A new article on “herd immunity” is now available in The Conversation. It took me a couple of weeks plus quite a lot of research into history and different aspects of this concept. There is also a more technical article available on this blog. I am also hoping that at some point there will be an online tool to explore simple models of herd immunity; an extension of the model for the second wave.
I was particularly keen on getting the last section right. Herd immunity is a very powerful concept, but also one that is badly misunderstood and dangerously misapplied.
At the end of the day, it is about a potential conflict of interest between an individual and the “herd”; something that can possibly be resolved, but only in a very careful way. This is particularly important for vaccination and I understand where (at least some of) the opponents of the mass vaccination programmes come from. But this is probably a topic for another story, another day.
Simple masks are effective, but mostly for protecting the public from the person who wears them, not the other way round. To protect the person, a medical-grade PPE is needed, and proper procedures of putting it on and off need to be followed.
Most advanced masks, particularly those with a valve, are designed to filter out air which comes in, but not which goes out. As a result, they might actually be counterproductive when mass used.
The main aim of masks outside the health force setting is to slow down the air so that it does not spread as far. A well-fitted face covering which covers the mouth, nose and chin works well. Loops around ear or other support needs to ensure that there are no gaps on the sides.
So, masks are primarily a way to protect others, and only protecting ourselves indirectly. They can be a nuisance, but as the virus is likely to stay with us for longer, it is important to get used to them. After all, donning a mask is easier than staying at home because of the lockdown, even if it might not be as effective. Or, dying because of other people not playing according to the rules.
And they can look cool (see above and below). Is there perhaps a place for Instagram influencers, celebrities and leaders to put on their masks and make it an example for others?
A story broke earlier this week about the lockdown in Leicester (I was interviewed on this on BBC Radio 5, BBC Radio WM Birmingham, and BBC World Service on Tuesday).
It has turned out that the Public Health England has two streams of case reporting, with Pillar 1 broadly based on testing done in hospitals, and Pillar 2 done commercially. However, the two sources had not been combined in official reports (see this Financial Times article for an explanation). But the two data sources tell a completely different story:
From COVID-19_activity_Leicester_Final-report_010720_v3.pdf
Pillar 1 shows the epidemic to be following the (official) national trend, with the number of cases currently low and slowly declining since the ‘peak’ in April. Pillar 2 shows a completely different case, with the epidemic out of control since early June.
This is not only the case in Leicester, but in the whole of UK, as exemplified by people <19 years old, whereby Pillar 1 shows a nice decline in numbers and Pillar 2 shows a much more ongoing epidemic:
From COVID-19_activity_Leicester_Final-report_010720_v3.pdf
Now, to be fair, we all know that there are problems with interpreting data based on testing (see here for my take on it). But we at least hope that testing is somehow done representatively i.e. that it results somehow represent the actual trends, even if not the numbers (it is estimated that for every reported case, there are 3-10 unobserved cases).
What is worrying here is that in the case of Leicester data Pillar 2 results show a different trend to Pillar 1. This puts a question mark on any modelling that uses Pillar 1 data to predict the future of the outbreak. In particular, for the <19 years old, the reproductive number R would be well below 1 for Pillar 1, but much closer to 1 for the combined Pillar 1 and Pillar 2 data.
This has immense public health consequences as R is used to decide whether our control strategy is working or not, and the low values have been used to justify the reopening of the country.
It also questions the way in which the data are reported. Maybe it is a stretch of imagination, but there might be a temptation for some people in the authority to manipulate testing for their own political goals:
Our testing is so much bigger and more advanced than any other country (we have done a great job on this!) that it shows more cases. Without testing, or weak testing, we would be showing almost no cases.
You state that “Other countries, including the UK, achieved significant progress in arresting the spread of the disease.” I fail to see how you can include the UK in that sentence. The UK is in 5th place at 298,466 cases in the listing by country, which includes an increase of 1,229 in the last 24 hours. So far, 41,969 have died, only 1,293 have recovered, and the number of active cases is still very high at 255,204 (Ref. covidly.com at 11:15 PDT on June 16, 2020).
Anonymous expert request, The Conversation
Without going into merits of either my statement or the comment on the effectiveness of the UK response, I want to concentrate on the data quoted in the letter above. Covidly is a web site that collates the latest data on the COVID-19 pandemic. They are presented in a nice and comprehensive way and so are easy to access.
They are also easy to misinterpret.
So what about the UK data? What has caught my attention was the statement that only 1,293 individuals recovered and the number of active cases is 255,204. These two numbers just simply did not make sense. The total number of cases in the UK was 298,466 at the time of writing, including individuals who became ill in February. Surely, by June – three months after they became ill – they would have either recovered or died. Different estimates exist for the infectious period, but it is of the order of days, up to a week. A quick look at the graph at Covidly shows that there is only a trickle of people to be recovering from COVID-19 in the UK.
A screenshot from Covidly
Or, rather, the UK simply stopped reporting recovery from COVID-19. A quick look at the Johns Hopkins University spreadsheets shows that the UK stopped reporting recovery in early April and so the later entries in that database are 0. Note that the graph below shows cumulative number of recovered; the values after 12th April should not have been entered as 0, but as NA (not available). To interpret them as 0 is simply wrong.
Plot based on Johns Hopkins University data.
However, Covidly is trying to collect data from multiple sources. This is a noble task, as it hopes to fill gaps in reporting. But in this case, it provides even more confusion, as it uses other, also unreliable, sources.
To be fair to Covidly, the FAQ section says:
The vast majority of countries have some sort of reporting accuracy issue, including data for confirmed cases and deaths. The goal of this tool is to provide an easy way to visualize the data without judging the validity of the nation providing the data.
By the way, a quick calculation shows that the number of active cases on the Covidly database is a difference between total cases and dead and recovered cases. If the number of recovered cases is low, the remaining cases are (mis)labeled as active.
