Is it safe to come out?

The media is currently obsessing over when precisely we will be able to stop social distancing, self isolation and quarantine and the many subtle variations on this. The press is hungry for a date, something to work around, some beacon on the horizon for the readers. The concern is that, faced with too distant a date, people may simply disobey.

It’s a very real possibility but, at the same time, it cannot be justified on current medical evidence. Shutdown was initiated on March 23 at which point in time there were 6650 cases of coronavirus, an increase of around 1000 on the previous day. So if we assume that a daily occurrence rate of 1000 new cases per day is enough to shut down the country, it makes sense that a similar figure should be the earliest point at which we consider scaling down the shutdown and starting to open up again.

You can be sure that, once businesses are reopened, there will be an upsurge in the number of cases. How big an upsurge is hard to predict but, if everybody follows their oft declared intention to party, the rise may be sufficient to reinstate the lockdown.

But even 1000 new cases per day hardly amounts to a medical victory. Projected over the summer, that would amount to around 200,000 cases by autumn and around 8,000 deaths. Far from being a medical victory, the figure is more a pragmatic and political decision weighing into the equation the profound sociological, political and economic damage resulting from shutdown.

On purely medical grounds alone, one would wish to keep the social distancing measures in place until the daily caseload had fallen way below 1000. It is currently around five times that figure. If it takes as long to get the caseload down to 1000 as it has taken to go from 1000 up to the present 5000, then lockdowns will continue, on medical grounds alone, for another 3 to 4 weeks. And all of that is based on the premise that 1000 new cases per day was enough to trigger lockdown and therefore would be enough to trigger the cessation.

In all probability, the epidemiologists and statisticians, making their decisions on purely medical grounds, would rather see a much more substantial and sustained reduction in the number of cases than the token 1000 per day. The politicians doubtless view it differently and will be pressing for an earlier release, if only to preserve those businesses that are hibernating rather than simply going to the wall. Already economists are predicting the worst recession in 300 years.

There is of course also the sociological damage. We have never before had occasion to incarcerate the entire country’s population. But that’s fundamentally what we are doing. Social isolation means exactly that and will be a test (is already a test) for the more mentally fragile of our society. What happens when we unlock those dark chambers? Are we ready for the tsunami of mental illness that will likely follow? Primo Levi once said that a major cause of death amongst the Jews post-Holocaust was suicide, often triggered by an inability to understand why they had survived but others had died. There was guilt for being amongst the saved rather than the drowned.

Each of these three caucuses (medical, sociological and economic) doubtless have different ideas of when it will be best to relieve the lockdown. Clearly each must have their say. And all of these factors must be weighed in the decision to be taken, I’m sure, as a compromise between the needs of all three aspects.

From a purely medical stance, one would not, out of preference, remove the lockdown until either significant herd immunity was in place or a reliable vaccine was in place. Herd immunity can only occur when the majority of the population has immunity. In order to achieve this, much of the population has to be infected. If we knew we could fight the infection confidently with anti-viral agents that would perhaps be our preferred course of action. But the problem is that we have no effective treatment for the illness and therefore to infect the majority of the population is simply not an option. Unless of course one is prepared to accept a death toll in the region of 2 million (don’t even think about it, Boris).

So we have no effective antivirals. What about the vaccine, I hear you ask. I’ve been impressed by the sheer number of people who have said that a vaccine will be here by the end of the year. I think they are perhaps confusing hope with reality. We would like it to be here by the end of the year but that’s not the same thing. But let’s look at our record. As far as I know we have never successfully produced a vaccine for any coronavirus (and yes, there are others – the common cold for instance). So we’re back to square one – our only weapon against coronavirus is to cut of the route of transmission, which means social isolation. The problem with social isolation is that not only do you cut off the route of infection but you also prevent the development of herd immunity. And if you have no herd immunity through infection, the only way is to generate immunity by vaccination and we are still a long way off. Isolation prevents transmission but it also means that people do not have immunity. It’s a catch 22.

In truth, the only solution will have to be one that balances social, economic and medical dimensions. In order to save the economy, we may have to accept a certain level (and likely a high level) of mortality to preserve society. In the end comes down to the disparity between the rationales for imposing and lifting the lockdown. We made the decision to impose a lockdown on purely medical reasons. Economic and sociological implications were given barely a thought. And nor could they have been – the mood of the populace called for action. The government more or less had to respond. But as the lockdown has bitten hard, it has become apparent that we simply cannot sustain a lockdown on medical grounds which might last as much as a year. At that point there would be no economy left and that itself will have taken a toll in terms of suicides and deaths due to deferment of routine and nonroutine surgery and medication. Either way lives will be lost due to coronavirus whether explicitly or secondarily.

Some seriously tough decision making ahead. And I wouldn’t want to be in Boris’s slippers.

Home sweet home…

I’m very fortunate. I have a house with a garden. During the current lockdown I can escape my four walls, weather permitting, and sit in the garden. I’m doubly fortunate in that I have very little work to do and such as there is can be done using a laptop. For me, the lockdown makes very little difference. My friends are largely international, at the end of a messenger or Skype video call. I see them as much today as I did before lockdown. And since my car crash in October, I no longer drive. My friends, the local ones, help out with groceries and so on. Nothing has changed. And of course there is always Amazon if my penchant for retail therapy periodically gets the better of me.

I feel sorry for office workers, compelled to work from home and deprived of the water cooler conversations and office gossip. “You’ll never guess who she’s going out with now – yes, Brian from accounts. That’s right. Gold digger!” Or those compelled to work from home at high power jobs whilst attempting to keep young Freddie or Florence entertained or educated. Who can forget that wonderful video clip last year of the South Korean correspondent attempting to conduct a Skype call with his children invading the room. A brief but wonderful moment where the reality of family life imposed itself upon the illusion of business as usual.

But I feel especially sorry, really I do, for those in flats and bedsitters, unable to leave their cells during the recent sunshine. I feel sorry for those confined against their will with abusive partners, the home a weapon of oppression not sanctuary. Or those Eleanor Rigbys, deprived of what little social contact they have, sinking deeper into that mire of loneliness and depression. For them, lockdown is no mild inconvenience. It amounts to a severance of their lifelines. We should not underestimate how narrow is the mental health precipice along which many are walking. Everyone is facing tribulations of some sort, tests and trials of their resilience and fortitude.

Comparisons are drawn between the deprivations our parents and grandparents had to endure during the Second World War and those that we face in this conflict, fundamentally the Third World War. We may be fighting germs rather than Germans but it amounts to the same thing. And in some ways it has drawn out the same Dunkirk spirit if you will. The same determination to resist. Comparisons have even been made, somewhat laughably, between Boris Johnson’s press briefings and Winston Churchill’s speeches. Hard to believe that there are people out there who cannot distinguish between a blonde buffoon’s stuttering utterings and the timeless oratory of this country’s greatest war leader. But there you have it.

Even at this stage, after less than four weeks of lockdown, some are beginning to ask when this curfew will be ended. As though it was imminent. Maybe that’s how people continue to endure the hardships, by believing in the unbelievable. So let’s be clear on this. Until we have clear evidence that the rate of infection dropping dramatically, there will be no lifting of the curfew. There cannot be. If you believe it will be lifted in the next couple of weeks, you are deluding yourself. We are looking at the beginning of June as a earliest possible date. And in my view, it will be later than that. As far as normal living goes, you can write this year off already. And all of that assumes that we comply with the curfew as it stands, that we stay home, don’t socialise and only leave when permitted. If we fail to do so, the death toll will be even more astronomical.

We are fundamentally mortgaging the entire social structure of the country, indeed the world, in order to beat this virus. And there will come a point when we ask ourselves whether the price is right. There will come a point when we weigh the perhaps irreversible collapse of society against the desire for individual survival. We will have to balance a risky social structure against a future lived virtually as cave dwellers.

How will it end? Will it end? The truth is we don’t have an answer to this. We have done the only thing that we could do to stem the tide of this virus. Isolation. Our only card. And even then, we probably played the card too late. But we don’t know how to end it, how to emerge from our caves blinking in the sunlight at the end of this. Because we neither know what the end is nor how we would recognise it. We can only buy time in the hope that an ending, an ending that will suit us as humanity, can be conceived and implemented. And it’s important that we do. Because, if not, nature is ready with her ending.

An epidemiologist’s dream

There’s no escaping the fact that this is a fantastic time to be an epidemiologist. Often regarded as one of the geeky backwaters of medicine with more hours in the library and behind a computer terminal than actually seeing patients, suddenly it finds itself pushed to the front. Throughout the world, epidemiologists are looking for their shirts and ties, as the media circus draws them in.

And who should be surprised. So much of an epidemiologists career is spent writing papers for dusty journals, looking at small outbreaks of far-flung diseases that people can’t pronounce let alone express any interest. Some 30 years of bookish research, then a chair and the respect of your peers. And as for the general public, you have almost complete anonymity.

Epidemiologists dream of a pandemic. A real monster, spreading round the world in real time. The chance to witness an old-fashioned biblical plague playing out in front of their very eyes. They certainly know about pandemics – they read it in the books. The books written by other epidemiologists. But to witness one first-hand is beyond their wildest imaginings. It’s like all their birthdays and Christmases at once.

Epidemiologists appearing on television! Who’d have thought it. From the token geek on medical discussion panels, to prime-time television with journalists and the general public hanging on every word they say. Graphs and projections. Who could imagine something so big that Joe Bloggs in the pub (well actually in his own home now I hope) would be using epidemiological language and talking of ‘flattening the curve’ and the role of different social behaviours influencing mortality. This is epidemiology.

It’s rather like a physicist being present at the big bang. It’s the stuff of dreams. Yes, there has never been a better time to be an epidemiologist.

Crunching the numbers

The one problem with being a scientist for many years is that you can take the scientist out of science but you can’t take science out of the scientist. It’s in their nature. When I left research science, I didn’t cease to be a scientist.

I still have a scientists instincts, motivations, thoughts and ideas. I cannot leave a piece of data alone without thinking of alternative analyses or different ways of looking at the same. Like all scientists, when I look at data I think “what if…”.

Like so many others I have watched this unfolding catastrophe with a kind of morbid fascination. The same fascination that prevents you from averting your gaze from a car crash. And the numbers emerging from the WHO and elsewhere (Johns Hopkins is a very good page) are fascinating in their insights into each national response to the pandemic. The data are, to use President Trump’s comically inappropriate adjective “beautiful”.

But you have to know how to think about the data. The raw numbers themselves are a code and it’s up to the scientists to decode the information. Let me give you an example.

Take the UK for instance (not that anybody would bother). 8000 cases of coronavirus more or less. 400 dead more or less. On the face of it that amounts to a 5% death rate for the condition. The number of dead divided by the number of cases. 5% is an awfully high figure even for this virus so can it be accurate? Other countries publish much lower kill rates. How can this be?

It comes down to testing. Covid-19 is not the only illness to present with a dry cough. Nor is it the only illness characterised by fever, aches and pains. And it wouldn’t be the first lung infection to mature into pneumonia. So a patient presenting with any or many of these symptoms could well have Covid-19. It’s a fair bet.

But it’s exactly that – a bet and not a certainty. The only way to be sure that it is Covid-19 is to test. Without the certainty of a test result, it is no more than a backed hunch. So it’s clear that you have to test in order to have a firm diagnosis, the correct treatment plan and the appropriate recording of outcome whether good or bad. Individuals need to be traced and tracked through the entire sequence of diagnosis to treatment to outcome.

In the UK, although things are changing rapidly, patients are mostly tested when they present in hospital. Many of these patients will be transferred to intensive care where their outcome will be documented. Not surprisingly, these are very sick people. Many die. So our testing programme in the UK is, until recently, focused on those who present as hospital and are therefore already very sick and thus more likely to die.

In order to get a true picture of the mortality of Covid 19, we need to know how many people in the country either have had the illness or currently have it in a very mild form. We have been told throughout that, say, 4 out of every 5 people who contract the illness will not find themselves hospitalised. We don’t have those numbers because, until recently, it was not part of the testing programme.

Yet these data are critical to our understanding of how the disease spreads and how ultimately it may be defeated. Without this information we are applying controls and measures of uncertain value. Why? Because we can’t assess their efficacy without a knowledge of the whole population. As it stands, all we have is this 5% mortality in the UK. If it turns out that four out of every five recover in their own homes, then we are in reality looking at a 1% rate. Much more plausible.

Don’t get me wrong – an illness which kills 1% of the country’s population, particularly the old and wise, is cataclysmic by any standard. A 5% kill rate on the other hand is apocalyptic.

We also need to be careful of comparing data over different time frames. The number of people diagnosed is straightforward and up-to-date. But the number of the dead does not have the same temporal consonance. Going back to the figures for a moment – 8000 diagnosed, 400 dead – we are looking at different time points. To put it bluntly, most people do not die immediately after being clerked. Patients may be treated for a week, two weeks perhaps, before they die. In this case, the 400 dead should not perhaps be compared with the current 8000 diagnosed but with the figure a week ago. Looking at the date of this way paints a more bleak picture. On this basis, the kill rate is much higher.

Let’s also factor in health service resources. The death rate obviously bears a relationship to the provision of ventilators and staff to operate them correctly. If the number of intensive care beds needed falls below those available, then patients are in with a good chance. If on the other hand the number of beds needed exceeds those available, the outcomes are inevitably going to be worse. In Italy, demand outstrips availability manyfold and doctors are having to triage the arrivals. Triage, most often applied in the battlefield context but then this is a battlefield, means dividing patients broadly speaking into three categories – those that will most likely survive without ventilating, those that will most likely occupy a ventilator and then die and finally those where there is a realistic chance of improving the outcome by treatment. Only the last category will have access to a ventilator. And the doctors in Italy have found themselves having to make those choices.

When the health service resources are inadequate, the death rate rises dramatically. And this is why when there’s been so much talk about “flattening the curve”. I have seen illustrations with graphs, memes and buckets of water. They all illustrate the principle well, that of keeping demand below supply by flattening out the number of cases per week. And on the face of it it looks reasonably optimistic until you factor in the harsh reality of numbers and acknowledged that even the best estimates put demand way above supply. Our health service already cannot cope and we haven’t even begun this battle yet.

Much is said where we are on the curve relative to Italy. Italy has become the tragic illustration of what happens when you don’t get it right. Complacency for perhaps two weeks when the condition wasn’t taken seriously as led to the present viral holocaust. In turn, other governments have learned or ignored the lessons of Italy. Only time will tell.

That is why social distancing, self isolation or whatever we want to call it needs to be taken seriously. Because this is where everyone of us can make a difference. If we become ill, we may need an intensive care bed. And if we are occupying it, somebody else isn’t. By becoming ill, we are in essence depriving another person of life-saving treatment. So when the Prime Minister talks about everybody doing their bit, this is what he means. We have to stay well so that others can stay alive. It’s that simple. For every one of us that stays out of hospital, somebody who needs to will be able to. This is what flattening the curve is all about. Because if we don’t, the alternative is unthinkable.

Mutation is not all bad

People are already beginning to talk a lot about virus mutation, in essence taking the view that the virus is one step ahead of us in our development of a vaccine. The inference is that with every successive mutation it becomes a more dangerous little chap, and we’re left chasing shadows.

I’m no virologist, let me make that clear. But I don’t think that’s the case. My recollection, from the limited amount of microbiology I have been exposed to, is that with time viruses become less pathogenic. Not always but in general.

Look at it from the virus’s point of view, if it had a point of view. The virus has only one purpose in life – to replicate and therefore spread. Any mutation that improves the chances of doing so is likely to be successful. And vice versa. So in terms of propagation of one’s genome, killing the host is not just rather ill mannered but also counter-productive.

You have to remember that being harmful to the host does not improve your chances, as a virus, of proliferating your genome. Actually a pretty bad idea. If a virus is particularly virulent and kills its host in too short a space of time, it actually reduces its reproductive capacity.

It’s a fine balance. The virus needs the host in order to replicate its genome. It’s best chances of doing that are by reducing its pathogenicity or by increasing its infectiousness during the presymptomatic stages in the host. The latter is perhaps more difficult to achieve so in general viruses become less virulent with time. Presumably mutations which cause less damage to the host allow more opportunities for virus transmission.

There are of course exceptions. The 1918 influenza pandemic was biphasic. The first phase, in the early months of 1918 killed many but the second phase in autumn killed twice as many.

There are no guarantees in virus mutation. Each is in essence a throw of the dice. But to mutate to a less pathogenic form makes the virus more successful in its own terms of replication. From a Darwinian perspective it makes sense for the virus to be less harmful. With time, less pathogenic forms will win out. So my message to the coronavirus is to try and be a little less antisocial. Play nice.

*If a proper virologist has time to skim through these ramblings, I would be very grateful. I don’t want to spread misinformation. Or sound like Donald Trump.

The good, the bad and the ugly.

On the whole, this has been a much less depressing weekend than it might otherwise have been. Why, I hear you ask. Because finally we in the UK are beginning to strike back against the virus. The private medicine sector has been co-opted by the health service to help out in this crisis, bringing with it some 1100 ventilators and 20,000 staff. A small army. To be honest we need a large army but it all helps.

A big story and it was interesting to observe how that tasty morsel was given to the journalists. The NHS had, at substantial cost, bought up the private sectors services to fight coronavirus. Don’t get me wrong, I’m grateful, terribly grateful, for anything that will make our chances of surviving this improve. But it’s significant, to my knowledge, that the NHS made the approach. As I understand it, this wasn’t a case of the private sector saying “how can we help you?” It was more an example of Boris saying “what do you want for the ventilators?” Now I may be completely wide of the mark (in which case please correct me) but I have the impression that this was no bargain buy.

In actual fact neither party had any real choice. The NHS needed the ventilators. The private sector had ventilators. Some agreement was bound to be reached. People would not put up with the accelerating daily death toll in the NHS if the private sector was continuing business as usual. But wouldn’t it have been a much better headline if the private sector had made the offer rather than waiting to be asked. As I said before, correct me if I’m wrong but they seem a little slow out of the blocks.

The good?

The good news for me was the way in which small engineering firms (and some pretty big ones – let’s not forget McLaren) have turned their hands to making ventilators out of… Well more or less anything. I saw one man taking an angle grinder to a Dyson vacuum cleaner – and who hasn’t wanted to do that. Everywhere, saws, hammers, screwdrivers and who knows what else are being turned on household appliances to produce contraptions worthy of Professor Branestawm. You’re probably too young to remember him. This is British inventiveness at its absolute best. It’s what happens to men when they have power tools and a shed far enough from the house that nobody can hear what they’re up to. These are men who played with Meccano and watched Blue Peter during their formative years. And I’m not talking about the Johnny come lately’s of the more recent series. I mean Valerie Singleton, John Noakes and Peter Purves. At a pinch I will admit Lesley Judd. We can debate that one.

If anything defines British resolution in the face of adversity it is this. Small-scale, fussy but effective solutions with huge ramifications. Think of cats eyes in the road. Same deal. And if anything gives me hope in this pandemic it is this kind of garden shed engineering. Forget about stealth fighters at $100 million each or whatever it is and are the fruit of design teams bigger than towns. This is a testament to the use of hand tools and gaffer tape. This is what built the empire. This is why men have sheds.

The bad?

Despite being given a substantial smack on the wrists, the British public still continues its pillaging of the food stores. It really is time to stop this nonsense. All this will achieve is rationing. And don’t think the government won’t do it – look at what it has done in the last week. And you really don’t want rationing – you might get broccoli.

But that’s not my biggest bugbear. The thing that is really worrying me is the extent to which people are ignoring the advice, nay instruction, to stay at home for your own benefit and that of others. Only today I saw a troupe of people heading up my street. Three generations of the same family it appeared all in close proximity with linked arms and hugs. I thought initially that they were making some kind of statement but, on reflection, I don’t think that’s the case. I think they just simply don’t appreciate the importance or choose to take the risk. They may be “determined to carry on as normal”. Good luck to them. The virus is certainly carrying on as normal. And that means killing people. Sadly the actions of stupid people will be paid for by everyone. If the isolation instruction is ignored, and in places it is, there will be many more deaths than necessary. This isn’t rocket science. It’s that simple.

The ugly?

Well that’s easy. You don’t need to look further than the White House and its orange occupant. At least the American people are finally seeing the man for what he is. Morally bankrupt and both intellectually and emotionally inadequate. His dawdling and denial cost valuable time. Many more will die as a result.

That’s all for today. Continue isolating. Start isolating. This is not a drill. If we don’t lock down voluntarily, you won’t believe what happens next.

‘The better angels of our nature’

I’m tired of hearing that we are in uncharted waters or that the present viral outbreak is unprecedented. We are and it is. Enough said. Move on.

It’s still hard to imagine that two months ago the coronavirus outbreak in China was a “… And finally” item on the news. Now it is the news. All of the news. Sport is suspended indefinitely. The schools are closed. Contractors are building makeshift mortuaries to cope with the anticipated number of dead. Over 70s and the chronically unwell are more or less under house arrest. For their own safety you understand. Supermarket shelves look like stock images from pre-glasnost Communist Bloc countries. And this is only Friday. More extreme measures will be needed for sure.

And we have seen the worst of humanity – the fatuous stockpiling of toilet paper is the thin end of the wedge. Clearing the shelves of food like locusts is even more unattractive. If it were not for the fact that they queued and paid, it would be called looting. In terms of depriving other people of necessities, it amounts to the same. Perhaps most repulsive of all are those individuals who steal the hand sanitiser from the ends of hospital beds, thereby endangering patient and health service staff alike. And ultimately themselves of course if they happen to find themselves as patients in due course, as many of us will.

We forget that ‘society’ is little more than a veneer of manners, codes and rituals designed to provide order or the illusion of order over a fermenting cauldron of different opinions and behaviours. In the end, we are fundamentally hedonistic creatures, separated from other lifeforms by much less than we would like to believe. We share 60% of the same genetic information as watercress. Chimpanzees are 99% human, genetically speaking. It is no wonder our behaviour, when brakes and restraints are removed, reverts to animalistic, almost feral.

A good friend of mine frequently dissects, for my benefit, the two principal motivators of human action – fear and greed. He is a Skinnerite behaviourist without knowing. And his analysis is entirely reasonable. The stock market, perhaps the most overt embodiment of this, is quick to revert to animal behaviour. Just watch the trading floor as a crash gets underway – it’s like Lord of the Flies.

Fear and greed. And of course panic is the symbolic embodiment of both. We become animals, prisoners of phylogenetically ancient parts of the brain such as the amygdala. The coronavirus outbreak has given our amygdalas full range. That’s why you can’t find pasta or toilet rolls anywhere.

But set against this backdrop of selfishness, I’ve sensed a change. In Madrid, people stood to applaud the emergency workers. Shops are providing food gratis to those on the frontline. Amid the darkness flicker tiny lights of compassion, fireflies of altruism. People are keen to help. Several times my door bell has rung and a neighbour or friend wants to know what they can do to help me. Can they get me groceries? Do I need a lift to the post office? Am I okay for food? Do I have enough toilet paper?

And it goes beyond individuals. Already groups are being formed online to help counter the loneliness of long-term self isolation. Volunteer teams help identify the vulnerable and needy and offer practical help. Gradually people are looking to help.

The frenzied overpurchasing is stopping (mind you, there is nothing left on the shelves to buy, whether in a state of panic or not). Slowly but surely people are becoming less self-centred and turning into better versions of themselves. I believe it. At least I want to believe it. I want to believe that when this plague has passed, when we emerge, blinking in the light, it will be as what Abraham Lincoln called ‘the better angels of our nature‘.

The beautiful game

It’s funny really – I haven’t been to a football match in more than 30 years yet suddenly, as the football authorities shut down all manifestations of the beautiful game, I feel a yearning to be back on the terraces at Elland Road. The moment you tell me I can’t have something, I want it more. And it’s not as though I can claim to be a resolute come-rain-or-shine supporter. So why do I feel this misplaced sense of injustice, just as the once mighty Leeds United, take the top spot in the EFL championship, poised once more to take up their rightful place in the premiership?

Amongst the various options being considered by the footballing authorities in the UK, there are three front-runners – abandon the season and pretend it never happened, stop the season where it is and declare promotions and relegations on the basis of current positions, or try to complete the season in some form later in the year.

Currently all football in the UK is suspended until the first week in April. Obviously the notion that it can be resumed then is fanciful. If a current death toll of 21 was enough to stop all football, the position in a few weeks time when the body count will be much higher is clearly not going to provide a mandate for a resumed kick-off. I think we have to face the fact that the season is over whatever way you look at it. It seems hardly relevant in the face of the current situation, but my preference is for promoting Leeds United on the basis of the current position. In the premiership, that would make Liverpool champions. And rightly so. There has never been a team so overwhelmingly talented as the current Anfield squad.

Ridiculous really that in a time of pestilence, football should suddenly be important again. But then, to quote the late great Bill Shankly, “Some people believe football is a matter of life and death. I am very disappointed with that attitude. I can assure you it is much, much more important than that.”.

Schools – open or closed?

Two days ago we were shocked by the first daily influx of new cases exceeding 100 (in the UK). The government did nothing. Elsewhere in Europe and further, the administrations were closing schools and limiting mass gatherings. Today, Friday 13th, the UK tally of new cases is 208. That’s what happens when you do nothing. I am rapidly growing tired of listening to government talking heads telling us that the measures have to be proportionate and delivered at the right time. Nobody has specified what the right time is. Is there a predetermined number of new cases that will trigger an emergence from this governmental torpor? Is there a time component?

A week ago we laughed at President Trump’s incoherent ramblings in the face of the CDC. At least we didn’t have anyone like that in power. Then we had the briefing from Boris Johnson to the effect that we would all lose loved ones before their time before passing it over to the scientists to do the hard yards, explaining an inexplicable “wait-and-see” approach to the condition. Well we have waited and we have seen. In the space of a week, we have gone from just over a hundred cases to just under 800. Projecting forwards, we will have around 5000 this time next week. Assuming no decisions are taken and implemented by government.

One of the pivotal decisions to be made is whether or not to close the schools. And here, Britain stands very much out of step with the rest of Europe. In Europe governments are beginning to close the schools in the countries. The philosophy is simple – hundreds of kids interacting with each other in the playgrounds and classrooms is a huge potential reservoir of infection. Admittedly it appears that the very young are not particularly vulnerable to this virus but the point is the same. Remove them as a reservoir of infection.

Britain has so far resolutely held firm against this line of action, stating that it is currently unnecessary but with the caveat that they may call upon this measure “when the time is right”. Sir Patrick Vallance, countries chief scientific officer reasons it thus:

  1. You cannot keep large numbers of children at home anyway. They will always find friends to play with.
  2. By being at home, children will require childcare. This will often be in the form of grandparents, pretty much the most vulnerable group of all.
  3. In the absence of grandparents, parents themselves will need to take time off work to supervise their children. Many of these parents are health service workers who really cannot be taken out of the front line without dire consequences.

I have to say the logic is quite strong. It is unclear whether this is a premeditated response rationale however or a post hoc justification for the inertia shown by the government.

Counter reasons are (point by point):

  1. Yes children sent home from school will probably find ways of interacting with their friends. But even the most popular kids will tend to have friends round one at a time. An average school these days is maybe 1000 pupils. Having visitors in ones and twos is nowhere near as harmful as allowing 1000 children to interact in close proximity. Try telling 1000 kids to stay 2 m away from each other. In any case, most teenage boys will simply lock their bedroom door and play on the computer. Social distancing is practically part of adolescence these days. We complain about normally but now misanthropy and social withdrawal are survival characteristics.
  2. Childcare certainly would be an issue, no doubting that. But we live in unimaginable times at the moment that I am sure solutions can be found. Again, most kids with access to a computer will entertain themselves these days. I don’t suppose any of us foresaw that it might be the route to their family’s survival!
  3. Exposing the grandparents shouldn’t be an issue if families are aware of it. In any case that depends on whether the children are already infected. And they are more likely to be infected if they have been at school.

I thought initially that it was a clear-cut issue. Close the schools. Simple. But in actual fact it isn’t. There are counterarguments. And some of these are quite persuasive. At the end of the day it’s a numbers game. Which strategy will result in the fewest deaths? We simply don’t know and in some ways we are part of a gigantic experiment which will answer those questions.

It’s hard to believe, and I can’t quite believe I’m writing this, but the current pandemic is going to provide a wealth of information on how best to handle epidemics. If we pull through this one in reasonable shape, we will know much better on how to do the next one. It’s not an experiment that we would have chosen to make but the sheer variety of different approaches in different countries is gradually putting together what will be the ultimate manual of best practice in outbreak management. Sadly, it looks as though some of these strategies will be losers.

We’ve never played this game before. It’s going to take time to learn the rules. And sadly time, as the Italian premier said, is something we don’t have.

The wrong tense

Yesterday (12th of March), France closed schools, colleges and universities. The US shut down all Broadway theatre, major sporting events and travel to from Europe. The Dutch closed the Rijksmuseum. These are just some of the measures around the world being taken their bid to halt or to slow coronavirus and its relentless progress. And what have we done in the UK?

Nothing.

The Prime Minister has addressed the nation and told us that many more of our loved ones are going to die and that the country was now moving from containment to delay as its strategy.

Big deal.

I judge people less by their words than by their actions. Crocodile tears from our leaders don’t sway me in their favour. So what exactly does the movement “from containment to delay” actually entail?
Principally it involves the Prime Minister saying one thing and doing another.

The tenor of Mr Johnson’s speech yesterday was that the government has a veritable smorgasbord of options available and would be thinking which to best use over the coming days.

This is ridiculous. It’s 24 hours more of the battle that we are losing. 24 hours in which our enemy grows stronger and we grow weaker. There is no half-time in this war. Time in which we tread water is time lost in the fight.

Why are we laying out our options but not implementing them immediately. If viruses could laugh, coronavirus would be rolling on the floor laughing at our inertia.

So what will it take for us to do the obvious and stop large gatherings of people? There must be some kind of trigger point at which the government actually moves into “delay” rather than simply talks about it. What will it take? A day in which the number of new cases rises by 200 perhaps? Maybe a day in which say five people die?

Yesterday the chief medical officer, presumably speaking from a government script, attempted to explain to journalists how the delay strategy would work. And why going for a blanket ban on gatherings too soon was a bad idea because of people’s innate impatience over time.

I can see this argument but I don’t buy it. If you are fighting an enemy that is gaining strength, you don’t give it the benefit of time. It’s all very well telling us, the people, how we are likely to behave, but without any evidence. We simply don’t know how people will behave. We have never faced a plague like this in our history. Every day we prevaricate is a day when we have lost the battle. A day closer to Italy.

I’m tired of hearing what we will do, what measures we will take. I want to hear about what measures we are taking. Tell us that. Because at the moment you are using the wrong tense.