Does Boris Johnson knows the risk he is taking with his coronavirus strategy?
14 March 2020, 10:04am
As more and more other countries go into lockdown or opt for mass school closures, there is going to be political controversy over this government’s approach to coronavirus.
The political consensus on the handling of the virus is already beginning to fray. But it is worth trying to understand why the UK isn’t doing what so many other countries are doing. I write in the Sun this morning that the government isn't behaving in this manner because it doesn’t think the virus can be stopped.
One of those at the heart of the government’s efforts says, ‘A lot of the international response is, how do we stop coronavirus? But that cannot happen: It is a global pandemic. What we are saying is, we can’t stop it; but we can mitigate it and save as many people as possible.’
The risk countries that have imposed draconian controls are running is that as soon as they ease back on these measures the virus will flare right back up. The UK strategy is designed to spread out the caseload and ensure that coronavirus doesn’t return this winter, when the NHS would be least able to cope.
In government, they are acutely aware of the risk that they are taking. They know that voters will compare how many people die here with how many people die in other countries and, in the words of one senior source, ‘we will be judged accordingly’.
Even if the government’s strategy is vindicated in the end, there could be several months this summer when it looks like the approach taken in other countries has led to a lower death rate.
But what is telling is the government’s decision to take the more politically difficult path. It shows that they really do believe that this approach is the best way to limit the devastation caused by the virus.
What the government doesn’t yet know about the coronavirus
13 March 2020, 10:14pm
I understand a bit more than I did about what the prime minister, the chief medical officer Chris Whitty and the chief scientific adviser Sir Patrick Vallance are trying to achieve with their Covid-19 policy, what that policy actually is, what they actually know about the illness and - importantly - what they don't know.
Let's start with the most important thing they don't know. This is the proportion of people who will get the virus but will show no symptoms.
It is a hugely important ratio, because it conditions how far the government should take measures to restrict our ability to move around and socialise.
The point is that the more people who get the illness without showing any symptoms, the fewer people will need hospitalisation - which in turn means that the fewer actions the PM would need to take to curb our precious freedoms to be with who we want, where we want and when we want.
But the more people who would have symptoms when ill with the virus as a proportion of the population, the more urgent it is to delay its spread - because a massive surge of seriously sick people would overwhelm our healthcare system.
Just to explain with notional numbers, based on one statistic that Whitty and Vallance seem to have some confidence in, namely that 5 per cent of those with symptoms will need hospitalisation. On that basis, if 30m people got Covid-19, but half of those were asymptomatic (with no symptoms), then 750,000 of us would require help in a hospital during the epidemic's duration. But if the asymptomatic ratio were just 20 per cent, then the Coronavirus burden on the health service would be a near impossible 1.2m newly sick people.
So as I hope you can now gather, a massively important statistic is this ratio of asymptomatic sufferers to those showing any kind of symptom. But Whitty and co. have little idea what it is, and the problem is that there is no available serological test, or test for the viral antibodies in our blood, that would conclusively show who has had the virus, whether or not they ever manifested symptoms.
Huge amounts of work are going on to establish such a test. But it almost certainly won't be ready in time to inform the decision of Whitty, Vallance and Johnson about how much so-called 'social distancing' - staying away from people - to enforce on all of us.
If you are with me so far, let us now examine what Whitty and Johnson want to achieve with social distancing.
Now I understand Whitty has not been instructed by Johnson or the health secretary to restrict his advice to policies that are affordable or do less damage to the economy. That may happen at some point, but so far Whitty has given the advice he believes is best for our health and has encountered no push back.
Which then brings us to his core ambition.
It is, as far as possible, to manage the rate of infection through the population so that it is not so rapid that the NHS can't cope at all, but is not so slow that the ability of the NHS to help people with other illnesses and life-threatening conditions is impaired for months and even years.
To put this in the grimmest possible terms, Whitty's primary function is to minimise deaths from coronavirus, though these deaths may not be directly from the virus itself but also from the inability to treat those who suffer strokes, cancer, heart attacks and so on.
Calibrating all this is spectacularly hard, not just because the government does not know the asymptomatic ratio, but it also doesn't know whether the virus will automatically calm down in summer, only to rear up again next winter, nor does it know whether those who suffer it are likely to acquire immunity for a short while or a long time.
For what it's worth, Whitty's central planning assumption is that this virus will have a spike in numbers soon, and then come back - probably less aggressively - in the winter.
‘Herd immunity’ will be vital to stopping coronavirus
12 March 2020, 9:32am
The key phrase we all need to understand is 'herd immunity' – which is what happens to a group of people or animals when they develop sufficient antibodies to be resistant to a disease.
The strategy of the British government in minimising the impact of Covid-19 is to allow the virus to pass through the entire population so that we acquire herd immunity, but at a much delayed speed so that those who suffer the most acute symptoms are able to receive the medical support they need, and such that the health service is not overwhelmed and crushed by the sheer number of cases it has to treat at any one time.
The government’s experts – the chief medical officer and the chief scientific advisor – have made two big judgements.
First, as the World Health Organisation on Wednesday in effect conceded, that there is no way now of preventing the virus sweeping across Africa, Asia and the Americas – which in practice means that it will be an ever-present threat to the UK, unless and until a mass vaccine is available for use.
Second, the kind of coercive measures employed by China in Wuhan and Hubei have simply locked the virus behind the closed doors of people’s homes.
And just as soon as the constraints on freedom of movement are lifted there, the monstrous virus will rear its hideous face again.
What are the consequences for the UK of these judgements, which the Prime Minister and Health Secretary are accepting?
We will know the detail later on Thursday, after the Cobra meeting of ministers and experts make the formal decision to move from the phase of containing the virus to delaying the inevitable epidemic.
But we already know that at the heart of their plans are increasing the proportion of the population able to be tested and also what’s known as 'social distancing'.
In the first instance, this will mean encouraging anyone showing even the mild symptoms – such as a dry cough – to self-isolate at home.
Boris Johnson is following science in his coronavirus response. (Part 1)
13 March 2020, 12:26pm
Boris Johnson, according to a large Twitter mob this morning, is a reckless libertarian – ignoring the drastic but effective measures being taken against coronavirus in other countries – in the same spirit he once praised the mayor in Jaws who kept the beaches open in spite of swimmers being eaten. A large body of opinion appears to be on the side of Jeremy Hunt, who questioned the government’s strategy on Channel 4 news last night.
But there is a fundamental problem with this narrative – and not just that many of the same people now praising Hunt were lambasting him several years ago as a charlatan, ignoring the advice of experts in the NHS. The government’s policy has quite clearly been informed by the chief medical officer and chief scientific adviser on a very broad platform of evidence.
They were clearly not under duress when they appeared flanking the Prime Minister at yesterday’s press conference: they both calmly explained the reasoning behind Britain’s policy of keeping schools open, allowing sporting events to continue, and not entering the kind of lock-down visible in Italy and Denmark.
The government’s policy has quite clearly been informed by the Chief Medical Officer and Chief Scientific Adviser on a very broad platform of evidence
Why the assumption that other countries have got it right, or that they are acting on better evidence? Hunt yesterday said he would like to see the modelling on which the government’s policy is based. Fair enough, but he might also ask to see the modelling on which Leo Varadkar and Emmanuel Macron have based their decisions to close their respective countries’ schools and colleges – and in Ireland’s case childcare facilities too. Are they evidence-based or are they, like Donald Trump’s EU flight ban appears to be, a spur-of-the-moment decision? What happens to the Irish kids who will no longer be able to go to nursery?
At least some of them will inevitably end up being looked-after by elderly grandparents who ought to be isolating for their own good. And what happens when, as planned, Ireland’s schools reopen at the end of the month? If Professor Chris Whitty is right about the timings of this epidemic, the peak won’t have nearly been reached by then.
There are a few reasons why school closures are not regarded as sensible, not least that children themselves are the least at risk from the virus – although they may well be an important channel of infection-transmission to older people who are at risk.
However, the government’s main argument against closing schools is it would – at a stroke – massively deplete the manpower of hospitals and care homes, because vast numbers of medical staff would be forced to stay home to look after their children.
And at the heart of the UK’s challenge – as confirmed on Wednesday in the Budget with its extra £5 billion for the NHS, as a down payment on the needed extra beds and relevant kit – is how to make sure hospitals have the resources to treat the expected surge in those needing urgent attention.
For what it’s worth, ministers are looking with grim bemusement at the debate in football’s governing bodies about banning the public from stadia.
They fear this fuels alarmism and do not think playing matches behind closed doors is necessary at this stage.
Far more sensible, they believe, is for all of us to become much more wary about physical contact with everyone in our day-to-day lives – whether travelling to work, at work, or at the shops.
And many more of us should take the opportunity to work at home, perhaps all the time, if we possibly can.
To get through this, we all need to become less tactile, more cautious in our physical contact.
And, as the WHO’s Margaret Harris said on my show last night, these social and cultural changes may have to become permanent.