31 October 2020

COVID-19: ENGLAND NOW. MORE OF THE 'TOO LITTLE, TOO LATE' STRATEGY

PM Johnson's Government has been repeatedly criticised for doing too little, too late.  Indeed that is the best name for their strategy against COVID-19.  We saw that twice today at the press conference:

  • Ignoring the advice from SAGE on 21 September to do a national lockdown.  We now see some hospitals already with more COVID patients than at the peak of the first wave
  • A lockdown which is half-hearted, as I'll explain

Professor Chris Whitty was at pains to point out the drawbacks of a lockdown, and quite rightly so.  We looked at the painful 'side-effects' of lockdown here.  It is therefore important to keep any lockdown short.  Four weeks as proposed is too long.  Three weeks tops.

It's four weeks rather than two or three weeks because a number of activities that ought to be closed are being allowed to stay open:

  • Various businesses and organisations
  • Schools

Isn't it good news that schools will remain open?  Yes, until you realise that a significant proportion of schools are either closed as a result of COVID, or have sent children home.  Better to drive infections down so schools can stay open with confidence.

Which highlights a key point.  The choice isn't between COVID and the economy/education, it is a choice between:

  • High COVID with high costs economically, education, lives and livelihoods, and
  • Very low COVID with low such costs

 

AN ENHANCED FIREBREAK

As set out here, an Enhanced FireBreak of 17-21 days would have been a far better approach.  That is:

  • 17-21 days maximum, non-extendable
  • All non-vital businesses and activities closed
  • Everybody encouraged to self-isolate when at all possible, though with exercise permitted

This approach leverages the life-cycle of the virus, in that:

  • People display symptoms after typically 5 days, but can be 14 days or so. 
  • People will infect other members of their household within a few days
  • Hence 17-21 days mass self-isolation
  • Anyone displaying symptoms at the end of that period would continue to self-isolate for a few days longer

 

PM JOHNSON'S APPROACH

By keeping so much of the economy open, as PM Johnson proposes, the mass self-isolation effect is undermined.  So there is less of an effect on driving down the virus, even over a longer period. 

 

WHAT ENGLAND SHOULD HAVE DONE

England should have moved with Wales with a FireBreak to make use of the half term break.

Too little, too late.  We need an Enhanced FireBreak like this.


ABOUT THE AUTHOR

I'm able to take a 360 degree view of the COVID-19 situation having a background in science, business processes, finance and much else besides:

  • For the last 40 years I have been solving problems and implementing solutions for Board level personnel in FTSE, AIM, private and start-up businesses.  Plus the UK subsidiaries of multinationals such as Sony and Alcatel, including doubling profits of their UK business
  • That work is leveraging technical, financial, systems, commercial and people expertise and understanding. Often for biotech and other hi-tech businesses.
  • This is based on being:
    • Achiever of top Oxbridge degree in sciences, including cells, genetics, chemistry and spectroscopy
    • The Thames Valley overall first prizewinner in final ICAEW examinations, covering all the various financial and management subjects
    • Member of Institute of Management Consultants

The tough problems require taking a 360 degree view of the situation, and all the available evidence, before proposing a solution.  I only ever propose a solution that I would be happy to implement.

In that sense, how best to tackle COVID-19 is just another problem.  Not as tricky as some I have solved, which had stumped other CAs or the directors thought the problem was insoluble.

That's not to say how best to tackle COVID-19 is easy.  There is no painless  solution.  But balancing lives, livelihoods and the economy to allow education, the health system and business to flourish, whilst minimising the net cost to the Treasury, does have a far better solution than the UK government has followed, as outlined above.

COVID-19: OPTIMISING THE LOCKDOWN

Carrot or stick?

A likely national lockdown is now dominating the news headlines in England.  PM Johnson is holding a press conference later this afternoon.  Announcing a national lockdown?

There are two objectives from a lockdown:

  1. Reduce infections so the health service doesn't get overrun
  2. Reduce infections more, to a very low level, so the economy can re-open and life can get back to near-normal

All the talk is on doing the first.  Rather than look to achieve the second, talk is of "The economy cannot bear another lockdown".   

This is fundamentally the mistake the UK government has made throughout this COVID-19 crisis.  Thinking the economy and education are best served if infection levels are left at a low or medium level, with a strategy best described as 'doing too little too late'. Deaths and LongCOVID higher too.

Alternatively, when infections are at a very low level, #NearZero , most if not everything can re-open.  That depends on how low the infection level goes, and what venue testing techniques and general mitigation measures can be put in place.  That includes border restrictions on people and risky goods.

We've seen schools and universities being severely disrupted, with schools sent home and students being deprived of the social side of their education.  We've also seen the Arts and Sports sectors being unable to re-open since March, with the hospitality sector also on its knees.  This cannot continue.

So what's the best approach for lives, livelihoods and the economy?


MY PROFESSIONAL EXPERIENCE

Before discussing the proposed solution to this COVID-19 problem, it's worth explaining where I am coming from:

  • For the last 40 years I have been solving problems and implementing solutions for Board level personnel in FTSE, AIM, private and start-up businesses.  Plus the UK subsidiaries of multinationals such as Sony and Alcatel, including doubling profits of their UK business
  • That work is leveraging technical, financial, systems, commercial and people expertise and understanding. Often for biotech and other hi-tech businesses.
  • This is based on being:
    • Achiever of top Oxbridge degree in sciences, including cells, genetics, chemistry and spectroscopy
    • The Thames Valley overall first prizewinner in final ICAEW examinations, covering all the various financial and management subjects
    • Member of Institute of Management Consultants

The tough problems require taking a 360 degree view of the situation, and all the available evidence, before proposing a solution.  I only ever propose a solution that I would be happy to implement.

In that sense, how best to tackle COVID-19 is just another problem.  Not as tricky as some I have solved, where others had failed or the management thought the problem was insoluble.

That's not to say how best to tackle COVID-19 is easy.  There is no painless  solution.  But balancing lives, livelihoods and the economy to allow education, the health system and business to flourish, whilst minimising the net cost to the Treasury, does have a far better solution than the UK government has followed.

In tackling COVID-19, relevant experience includes:

  • A lot of my work on developing business strategy, systems strategy and financial forecasting requires taking a 5 or 10 year view of the future
  • In implementing solutions, it is far easier if there is a positive in it for the individuals involved. Some will see the 'greater good' to the organisation, or in this case the country.  But many won't.  'What's in it for me?'

In these respects:

  • It was clear back in February that COVID-19 was so infectious, it would be with us somewhere in the world for the foreseeable future.  Always the risk of re-infection from abroad, as New Zealand has found.
  • It is not surprising that the tier system hasn't worked, being open-ended, with no criteria for releasing restrictions, and anyone under 45 thinking that they are not at risk of death.  Many won't have heard of LongCOVID, as the government never mentions those nasties, nor the other risks
 

TAKING A MEDIUM TERM VIEW

If final stages of vaccine testing go well, a vaccine for COVID-19 should be available in Spring / Summer 2021.   Testing techniques are getting faster and cheaper, though mainly still not as fast and cheap as would be ideal for screening entry in ports and venues.

In the meantime Medium Term we need a strategy that achieves those two key objectives at the start of this blogpost, by getting infection rates across the country down to #NearZero. and then keeping them low.  Not just this side of Christmas, although the short term is obviously important.

The likelihood is that until a vaccine is in widespread use there will be the need for periodic lockdowns.

The question is what form should those lockdowns take, and how often in between?  I have separately suggested and justified a 17-21 day fixed length FireBreak. much like currently adopted by Wales but based on 'vital' rather than merely 'essential'.  Indicatively:


The fundamental basis of the Enhanced FireBreak type of lockdown is to be a Mass Self-Isolation, so that the virus can be best part eliminated, almost regardless of the level of infection at the start.  But that means as sharp as possible:

  • Definite end date, not "at least" as being done in France.  People need the carrot of exit at a fixed point in time
  • All but 'vital' businesses and activities closed
  • People encouraged to stay at home to live off their stores of food, medicines and other essentials, just as they would if self-isolating
  • Schools preferably closed for the FireBreak period.  Mainly because of the staff and parents involved.  Though schools would need to be open for children of key workers, like earlier in the year
  • Exercise permitted.  Indeed as far as possible people seeing that it is worth them abiding by the rules for what can be opened after the end of the period if they comply

Feedback from senior professionals of the Enhanced FireBreak blogpost includes:

  • "Great article",
  • "Well written! Can't add anything to that"
  •  "Interesting and persuasive article"


THE CARROT

For everyone including the anti-lockdown tribe to abide by restrictions, there needs to be a carrot.  Which is this set of benefits of a successful FireBreak:

GEOGRAPHY


Any FireBreak should be conducted for the whole of Great Britain, with or without the island of Ireland.  

Wales has already started its 17-day FireBreak.  England and Scotland should join them as soon as possible.

 

 

 

FINANCIAL SUPPORT

Full support during the FireBreak is needed for businesses, individuals and the self-employed in excess of what currently announced.  Everybody must have the means to comply with restrictions.

The re-opening of the economy will provide payback for the Treasury.  Indeed a FireBreak should be regarded as a financial investment, not just necessary to control the virus.


WILL THE GOVERNMENT DECIDE TO GO DOWN THE ENHANCED FIREBREAK ROUTE?

Unlikely.  They seem hell bent on limiting the restrictions in the mistaken belief this is better for the economy and education.  But let's see.

They might just see the light.




 

29 October 2020

COVID-19: LOCKDOWN OR FIREBREAK?



Re-opening potential
France and Germany have just announced national lockdowns, both open-ended, to avoid their health services being overrun:

  • France will be closing non-essential businesses from tomorrow, Friday, though schools and factories will remain open.  People cannot leave home unless 'essential'
  • Germany's measures start next Tuesday 2 November, tough but lighter than France

England is still under the national lockdown started on 23 March, with some sectors of the economy such as music and theatre still closed.  The whole country is on at least the "Medium" level of restrictions including the 'rule of 6' and the 10pm curfew for bars and restaurants.  Plus extra regional restrictions that have reduced but not yet reversed the increasing rate.

Wales on the other hand have started what they call a FireBreak for a time-limited period of 17 days.  That includes half term when schools are closed, and then only allowing pre-teen years to return.

 

THE IDEA OF A FIREBREAK

People display symptoms typically around 5 days from infection, but the vast majority up to 14 days.  If anyone displaying symptoms continues to self-isolate, a national 14-day mass self-isolation would virtually eliminate the virus.

Just add a bit of time for anyone infectious to infect other members of their household, for a total of 17 days or preferably a full three weeks, and infections would be down to low or very low levels.

Whilst adopting controls on people and items coming into the country, and pouncing on any outbreaks.

Letting most if not all the economy re-open:

Best for FireBreak to be whole of British Isles, preferably with island of Ireland.

 

KEEPING INFECTIONS LOW

There's one thing getting infections down to low or very lwo levels, there is something else keeping them low:

  • Control on people and items (especially chilled items) coming in from abroad. 
  • Pouncing on outbreaks, including by testing everybody so anyone infected self-isolates
  • Continuing basic precautions, such as social distancing
  • Use of improved rapid testing at entertainment and sports venues, and at ports and airports

Test and Trace has a role, but it will never be good enough to replace such measures.

The sum total of these measures will never be enough to stop infections rising, but the lower the starting point, the longer that will take.

Vaccines will help, but mass vaccination is still months away.  We need to do something in the meantime.


CYCLICAL LOCKDOWNS AND FIREBREAKS

It is clear from France and Germany that lockdowns will need to be cyclical.  Wales reckons their Firebreak will last until January or February, implying a cyclical series of Firebreaks.

The lower infections get, the longer the period between extreme restrictions.  Hence the idea of an Enhanced Firebreak, based on 'vital' not just 'essential', here compared against the Welsh approach and the existing three tiers in place in England:

 

The UK Government announced through Robert Jenrick on Radio4 this morning that they want to continue their 'too little too late' strategy, continuing  with regional restrictions.  But that costs the economy more than taking decisive FireBreak action.

The sooner a FireBreak is done, the sooner the benefits for lives, livelihoods and the economy.


THE ENHANCED FIREBREAK

The tougher the FireBreak restrictions, the lower the infection level achieved and the longer it would take before the next would be needed.  Here's a comparison to Wales:


SCHOOLS AND HIGHER EDUCATION

Education is important.  Clearly.  But currently education at all levels is being severely disrupted.  Schools closed or sending kids home. 

That has a negative knock-on effect on child-care and parents who cannot work as normal.  Universities in chaos too.  Better to have a planned closure for a short period that then lets schools re-open with only a very low risk of being disrupted.

Indeed renewed disruption at schools would be an indicator as to when another FireBreak would be needed.

 

FINANCIAL SUPPORT

Financial support from the Government for businesses, organisation and individuals is essential during a Firebreak.  

Given the way the economy and activities can re-open, that investment will pay back quickly in higher tax receipts, and reduced costs for support and social security.

FireBreaks are better for the Treasury.  Sooner the better.

 

STICK OR CARROT?

Currently there are severe fines for individuals and businesses flouting the regulations.  But if we are going to bear with cyclical FireBreaks, people need to be convinced that they are for their benefit, with the economy and activities they enjoy re-opening.  

The more restrictions can be made voluntary, with the carrot of resulting such improvements, the better.   Leaving fines for those that deliberately undermine the strategy.


IN CONCLUSION

The sooner England adopts a FireBreak the better for lives, livelihoods and the economy.  An Enhanced Firebreak would be even better, producing a very low level of infections and longer period between FireBreaks.

Update 31/10/20:  Thoughts on the English National Lockdown just announced


ABOUT THE AUTHOR

I'm able to take a 360 degree view of the COVID-19 situation having a background in science, business processes, finance and much else besides:

  • For the last 40 years I have been solving problems and implementing solutions for Board level personnel in FTSE, AIM, private and start-up businesses.  Plus the UK subsidiaries of multinationals such as Sony and Alcatel, including doubling profits of their UK business
  • That work is leveraging technical, financial, systems, commercial and people expertise and understanding. Often for biotech and other hi-tech businesses.
  • This is based on being:
    • Achiever of top Oxbridge degree in sciences, including cells, genetics, chemistry and spectroscopy
    • The Thames Valley overall first prizewinner in final ICAEW examinations, covering all the various financial and management subjects
    • Member of Institute of Management Consultants

The tough problems require taking a 360 degree view of the situation, and all the available evidence, before proposing a solution.  I only ever propose a solution that I would be happy to implement.

In that sense, how best to tackle COVID-19 is just another problem.  Not as tricky as some I have solved, which had stumped other CAs or the directors thought the problem was insoluble.

That's not to say how best to tackle COVID-19 is easy.  There is no painless  solution.  But balancing lives, livelihoods and the economy to allow education, the health system and business to flourish, whilst minimising the net cost to the Treasury, does have a far better solution than the UK government has followed, as outlined above.



26 October 2020

COVID-19: ALL EYES ON WALES

On Friday, Wales started a 17-day FireBreak across three weekends.  This is sharper and slightly longer than a 2-week Circuit Breaker.  Here are Welsh rules.

Why have they done that?  What do the scientists think?


THE BASICS OF A FIREBREAK

A real FireBreak
As the term implies, a FireBreak is action to stop the spread of COVID-19, and therefore protect life the other side of the shutdown period.  Allowing most if not all the economy to re-open.

People display symptoms typically after 5 days from infection, although can be as long as 17 days.  They then remain infectious for a week or so. Some people do not develop symptoms, but are thought to be infectious.  It is still early days in our understanding.

In theory, if everybody could self-isolate on their own for 17 days, and if developing symptoms continue to self-isolate, COVID-19 would be eliminated.  

 

BUT REAL LIFE

However there are three key issues with real life:

  • People often cannot self-isolate on their own, but with family or housemates. Infection will continue to spread for a few days in a household.  
  • Key workers cannot self-isolate.  Even if only vital organisations and businesses stay open, there will be still be a background level of infections after the Firebreak period ends.  The more stays open, the higher that level will be.
  • There will always be the threat of re-infection from abroad.  New Zealand has found that even with the strictest of immigration controls, new infections can still occur

As a result an Enhanced FireBreak is appropriate, here compared with Wales:

  • Slightly longer, say three full weeks
  • As tight as possible.  Wales has tightened restrictions since first announced, but is having to re-consider what counts as "essential".  The test should be whether something is "vital" for a FireBreak to be most effective.
  • Consider keeping all schools closed for period of FireBreak.  Wales will be allowing up to year 8 to go back after half term
  • Ever vigilant for fresh outbreaks arising either from the FireBreak not being totally effective or from fresh infection from abroad
  • Across the whole of Great Britain, without or without the island of Ireland, so cross-border infection is better controlled

Depending on how complete the FireBreak is:

  • How low daily infections will become, and how much of the economy can re-open
  • How long it is before a further Firebreak is required.  Wales is expecting to get past Christmas into January or February

The sharper and tighter the restrictions, the lower the infection rate will fall, and the longer it will then take to rise again.  An Enhanced FireBreak should get the infection rate down to a very low level, allowing most if not all of the economy to re-open.  Music, theatre and sports events to re-open, albeit with some basic controls helped by new on-site testing techniques.  

The aim would be to get to the February half-term, and make that longer for a second Firebreak, depending on experience with the first.


WHAT SAGE SAID

Joint chairmen
The Government's group of scientists, the Scientific Advisory Group for Emergencies famously said in their 21 September report that "A package of interventions will be needed... A circuit-breaker (short period of lockdown) to return incidence to low levels..." together with some specifics.

It is clear from other comments that the concern was stopping exponential growth, keeping R below 1.  That would take the pressure off the NHS and reduce deaths and LongCOVID.  But there seemed to be no ambition to get infection levels to a very low levels that would allow the economy to re-open.

Without this benefit, the UK Government couldn't see that a short circuit-breaker would be worthwhile beyond the three-tier approach to restrictions. 


WHAT 'INDEPENDENT SAGE' SAID

Some participants 23 October
Independent SAGE is a group of former SAGE members and academics who hold weekly broadcasts on Fridays.  The last broadcast on 23 October included "how a 2-week circuit break would work and why we think it is needed"

  • Get infections down to around 4000 a day. "It is not enough to slow growth, must turn it around"
  • Provide time to "fix Test and Trace" to help get infections down further and not need further circuit breaks in future

They have also published a "6-week Emergency Plan" called "A Blueprint to achieve an excellent Find, Test, Trace, Isolate and Support system" (FTTIS). 

The key point being that without a massive improvement in isolation, the system will not be effective, and that will not happen without support, especially for the low paid who cannot afford to skip work.

But overall, again this is not sufficiently ambitious to get infections down to very low #NearZero levels, to allow the economy to open quickly.  That's what an Enhanced Firebreak could achieve.  

 And is improving FTTIS enough to stop the need for further FireBreaks?  Unlikely.

 

THOUGHTS ON TESTING

Back in early August I reviewed testing technologies and the NHS Test and Trace system.  I said then "At the national level, it is clearly a waste of money, with little chance of getting better the way it is currently organised."  This has been borne out in the last couple of months.

I also said "The current technology simply isn’t the basis for a national TTI strategy, until it can be focused just on local surges."

That means:

  • Faster tests are needed, so contact tracing can start more quickly when a  positive test is recorded
  • Cheaper and easier tests are needed to test everybody, to catch infectious people earlier before symptoms and indeed catch those asymptomatic

Although new tests are coming through, with some already out on public trials, these are still expensive.  More than £20 a test. 

It was interesting to hear an expert on BBC radio make essentially the same points.  It is not realistic to think that even the best FTTIS sytem based on the current RT-PCR testing will have sufficient impact on the spread of infection to avoid a further FireBreak.  Indeed a second Firebreak is the Welsh plan for the new year.

Indeed the new test which Boots is launching is to be £120, which is says is cheaper than other publicly available tests, is not going to help much.  The 'Got it' LumiraDx test for Covid-19 antigen protein (not to be confused with 'Had it' antibody tests) is according to the company's website only "authorized for use using nasal swab specimens collected from individuals who are suspected of COVID-19 by their healthcare provider" and then only "within the first twelve days of the onset of symptoms." Reliability prior to symptoms is not disclosed.  Further details awaited from Boots as to how this can fulfil the published objectives for people not displaying symptoms.

 

WHAT ABOUT SCOTLAND?

Both Scotland and Wales have tended to be more aggressive against COVID-19 than England.  The English strategy can best be described as 'too little too late', including releasing restrictions earlier than the devolved governments.

What Scotland has just done is announce a 5-tier strategy from 2 November, where:

  • Tiers 2-4 correspond to Engand's 3 tiers, which might have something to do with funding from Westminster
  • Tier 5 is lockdown, but with schools remaining open
  • Tier 0 "Nearly Normal" is with a few restrictions on the numbers that can meet indoors and outdoors

So why hasn't Scotland followed Wales with a FireBreak over half term?

The clue is probably in what Nicola Sturgeon said  at her media briefing on Friday that Scotland got “very close to elimination” of the killer bug but then “reseeded it from travel across the UK” and overseas.

Scotland shares a land border with both the north-west and north-east of England.  The border cannot be closed despite very high infection levels in these two areas.  This will also be the Achilles heel for Wales becuase of the border with England, but not so much.

Indeed an Enhanced FireBreak would need to be at Great Britain level at least, preferably the whole British Isles with the island of Ireland.  One day perhaps at a global level.


IN CONCLUSION

Let's hope the FireBreak in Wales is successful.  Then England and Scotland can do likewise, with an Enhanced FireBreak.  Though the sooner the better, before infection levels rise even higher.  To unlock the economy and get back to some normality with very low #NearZero infection levels:



 

 

25 October 2020

COVID-19: TACKLING COVID-19 AS A MODERATE DISEASE

Battle at Mers
In one sense the battle against COVID-19 would have been easier if it it had been as deadly as SARS and MERS, two other coronaviruses with deaths up to one in three of those contracting the disease.   We would have all clubbed together and done whatever it took to quickly eradicate the disease worldwide.

Indeed with the virus behind COVID-19 being "SARS-COV-2", or SARS2, we need to be ready for SARS3 or SARS4 that are as infectious as SARS2, but as deadly as MERS.

But for now we have SARS2, highly infectious before symptoms, with a modest death rate and a somewhat higher incidence of LongCOVID.  By comparison to SARS and MERS, COVID-19 is a medium-severity disease.  People are not agreed on the best way of living with such a disease before a vaccine appears.

So let's look at some of the issues and approaches.

 

SOME BARE FACTS

The first thing to realise is that small percentages represent tens of thousands of people, becoming hundreds of thousands of people over time:

  • The "excess deaths" in England and Wales to 2 September was some 53,000 people.  That will be climbing fast now the second wave is well in play.
  • The latest seven-day average for the daily confirmed infection rate is 21,227.  That is still rising, but at that rate over a month that's some 650,000 people.  And that's significantly under-stated as not everybody gets tested.  Given the LongCOVID statistics coming from the King's College ZOE app, the minimum who will be suffering from LongCOVID from just a month of infections at that rate would be:
    • Some 94,000 people across all ages ill for at least 4 weeks (14.5%)
    • Of which some 33,000 ill for at least 8 weeks (5.1%)
    • Of which some 14,000 ill for at least 12 weeks (2.2%)
    • Higher as everybody infected is considered, as infection rates rise, and more than a month is considered.  tens and hundreds of thousands

The second thing is that the NHS cannot provide cancer care or any other services if the system is overrun with urgent critical COVID-19 patients.  All the extra beds and Nightingale hospitals have to be staffed, and that means re-assigning staff have to be re-assigned to COVID-19 work.  We're already seeing hospitals in northern England approaching saturation.  Letting the virus run rampant simply isn't an option.

Letting the virus run rampant is what some people advocate to gain herd immunity.  That is nonsense without an effective vaccine.  At least 60% of the population needs to have been infected.  With a UK population around 65 million, it would take some 3000 days at the current infection rate.  Even at the maximum rates the NHS could cover, that's at least a couple of years.  We need a solution before next Spring, preferably this side of Christmas.

Next Spring is when Sir Patrick Vallance, the Chief Scientific Adviser told the National Security Strategy Committee last week (19 October). He thought it "unlikely" that a COVID-19 vaccine would be available for "any sort of widespread community use" before at least Spring next year.

Whilst there has been some progress in identifying drugs like dexamethasone that help reduce deaths in hospital, and shorten recovery times there, there has been no new drugs for use at home to avoid LongCOVID or avoid needing hospital treatment.

The last Downing Street briefing on 22 Ictober highlighted that this second wave is being characterised by infection spreading amongst younger people, and then spreading into older more susceptible groups.  PM Johnson highlighted that there are many multi-generational households, like my next door neighbours.


THE GREAT BARRINGTON DEBACLE

The idea is to shield older people whilst letting younger people do what they like, explicitly in pursuit of herd immunity.  This is clearly nonsense.  Indeed dangerous nonsense:

  • Herd immunity in any large subset of the population still takes too long
  • You physically can't cut off older people easily.  For example a large proportion of teachers would need to be locked away, with obvious consequences for schools and higher education
  • In addition, it is simply not acceptable to lock away older people for an indefinite period.  The mental health issue for millions of people would itself cause major problems

 

THE GOVERNMENT'S POSITION

Whatever an individual's opinion on what they should be allowed to do, such as the anti-maskers, the Government is an unenviable position.  I might be exaggerating, but you'll get the idea:

  • Allowing excess deaths is tantamount to murder unless there is a clear justification
  • Allowing LongCOVID is tantamount to GBH
  • Locking up older people is tantamount to false imprisonment

 

THE PROBLEM WITH LOCKDOWNS

I'm no fan of lockdowns.  There is a whole armful of nasty 'side-effects' that we've seen.  Not least that music, theatres and sports venues remain closed.

It's therefore important for any lockdown to be short and sharp.


THE SOLUTION

If we want to open music, theatres and sports venues, and let youngsters enjoy themselves, the only answer is to get infection rates down to #NearZero levels, and keep them very low.

That would also allow most if not all the economy to reopen.  Good news for businesses, livelihoods and the Treasury:

Getting there?  Let's follow the Welsh example, but Enhanced.





24 October 2020

COVID-19: LONGCOVID STATISTICS

It's six weeks since we last looked at LongCOVID in detail.  It was apparent that even for people who were not seriously ill enough to be hospitalised there were two types of long-lasting problems in a significant proportion of people contracting COVID-19.  This is for all ages, including children:

  1. Significant lethargy and 'brain fade' for a prolonged period, which is common after any serious infection
  2. Organ damage such as to heart, liver, kidneys, digestive system and even brain, in addition to the lungs.  This is due to viruses getting into the bloodstream where:
    • Microclots are formed, which can damage all organs (and can cause strokes)
    • The viruses can directly attack any cells with the ACE2 receptor the virus uses to infect the respiratory tract

In addition, people who have been in hospital often have long-lasting symptoms, such as damaged lungs which leaves them breathless.

These three issues are collectively called LongCOVID, for which there are an increasing number of horrendous stories of young people where their lives have effectively been wrecked.  There's a growing number of support groups, such as LongCovid.org which includes a number of such stories.


STATISTICS

Unlike death certificates, there is no official way of recording the incidence of LongCOVID.  But this week the King's College ZOE app study published an assessment.  

They say "This long-term illness is frustrating and debilitating for those who are affected, with the potential to have a significant impact on wider society."

Whereas most people recover from influenza is just a few days, "most people with COVID-19 reported being back to normal in 11 days or less".  Around a week longer.

"The more different symptoms a person experienced within the first week of illness, the more likely they were to develop long COVID"

They estimate from a sample of app users that without being hospitalised:

  • "One in seven (14.5%) of people with symptomatic COVID-19 would be ill for at least 4 weeks
  • One in 20 (5.1%) for 8 weeks 
  • One in 45 (2.2%) for 12 weeks or more"


These 'morbidity' numbers are all significantly higher than 'mortality' death percentages, which are under 1%, and represent many tens of thousands of people.

On the basis of age and gender:

  • Long COVID affects around 10% of 18-49 year olds who become unwell with COVID-19
  • Rising to 22% of over 70s
  • Although men are more likely to be admitted to hospital with COVID-19, women appear to be slightly more likely to suffer from long COVID than men (14.5% compared with 9.5%), but only in the younger age group.
 "There were no clear links to any ... underlying health conditions", except:
  • "People with asthma were more likely to develop long COVID"
  • "Weight also plays a role, with people developing long COVID having a slightly higher average BMI"
These statistics are consistent with other studies.  But there now needs to be more detailed studies, ideally linking statistics with deaths, so each group iof people can understand the risks:
  • By gender
  • In the same age groups as ONS death statistics
  • Analysed by type of LongCOVID illness

It is also clear that the level of infections must be reduced to avoid people suffering from LongCOVID.  That includes youngsters who tend to think they are at little risk from COVID-19.

A key reason why an Enhanced FireBreak is needed as soon as possible.


COVID-19: UPDATE ON VACCINES - WHAT IF?

In business, preparing financial forecasts, and considering the topics that need to be in a legal agreement, it is important to ask the question "What if?":

  • What if such and such happens?
  • In particular, what if this goes wrong?

With vaccines, the scientists have been at pains to point out there might never be a vaccine, and in any case Spring 2021 at the earliest.  Why is this?

A vaccine, just like a drug, needs to be both effective and safe, by comparison to the illness being treated.  So, for example, cancer treatments have a lower threshold on safety.

For a COVID-19 vaccine, two key questions come to mind:

  1. What if immunity is only achieved for less than a year?  Would more regular injections (or other delivery mechanism) be effective and sensible, given the cost?
  2. What if the vaccine causes an over-reaction, such as a cytokine storm, in even a small proportion of people given the vaccine?  COVID-19 is notorious for having a 'second wind' after an initial recovery, which can put people into hospital, such as happened to PM Johnson

The second question in particular would make a vaccine more trouble than it is worth.  The only way either question can be reliably answered is to have a prolonged period of testing.  Months not weeks.

Should any vaccine fail either one of these tests, or indeed many others, it would not be licensed for use.  There are corners which simply cannot be sensibly cut.


CORONAVIRUS COMMON COLDS AS A VACCINE?

There are four types of coronaviruses that cause common cold symptoms, and do not pose a serious threat to health.  I wrote over two months ago about cross-immunity, because there is some evidence that people who have had one or more of these types of colds do not display symptoms of COVID-19 if they become infected with the virus.

The human immune system is complex, and it is thought that T-cells are responsible for this effect, rather than antibodies (produced by B-cells).

Cross-immunity may explain:

  • Why around half of people contracting the virus do not display symptoms
  • The reduction in infection rates in Sweden suggests there is immunity in the population well beyond what would be expected from the extent of COVID-19 infections

Cross-immunity would potentially open up two options for vaccines:

  • People could be given a dose of the relevant cold virus(es) as a vaccine, or
  • Given in combination with a new vaccine, perhaps a week or two beforehand, to boost the effect

I've been keeping my ear to the ground on these concepts, but little.  Anyone heard of any initiatives around coronavirus common colds, especially use as a vaccine?


WOULD A VACCINE BE A PANACEA?

Total eradication of COVID-19 worldwide would take years, if ever.  Vaccinations would need to be made across all populations in all countries.  Otherwise there would always be a threat of infections reappearing in our country.

We already have a vaccine for influenza, but still have thousands of deaths a year in the UK, mainly in the elderly.

Unlike influenza, COVID-19 causes LongCOVID symptoms in all ages, including children when it is called Mutlisystem Inflammatory Syndrome, MIS-C.  Vaccines would therefore need to be given to a much wider group of people than influenza jabs.  Costly, as well as a big logistics issue.

So although a vaccine would make a big change to how we can live with COVID-19:

  • We'll still have to live with the threat of COVID-19
  • In the coming months before a vaccine we need to adopt other measures

Hence the idea of a series of Enhanced Firebreaks, far enough apart for the economy to thrive in between.

 




 

22 October 2020

COVID-19: HOW TO ENHANCE THE FIREBREAK TO RE-OPEN THE ECONOMY

We want the economy to re-open, don't we?  We would love to go to a concert, theatre or sports event wouldn't we?  What about saving Christmas?

Then there's schools and universities.  Last week some 5% of school pupils were not in education because of COVID-19 outbreaks.  Universities have encountered mass outbreaks.  We need to get education fully open consistently.

All these things are possible if we can get COVID-19 infections down to #NearZero levels across the country, and then keep them very low.


ENHANCING THE FIREBREAK

If everybody self-isolated for three weeks, the virus would be eliminated.  That is a fortnight for individuals, plus a week more for anyone infectious to infect their household.

In the real world some activities are vital, such as hospitals, utilities and steel foundries.  But the more complete the self-isolation, the lower the resulting level of infections.

Wales is implementing a three-weekend FireBreak for a total of 17 days starting tomorrow Friday.  For England, if this is enhanced it will be far more effective, and get infection rates down to #NearZero:

  • As many people as possible self-isolate.  That is for people to use their stocks of food, medicines and other essentials so they only need to go out for exercise.  Self-isolation would need to be voluntary, for simplicity.  The Welsh could do this without further legal provisions
  • Optionally, an overnight curfew
  • This would need as many businesses and activities as possible closed down for three weeks.  Just the vital remaining open.
  • Schools closed down too.  Many are already affected, with the number increasing. 
  • Financial support for businesses and individuals for this short period.

Imagine then being able to get on with life almost as normal, though continuing with basic precautions:

Even the Treasury would gain, with the economy re-opening improving VAT and income tax receipts, and reducing Social Security payments.  Keeping unemployment down.


KEEPING INFECTION LEVELS DOWN

Totally eradication of the virus worldwide is not going to happen anytime soon.  We should assume there will be a continuing threat of re-infection from abroad for the foreseeable future.

Vaccines need time for testing of effectiveness and safety, and are not expected to be avilable until Spring 2021 at the earliest per Sir Patrick Vallance, Chief Scientific Adviser.

So we need to adopt a set of preventative measures for months to come.  

New, faster testing methods that are being developed will help, at borders and to bear down on any outbreak.  The existing testing capacity at #NearZero infection levels will be available to test everyone associated with an outbreak, and at places prone to outbreaks such as abattoirs. 

Drugs such as dexamethasone have been shown to be effective in hospitals for severe cases of COVID-19.  We need drugs for use at home to relieve symptoms, shorten recovery times and keep people out of hospital.  Though these would be  a bonus that cannot be guaranteed.

Social distancing and hand-washing will need to continue at #NearZero levels of infection.  But masks are probably not necessary until infections start rising again, and could be made voluntary.

But with the best will in the world, infection levels will be prone to rise.  The lower the level reached by an Enhanced FireBreak, the longer that would take.  Probably getting to at least half-term in February and then in May before further restrictions would be necessary.

By comparison to the Welsh Firebreak or continuing with the three-tier approach, the indicative picture for the next six months or so would be:

 
Which line would you prefer?

 

TIMING

Most schools in England break up tomorrow, Friday.  Let's get this Enhanced FireBreak started so was can all reap the benefits to our lives, livelihoods and life before Christmas.




21 October 2020

COVID-19: LET'S DANCE! RE-OPENING THE ECONOMY

Rockin' in Rothesay
Hospitalisations rising.  A silly number of schools closed, disrupting parents and their work.  Music, theatre and sports closed to the public.   Even the scientists don't believe the top tier restrictions will work, and are worried lower tier places will simply rise up the restrictions ladder.  The result of the 'Too Little Too Late' strategy the Government keeps following.

There is an alternative.  Get the infection rate down to #NearZero and most if not all the economy can re-open.  Music venues open, theatres open, and fans allowed back into stadiums.  With sensible precautions.  

Even nightclubs, the industry believes.  We can dream of dancing!

THE ALTERNATIVE STRATEGY

A #NearZero super-suppression strategy is the answer, with two key aspects:

  • Getting infections down to #NearZero
  • Keeping infections down

Infections can be kept down by appropriate control on people and products coming in from outside the country, and pouncing on any outbreaks.  Such measures wouldn't be perfect, but the lower the infection rate in an area, the longer it would take for the rate to rise such that restrictions have to be re-imposed.

The challenge, though.  How to get infections down to #NearZero?

 

GETTING INFECTIONS DOWN TO #NEARZERO

The answer is a Mass Simultaneous Self-Isolation.  The logic is this:

  • If someone self-isolates with COVID-19, they will show symptoms within about 14 days
  • Do that with their household, be it with a family or a housemates, and other members of the household could get infected.  So we need to allow a little longer, say 21 days of self-isolation for other people to show symptoms
  • Anyone displaying symptoms would continue to self-isolate in accordance with Government guidance.

Not everybody can self-isolate easily.  Some businesses and activities are vital, and so some people need to carry on working.  But if as many people as possible were to voluntarily self-isolate for 21 days then the infection rate would plummet.  That means closing all non-vital businesses.  A short and sharp 'Enhanced FireBreak'.  Here's the comparison with the Welsh FireBreak, just announced.

The good thing about a Mass Simultaneous Self-Isolation is that in a perfect world it doesn't matter how high the infection rate starts, the rate would drop to virtually zero after 21 days.  In the real world it won't be quite so good, but #NearZero would still be expected.

It is also important that as much as possible of any restrictions become voluntary, as we will have to live with the SARS-COV-2 virus for the foreseeable future, even wth a vaccine. Sir Patrick Vallance said this week that next Spring is his expectation for a vaccine, but even this isn't guaranteed.

 

FINANCIAL SUPPORT

Financial support from Government is vital.  But as that would only be required for three weeks, that would cost the taxpayer far less than a lockdown like earlier in the year.  

The Government would also benefit from the economy re-opening, with higher VAT and income tax receipts and a lower Social Security bill.  A No-Brainer for the Treasury and Rishi Sunak, with the National Debt an increasing problem.


DO IT NOW

Schools would need to close, mainly because of the adults involved.  With many schools breaking for half-term this weekend, the obvious thing to do is to kick off the Enhanced FireBreak to coincide.  So let's do it now.  

Doing so now would also reduce the infection rate and its nasty consequences sooner.


KEEPING IT GOING

The Welsh FireBreak is expected to remove the need for further restrictions until after Christmas.  So a sharper Enhanced FireBreak should allow infections to stay down for at least three months, which would last until the February half-term.  Then the May half-term.  By which time we'll know about vaccines.

On an indicative basis, the Enhanced FireBreak by comparison to the Welsh Firebreak and the three-tier system would allow us to live like this.  With most if not all of the economy open:


THE POLITICAL ANGLE

The Enhanced FireBreak as part of a #NearZero strategy is a technical solution.  But we have to recognise that the decisions are taken by politicians, and so there is a key political angle to consider.

 PM Johnson has three relevant political problems:

  • He doesn't want to be held responsible for cancelling Christmas
  • He doesn't want to be held responsible for further deaths and LongCOVID
  • He doesn't want to simply follow Labour's call for a Circuit Breaker, or follow Wales with a similar FireBreak

An Enhanced FireBreak would address all three problems, allowing him to leapfrog Labour. 

Let's do it.  An Enhanced FireBreak.  Now.




 

20 October 2020

COVID-19: AN ENHANCED FIREBREAK AS PART OF A SUPER-SUPPRESSION STRATEGY

The stated objective of this blog is "...getting back to normality by defeating COVID-19 disease...".  Don't we want to see music, theatres, sports and other mass entertainment open?  With the hospitality industry?  Pantomimes too for Christmas?

The two western-culture countries that have arguably done best in keeping their economies open are New Zealand and Sweden.  Two completely different strategies, but difficult to see how either of their strategies could work in the UK.  That's because of the UK's close ties to the continent on the one hand, and constraints in the health service and the public's willingness to accept another high toll in deaths:

But we can still learn from them, and several of the South-East Asian countries with very different cultures,  that are also said to be shining beacons of how to deal with COVID-19.  

The end result of considering all the strategic options is to agree with Professor Chris Whitty from back in May that:

  • Eradication of the virus worldwide is impossible, so we'll always have to live with it to a greater or lesser extent, dependent on the use of vaccines
  • The second wave could be worse than the first, as the virus is so infectious
  • New cases need to drop to the hundreds for the economy to reopen, a 'very low' level of infections

A 'very low' level of infections is #NearZero.  The UK has tolerated a 'low' level of infections by following a 'suppression' strategy in the hope of opening the economy, but has since lost control.  If we want to open the economy with a #NearZero strategy then that needs to be a Super-Suppression strategy.

 

A SUPER-SUPPRESSION STRATEGY

A Super-Suppression strategy requires two things:

  • Getting infections down to #NearZero
  • Keeping infections down to #NearZero

It is worth getting infections down to #NearZero for two fundamental reasons:

  • Reducing deaths, LongCOVID and all the other problems of a medium to high level of infections that UK is now experiencing
  • Re-opening the economy 

KEEPING INFECTIONS DOWN TO #NEARZERO LEVELS
 

But those two objectives can only be achieved sustainably if steps are taken to keep infections down, including:

  • Controls on inbound travellers, be they returning citizens, visiting business people, or tourists
  • Controls on inbound goods, especially chilled goods in or on which viruses may have survived
  • Spotting and dealing with outbreaks as soon as they arise:
    • Testing of those without symptoms being at least as important as testing the symptomatic, who should self-isolate anyway
    • Workplace testing, especially riskier industries such as slaughter houses
    • Monitoring virus levels in sewage system

Even New Zealand, which has far stricter controls on immigration than could be practical here, has had virus get into the country.   Outbreak control is never perfect, so we have to assume that even under super-suppression, infection levels will tend to rise.  

The idea is if the infection level in each area of the country is down to #NearZero levels, it would take weeks if not months before levels rose to force businesses to close.  

 

GETTING TO #NEARZERO

If we can adopt an Enhanced FireBreak by extending Half Term in England now, we could get infections down to a #NearZero level.  Then the best estimate would be three months before further action would be needed, getting to half-term in February, then half-term in May.

The Welsh only expect to get to the New Year with a shorter standard FireBreak, which would then need to be repeated on a more regular basis.

The current three-tier strategy in England is far too complicated.  It is unlikely to bring infections back down to summer levels, now the colder weather is bringing people more indoors.  Neither the British Medical Association nor Professor Chris Whitty, The Chief Medical Advisor, believe the restrictions will be effective.

Diagrammatically, indicatively, the comparison would be:

FINANCIAL SUPPORT

Financial support from the Government is critical if businesses are to be instructed to close down in any form of lockdown.  As you'll see from the diagram, the #NearZero strategy in blue has three advantages for the Treasury:

  • Closure times will be minimised, minimising the financial support needed
  • A more vibrant economy will minimise Social Security payments
  • A more vibrant economy will also maximise VAT and income tax receipts

A No-Brainer for the Treasury?

 

IN CONCLUSION

So by adopting a #NearZero super-suppression strategy with periodic Enhanced FireBreaks we could keep infection rates low enough to keep most if not all of the economy open.  Living with the virus much as we live with flu, at least until a vaccine is available.  

Saving Christmas.  Saving Lives.  Saving Livelihoods.  And better for the Treasury.


 

19 October 2020

COVID-19: HEALTH MEANS WEALTH. ENHANCING THE FIREBREAK

The problem with a standard lockdown is the damage it would typically cause - economic, educational and living.  Indeed the lockdown that started in March in England has suffered from all those unwelcome 'side-effects'.  Furthermore music, theatre, sports and other mass events are yet to re-open.   A second lockdown of similar ilk would suffer from those same drawbacks.

But what if you could do a shorter, sharper lockdown that provided more benefits, such as allowing most if not all of the economy to re-open, whilst keeping the side-effects to a minimum?   To improve both health and wealth.

I woke up one morning back in late September with an idea for a Mass Simultaneous Self-Isolation that would virtually eliminate the virus from the British Isles if as many people as possible could self-isolate for two to three weeks.  Allowing most if not all the economy to re-open, including mass entertainment.  That has developed into what I am calling an Enhanced FireBreak (EFB), where self-isolation is voluntary, not enforced by legislation.  

A 'hard reboot' for the country.

 

THE WELSH FIREBREAK

So it was with some sense of deja vu that today I watched the Welsh First Minister Mark Drakeford announce a FireBreak for Wales, to start this coming Friday.  He was using much of the same terminology and concepts, such as "short and sharp".  

But the question is how effective would the Welsh FireBreak be?  Not as effective as a sharper Enhanced Firebreak which would preferably be slightly longer.  

 

ENHANCING A FIREBREAK

The objective of a FireBreak is to eliminate the virus.  This is by everyone self-isolating so anyone infectious self-isolates until they are no longer infectious.  But as it takes some days for symptoms to develop, that has to be at least two weeks from onset of the FireBreak. Plus some time in case they infect their household, be it family or housemates.  A total of about three weeks.  Then everyone who has caught the disease stays self-isolated until they could no longer be infectious.  

Self-isolation would need to be voluntary, with an overnight curfew an option.

The more of the country's activities can be closed, the more effective a FireBreak can be.  The lower the infection rate achieved, the more of the economy can be re-opened, and the longer it would take before the inevitable outbreaks mean another FireBreak is required.

There are two ways a standard Circuit Breaker or FireBreak can be enhanced:

  • When a Circuit Break or FireBreak is announced, people could voluntarily enhance it by self-isolating.  That can happen in Wales and if a Circuit Breaker or FireBreak were to happen anywhere else such as in England.
  • An Enhanced FireBreak should also involve a tighter programme of shutdowns.  A somewhat larger investment, but for far more significant benefits.  
Any shutdown needs to be accompanied by financial support from the Government.  The idea being the greater recovery in the economy will pay back the investment handsomely.

In summary, the differences to a standard FireBreak like announced for Wales would be:


The three-tier system of restrictions in England is far too complicated.  Neither the British Medical Association nor Professor Chris Whitty, The Chief Medical Advisor, believe the restrictions are effective. 

Here's how an Enhanced FireBreak would fit into a strategy for the coming months until a vaccine is available.  Sir Patrick Vallance, Chef Scientific Advisor, told the National Security Strategy Committee this week (19 October) that he thought it "unlikely" that a COVID-19 vaccine would be available for "any sort of widespread community use" before at least spring next year.

 

ACTION NOW

So England should now quickly follow Wales into announcing a FireBreak for this coming weekend, corresponding to Half Term for many schools. But preferably make it sharper, as an Enhanced FireBreak.  A 'hard reboot' for the country.



COVID-19: MAY KEY POINTS BE UNDERSTOOD

Prof Chris Whitty

This was a newspaper headline back on 1 May:

"Ministers warn lockdown could stay for MONTHS until new cases drop to the hundreds - as Prof Chris Whitty says a second peak could be WORSE than the first and eradicating coronavirus is 'technically impossible'."

So let's establish what this means, as the points made are vital for us to understand if we want to defeat the virus:

  • "...eradicating coronavirus is 'technically impossible'."  This means there will always be coronavirus somewhere in the world, waiting to re-infect a country even if virus has been eliminated.  We have to learn to live with it.  Sir Patrick Vallance, the Chief Scientific Advisor, recently confirmed this would be the case even with vaccines.
  • "...lockdown could stay for months..." as we have now experienced, with the music, theatre, sports any other entertainment still locked down
  • "...the second peak could be worse than the first..." especially if people get frustrated with the restrictions, or even fight against them as we have seen.
  • "...until new cases drop to the hundreds...", at which level most if not all the economy can open.  This is daily new cases under a thousand, around five times lower than the "confirmed new cases" which don't cover all people infected.  So "confirmed new cases" needs to be below around 200 a day, about a quarter of the lowest level reached in England this summer 

Sir Patrick also told the National Security Strategy Committee this week (19 October) that he thought it "unlikely" that a COVID-19 vaccine would be available for "any sort of widespread community use" before at least spring next year.

These are the key aspects behind the idea of a #NearZero strategy.  Whilst elimination of the virus in the British Isles is a good target, it is not a realistic outcome, and we need to learn to live with a very low level of infections below 200 per day.

The benefits of a #NearZero strategy are as follows:


We've then got to get there.  Hence the idea of an Enhanced FireBreak, which aims to eliminate the virus as far as possible in the shortest possible time, to allow most if not all of the economy to re-open for a reasonable period of time.


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