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.