As many of you will know, I gave a talk on the coronavirus the other night to Dorset Humanists.
For those of you who might know my thoughts already, the Q&A session at least provides some valuable insights due to the input from several experts. Many of you will no doubt disagree with my claims. I will be very interested in your thoughts below. I will share with you a few such claims and further thoughts that have emerged from the talk:
A new vaccine will probably not be the panacea you are expecting it to be
As I have frequently maintained, the only way out of this is with a viable vaccine or robust treatments. This was what Prof Chris Whitty also finally admitted at the government briefing at Westminster a few days ago. A lockdown mitigates against overwhelming the healthcare systems in whatever context is in question. But all a lockdown does is to move when someone dies from one place in time to another in order to flatten the curve and delay things until better treatments are available or we have more understanding of the virus. It doesn’t mean that, at this other time, a person who is vulnerable to dying from coronavirus will somehow not be vulnerable. They will still be equally as vulnerable, ceteris paribus. Those people who are likely to die from coronavirus are just as likely to die (though they may be some shift with a better understanding of the virus as time advances). The only way around this, at present, is to have a lockdown indefinitely, or at least until a vaccine is developed.
The problem is, vaccines for flu-type viruses are notoriously either ineffective or difficult to create. This is because of the mutability of the virus. We are already aware of a huge number of strains of Covid-19 (33 in China alone as of four days ago), which means that dealing with the virus in terms of a vaccine is demanding. Not only this but, just like flu, it is likely that we would need to change the vaccine every year. The spike that we had in 2015 with regular influenza deaths was as a result of the vaccine not working against that particular strain of the virus.
Vaccines for such viruses generally work to make the sufferer have a greater chance of fewer, less harsh symptoms. They aren’t necessarily the cure-all panaceas that we are led to think they are.
In other words, putting all of our eggs into the vaccine basket, whilst it might be our best bet, is by no means something to rely on in perhaps the way that we are.
The vaccine will need to “rip through” society
Another depressing nugget to take out of the Q&A session is that, arguably, the only way to deal with the virus is perhaps not to deal with it at all, sort of. As Johan Giesecke has stated, the outcome for countries, no matter what mitigation or policy they adopt, will most probably be about the same, give or take. That means that, whether you are Sweden with herd immunity, or Britain with a lockdown, the outcome of deaths will be largely similar, adjusted by population. Even if Sweden’s death rate was double the UK’s, there can be an argument made that, if they don’t shut down their economy, such loss of life is a price worth paying. See The Cost or Value of Human Life. It has been suggested that we should let the virus “rip through” society whilst trying our best to shield the vulnerable and have it give least impact – as such, there is an air of inevitability to it.
This is also predicated on the fact that the only viable way out of this is a vaccine or treatments since a lockdown can’t go on forever. This means that, at some point or another, lockdown will eventually become a sort of slower herd immunity, the ease becomes what I like to term a “leaky lockdown”. We already have leakage in our lockdown as we can see from continued deaths and infections in the UK during a fairly tight lockdown well-adhered to by the vast majority of the population.
Absent a vaccine (further given its potential lack of golden key status), both options are merely differentiated by a lack of overwhelming of the healthcare system achieved by successful lockdown and probably not achieved by herd immunity policies. Other than that, both outcomes look fairly similar over time.
Neither are ventilators a panacea as they come with their own problems
As the ICU expert stated in the talk above, ventilators are problematic: they require an awful lot of effort and manpower before, during and after use, and are very expensive. The patient also often requires a very taxing amount of recovery, in both time and physiological effect. The specialist quoted a 70% death rate in those put on ventilators; this report states it is higher:
In China, 86% of 22 COVID-19 patients didn’t survive invasive ventilation at an intensive care unit in Wuhan, the city where the pandemic began, according to a study published in The Lancet in February. Normally, the paper said, patients with severe breathing problems have a 50% chance of survival. A recent British study found two-thirds of COVID-19 patients put on mechanical ventilators ended up dying anyway, and a New York study found 88% of 320 mechanically ventilated COVID-19 patients had died.
That said, the results are very variable.
Of course, for the many people they work for, they are life-saving. The whole process (well documented in the above article) is thoroughly complicated. I suppose my point is that these measures, whether lockdown, herd immunity, vaccine or ventilators, are far more complex than we initially give them credit for, and we need be wary.
Beware second and third waves
As we come out of mitigations, and we can learn from the Spanish Flu here, we will be in store for some potentially even bigger hits. A controlled easing, if done properly, will result in a very long process since the lag time for measuring impact of each given change in lockdown procedures will be two to three weeks. Change one thing, wait two to three weeks, measure; roll it back or accept it and change another, wait two to three weeks, measure; and so on. Rush these things and we will swamp the healthcare systems.
As time passes, though, more and more of the population will have come into contact with Covid-19 and will have passed through the system. Are these waves largely an inevitability, even if in a different curve shape (deaths from overwhelmed systems notwithstanding)?
All of this is thoroughly pessimistic. We have done such a good job around the world (to varying degrees, admittedly) of locking down in order to mitigate against overwhelming our healthcare systems. There have been many ancillary benefits to this as well as serious challenges (not even considering the economic ramifications).
The million-dollar question will be, of course: will the evasion of the overwhelming of healthcare systems be worth the price paid for shutting down economies? This will be the main evaluation that people will be demanding, though it appears callous. This is what libertarian protestors are shouting about in the US – they think the line has been reached where inconvenience and economic cost is now not worth paying to save lives.
I have been in support of the lockdown here, primarily concerning flattening the curve and saving lives; but that big question remains to be answered for me. And, importantly, I think we will end up not too far from where somewhere like Sweden ends up. People won’t isolate forever. People will want to return to some kind of normal. And the price to pay for this is running the gauntlet with Covid-19. And, if you are vulnerable like me, perhaps over 80, you might even be able to quantify this.
“I could stay inside and have no physical contact with anyone for the rest of my life, or for the next year at least, or I could be damned with it and take an 18% chance of me dying from this thing, dying horribly, or living the kind of life I think I want.”
I do wonder how people will approach this from now on.
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