Coronavirus – ‘we simply don’t know’

In my previous post I said that the initial disorientation caused by the eruption of SARs-CoV-2 was ‘evaporating’, but I got that wrong. I had hoped that what was happening was a recovery from an initial shock so that some rational inquiry would emerge among the general population.  This hasn’t happened, at least not as far as I can see.

In part this is due to the mass media, which has a story and are going to run with it; I’m reminded of that great film starring Kirk Douglas – ‘Ace in the Hole‘.  It also reflects the disintegration of the socialist and labour movement that there are no scientific organisations, milieu or debate that could focus and inform debate on what approach is in the interests of the mass of working people.  Instead we have dependence on the state which breeds deference and subservience instead of critical thought.  The illusions that arise are all the greater for their being based on real dependence.  I’d hoped that the healthy dislike and skepticism of Boris Johnson among many would lead people to be more critical, although there is still plenty of time for this.

I have stayed away from BBC News and current affairs, with the exception of the web site, for years and especially after seeing some of the coverage of Jeremy Corbyn, but I tuned in this past week to watch the Prime Minister broadcast announcing increased restrictions and the half hour ‘analysis’ afterwards.  If this is reflective of the rest of the coverage then I have missed nothing.  BBC journalists often complain about the ‘Westminster bubble’ but it is they who are the prime culprits in inflating it; when they are not talking about political personalities they are essentially talking about themselves.  I also watched one of the daily press conferences, and this was much more revealing.

None of the questions asked were answered and the two experts demonstrated that they were more skilful in not answering the question than Johnson.  What answers were given provided plenty of grounds for skepticism.  We were informed that ‘the science is coming from a low base’ and when asked whether it was true that perhaps half the population had the virus, as suggested by a study from Oxford University, the answer was ‘we simply don’t know.’

The Chief Medical Officer stated that it was ‘going to be a close run thing’ whether the health service could cope while another advisor Prof. Neil Ferguson expressed confidence that NHS capacity won’t be breached.  Johnson has got by by with promises that testing, protection equipment, and ventilators etc.will all be coming soon while also claiming that everything is going to plan.  The machinery of Government has ignored offers of ventilators while giving contracts to Brexit-supporting friends who don’t make them, just like it earlier gave shipping contracts to companies without ships.

It absents itself from cooperating with the EU, giving us all a taste of things to come, while lying about why it did it, the taste of things just past.  The only thing more personally aggravating is the silence from the British Labour Party, which is only interrupted by craven agreement with Tory policy and calls for ‘more’; which reminds me of another film – ‘Oliver Twist’.

At the end of February, the Government’s Rasputin – Dominic Cummings – is reported  to have outlined the government’s strategy as “herd immunity, protect the economy, and if that means some pensioners die, too bad.”  It is supposed to have resulted in that strategy being revised on foot of a report from Imperial College London.  This report considers that there are two possible strategies: mitigation and suppression, outlining evidence that the Government strategy was mistaken and that ‘suppression’ of the virus was the only way to avoid a ‘likely result’ of ‘hundreds of thousands of deaths’.

It describes as its main conclusion “that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over.”  The Government strategy therefore appears compromised because the health service can’t cope.  This is why the ‘strong and stable’ mantra of the latest Tory Prime Minister includes the dictum ‘protect the NHS’, which actually means protect the political fortunes of the Tory Government that fought the demands of junior doctors, cut nurses pay and inflicted a decade of unprecedented austerity on the NHS.

The difference between the two approaches is to move the R number, the average number of secondary cases which each antecedent case generates, to below 1, thus reducing the number affected over time.  It argues that only a strategy of suppression can do this.  The study recognises that the main challenge to this is that it has to be maintained indefinitely, until a vaccine becomes available; but it also suggests that there should be periodic relaxations of restrictions when infection numbers reduce and their reimposition when they increase again.

It may be doubted if such fine tuning is possible given lack of data on the extent of infection, the potentially misleading character of the data available as a true indicator of infection rates, and the risk that people will not find it easy or reasonable to open and shut down their lives at instruction from the Government.  The study itself notes that:

‘Once interventions are relaxed . . .  infections begin to rise, resulting in a predicted peak epidemic later in the year. The more successful a strategy is at temporary suppression, the larger the later epidemic is predicted to be in the absence of vaccination, due to lesser build-up of herd immunity.’

 

So what the report doesn’t do, as we can see, is condemn in principle the idea of ‘herd immunity’; in fact it notes that such an approach has been taken before,’by the world more generally in the 1957, 1968 and 2009 influenza pandemics’.

The report also doesn’t factor into its ‘suppression’ strategy the ‘enormous social and economic costs which may themselves have significant impact on health and well-being in the short and longer-term.’  It does assume that on recovery from infection individuals are immune to re-infection in the short term.

The significant assumption on which the study rests is an infection fatality rate (IFR) of 0.9%, based on an estimate of the experience in China. (It should be noted that the paper referenced in the Imperial College study states that ‘we obtain an overall IFR estimate for China of 0.66% (0.39%-1.33%), again with an increasing profile with age.’  That is, the application of the estimate of the IFR for the GB population derived from the estimate for China results in a figure over a third higher.)

The study then estimates the impact of the virus in age cohorts based on this figure and taking account of its increasing severity with age (for much more analysis of the full table see Boffy’s blog here):

Age group (years) Infection Fatality Ratio %
0 to 9           0.002
10 to 19           0.006
20 to 29.           0.03
30 to 39           0.08
40 to 49           0.15
50 to 59           0.6
60 to 69           2.2
70 to 79           5.1
80+           9.3

What this shows is that it is only for those aged 60 and above that the virus contains a significant risk.  As noted, the figures above rest on estimates for China and there has been criticism that decisions are being taken without reliable data. Others have pointed out that many cases of the virus have not been detected, because carriers have been asymptomatic or their symptoms were too mild to report:

‘Research published last week by Jeffrey Shaman of Columbia University in New York and his colleagues analysed the course of the epidemic in 375 Chinese cities between 10 January, when the epidemic took off, and 23 January, when containment measures such as travel restrictions were imposed.  The study concluded that 86 per cent of cases were “undocumented” – that is, asymptomatic or had only very mild symptoms (Science, doi.org/ggn6c2).’

The Imperial College report quotes unidentified cases as 40 to 50 per cent of infections, based on the experience of China and those returning on repatriation flights.

This would mean that the Infection Fatality Rate in the table above would be too high since deaths recorded would be a smaller proportion of those infected, many of whom were ‘undocumented’. This does not nullify the seriousness of the threat to those in older age groups, or to those with a suppressed immune system, or who rely on the immune system for effective treatment, such as targeted cancer drugs.  It means that this is where the real problem lies.

It is also recognised that all deaths of patients with the virus have not died because of it, just as it is well known that all men with prostate cancer will not die of it.  The Government advisor mentioned above noted that one half to two thirds of those dying might have died anyway.

So it is not just that the health service was, and still is, unprepared for a pandemic, which the Government knew, but that the various arrangements that are required to protect the most vulnerable are still not in place.  Lots of initiatives have come from outside Government, which can barely coordinate its own actions, and many of the grand schemes announced by it are like its promises on testing and equipment, they remain promises.  The second category of people who may suffer is therefore health service staff themselves if, as seems possible, they become exposed too much to the virus without adequate protection.

It is therefore clear that the strategy of suppression may go the way of the previous strategy of mitigation.  The Imperial College report states that its preferred strategy involving social distancing, home quarantine, case isolation at home and closure of schools should be in place for five months, not the 12 weeks spouted by Johnson.  It envisages maintenance of such policies for perhaps 18 months until a vaccine is discovered.  This raises the question whether the shift of NHS resources to treatment of the virus for such a long time would have implications for the treatment of other patients.

The report also states that ‘suppression policies are best triggered early in the epidemic’, and ‘for suppression, early action is important’, while the British and Irish Governments cannot be accused of acting quickly, and it also admits to ‘very large uncertainties around transmission of the virus.’

In accepting the difficulties of long term suppression policies it states that ‘social distancing of high-risk groups is predicted to be particularly effective at reducing severe outcomes given the strong evidence of an increased risk with age.’

The report ends by noting that ‘we emphasise that is not at all certain that suppression will succeed long term; no public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time. How populations and societies will respond remains unclear.’

What should be clear is that the promises of the Government have a sell by date and a use by date; promises of delivery of tests and equipment and the mobilisation of additional staff and hundreds of thousands of volunteers will require that these are organised effectively.  If they are not then this will become a political challenge to the Tory Government that no amount of self-isolation will shield them from.

 

3 thoughts on “Coronavirus – ‘we simply don’t know’

  1. Many people are social distancing and isolating to avoid getting the infection, their main pursuit is their own self preservation.

    The preserved self, hallows an instrumental rationality, the original basis of ‘capitalist society’ an appeal to the strongest of the instincts ie for self preservation was the original basis of Hobbes’ philosophy, from Hobbes to Adam Smith, individual self preservation and instrumental rationality arose together, the right of self preservation in Hobbes became the right of comfortable self preservation in Locke and Smith. Professor C.B. Macpherson back in the day called it the spirit or philosophy of possessive individualism, we now just call it classical liberalism.

    The the other reason at work at this time does not belong to instrumental reason, to save others from ending up in hospital or in the graveyard is less about self and more about them.. The Government measures still belong to instrumental thinking, not to over burden the Health Service, stopping too many people looking for medical assistance at the same time. This is an administrative approach. We can see the dominance of instrumental thinking in the fact that all of the public conversation is about statistics and modelling and not about morals. No public conversation is taking place about the morality of the problem posed , individual doctors and hospitals are being left to decide who should be treated first, the young or the old, the rich or the poor, the good or the bad etc. The pretence is that everyone will be looked after without favour or prejudice. I have heard that Harvey Weinstein has the new infection, should he be treated without prejudice or favour? perhaps a twitter poll my come up with the answer.

    Stopping too many getting sick at once is not the same thing stopping the virus, the mass of the people under the law of instrumental rationality should expect to get the virus at some point, if not today, maybe next month or the one after that. In fact most people are deluding themselves that they can avoid getting the infection, they can only do so if a miracle happens, a vaccine turns soon up or a herd immunity develops over a longer time.

    It would be my bet that universal capitalist society will after some political hesitation opt for a full on herd immunity strategy. We already see a loss of patience in some quarters, recent examples Red Bull’s Helmut Marko proposing to bring all his drivers and technicians together to catch the virus and then get quickly back to work, Trevor Kavanagh the associate editor of the Sun going on LBC radio to complain about ‘destroying the economy over this small health panic’ LBC radio has a fine roster of right wing shock jocks, including Farrage. Then we have Peter Hitchens questioning the science and the infringement our civil liberties, meaning his own civil rights and the class that he speaks for.

    If we lived under socialist auspices we would indeed lock things down on the basis of agreement and not of policing, be patient enough to wait for a vaccine or find better anti viral drugs, it might take a year of living with less material comforts, but capitalist society has little truck with patience or abstinence, and will not forgo the loss of the comfort of things ‘commodities that give comfort ;

    ‘The painful relief of pain culminates not so much in the greatest pleasures as ” As in the having those things which produce the greatest pleasures” (John Locke).Life is a joyless quest for joy.’
    Leo Strauss on the political philosophy of John Locke.

  2. Thanks for referencing the table I provided on my blog. However, I would recommend that readers also read that blog post, as you suggest, because it necessary to understand the qualifications I add to it, some of which you have referred to.

    So, for example, as I point out, the percentage figures for mortality need to be shifted to the right by one whole decimal place, because the printed figures are only for “reported” infections. In fact, we know that the actual number of infections is much greater, because the Chief Scientific Advisor, Sir Patrick Vallance, has admitted that the real mortality rate is 1:1,000, i.e. 0.1%, as opposed to the 0.9% assumed by Imperial based purely on those that have been tested. Its only those that go to hospital that get tested. In China, those tested who have had the virus but are now immune to it, are themselves not counted as infected, which itself gives a highly inflated mortality figure compare to the real situation. If, the Oxford study is correct, and half the population is, or has been already infected, i.e. 30 million people, then the real mortality rate, even if deaths treble from here, will be much less even than 0.1%.

    It also means that the number of hospitalisations and deaths would be expected to slow from here, irrespective of the lock down, because if 50% of the population is already infected, the vast majority, around 80% having no or only mild symptoms, then herd immunity kicks in, and the infection rate slows. The majority of deaths is amongst those in the at risk 20%, and the figures show particularly that this affects the elderly. The high mortality rate amongst this cohort, however, is not just because of greater susceptibility following infection.

    A look at news reports recently illustrates the cause. Large numbers of old people are confined within care and nursing homes. the pictures show none of the care workers wearing PPE. This is what happened in Italy as the virus got into the health and social care system. There is no problem per se of carers coming into contact with the virus if they are fit and healthy, and part of the 80%. There clearly is a problem, however, with them passing it on to elderly residents of the home. Once such an infection enters the confines of the care home, there appears little to prevent it ravaging the elderly population within it, because there is an absence of isolation of residents, and no PPE for staff to prevent them infecting residents. The same applies with hospitals.

    The figures are not being released I guess for obvious reasons, but its almost certain that the vast majority of cases requiring critical care, and of deaths will have been of people in care homes and already in hospital.

    The answer is simple that those in the at risk 20% should have been isolated early on. The 80% should have been free to continue work producing all the goods and services the whole of society requires, including all of the PPE required by health and care workers. Those health and care workers should have been provided with appropriate equipment from Day 1. Proper isolation protocols should have been introduced in hospitals and care homes, and should have been implemented on the basis of Workers Control and Inspection by the trades unions. Any health and care workers themselves in the at risk group should have been put on sick leave with full pay, and their place filled by additional workers. To help achieve that, the idiotic Brexit decision should have been set aside so as to allow available EU health and care workers to fill the posts.

    Those in the at risk 20% should have been told to self isolate, and other workers should have impressed on them the need to do so. In return, those in the at risk group should have been provided with all of the resources required for such self isolation, including deliveries of food and other requirements.

    The situation in Italy where food supplies are running out, and social breakdown is starting to occur, indicates where Britain is likely to be in a couple of weeks time, which is no doubt why the government has essentially introduced martial law to an even more draconian extent than it did even in the 1984 Miners Strike. One former Supreme Court judge has described Britain as heading towards becoming a police state, which was always a possibility with a Bonapartist like Johnson leading the government.

    That labour is not standing out against such developments, and there is even talk of Labour participating in a National Government, is a disgrace. In years, or perhaps even just months to come, the behaviour over the last couple of weeks of the Tories will be one marked by infamy. Labour should make sure to be as distant from it as possible.

  3. This whole pandemic phenomena continues to amaze me. It was obvious two months ago what was coming down the track, lord knows there was plenty of advance warning. So many governments have been found out, failing to make even very basic preparations like equipping medical staff with vital PPE. I see tonight on the RTE news some of the required PPE arrived on a specially arranged flight from China. Lets hope it works unlike some of the PPE that has turned up in other countries that has been inoperable. How is it almost every hospital in Europe and America is dependent on supplies coming from a ‘communist dictatorship?

    Now I hear that opinion polls are saying Johnson’s government is doing a good job at dealing with the problem, YouGov says his government has a 78 per cent rating way up than before, Leo Varadkar is praised just as much as Johnson and Joe Brolly is castigated for saying both of them are terrible political leaders. What the hell is wrong with these people heaping praise on abject failure?

    The facts are that the Hospitals have been systematically run down to the point that they have a massive shortfall in ICU beds, not enough trained staff, not enough ventilators, OK this is expensive equipment, but what about the drastic shortage of gloves, masks and even hand sanitiser. And don’t even ask about testing for the virus, the World Health Organisation has been pleading for testing to take place, but the capitalist Governments say they don’t the capacity to do anything more than minimal testing, so minimal that they can’t even test the doctors and nurses etc who are treating the patients.

    In the north of Ireland we have two bio firms that have been doing tests for those who can pay for the privilege, Randox laboratories received the map if the RNA virus very early due to its business connection to mainland China and developed a test. They have large manufacturing facilities in Antrim and Donegal. Channel four sent a reporter to Belfast to be tested as part of a news investigation some three weeks ago.Yet the two local bio firms are not currently assisting the NHS in the North of Ireland. It looks like the reason why, is the usual one, the high price, £112 per test Have not heard anyone say ‘maybe the Emergency Power Government should just take control of the bio firms’,even with the concession that the share holders can have it all back when the crisis is over.

    I will make only one soft prediction. The propaganda line from most western Governments and their advisers has been face masks are not helpful. This point was point to the central director of the S.Korean organisation in charge of controlling the pandemic there, he just rolled his head in astonishment. The masks are obviously needed, the problem is that they are impossible to get the correct masks, and our governments know that they have completely failed to stock enough of then, even to protect the hospital staff in an emergency.

    So now that a number of big Western manufactures have been charged with making the said masks the tune of our Governments will soon change. When the supply is ready, every worker in the land will be told that it is perfectly save for them to get back to work, if they just wear a face mask and wash their hands they will be good to go. My prediction is that in about 6 weeks time everyone will be sporting face masks and the previous Government advice will be quietly dropped.
    The capitalists will be buying the face masks to get the workers back were they belong.

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