Britain’s virus response is not only faltering ... it’s fragmenting the country
As Andy Burnham delivered a potentially fatal blow to the Government’s coronavirus strategy on Thursday, his casual attire stood in contrast to the foreboding municipal building behind him.
Elected Mayor of Greater Manchester in 2017 on the back of rhetoric condemning “Londoncentric” politics, Mr Burnham lost no time in returning to the North-South divide. “They are willing to sacrifice jobs and businesses here to try to save them elsewhere,” he declared.
“Greater Manchester, the Liverpool city region and Lancashire are being set up as the canaries in the coal mine for an experimental regional lockdown strategy.” It took 24 hours for the
Prime Minister to hit back, essentially telling him that unless his position shifted, Burnham personally would be responsible for a surge in Mancunian Covid hospitalisations and deaths.
The dispute marks a week in which any sense of one-nation co-operation was stamped out – possibly for good.
Scotland, Wales and Northern Ireland have all gone their own ways, each announcing their own “circuit breakers”. Now England itself – home to roughly 85 per cent of the UK’s 66million population – appeared to be dividing in the face of a second wave.
Sir Patrick Vallance, the Chief Scientific Adviser, set his expression firmly to smirkless as he ran through data that showed his Covid “non-prediction” from almost four weeks ago had come to pass. Quoting three sources he showed slides estimating that new cases were now running at anywhere between 22,700 and 74,000 a day. Split the difference and you arrive almost exactly at 50,000 – the number he and Prof Chris Whitty, the Chief Medical Officer, alighted on at their joint press conference of Sept 21.
Yet scientists, too, are split – if not on numbers – then on strategy.
The grandly titled Great Barrington Declaration of two weeks ago, which proposes suppression be replaced with a “herd immunity” approach, was met with the John Snow Memorandum, which demands we double down on “restrictions” until we have a vaccine.
Both “lack rigour, humility and empathy”, said the independently minded geneticist Prof Francois Balloux. “They whip up fervour in the convinced, but neither even attempts to engage with anyone outside the ‘true believers’. I find them both unhelpful.” Surfers know that when the swell starts to rise you must either get to shore quickly or paddle out to sea to avoid being crushed by the approaching breakers. What you must never do is dither in the impact zone.
Yet this is where the UK appeared to be this weekend; a nation too divided and fatigued to paddle in either direction, even as the seas were rising.
It raises the question: is Britain’s Covid response going to bring with it all the costs but none of the benefits?
Suppression
The UK strategy is one of suppression; to hold the virus down at levels low enough to prevent the NHS and other services from being overwhelmed until a vaccine or a cure is invented.
Its costs are counted in vast capital investment, lost economic output and a good deal of collateral human and social damage. The hoped-for benefits include the avoidance of overflowing mortuaries, maintenance of essential services and minimisation of longterm economic and social scarring.
It is the strategy being pursued across much of the rest of the world, albeit with varying degrees of success.
In countries like Singapore, Taiwan and South Korea, which acted early, life has all but returned to normal. These south-east Asian countries are the surfers who got quickly to shore at the first signs of the impending storm.
In Europe, things are very different. Few countries, if any, were properly prepared and most have had a much greater incidence as a result.
Those that have done best, as measured by excess mortality, include Bulgaria, Slovakia, Czech Republic, Hungary, Poland, Norway, Denmark, Finland and Germany.
The UK, Spain, Italy, Belgium, Sweden and Holland sit at the other end of the scale. Today in Europe, only ‘We’ve got to come together as a country. This fragmentation is … a very dangerous route to go down’
Norway and Finland look like they have got safely to shore.
Chancellor Angela Merkel warned on Wednesday that Germany, which only weeks ago appeared to have escaped the second wave, could be heading for “disaster”.
But as others paddled out for protection, the UK – or England at least – appeared to be still bobbing in the water aimlessly in what may yet turn out to be a rerun of early March.
Jeremy Farrar, director of the Wellcome Trust and a member of Sage, told the BBC: “I think we’re in the worst of all worlds here. I think we’ve got to come together as a country. This fragmentation is frankly making this either a North-South or a party political issue – that’s a very dangerous route to go down.”
Prof Susan Michie, director of UCL Centre for Behaviour Change, is one of many calling for a two- to three-week “circuit breaker”, which would be not a full lockdown but a nationwide ban on households mixing inside or out.
“The current situation of continued uncertainty, mixed messaging and divisive policies undermines trust, a sense of national purpose and motivation to adhere to restrictions,” she said.
Herd immunity
For most, the debate was focused on timing and the backroom financing deals that have proved necessary to get local authorities to implement the new three-tier system. But others were still debating the suppression strategy.
On Friday, Sir Iain Duncan Smith attacked Sage for falling victim to a “form of groupthink that focuses exclusively on a drive to push down the infection rate to the exclusion of all else”. He urged ministers to focus on the “prescribing of antivirals... to the most vulnerable” instead.
It channelled the spirit of the Declaration, which argues that the cure of widespread social distancing does more damage than the disease.
“The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection,” say the authors.
The trouble with this strategy is that it either requires difficult and detailed measures to protect large numbers of vulnerable people (perhaps as many as 17 million in the UK) or to accept a much higher death toll.
Talking to The Telegraph yesterday, Sunetra Gupta, professor of theoretical epidemiology at the department of zoology, Oxford and a co-author of the Declaration, said it was premised on saving more lives overall – direct and indirect. “I want to do it by minimising the numbers of deaths,” she said. “We can protect a very large segment of those [vulnerable] people, by not locking them up in their homes but through infection control in care homes and the wider community.”
If that proved not to be possible, because shielding could not be made to work, would she think again?
“If shielding really doesn’t work at all then we have to think about what those [mortality] numbers actually are… We would need to sit around the table like grown-ups… factoring in all the collateral damage as well as direct deaths.”
Ultimately, Prof Gupta believes we will need a new “social contract” in which society accepts a certain number of Covid deaths as the price for economic and social freedoms. We accept around 26,000 road traffic deaths and serious injuries in the UK each year as the price for keeping the country moving, for example.
Neil O’Brien, the Conservative MP, calculates that a herd immunity strategy would lead to between 90,000 and 175,000 deaths even if you assume the NHS does not become overwhelmed, cutting off care to the healthy. “Having crunched the numbers, I conclude the Declaration isn’t a viable solution,” he says.
“The countries that are doing best have followed completely different approaches. We should learn from them, rather than embark on a route that would see the NHS overwhelmed and would be likely to lead to hundreds of thousands of unnecessary deaths.”
The difficulty with shielding was further highlighted by new evidence. Even as Sir Iain was advocating for antivirals to replace social distancing, a vast global study of remdesivir, the only antiviral so far licensed for use against Covid-19, concluded it “has little or no effect” on survival.
“This idea is barking mad, it needs to be put to bed,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, of the herd immunity approach. “It’s nonsense on stilts.”
‘If shielding really doesn’t work at all then we have to think about what those mortality numbers actually are… We would need to sit around the table like grown-ups’