A pro-independence blog by James Kelly - one of Scotland's three most-read political blogs.
Saturday, March 21, 2020
A suppression strategy is the ONLY way to protect Scotland's rural communities
Friday, March 20, 2020
UK continues relentlessly with its wholesale defiance of the World Health Organization
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
Tuesday, March 17, 2020
Imperial College paper: "managed epidemic" / "herd immunity" strategy would kill quarter of a million people in the UK
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.
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
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
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.
Saturday, March 14, 2020
Don't follow the herd, Nicola, and don't let's "take it on the chin" - untold numbers of lives will be needlessly lost unless we radically change course and move into line with the WHO's recommendations
(Note: I've copied and pasted the tweets below, because embedding a full thread is a bit tricky. You can see it in its original form HERE.)
"Unlike all other countries, the UK strategy aims to build herd immunity by allowing the steady spread of #COVID19. The government argue it will block a second peak in several months time. Here are EIGHT questions about this HERD IMMUNITY strategy:
1. Will it impair efforts to restrict the immediate epidemic, and cause more infections and deaths in the near term? Evidence suggests people shed virus early, and those without symptoms may cause substantial spread...
...this argues for policies against mass gatherings, for school closures, and for strict national and local measures for social distancing.
2. Will it weaken containment systems (testing, screening, radiography, isolation)? China quickly built a robust nation-wide system of mobilised communities/workers for identifying cases promptly, isolating contacts + treating vulnerable people promptly to contain the outbreak.
3. Does coronavirus cause strong herd immunity or is it like flu where new strains emerge each year needing repeat vaccines? We have much to learn about Co-V immune responses.
4. Doesn’t this herd immunity strategy conflict with WHO Policy? After the announcement of this being a pandemic, Dr Tedros, Director General WHO, said “The idea that countries should shift from containment to mitigation is wrong and dangerous.”
5. Shouldn’t we wait to see the China situation? They've contained the epidemic after 7 weeks of intense national effort. Will their strengthened systems not contain outbreaks quickly? What is their herd immunity? We don’t have serology available yet? It might be substantial.
6. Without an all-out national mobilisation plan for social distancing, are the UK government behavioural and nudge strategies really evidence-based to flatten the peak? Or simply based on models?
7. On the precautionary principle shouldn’t we go all-out to snuff this UK epidemic out, with national mobilisation at all levels, using all possible preventive measures (whether evidence is strong, uncertain or weak) and worry about herd immunity when we have more evidence?
8. Vaccines are a safer way to develop herd immunity, without the risks associated with the disease itself. Is it ethical to adopt a policy that threatens immediate casualties on the basis of an uncertain future benefit?"
Friday, March 13, 2020
World Health Organization: "Do not just let this fire burn"
The best hope is that "social distancing from the bottom up" builds up enough economic pressures that the govt start considering the South Korean strategy. It's clear any change won't come from the govt's medical advisers, who are hellbent on ignoring the WHO's recommendations.
— James Kelly (@JamesKelly) March 13, 2020
In a live press conference, @WHO chief @DrTedros just had the following message for world leaders:
— Rachel Clarke (@doctor_oxford) March 13, 2020
“Not testing alone.
Not contact tracing alone.
Not quarantining alone.
Not social distancing alone.
You must do it all.”
How precisely does @BorisJohnson know better? https://t.co/jNXefhuUyB
"Do not just let this fire burn" says the head of the WHO to European countries. Unfortunately it seems the only people not listening to him are the UK government's scientific advisers, who think they know better and want a huge epidemic to produce "herd immunity".
— James Kelly (@JamesKelly) March 13, 2020
Will the complacent media people saying "we must listen to the science" please, for the love of God, listen to this man, the head of the WHO, who is telling the UK government and its advisers to change course urgently?https://t.co/0xYQ5aTI2s
— James Kelly (@JamesKelly) March 13, 2020
Two days ago, "taking it on the chin" was just a wacky theory. Now, it's being put into practice under the pretext of achieving "herd immunity."
— Joanne Harris (@Joannechocolat) March 13, 2020
Guys: herd immunity only works when the herd has been vaccinated. Otherwise, we call it "natural selection."
Powerful ,authoritative contribution from Dr Michael Ryan of WHO
— Bruce McD (@brucemcd23) March 13, 2020
Speaking from experience of fighting epidemics says work closely with your community, move early and move fast . Leave no room for regret because if you don’t move fast the virus will
Anyone listening in No 10? pic.twitter.com/gS1gyWnrPu
No vaccine and no data on immunity following recovery. In that context talk of herd immunity amounts to social darwinism
— Darius Humperdinkt (@DHumperdinkt) March 13, 2020
It seems ages ago, but Chris Whitty said to MPs a couple of weeks ago that, whatever his personal feelings on the futility of containment, he'd have to take heed of international feeling on whether to attempt it. So why are the UK govt studiously ignoring what the WHO are saying?
— James Kelly (@JamesKelly) March 13, 2020
If it's true that the UK's idiotic response to this catastrophe is being driven partly by "behavioural psychology", you'd think it would have occurred to someone that "wash your hands but we'll make sure you get the virus eventually anyway" isn't the most promising message?
— James Kelly (@JamesKelly) March 13, 2020
Absolutely. And history will record that when some (not enough) of the right things started happening, it was in spite of the government, not because of them. That'll make the UK (sadly including Scotland) almost unique in Europe.https://t.co/ubPQe8tkgs
— James Kelly (@JamesKelly) March 13, 2020