Re-opening to the virus? How the UK government’s conditions for ending the lockdown differ from the WHO.

These are the WHO’s conditions for a safe ending to lockdowns These are very clear and are aimed at eliminating the virus.

  1. Disease transmission is under control
  2. Health systems are able to “detect, test, isolate and treat every case and trace every contact”
  3. Hot spot risks are minimized in vulnerable places, such as nursing homes
  4. Schools, workplaces and other essential places have established preventive measures
  5. The risk of importing new cases “can be managed”
  6. Communities are fully educated, engaged and empowered to live under a new normal

These are very clear and are aimed at eliminating the virus. In China, the point at which disease transmission was under control was when deaths were down to single figures.

As in China, at that point the Health system has to know where any new infection takes place and have the equipment and infrastructure to rapidly intervene, test, contact trace and isolate to prevent it getting out again. This virus is very infectious and spreads very quickly.

At that point, anyone coming in from an area where the virus is still in spate will need to be tested and quarantined if need be and all schools and workplaces will have to have the appropriate preventive measures in place and be fully equipped.

The last point is as crucial as the others. Communities have to know the risks, know the procedures and recognise that this is not a blip that will “disappear like a miracle” (D.Trump) but a threat that will still be lurking at least until a vaccine is produced – which is scheduled to take 18 months if all goes well. So, even when we are out of the woods, we could still meet a wolf; and have to be on our guard.

The UK government puts different conditions. They say

  1. The government must have confidence that the NHS can still provide sufficient critical care and specialist treatment across the UK.
  2. Secondly, there is a need to see a sustained and consistent fall in the daily death rate to be confident the UK is beyond the peak of the outbreak.
  3. There also must be reliable data from SAGE that the infection rate has decreased to manageable levels.
  4. Testing capacity and PPE must be in hand to meet supply for future demand.
  5. There also must not be a risk of a second peak of infection that could overwhelm the NHS.

As the words are not the same, the differences must be deliberate. While some of them sound similar, the devil is in the detail.

  • Being “beyond the peak” can be any time from when death rates start to decline in a “sustained and consistent” way. It does not necessarily mean that the death or infection rate would be under control if the restrictions were lifted.
  • There is no specific mention of schools or workplaces, no mention of imported cases, no mention of having to minimise the risks in vulnerable hot spots.
  • There is an emphasis instead on making sure that the NHS is not overwhelmed. A laudable aim in itself, but when you consider that it is currently being achieved by pre-triage on the one hand and rapid removal of the elderly into hotspots like care homes on the other, you can see its limitations.
  • There is no mention of communities being fully educated, engaged and empowered to live under a new normal, which reflects the UK’s relatively lackadaisical lockdown.
  • Having infection rates at “manageable levels” does not mean the same as having them “under control.” “Under control” means on the path to elimination. Manageable means copeable with, not overwhelming.
  • Avoiding the “risk of a second peak” is not the same as eliminating the virus. Their bottom line is that the second peak should not be so great as to overwhelm the NHS. That could describe the current situation. The NHS is not being overwhelmed, but the UK has the second highest daily death rate in the world.
  • The phrase “testing capacity and PPE must be in hand to meet supply for future demand” implies that there is going to be a future demand. This is not the same as having a system ready and primed to “detect, test, isolate and treat every case and trace every contact”. Managing. Not eliminating.

So, we have a half way house policy here. Just as the UK “lockdown” is half a lockdown.

The danger is that there will be a return with infections at too high a level; so the rate of infection will go up again, without adequate PPE, without a testing and contact tracing system in place – with schools one of the first places to open simply to have kids taken care of during the day so the economy can “open” (in Trump’s phrase) and their mums and dads can go back to work.

This would let the genie back out of the bottle and then require restrictions to come back in to stop it running out of control. So instead of getting a grip and crushing the virus in one determined go, we end up with a reactive yo yo of restrictions going up and down; with the presumption that a vaccine will arrive like the cavalry coming over the hill. The problem with this – of course – is that it might not.

So, an apposite question for Labour (and others) to be asking is why it is that the government is not adopting the WHO guidelines without equivocation.

Lives rest on this.

Are we in a “hokey-cokey” lockdown?

I suspect that we are being subject to “herd immunity” by stealth.

A failure to get a grip.

  • An absence of open source public data in the UK is an indication of this.
  • Publishing data is secondary to knowing what the situation is in the first place. Any data the government publishes – and they should – is just what Donald Rumsfeld would have called the known knowns.
  • Chris Whitty said – rather airily – at the point they abandoned what limited community testing they were doing, that there could have been ten times as many cases out there that they didn’t know about. Almost with a shrug. They didn’t test comprehensively in any targeted way from the outset; so had no idea who had it, or where they were. Put simply, they didn’t, and don’t, have a grip. Laura Kuensberg on the BBC – with her usual direct line to government thinking – has just revealed (World at One, 2 April) that they expected the virus to develop more slowly – giving them up to the middle of May before it hit hard. How they could have such a view in the face of how quickly it actually did develop in China, Iran and elsewhere beggars belief.
  • Further, the only figures they count as coronavirus related deaths are those that happen in hospital after a definite diagnosis and test. People who may die of it at home are not being counted in the official stats. Its all about the numbers and, as the relatively lax UK approach is likely to lead to many more deaths than those in Italy and Spain, you can see why they’d want to keep them as low as possible. Accuracy is a secondary consideration.

 

Alternative facts – or do you trust Mike Pence more than the WHO?

  • Its important to have data to limit the degree to which malignant interpretations of them can be made. As the US death toll rises above the Chinese number – in absolute terms let alone per capita* – it becomes a political imperative for the US administration to cast doubt on the Chinese figures; and/or accuse China of not sharing information in a timely way; even though they had alerted the WHO on Dec 8th and given a full alert on what the virus is and the scale of the danger it presents on Dec 31st; giving the US (and UK) governments two months to get prepared; which both squandered. This is the “alternative facts” strategy; which has to rely on people being prepared to trust Mike Pence and US Intelligence – who have never been known to fib – more than the World Health Organisation; or hoping that broadcasting the accusation loudly and widely enough will be sufficient to bury the facts.
Preparing for a Hokey Cokey half Lockdown.
There’s a rather chilling article on the BBC site today which argues the following.
  1. That most of the people dying with coronavirus are probably dying of something else. The virus is just the final straw and they would most likely have been dead within three months anyway. So the problem isn’t the deaths themselves, its that they will all happen at once, leading to knock on effects that cause more deaths as the hospitals are overwhelmed. Therefore its about managing the virus not suppressing it. This is the logic of the government’s initial declared “herd immunity” strategy in a new form.
  2. The effects of a lockdown will lead to a significant number of deaths anyway. This isn’t quantified. Nor is it related to the actual experience of lockdown in Wuhan. Its speculation designed to make people shrug at the accelerating rate of deaths that are happening. 560 in one day yesterday on a terrifying exponential curve that could double in three days at the current rate, and again three days after that.
  3. The point at which the economy collapses to a point at which more deaths are likely from lockdown than letting it rip is quantified in the article as a 6.8% drop in economic activity (which is about the same as the 2008 crash). I suspect that this is the rule of thumb being used by the government. In China the drop in economic activity was about 20% overall for the quarter affected by the lockdown. That is putting lives ahead of economic returns in a way that the UK government looks very reluctant to do.

We can therefore assume that the UK government will try to play a kind of hokey-cokey part lockdown in an attempt to limit the damage to “the economy” while “managing” the number of excess deaths and the pressure on the Health Service. Given that this government is considerably more adept at coming up with excuses for why they haven’t done things than doing them, I can’t see this working for either.

*As China has four times the US population, a more appropriate comparison.