The government needs to further explain its Coronavirus strategy
BY MATTHEW LESH
In H. G. Wells’ classic, The War of the Worlds, it is ultimately bacteria that forces the invading aliens to succumb.
Humans are today learning the same lesson: despite our advanced technology, a pathogen emerging from a wet market in Wuhan can have truly devastating global effects.
For most this will mean weeks if not months of social isolation and loss of incomes, for many it will mean a dilapidating flu and even pneumonia, and for a few (though sadly not few enough) it will mean lives cut short.
None of this will be pretty. It is not something we should downplay. The social and economic effects as we try to save lives will be huge. I share the view of Matt Ridley, a self-proclaimed “serial debunker of false alarms,” who says that “coronavirus is the wolf on the loose”. Ridley explains that this is new, lethal, spreading rapidly. It may settle down eventually, but for now this is serious.
This is no longer a far away problem. According to the World Health Organisation, Europe is the new epicentre of Covid-19. Many governments and people have failed to take this seriously. Healthcare systems are being rapidly overwhelmed and thousands are dying.
You have a moral responsibility, as an individual, to act to help prevent the spread. Washing your hands is no longer enough. It is time to minimise social interactions. Fewer interactions and smaller crowds means less spread.
The alternative is not pretty. “Our country has universal health care, so patients aren’t turned away from hospitals here,” Italian anesthesiologist Mattia Ferraresi has written. “But in a matter of days, the system was being felled by a virus that I, and many other Italians, had failed to take seriously.” Already 1,441 have died in Italy alone.
In recent days a number of serious questions have been raised about the UK Government’s approach to the crisis (see here, here, and here). The strategy appears to be to allow a large proportion of the population – could be as much, if not more, than 60% – to get the virus over time to reduce peak pressure on the NHS. The people who get it would ideally be young, at much lower risk. The claimed advantage of this approach is that by building herd immunity over the summer months it would limit the chances of it coming back with a vengeance next winter.
The precise messaging on this has been confusing. In response to criticisms, Health Secretary Matt Hancock has written in The Telegraph that herd immunity is not an explicit goal of the Government. “That is a scientific concept, not a goal or a strategy,” he says. Nevertheless, the more ‘extreme’ social distancing methods such as banning gatherings and closing schools have not been put in place (though under pressure the Government has said they’re on the way). This is because the Government’s strategy is to allow a flow of people to get sick in the short run in the hope that it leads to fewer cases in the longer run (see this water metaphor shared by Health Minister Nadine Dorries).
Allowing a large number of people to fall ill in the hope it takes pressure off the system in the longer run is a dangerous strategy. This logic presumes that the Government can turn on and off the tap of contagain at precisely the right time, like a master of the universe. The experience in Italy or France or Spain is that it is difficult to control the timing. We are in a fog of war, we simply do not know the precise number of cases or where they are or how quickly it is spreading. Not only is testing extremely limited in the UK (to about 1,500 a day), people are asymptomatic for, on average, 5 days. The danger is that the system could be overloaded before social distancing is introduced. It may already be too late.
The Government’s strategy could mean accepting tens if not hundreds of thousands of people will die. A back of the envelope calculation of a sixty percent infection rate of the UK population, with the best-case death rate of 0.6% from South Korea, would point to about 250,000 people dying before their time.
This approach raises a lot of questions: how will we ensure that only those at lower-risk get Covid-19 when it is spreading so broadly? Are we certain people can’t get it twice (as at least one person appears to have in Japan)? Is home self-isolation even the right approach (China have separated people with symptoms to be tested and, if found to be positive, they recover in isolation to avoid spreading to family)? Why does the Government think that the impact of closing schools or banning large gatherings would be “somewhat limited”? Would it not help flatten the curve and prevent overrunning the NHS with cases? Perhaps most importantly, why are the UK’s experts using a dramatically different strategy to what appears to working elsewhere?
Singapore, Hong Kong and South Korea have had immense success introducing strict quarantining, shutting down schools, and contact tracing. Their rate of new cases has remained low or dramatically shrunk in recent days. They adopted extreme social isolation very early in the pandemic. Notably, weeks before even where the UK is currently. This has interrupted people’s lives but substantially minimised the spread. It could all turn around when social isolation is reduced, but it appears to be working at least for now. Albeit at different stages, the likes of Israel, Denmark, France, Italy, Ireland and Norway are doing the same.
Despite being weeks earlier in the outbreak, we can already see that the growth in Covid-19 cases in the UK (just under a 33% daily increase) is much faster than Hong Kong, Singapore or South Korea. Frighteningly, we are on a similar trajectory to Iran and Italy. These two countries have put in place extreme forms social isolation only in the last few days – but this appears to be far too late, with hospitals already overwhelmed and hundreds dying.
This maps quite well onto how the historical comparison between how Philadelphia and St Louis responded to the 1918 influenza pandemic. Upon the discovery of the first few cases, St Louis immediately closed schools and banned social gatherings. By contrast, Philadelphia allowed a war bonds parade to go ahead even after the discovery of the first few cases, and did not undertake social isolation till days later. A study that compared the pair found that the peak death rate in St Louis was half that of Philadelphia, and in the longer run twenty percent fewer people died in cities that implemented multiple interventions in the early stage.
The lesson appears to be that to actually ‘flatten the curve’: go social isolation early and go social isolation hard.
The common retort to these criticisms of the UK Government’s strategy is that we should “listen to the experts”. But appeals to authority are never good enough. In fact, we should never uncritically listen to anyone; we should be constantly questioning the logic and evidence. Experts are not a homogenous group, as different responses and criticism by experts of UK’s experts shows, they often disagree. Experts aren’t always right; they suffer from biases and groupthink as well. Therefore, we have vigorous debate and a specific scientific process.
At the absolute minimum, the Government should release the evidence on which they are making many of its contested claims (i.e. social distancing will only “work” for a limited time). If there is a persuasive case, then so be it. If there are problems, sunlight is the best disinfectant.
While our tone should be concerned, we should not be panicked.
We should not underestimate human resolve, we’ve been through much worse. This will be an important reminder of our ingenuity and our entrepreneurialism. Over the coming months we will be creative and inspiring, doctors and nurses will save many lives, scientists will work on this problem and better testing, venture capitalists and pharmaceutical companies will fund solutions.
Now is the time to do what we do best: take this challenge seriously and overcome it.
Matthew Lesh is Head of Research at The ASI and Adjunct Fellow at The IPA. Follow him on twitter: @matthewlesh