. As has been pointed out by George Osborne, among others, Italy had fewer cases a fortnight ago than we do now. See for instance https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_in_Italy .
10. Because of the large number of individuals who are already infected, any further delay in the lockdown measures necessary to prevent the virus spreading further is likely to be catastrophic. The NHS would struggle to deal with the current pipeline of cases, let alone more. The patients currently receiving intensive care in Italy’s hospital corridors became infected up to a fortnight ago.
11. The government is concerned about the economic cost of lockdown (though they’re calling it the “Delay phase”). But a recession is already inevitable and many important sectors of the economy – such as tourism, hospitality, entertainment, education and travel – will not recover until the country is effectively clear of Covid-19. Merely delaying the epidemic and “flattening the peak” will not revive the economy, whereas eradicating the virus would.
12. The arrival of infected individuals in the UK is a particular concern, so it is a prerequisite for eradicating the virus that more effective travel protocols are further developed and (ideally) agreed internationally. At present we are importing significant numbers of cases, mainly from Italy, a situation that is bordering on the insane, since any travel risks passing on the virus (there are documented cases of multiple passengers catching Covid-19 on plane flights). Even if they are not passing the virus on en route or in the UK, such cases are diverting scarce contact-tracing and diagnostic resources. In the longer term, travel from infected areas must be more strictly controlled and any arrivals may need to be quarantined for a short period while test results are awaited. Contact-tracing of any cases that slip through must be strengthened even further. As mentioned in my email of 4th February, spurious privacy issues should not be allowed to prevent the publicising of the movement of infected individuals (I’d expect to hear, for example, that someone carrying the virus travelled in coach D of the 12:30 service from King’s Cross to York on such and such a day, so that those sharing the train could come forward).
13. We need to continue to build up our testing capability. At present it is around 2,000 tests a day. It is possible to do many more: New Scientist reported last week that South Korea is carrying out 10,000 tests a day, so why aren’t we? If we can do more tests and turn them around faster (perhaps using new technology), we are more likely to be able to prevent a second UK outbreak of Covid-19. We also urgently need to deploy a “serum test” for antibodies to the virus, which would reveal individuals who have been infected and recovered, helping contact-tracing and also allowing mortality and morbidity rates to be more accurately determined.
14. Because of the risk of reintroduction of Covid-19, it would be preferable to coordinate lockdown measures internationally. This would probably also minimise the overall impact on the global economy. We should therefore be discussing a coordinated response with the EU, other international partners and the UN.
I fear the UK authorities have accepted that a Covid-19 epidemic is inevitable. It seems to me that if we do experience tens of thousands of fatalities, compared to China’s few thousand, whilst our economy flatlines for a long period of time, many will lose confidence not just in the current government (yes, hard as it may be to believe, there are people with confidence in the government), but our whole system of government.
In addition, if this crisis drags on and the epidemic is not tackled decisively we’re going to have to put aspects of our lives on hold for quite some time (perhaps a year or more). For example, how can I visit my elderly parents, given the risk of acquiring Covid-19 en route and passing it on, with potentially fatal consequences?
As I write, the Health Secretary is claiming that “[t]he scientific advice is clear: acting too early creates its own risk.” Apparently the “scientific” advice is that people will get bored after a while and start partying, which makes no sense to me, since, even if we can only manage to sustain a lockdown for the time required to reduce the incidence of Covid-19 by say 90%, it would save more lives doing this when there are fewer cases of Covid-19 rather than later on. All the risks are in fact weighted on the side of acting too late.
And the government’s Chief Scientist, Sir Patrick Vallance, is quoted as making the bizarre statement that: “What you can’t do is suppress this thing completely, and what you shouldn’t do is suppress it completely because all that happens then is it pops up again later in the year when the NHS is at a more vulnerable stage in the winter and you end up with another problem.” But the only way we won’t be vulnerable to a second wave of the epidemic next winter is if we have developed herd immunity by then, which would probably require an 80% infection rate in the first wave, which, as discussed already, we simply couldn’t cope with. The best way to avoid such a second wave is to eradicate the virus now, or at least minimise the number of cases (since it’s only realistic to assume it will continue to circulate at a low level) and stamp on any outbreaks.
Please push for an emergency debate on the coronavirus epidemic and urge the government to immediately adopt the measures necessary to eradicate Covid-19.“
I guess my overall strategy could be termed “contain – eradicate – contain again”, with a research stream of course. And repeat – though we should get better at the “contain” part – until a vaccine and/or effective drugs are available.
The key point in the email above is number 4: it’s the numbers that make Tim’s Plan the one to choose. Both mortality and the time for which there is disruption to normal life in the country and damage to the economy are less than is the case for the government’s plan.
I rather thought it was obvious we would end up in lockdown, like China, if Covid-19 became established here when I first wrote to my MP on 4th Feb that “…transmission of the new coronavirus within the UK has to be stopped at all costs.” (I’m not blaming her: backbench Opposition MPs don’t have a great deal of influence).
And that completes the Covid-19 files.
I can’t believe I’ve actually kept one of my promises. New blog, new leaf!
16/3/20 06:00: Corrected some grammar and typos.