Saturday, March 21, 2020

A suppression strategy is the ONLY way to protect Scotland's rural communities

Over the last 24 hours or so, I've noticed an increasing number of senior SNP politicians quite rightly criticising people for going to rural areas (for example in camper vans) and putting vulnerable local residents at great risk.  Angus MacNeil posted a photo of preparations that had been made in Barra for anyone requiring emergency medical treatment, and he described them as "third world" in nature, lacking almost all of the necessary equipment.  He begged people to stay away from the island.

So there's a growing awareness in the SNP that the only way to protect rural communities is by means of a suppression strategy, ie. by stopping those communities from being exposed to infection in the first place.  That being the case, it's extremely hard to understand why Holyrood was, until only a few days ago, in complete lockstep with the insane "herd immunity" strategy of the UK government which would have entailed deliberately allowing 60%+ of the population to be infected over the coming weeks.  I'm sure you don't need me to paint a picture for you: if that had happened, there's no way rural areas would have been spared.  How did we get into such a grotesque position?  Did people in the SNP just not join up the dots and realise what they were signing off on?  Were they too in awe of a handful of London scientists to ask even the most basic questions?

Even now, it's far from clear that the UK government's chief advisers Chris Whitty and Patrick Vallance are actually sold on a suppression strategy.  Reading between the lines of today's illuminating BuzzFeed piece, it seems that they're reluctantly going along for the time being with the suppression measures described as absolutely essential by the Imperial College paper, but are refusing to acknowledge that anything has really changed.  That leaves open the disturbing possibility that their influence could see the UK backslide into a "take it on the chin" approach.  Can we be assured that the Scottish Government are privately making representations to ensure that doesn't happen, and that rural communities (and the rest of the country, for that matter) are protected?  

I must say that Jason Leitch's Grand Complacency Tour of the TV studios hasn't inspired any great confidence that the Scottish Government's own advisers are doing anything other than showing total deference to whatever the London "science" happens to be today.  I'd suggest it's time for SNP backbenchers to speak out and urge that the UK should start following the real science and adopt the recommendations of the World Health Organization on suppressing and controlling the virus - which are about as far removed from Whitty's and Vallance's reckless outlier views as it's possible to be.

(By the way, none of this should be interpreted as a criticism of Angus MacNeil, who I know has been speaking out.)

Friday, March 20, 2020

UK continues relentlessly with its wholesale defiance of the World Health Organization

I've just been watching a news briefing by the UK government's Chief Medical Officer and Chief Scientific Adviser, and it was an extraordinarily disheartening spectacle - it was as if time had stood still and the widely-briefed change of strategy from a few days ago had never even happened.  Yet again, Chris Whitty talked dismissively about the key recommendation of the World Health Organization to test every suspected case and trace all contacts as if it was some sort of fringe position taken by those who were "critiquing the science", rather than the international gold standard that it is.  He used a straw man argument to justify the abandonment of test-and-trace, suggesting that the practice is only supported by people who want "to make the virus go away" - but of course that's not the stated objective of the WHO, who merely suggest that the pandemic is "controllable" by means of test-and-trace.  Although testing in the UK will be ramped up, it doesn't seem to be with the intent of actually trying to control the epidemic - to a large extent it seems the aim is merely to prove Whitty's pet theory that a massive hidden wave of asymptomatic cases brought the outbreak in Wuhan to a natural end, which if true might be a get-out-of-jail-free card in this country.  But from what I can gather, that theory is regarded by most experts as optimistic at best and downright eccentric at worst.

And the situation is now worse than one of Whitty merely defying the WHO.  He also appears to be ignoring the recommendations of his own modellers, because of course the Imperial College paper reached the definite conclusion that a suppression strategy would have to be followed until a vaccine is available.  Incredibly, Whitty once again rubbished any suggestion of holding on for a vaccine.  If the modelling is right, that means inevitably at some point that the UK government's lack of sufficient action will lead to the NHS going into meltdown, with the potential for hundreds of thousands of needless deaths unless there's a change of course.  My own view is that a change of course would be bound to happen sooner or later in those circumstances, but I had been nursing the hope that the Imperial College paper marked the decisive turning point and that we no longer needed to rely on the UK advisers seeing the light when calamity struck.  It seems that may have been too optimistic.

There were a few crumbs of comfort - I didn't hear any mention of 'herd immunity' as a goal, or of the idea that it's actively desirable to let the virus spread as widely as possible in case it pops up again in winter.  (I didn't quite watch the entire briefing, though, which means there's a small chance those things may have been mentioned in the part I missed.)  So perhaps the impossibility of 'herd immunity' working has been grudgingly accepted.  Vallance also reiterated the objective of keeping deaths down to a few thousand.  But that leaves us with a mystery, because the Imperial College paper was adamant that such a 'low' death toll would only be possible with a full-on suppression strategy.  Do we just have two very stubborn men here who can't quite bring themselves to pull their public narrative into line with the steps that they privately know will have to be taken?  We'll have to hope that's what's going on, because the alternative is too horrible to contemplate.  There was some vague chatter about international technological progress providing the solution, so maybe what we're looking at is a modified version of the Imperial College recommendation, with some sort of suppression-lite strategy for a while, followed by the development of effective therapies as an exit strategy, as opposed to the farther-off development of a vaccine.

None of this exactly inspires confidence, though, and there must be a high probability that the weird mix of half-measures we've seen from the government thus far means we're hurtling headlong towards an Italian-style catastrophe, and a total lockdown as an emergency reactive step.  If a lockdown is near-enough inevitable anyway, it would be far better if it happened in an effort to stop us getting into a deep hole, rather than in an effort to get us back out of it.

Thursday, March 19, 2020

It's simply a fact that, until a few days ago, the UK government were pursuing a strategy that would have led to a large number of avoidable deaths

I've just had another exchange with Iain Macwhirter, who seems extremely muddled about the distinction between a 'herd immunity' strategy and a 'suppression' strategy - he thinks that herd immunity will somehow still be pursued during suppression.  That's not the case.  Although suppression doesn't wipe out the virus completely, it keeps the numbers so low that herd immunity is not achieved until a vaccine is available.

This tweet of mine seemed to particularly anger Iain -

"Herd immunity was a trade off. It did accept a number of deaths and severe illnesses as a price worth paying for getting back to normal more quickly. The only thing that has changed is that the numbers involved were far greater than the govt realised."

Iain replied that there was never any "callous calculation" in the herd immunity strategy that would have led to people dying needlessly.  He claimed it was "disgraceful scaremongering" to suggest otherwise.  But I'm afraid it's simply a fact that belatedly accepting that a suppression strategy is viable constitutes a tacit acknowledgement that the infections, illnesses and deaths associated with the herd immunity strategy had never actually been unavoidable.  Until a few days ago it was being pretended (not least in Jason Leitch's grand tour of the TV studios and in Iain's own Sunday column) that they somehow were unavoidable.

It's worth taking a look at this video from 11th March by Professor Neil Ferguson, the lead author of the Imperial College paper.  He sets out absolutely straightforwardly that the herd immunity (ie. "mitigation") and suppression strategies are binary choices, and that each option has its downside.  The downside of suppression is the length of time that social disruption will have to last, and the downside of herd immunity is the avoidable loss of life.  The politicians had to decide which was the lesser of the two evils, and until last week the government were plumping for the excess deaths.  Iain may or may not believe that was justified based on the known facts at the time, but to claim that the choice never even existed is deeply disingenuous (or delusional).

So what changed?  It's quite simple: a few days after he made that video, Professor Ferguson and his colleagues told the government in no uncertain terms that there was essentially no longer any choice at all, and that suppression was now the only game in town.  New modelling showed that pursuing herd immunity would have broken the NHS.

Tuesday, March 17, 2020

Imperial College paper: "managed epidemic" / "herd immunity" strategy would kill quarter of a million people in the UK

As you may have seen, a paper from Imperial College has concluded that the "managed epidemic"/"herd immunity" strategy followed by the government until now is simply not viable, because demand on the NHS would exceed surge capacity many times over, resulting in the deaths of 250,000 people in the UK.  For comparison, the UK death toll over six years of the Second World War was 450,000.  We all know Boris wants to be Churchill, but that would be taking it to an extreme.

I don't want to tempt fate in the way that some journalists have done tonight by taking it as read that the government will actually take heed of this paper.  Admittedly, it's hard to see how they can ignore it, because it's essentially an update of exactly the same modelling that gave rise to the "herd immunity" strategy in the first place.  But if we're now going to see movement towards a Chinese/South Korean-style suppression strategy, it's puzzling that there has been no sign yet of any U-turn on the decision to give up on testing of suspected cases and subsequent contact tracing, which the WHO have repeatedly made clear is the key part of any suppression drive.  Hopefully we'll see progress on that as time goes on.

It's incredibly frustrating that it's taken this long for the penny to begin to drop, when simply observing the experience in China could have provided a short-cut and saved many lives.  I recall watching an interview on the BBC News channel with a young doctor in Wuhan a few weeks ago, and he said the following -

"It turned out to be a pretty good idea to clamp down on travel, right?  If it had been done earlier, it might have had a bigger effect."

"The mortality rate with this disease is still far too high."

"Other countries need to be very, very careful with this virus."

We should have listened to him from the start.  But better late than never.

Monday, March 16, 2020

The UK is *choosing* to have a mass epidemic. It's not a necessity.

It's worth taking a step back at this point and recalling where we were a few weeks ago.  Why did the UK decide in the first place to start defying the World Health Organization by no longer taking sufficient steps to suppress the virus?  The main argument seemed to be that there was no point in any single country trying to control the virus within its borders (as both China and South Korea have shown can successfully be done) when spread is global - in other words, in an interconnected world, a country cannot protect itself from a pandemic.

But you may have noticed that the world has changed a fair bit over the last few days, let alone over the last few weeks.  Countries within the EU's Schengen passport-free zone have either closed their borders entirely or introduced strict border controls.  Remarkably, even Germany have done the latter, in spite of Angela Merkel insisting only a few days ago that free movement was sacred.  Countries further afield that have relatively low infection rates, such as New Zealand, have introduced quarantining for all arrivals.  Many of these measures are billed as temporary, but the likelihood is they'll be extended again and again.  Some countries may well try to stick it out until there is a vaccine, or at the very least an effective treatment.  The interconnected world is essentially gone for the foreseeable future, so that excuse for UK inaction no longer exists.  If we took South Korean-style measures to suppress the virus and then introduced quarantining to prevent it from being reimported, we would not become international pariahs - we'd be applauded for doing the right thing.

Once again, I recommend this interview with the WHO's Bruce Aylward for anyone who wrongly thinks that the virus cannot be controlled, or that it can only be controlled with authoritarian measures that would not be viable in this country.  The key is large-scale testing and meticulous contact tracing - something that the UK has just inexplicably turned its back on.  We were told by Chris Whitty that the "early stages of delay" would be very similar to "contain", with continued testing-and-tracing, but that turned out to essentially be a lie.  We've gone direct from "contain" to "mitigate" without passing Go - something which the WHO begged all countries not to do and warned would lead to the health system being totally overwhelmed.  Ironically, that just makes the most authoritarian outcome (total lockdown) more likely, not less so.

As far as the Scottish Government's role in all this is concerned, it's true that devolution means there are some things they can do and some things they can't.  But to the extent that their actions are helping to facilitate the UK government's plans to allow the virus to spread, they need to urgently look at themselves in the mirror and ask themselves why they're doing that.  If it's because they think there's more political cover in mostly going along with whatever the UK government decide, or if it's because they fear being lambasted for breaking a UK consensus, then those are the wrong reasons.  Nicola Sturgeon and her ministers should be taking every possible step to suppress this virus and to protect the people of Scotland, no matter what the political cost.

Sunday, March 15, 2020

The precautionary principle dictates that you do everything necessary to keep people alive for now, and that you solve hypothetical future problems if and when you face them

It's been interesting watching the evolution of Iain Macwhirter's views over the last few days about the UK's "herd immunity" strategy - which defies the wishes of the WHO by deliberately allowing the virus to spread and infect 60%+ of the population, in order to avoid a hypothetical "second wave" later on.  When I first spoke to Iain about this, I think he hadn't quite grasped the scale of what was being talked about - he thought that only a limited proportion of people would have to be infected to generate herd immunity.  A couple of days later, the penny seemed to have dropped and he started wondering aloud whether it was the UK or the rest of the world that was making the huge mistake (a useful rule of thumb when you ask that sort of question is that the answer is most likely to be the UK).  But now he's come full circle, and has penned a column today praising Nicola Sturgeon to the skies for ignoring 'people on Twitter' and listening to the UK scientific advisers instead.  The point he neglects to make is the one he made himself only the other night - ie. that first and foremost it's the experts of the rest of the world she's ignoring, not just 'people on Twitter'.  I don't doubt for a moment how difficult it would be for her to depart from the advice she's receiving directly, but when there is such a huge difference of view between the UK advisers and the leading experts of the World Health Organization, there comes a point where it's necessary to consider the strong possibility that the WHO are right and that the UK advisers are wrong.

Iain said to me a few minutes ago that Nicola Sturgeon would be guilty of dereliction of duty if she ignored the UK advice and people died as a result.  But that point is completely upside down.  The UK advisers want deaths to occur on a mass scale over the next few weeks and months to avoid the hypothetical second wave.  The WHO say the opposite - that the most stringent measures should be taken over the next few weeks and months to keep people alive.  Given that the second wave is an untested, unproven theory, the precautionary principle dictates that you keep people alive for now and then solve the hypothetical problem when and if you actually face it.  I strongly recommend this article in the Guardian by an epidemiologist (who thought the herd immunity strategy was "satire" when he first heard about it).  About the second wave, he says -

"Let me be clear. Second waves are real things, and we have seen them in flu pandemics. This is not a flu pandemic. Flu rules do not apply. There might well be a second wave, I honestly don’t know. But vulnerable people should not be exposed to a virus right now in the service of a hypothetical future."

Incidentally, you may have heard that community testing is being rolled out in Scotland to monitor the spread of the virus.  That's better than nothing, but it's important to be clear that it doesn't come even close to bringing us into line with the recommendation of the WHO, who want every suspected case to be tested, with close contacts traced (if the test is positive) to interrupt the spread of the virus.  We still won't be doing that.  Community surveillance mainly seems to be a passive exercise to help us "predict the peak".

UK lockdown petition

A commenter on the previous thread asked me to publicise the petition on the UK parliament website calling for the UK to implement an Italian-style lockdown, and I'm happy to do that - you can sign the petition HERE.  I know there might be a debate over whether now is the time for a full lockdown or merely for a French-style 'lockdown-lite', but regardless of whether you agree with every dot and comma of what the petition organiser is calling for, I think it's still very worthwhile to sign.  It's a good way to demonstrate the strength of feeling against the UK government's reckless and dangerous decision to completely disregard the recommendations of the World Health Organization on how to tackle this outbreak.

It's worth stressing that although the WHO acknowledge that lockdowns can play an important role when the situation has spiralled out of control, they don't think lockdowns are sufficient.  The most important thing of all is to interrupt the transmission of the virus by detecting every case and tracing all close contacts.  So even if the government agree to a lockdown (or more likely are forced into it by an Italian-type catastrophe), a second U-turn would then be needed - because they've essentially given up on testing-and-tracing.  They've announced that in future only hospital admissions will be tested, which means that mild cases will be completely missed and the close contacts of those people will continue spreading infection still further.  The excuse given for this crazy decision is that the world gave up on containment when the virus spread beyond Asia and that a mass epidemic is now inevitable.  Which is an odd claim, because the WHO are loudly repeating day in, day out, that this is a controllable pandemic and that every country can and must pull out all the stops to control it in the way that China and South Korea have demonstrated is entirely possible.

If this situation wasn't so unutterably tragic, it would almost be laughable.  The people who deliver pious lectures about "following the science" are the ones who are blithely ignoring the pleas of the world-leading experts of the WHO, and yet they seem oblivious to that irony.  Instead they're putting all their faith in a handful of UK scientists who are firmly in the minority of international scientific opinion.  And let's be frank - the Scottish government are as guilty of that as anyone.