Ok time to stick my neck out and do some more Coronavirus predictions, because you know, why not and these are the things that I think about at 5am!
Previously, when we’d had only 100 deaths in this country, I predicted we’d have at least 30,000 deaths and sadly we past the 30k mark at the beginning of May. I also predicted worldwide deaths would be 1-3 million if we do well, 25M if we do badly. We won’t know until 2022 I reckon what the final count is.
In recent weeks the global news has been awash with stories of clusters of new CoViD case in countries that are releasing their lockdown, and some countries are already reapplying lockdown measures that they released in April.
This is completely expected. See this graph from the infamous March Imperial College report.
Note the dates, it extends to the end of 2021! This is backed up by what happened in the 1918 Spanish flu, where assessment of the US cities’ response showed that some of them had to put lockdown measures in place multiple times before herd immunity stopped it.
There are 4 possible ways we get out of this current crisis:
1) The virus magically disappears.
2) A vaccine.
3) Herd immunity.
4) Test, track, and trace eradicates it.
Lets look at those possibilities in turn:
=== The Virus Magically Disappears ===
This has never happened before with a highly infectious virus like SARS-CoV-2. This virus isn’t going away on its own. 50 years on and HIV is still circulating. This is not a possibility and certainly no foundation for a strategy.
=== A Vaccine ===
Everyone is pretty much pinning their hopes on this. The good news is: it’s got the complete and undivided attention of the world’s scientists, there are many vaccine candidates with multiple human trials already underway.
Now for the bad news: most optimistically, the earliest an effective vaccine can get through the barest minimum of safety trials, get a license in all 195 countries on the planet, agree prices with gov’ts (no doubt the maker will charge a fortune for it!), have at least 5 billion doses manufactured, and then get jabbed into the arm of every person on the planet… well that’s not happening this year is it? At best it’ll be mid 2021 before vaccines are available in any sizeable numbers and every country will be clamouring for stock.
That’s assuming you only need 1 shot, what if you need a booster 3 months later, that would double the workload. But it’s worse than that, a few vaccine facts:
- The world record for a vaccine to go through trials and get a license is currently… 4 YEARS! Measles vaccine work started in 1959 and the first measles vaccine was licensed in 1963.
- There are currently no approved and licensed vaccines for ANY of the family of coronaviruses. There are current trials for SARS (17 years ago) and MERS (8 years ago) but they are not yet field ready.
- There are many diseases we still don’t have a vaccine for, the 2 biggies being Malaria and of course HIV, but many others like: Nipah, Lassa, Lyme, West Nile, Zika, Hepatitis C, Syncytial, even flu jabs only last a year, and none for the “common cold” which is caused by… 4 different coronavirus!
Why does it take so long to get a vaccine going, and why should it for CoViD-19? If you’re going to inject every human on earth (or try to), you’ve got to be damned sure about any side effects. What if it turns out to be another Thalidomide, or worse, that it makes people sterile for example? Get it wrong and you could virtually kill off the human race. That means to be sure, you need to give it to healthy couples, who then go on to get pregnant, and then see how the that baby does. There’s a year of testing right there.
Plus there’s the issue of virus mutation. As mentioned, flu vaccine shots only last a year, because every year the flu out evolves last year’s vaccine and you get several new strains every year. Every year we could see a new CoViD: CoViD-20, CoViD-21 etc. If a vaccine only lasts a year, that’s a big problem.
Oh and don’t forget the anti-vaxxors (indeed how could you!) who believe this is all a plot by the great Satan, Bill Gates, as if somehow his $100Bn fortune wasn’t quite enough for him to buy anything in the world he could ever want, 100 times over. You can already imagine the clamour they’re going to cause if a vaccine is eventually rolled out.
In summary, a vaccine may come but it’s not even close to being guaranteed, and if it does it’s still at least a year away. More likely it’ll be 2022+ before you and I get offered a vaccine jab.
=== Herd Immunity ===
In order for a population to get herd immunity, it needs between 60-90% of the population to be immune. C19 is very infectious, so we’re possibly looking toward the 90% end of the scale.
First the good news: the vast majority of people who get C19 suffer mild (or even no) symptoms. What we don’t know is exactly what % of people who get it require hospitalisation, because we haven’t been doing 100% random testing, but I’ve seen figures around 15% (though I suspect that’s too high and the real figure will turn out to be less than 5%, it’s also very dependent on age and health).
Of those 15% who get to hospital, about 15% again will die. This gives a compound death rate of about 2%, or look at it the other way, 98% of people live. In a population of 65M people in the UK, 2% means we’re talking roughly a million people may die then! This is likely right at the upper bounds of the range, I suspect the real rate will turn out to be 0.5 – 1.0%, so 250,000+. Again we won’t know probably till 2022.
It’s easy to lose sight of the fact that each death is a life of hopes and dreams lost, and a family devastated. I have 2 high risk members of my family, and I have close friends who have lost parents, it’s awful. Please don’t think for a second that a thought experiment into our future in any way means that I’m dispassionate about the impact and suffering this horrible disease is causing.
The facts are that if you’re young and healthy, the chances of you dying from CoViD-19 are very slim, not none, but very small. This gives us an in. 82% of the UK’s population is under 65, and the death rate won’t be anywhere near 2% in the under 65’s. It could be a tenth of that, and diminishing the younger you get.
The best profile for herd immunity is to shield the old, whilst the young develop a herd immunity. If we can get to 3/4 of the under 65 population developing a natural immunity, that would give us 60% nationally, which would mean we’re very nearly there in terms of an effective herd immunity percentage. The disease won’t be gone, but it should be manageable and should not spread easily.
E.g. say there’s an outbreak in a care home. The only way it spreads is if someone catches it, takes it out of the care home, and walks into another one. If all the workers of and visitors to the care home have already had it and are immune, they’re unlikely to carry it out (PPE should keep it off their clothes and hands etc). This also means that healthcare for those residents of the home can be better targeted at treating them, where there are isolated outbreaks.
Now the bad news: we don’t know how long natural immunity lasts. It might be for life, it could be a few years… could it be as bad a few months? If it is short, that’s a big problem for the herd immunity model. We’re also definitely going to see at least 100,000 deaths whilst we build up national herd immunity, and hope that it’s not as high as 250,000+. When we don’t know for sure that natural immunity will last, that’s a tough pill to swallow and will likely impact every extended family in the country.
(Those numbers are based on our current treatment of the disease, which is currently poor as the world scrabbles to understand its effects. If we can figure out a decent way to treat people who get very sick with it, then thankfully fewer people will die and those numbers will decrease. Remember that HIV was once a death sentence, but now it’s quite survivable.)
=== Test, Track, and Trace ===
Many people promote this approach and look at other countries like South Korea and China (outside of Wuhan) as examples of how it can work. The hope is that if we can identify and test people with it early, they and their family can self isolate and stop the spread. Coupled with social distancing and general measures, it can be manageable. Great in theory, not so easy in practice.
For the UK however, it’s already failed. We tried this when C19 was first an issue and there were only a few dozen known cases. It didn’t turn out too well. Let’s look at South Korea who did do it well.
They were well prepared, in schools for example they have infrared temperature monitors and their own stock of full PPE, with training in both. Every kid is temperature checked on entry to school, any with a high temperature are turned away, and the child and family have to self isolate. Kids are rechecked multiple times a day. Any that develop a temperature are isolated by the school nurse, who dons full PPE, the parents are called and the kid and family have to self isolate. They also quickly mobilised 15,000 gov’t workers to manage the whole process of tracing people connected to those infected.
South Korea also had a mandatory advanced tracking app that prioritised safety over privacy. For example there are cases where it gave out so much personal information about identified C19 cases that marital affairs were uncovered! In theory these kind of tracking apps are a good thing, but in the west we have somewhat of an aversion to being tracked by the gov’t. Already there are voices of dismay at the centralised tracking technology behind the UK’s tracking app that’s being trialled currently on the Isle of White.
These tracking apps and other non-pharmaceutical interventions can work to a degree, and have done, mostly in cultures that are more authoritarian. Like China, where facial recognition cameras scan your face every time you enter or leave a building (seriously, in some cases locked gates to/from buildings won’t open unless you scan your face), and there are “social rankings” where “bad behaviour” is punished in ways like preventing you from buying train tickets to limit your travel! Can you imagine that happening here? I can’t.
We in the west value our freedom to a degree that may make such measures inapplicable or ineffective. Just look at the anti-lockdown rallies in the USA for example.
Either way, track and trace won’t eradicate the disease. What’s particularly pernicious about SARS-CoV-2 is that it’s highly infectious, symptoms don’t occur for the first 5-7 days, during which we believe people may be infectious, and some people appear to not show any symptoms at all but are still infectious. This means track and trace will always be playing catch up.
Track and Trace is a mitigation strategy at best, not an eradication strategy. It’s what you use to flatten the curve. At the moment, as we’re in the tail of the first peak, the curve doesn’t need flattening any more. It will reduce the infection rate, but slow down the herd immunity processes.
=== The Human Cost of Lockdown ===
One thing that’s not been mentioned is the cost of lockdown, I’m not talking the economic cost (which is huge!) but the cost in extra deaths, not attributable to CoViD-19. If you look at the weekly Office of National Statistics figures released every Tuesday, at the time of writing they show over 12,000 extra deaths over the lockdown period which are NOT attributable to CoViD-19!
I’ve seen 2 cancer stats (there are normally approx 1,000 new cancer cases every day) one saying cancer diagnoses are down 72%, the other said that over a month where they’d expect to see 30,000 new cancer cases, there were only 5,000! That’s 25,000 undiagnosed cancers in a month. We’ve been in lockdown for 2 months… does that meant there are 50,000 more people out there with cancer but don’t know it? I also know people that do know they have cancer and were in treatment, only to have their normal cancer treatment postponed. If you had cancer, how would you feel about having your potentially lifesaving chemo course postponed?
I’ve seen people say “Safety first, lives are more important than jobs” and I can see the argument for that. However anyone who buys into Mazlow’s Hierarchy of Needs will tell you that safety isn’t first in people’s needs. They need food, shelter and warmth first. Safety is second. And for those things, people need money, which means jobs, which for most means not self isolating.
I know self-employed people who at the start of lockdown publicly announced they were quitting work and staying home, as that was the right thing to do… 2 weeks of £zero income later, they were back working! Safety is not people’s first consideration, sorry, don’t shoot the messenger. This is going to be most prevalent in the counties of the world that don’t have the safety net of a welfare state that can keep people fed.
=== Sooooo, where does this leave us? ===
C19 is not going to magically disappear (unless someone’s god makes that happen, having changed his mind from sending it in the first place, forgive me if I don’t hold my breath). A vaccine is a year or more away, if it comes at all, and if it’s effective for more than a year. But how long do we wait in lockdown, a year? 2? 3? 4 years?!? Track and trace can help, if we’re prepared to give in to unprecedented levels of gov’t monitoring and control, but will only mitigate and slow down the spread, not eradicate the disease.
That leaves us with herd immunity as the only semi-viable option, no matter how unpalatable it is. But it must be done in a way that doesn’t overwhelm the NHS. This means a rolling schedule of on-again / off-again lockdowns. Currently deaths are going down, so we’re relaxing the lockdown, but I reckon that in 2-4 weeks, cases and deaths will start to rise.
Then lockdown will have to be reapplied until the deaths and cases are falling again, probably another 4-8 weeks. What the threshold for that will be is an educated guess at the moment, and depends on NHS capacity. It was great to build the 3 extra Nightingale hospitals, but last time I looked, they were basically empty with only 17 patients in the one in London, and zero in the other 2, so we have capacity. Perhaps they become dedicated C19 hospitals and the rest of the NHS gets back to normal duties, sending any positive C19 patient off to the Nightingales?
Once deaths fall again, lockdown can once again be eased, focusing on allowing the young to mix first, i.e. schools, which are also necessary for parents to get back to work. We rinse and repeat until either: herd immunity starts to kick in and the periods of relaxation get longer and longer; or a vaccine comes riding over the hill like a knight in shining armour, making the company that found it very rich indeed.
I’d like to see the gov’t take a stance and be honest about it. e.g.:
“Right you ‘orrible lot, you’ve got 2 weeks of freedom, then we’re having another lockdown for a month or 2. If you’re under 40, do what you want, but stay away from old people. If you’re over 65, or you have a chronic health condition, you’d better lock that door and keep it locked, and get used to this because this is you for the next year at least. If you’re 40-65 and in good health, you’re likely to be ok, but it’s on you if you catch it and you turn out to be one of the unlucky ones.”
Either way, I reckon we’ll be in a rolling period of lockdowns / relaxation for another 18 months, till the end of 2021. I’ll set a calendar reminder for Xmas 2021 to revisit this and see how things panned out.
I’ve suggest a couple of ideas here, and I expect to have them critiqued. They are not fully fledged strategies, they are ideas / options / possibilities to think about. What do you think? Have I nailed it, or am I way off the mark? Is there something I missed?
Let me know, I’m interested to hear your thoughts, but here’s the deal: you’re free to criticise but how about suggesting what you’d do if you were King/Queen for a day too? Catch me either here, or on the corresponding post on Facebook.