“Freedom day” and herd immunity

A quote from the Politico newsletter this morning, which shows very clearly that we are back to the idea of “herd immunity by infection”:

A government official defended their position to Playbook last night by conceding that millions of people will catch COVID in the next few weeks, but arguing that the vast majority will have only mild cold or flu like symptoms thanks to being double jabbed, and that younger people who have only had one dose of the vaccine are very unlikely to be hospitalized. The hope among government scientists, the official said, is that the explosion in cases, coupled with the vaccination program, will build so much immunity in the population that cases will eventually drop back down and something much more approaching normality can be achieved.

https://www.politico.eu/newsletter/london-playbook/politico-london-playbook-ping-of-fire-fino-3-percent-pay-rise

This agrees with the news regarding modelling done by the UK government earlier this year, as reported by Byline Times a month ago:

The Cabinet Office incorporated ‘herd immunity by natural infection’, alongside vaccination, into all the modelling used to develop Boris Johnson’s ‘roadmap’ out of lockdown earlier this year, Government documents examined by Byline Times reveal.

https://bylinetimes.com/2021/06/24/the-ghost-of-herd-immunity-still-haunts-boris-johnsons-roadmap-out-of-lockdown/?s=03

Any increase in deaths in England due to COVID-19 as of today will be a direct result of this political decision taken early this year.

Masks and COVID-19 pandemic

A really good overview of the contribution of masks to suppressing the spread of COVID-19 has just been published in The Conversation. It is a very good article and I thoroughly recommend reading it. In this post, I want to concentrate on one of the seven points that are mentioned there.

Countries that quickly introduced masks – primarily Asian countries with SARS experience – seemed to be much more successful in suppressing the initial outbreak in March-April 2020.

https://www.ajtmh.org/view/journals/tpmd/103/6/article-p2400.xml

This figure comes from a very interesting paper by Lefler et al, 2020, which analysed data from March-April 2020 and categorised the outcomes of the pandemic (cases, deaths) in relation to lockdowns and mask-wearing. Essentially, this figure shows that countries that introduced masks earlier suffered much lower deaths during the initial period of the epidemic.

This reduction could have been due to other factors than just mask wearing. However, Lefler et al, 2020 actually consider these different factors (like lockdown, obesity, age) and find that mask wearing – or not – was the main factor determining the death rate in these countries (in fact the most significant one).

The authors of this study include a graph that demonstrates that the longer it took for a country to introduce masks, the higher the death rate was:

https://www.ajtmh.org/view/journals/tpmd/103/6/article-p2400.xml

Here, the start of the outbreak is 5 days before the first case reported, or 23 days before the first death (whichever was earlier) and the duration of the outbreak without masks is defined as the time from the start of the country’s outbreak until masks were recommended or until April 16 (whichever came first).

The line is the linear regression – note the logarithmic scale of the vertical axis, meaning that the differences were actually quite large – about 1,000 times from one end of the regression line to the other. In other words, countries that introduced the mask 12 weeks or so into the outbreak suffered 1,000 times higher mortality than those that started immediately.

Or, each delay of 2 weeks from the onset of the outbreak causes a 10-fold increase in per-capita mortality.

We of course need to be careful in the interpretation of the results. There were certainly many factors that influenced the outcome of the first wave. I have not seen an analysis extending this study to later stages of the epidemic. But, as The Conversation article reports, there have since been multiple lines of evidence showing that the virus spreads through the air (either by droplets or by aerosol) which points to masks as a key way to control.

Why is it so important now to read into this – quite old by current standards – paper? There is a current discussion in the UK on whether masks should continue or not when all other regulations are dropped on July 19th. SARS-CoV-2 is airborne and it is still spreading, so masks should continue to be worn, especially in places of high risk.

Moreover, even where and when it is not compulsory to do so, it should be socially acceptable for those who feel at risk – or those who might be ill – to wear them.

A disclaimer: I do not like wearing a mask, although I have invested in a high-quality one by Airinum having worn similarly excellent homemade masks at the start of the epidemic. But I am really puzzled by such a strong resistance to the idea of mask-wearing. Even in Western countries, we are taught from childhood that we should be doing things that protect us – and others – from risk, even if it comes with a cost. “Do to others what you would have them do to you” is the Golden Rule widely accepted in our culture. How is it then that so many people in the West feel so strongly against mask-wearing?

Freedom or “freedom”

The UK government is now (July 13th) determined to relax all pandemic restrictions while seeing the exponentially increasing numbers of people ill, taken to hospital, or dying. Scottish government (for those who are not familiar with the British government, Scotland is part of the United Kingdom but retains quite a level of independence) is more cautious and I suspect will get a massive bashing from many people for not allowing as much “freedom” here as in England.

The UK government is setting its policy in terms of “health or freedom”. It is ignoring scientific evidence of the impeding large outbreak and arguing that it is necessary to reopen to save the economics. It is removing all restrictions while the number of cases is growing exponentially and hospitalisation, ICU and death numbers are growing. On 6 July, the Health Secretary Sajid Javid told the House of Commons that: “freedom is in our sights once again”.

The following tweet exchange illustrates this attitude:

I am finding this attitude very disturbing. Firstly, I know a lot of people in India and they have been terrified by the outbreak and its consequences. They have been highly critical of their government. No, I do not think “NHS is not swamped India-style” is a criterion by which we should be judging the UK government.

But I also think that the “freedom or health” dichotomy is completely wrong.

An extreme version of the libertarian approach argues that the government intervention should be minimal and that citizens themselves should be able to mutually agree on the right balance of what we can or cannot do, possibly with help of the free market. This philosophy underlined Brazil, Sweden and Trump/USA approach to COVID-19 pandemic and has now resurfaced in Boris Johnson decision to reopen the UK.

Stephen Reicher writes:

A large part of the answer lies in the way in which the whole discussion has been framed in terms of a simple binary between “liberty” and “lockdown”. (…)

The consequence of such a rhetorical polarisation is that any Covid measure is now turned into a matter of endorsing “lockdown” and opposing “liberty”. However moderate or mild, it becomes the battleground for a symbolic struggle between perceived good and evil, and so any grounds for discussion or compromise are removed.

https://inews.co.uk/opinion/liberty-lockdown-covid-restrictions-government-neglect-freedom-1091022

The “anti-lockdown” argument is wrong. Reicher again:

Conceptualising all restrictions as removing our freedom obscures the fact that, as SPI-B proposed, many of the most important measures are about supporting and enabling people to do what they want, not stopping them. These include providing accessible facilities so people can easily get tested and vaccinated, supporting self-isolation so people can stay home when necessary, and ensuring public places are well-ventilated so people don’t get infected.

https://inews.co.uk/opinion/liberty-lockdown-covid-restrictions-government-neglect-freedom-1091022

But this is not what the “libertarian” approach does. By painting the choice in terms of black-or-white, the decision is now taken to remove (almost) all Non-Pharmaceutical Interventions, rather than having a sensible discussion on what should or should not stay to eliminate, and eventually eradicate, the virus.

This is already causing suffering and deaths which could have been avoided. Dominic Cummings’ question:

Who do we not save?

https://dominiccummings.substack.com/p/the-pm-on-hancock-totally-fucking

becomes again relevant.

Coming back to the question: Freedom or health? – it is simply a wrong question. We need both – enough freedom to help the government, society, schools and churches to function, and enough diverse measures to mitigate the viral risk to save those who might otherwise suffer or die.

What has been needed throughout the last 18 months, is a proper, serious discussion on how to balance the measures needed to quickly eliminate the virus – and Reicher points out that there are many more ways to do this beyond the “hard” lockdown – with the needs to keep the economy open and to give children something to eat and the right education. Such discussion has been missing, with tragic consequences.