herd immunity crops up a lot in my inbox over recent days

a thread

1/n

a lot now seem of the view that we should just simply do a rebalance of our approach to strategy on harm to individuals vs harm to the economy

2/n

the line of argument is we have got the balance wrong.

blunt tools (lockdown and whatever that means) we have supressed the virus but only delayed the point at which it comes back (as we are now seeing).

3/n

In doing that - we have incurred significant social and economic harm – that will have significant downstream impacts, some of which are very immediate and tangible. Most less so.

4/n

There is an inequitable impact of that social and economic harm (as there is an inequitable impact of the immediate harm from the virus)

5/n

So..... the counter proposition becomes essentially one of herd immunity. We allow the virus to take its course but obviously protect those most vulnerable.

many find it an attractive one

topical now, follow Prof Sikora letter https://twitter.com/ProfKarolSikora/status/1307972101463212032?s=20

6/n

so ... I keep getting asked my view...

which is here

1.herd immunity is a very difficult concept for lots of reasons
7/n

2.the PM was very clear on this yesterday – we cannot live in permanent lockdown, we cannot let the virus rip through unchecked. Implication is we find a middle path

8/n

3.of course protecting the vulnerable is hugely important. Protecting the economy is also hugely important. We cant ignore either. The impact of neglecting either is inequitable.

9/n

4.with the way in which we live (high density communities / shared housing / older folk looking after grandkids etc) it is probably operationally impossible to shield the vulnerable.

10/n

Esp given the sheer size of the community that is vulnerable. Cutting this cohort off from the rest of society for the foreseeable future also has costs. I’ve yet to see a good example of where a shielding policy REALLY works.

11/n

5.of course ....neglects the impact of long covid on younger people.
This is in itself a reason to keep transmission as low as possible.

12/n

6.nobody knows whether immunity post infection is long lasting and robust, or lifelong. If not, a deliberate policy of herd immunity is even more dubious, given the costs of it. Who knows whether re infection is possible.

13/n

7.Herd immunity will develop through natural infection and through vaccination. I remain of the view it is simply not ethical to push a deliberate policy of this. See what is happening in Brazil, India and elsewhere

14/n

8.yes of course be more open about the trade offs and big choices, but don’t neglect the basics of infectious disease control (which NOBODY is arguing for, fortunately!!)

15/n

9.there is a significant human cost to a herd immunity policy. It is unclear that many are prepared to accept this.

10.the middle path is to adapt the way we live and design our structures accordingly whilst never neglecting the basics of virus transmission.

16/n