30 years ago

On July 2nd, 1992, exactly 30 years ago, I landed in Dover. Although originally planned as a 12-month research post at Cambridge, it turned out to be a permanent move to the United Kingdom.

I came to Cambridge on a Royal Society-Wolfson Foundation fellowship. The idea was to work on modelling large animal populations in Africa, working with Nigel Leader-Williams and Phyllis Lee @pili_scotland.

However, due to a change of plans, the project was converted into epidemiological modelling. I had done modelling of measles dynamics in 1990-91, and the Cambridge fellowship was a return to this research topic.

In 1992/93 I had the tremendous privilege of working with Bryan Grenfell (he very kindly offered me a house sit in the first two months and on whose door I knocked at 2am on 3rd July 1992), Ben Bolker @bolkerb, and many others.

From this period, I will always remember sitting in Parkside Police Station Aliens Department, waiting to be registered as a visiting Alien.

I must confess, I half expected to see there somebody with green skin, a large head, and several eyes on stalks. Knowing Cambridge, I do not think this would have surprised the very kind lady at the Aliens Department.

Lockdowns again

There is a renewed discussion about the upsides and downsides of lockdowns in controlling COVID-19, and the alternative of protecting the vulnerable.

I stand by what I said in my The Conversation article:

(…) lockdowns can be seen as a failure of other, more gradual public health policies. A lockdown should be seen as an efficient but also very blunt public health tool, to be used in necessity but as part of a wider strategy.

https://theconversation.com/did-the-covid-lockdowns-work-heres-what-we-know-two-years-on-176623

But – in (another, slight) change of heart, I accept @pieterstreicher argument that the initial lockdown should have been followed by a critical evaluation and switch to other containment strategies.

Mark W has from the beginning advocated a “shielding” strategy of protecting the vulnerable; a strategy that I think would have been unworkable and disastrous if applied on its own.

The problem is that we saw lockdowns as the only solution. They gave us time and we used it to develop vaccines.

But we miserably failed to use the time to strengthen the health system. This is why the next waves were so devastating.

So, what do I think about the 2020 strategy:

  • at the time in 2020 we did not have many options to stop/slow down the epidemic;
  • the lockdown had to be applied and should have been applied much earlier;
  • it did work by giving us time;
  • we did not use the time very well.

Hindsight is a great thing, but I believe that with what we knew about the disease then, any other strategy would have led to a collapse of NHS and massive deaths.

What should we have done later – after the initial lockdown? Implement a combined strategy (some form of lockdowns, masks, quick development of treatment) instead of lurching from one extreme to another.

In our 2012 paper, https://link.springer.com/article/10.1186/1471-2458-12-679… we showed that the “middle ground” strategy is the worst solution. Instead, if the epidemic can be stopped, it should be stopped by the strongest measure available. If not, we should apply “soft” management.