Thread by @TonyMcKelvie, A clumsy thread on ‘Getting out of Lockdown’. Some hard choices.The usual [...]

A clumsy thread on ‘Getting out of Lockdown’. Some hard choices.

The usual Dummies caveat applies – for and by.

1/an absurd number...

Coronavirus has reached virtually every country in the world. Each day the virus spreads further, the number of people becoming infected and the number of poor souls dying increasing inexorably.

There is neither an effective treatment for those who become ill, nor a vaccine to prevent infection. In the absence of either, the virus will run its course through the population until such a sufficient number of people have been infected by it that it has nowhere else to go.

Those whom the virus infects acquire an immunity to it, and it is thought that when around 60% of the population have been infected by this virus, the ‘herd immunity’ threshold will be reached. That is, when 60% of us have been infected the virus should stop spreading.

In the UK, herd immunity means ~40 million people becoming infected. Of those, the Imperial College team estimate that 4.4% would need hospital treatment, with 30% of those needing critical care and half dying. It would take ~3 months for the virus to run its course in this way

Taking those Imperial College figures, we might expect ~1.75 million hospital cases, ~500,000 of whom needing intensive care, of whom around 250,000 might die, provided we had sufficient capacity in the NHS. We don't.

The Covid-19 nightmare is hospitals being swamped beyond their capacity to treat. That was the startling and terrifying picture painted in the earlier Imperial College paper: People dying in their tens and hundreds of thousands because there is no capacity to treat them.

Lockdown has been imposed to ensure that the number of those requiring hospital treatment does not exceed the capacity of NHS to provide care. So long as there are sufficient critical care beds (and staff and ventilators!!!), many of those with severe illness will survive.

This week a case study was published by the University of Bonn, focussed on the town of Gangelt. Gangelt is one of Germany’s Covid-19 hotspots. The results are highly significant, and can be read here: https://flutrackers.com/forum/forum/-2019-ncov-new-coronavirus/-2019-ncov-studies-research-academia/847341-preliminary-results-and-conclusions-of-the-covid-19-case-cluster-study-gangelt-municipality

Testing around 1000 residents, the researchers found that 2% of the population were currently infected, and 14% had previously contracted the virus and were now showing serum antibodies. The case fatality rate given these numbers is calculated by the researchers as 0.37%.

Two things are of immediate interest here: Firstly, with a case fatality rate of 0.37%, extrapolating to the UK we might expect some 150,000 deaths before the herd immunity threshold is reached (provided we have NHS capacity), much lower than the Imperial College forecast.

Secondly, and equally importantly, despite Gangelt being a Covid-19 hotspot, two months after the outbreak only 15% of the population had been infected, just a quarter of the herd immunity threshold.

In the UK we have locked down the population to limit the spread of the virus, while increasing the capacity of the NHS to treat Covid patients. Blessedly, it appears to be working. Infection rates are flattening and it seems NHS capacity has not yet been completely overwhelmed.

Now, less than three weeks after lockdown commenced, voices are being raised to ask when it will end. Some demand to know the exit strategy, others the date. When will it be safe to go out again? How long can we continue lockdown before the economy is irrecoverable?

But! The purpose of Lockdown is not to rid us of the virus. If Lockdown is relaxed soon the virus will still be out there, and inevitably, infections will start to increase again. Quickly. We need to figure out what to do.

One approach is to implement a cycle of lockdown and release, each cycle allowing infections to grow to a given point, each lockdown preventing NHS capacity from being exceed. Given the Gangelt case study we might expect six or more such cycles to achieve the 40 million threshold

As more people acquire the virus and recover, the rate of infection should slow and the periods of release might become longer. Perhaps a year from now the immunity threshold will be reached and measures can be largely withdrawn.

There are two substantial consequences of this approach. Firstly, the economy will be hammered for a year while much of the population sits at home, and it is unknown how long can we ‘afford’ to maintain ourselves when there is so little economic activity.

Secondly, with so many NHS resources focussed on Covid-19 cases, the availability of services for patients with other conditions is inevitably diminished. We can expect increased deaths from all manner of non-Covid conditions as treatment is reduced, suspended or withdrawn.

This second aspect may already be apparent in data from Scotland where there has been an unexplained increase in non-Covid deaths in the past last week.

There’s also a very human aspect to this approach that we can’t overlook: Obtaining herd immunity in a controlled manner implies that the virus will run its course, and those who the virus will take will inevitably be taken, just not all at once.

However, the controlled approach also buys time for an effective treatment to be developed. Virtually every public health lab, University biotech department and pharma company on earth is working on this.

The professional and commercial rewards - let alone the human reward – for the researcher/institute/company that finds either an effective treatment for the illness or a vaccine for the virus are profound. There is no lack of motivation in this endeavour.

The Lancet reported last week that there were 322 Covid clinical trials currently recruiting or ongoing worldwide, with more to come. Surely we’ll have positive news on a treatment for the illness soon? Surely? Maybe by the summer? Hope and pray it is so.

If that treatment is a known drug/s that has already been approved for use in the doses required, there’s little to stop manufacture scaling up and treatment commencing by, perhaps, late summer/ early autumn.

Of course, an effective treatment for the illness should greatly reduce deaths, but it also implies that we still need to reach the herd immunity threshold to bring the virus under control, and that means adapting the Lockdown cycle to suit.

In addition to the race to find a treatment, there’s also a race to find a vaccine. This one is more fraught though, as a new vaccine will likely be a new material, and a new material necessarily needs to be tested for safety as well as efficacy.

There is every good reason to ensure that the vaccine doesn’t cause downstream health problems, and those good reasons have been learned the hard way in human experience.

Despite the obvious challenges in finding, trialling and scaling up manufacture of a vaccine, there are grounds to hope that one may be available within 12 months, after which a global programme can commence.

With a huge effort and good fortune, we might have completed a global vaccination programme within 2 years. We should note that in all probability the herd immunity threshold will already have been reached before then.

As we can see, getting out of Lockdown comes with some hard choices:
Abandon Lockdown now and we’ll be back at square one, facing a latter-day depiction of the Black Death played out over three months. Many will die who otherwise would not. Society may break down.

If we apply a controlled cycle of lockdown and release over the coming year to achieve the herd immunity threshold, the economy as we know it will be trashed, and there will likely be many consequential deaths from non-Covid causes.

Continuing Lockdown until an effective treatment is developed means perhaps six months of similar restrictions as now, then an adjusted lockdown cycle to spread infection and deliver treatment. Fewer will die, but ONLY if a treatment is found.

For a vaccine approach, the herd immunity threshold will most probably have been reached long before a programme of immunisation could be delivered.

For some countries, where the virus is at an early stage, where test-trace-isolate can be implemented, and where borders can be securely closed, there is a possibility of Eradication.

That is: A) Measures to ensure the virus is no longer present in the population, and B) ensuring it cannot enter the country thereafter.
A) is difficult to achieve, but it’s being attempted in New Zealand.
B) necessarily implies an indefinite prohibition on international travel.

As I see things, this Dummy, these are the choices facing governments the world over. There are no easy decisions, and each presents very hard choices. Next time you hear a journalist or politician demanding to know when Lockdown will end, ask them which choice they would make.

Meantime, STAY THE FUCK AT HOME

As always, this thread is written by a Dummy. If there are errors in the workings, please point them out.

Ends. TFFT

Latest Threads Unrolled: