Coronavirus - what assumptions can we make?
By the editor, Apr 29 2020 07:09PM
Views on how to handle the crisis are for the experts. But there are a number of assumptions that I think can safely be made at this point based on what has been made public, and a number of misunderstandings that would benefit from being cleared up.
1. We can't rely on a vaccine. We may never get one. Even if we do get one, it could take many years before it can be used, and even then, it might not be 100% effective. A lot of discussion about the end of lockdowns and other restrictions has been based on comments by Government scientists that a vaccine would take at least a year to 18 months, as though this means it's likely the crisis will end in about a year. If the estimate is right, the assumption is wrong - it's far too optimistic. (Though see point 5.)
2. It's too early to tell what degree of immunity is given by having had the virus. It's possible (I understand unlikely) that it gives immunity for life. But it may very well give immunity for a much shorter period, such as months. So "herd immunity", in the absence of a vaccine, can't be relied on either at present.
3. Some progress has been made on finding effective treatments to mitigate the effects of the virus. Of particular importance, it seems (in terms of patient recovery and avoiding healthcare resources becoming overwhelmed), is preventing damage to the lungs at an early stage. But there's nothing yet on the horizon providing full treatment. It's possible - and some medical experts think probable - we will find a full treatment before an effective vaccine. But given the uncertainty, we can't base policy on potential treatments either.
4. Until either immunity is established or treatments are found, the only options for minimising harm, in addition to provision of adequate healthcare, are slowing and limiting the spread, and isolating the vulnerable. Such measures will only contain the virus; they won't eliminate it (contrary to what some politicians and journalists, including in the UK and US, occasionally suggest). The effectiveness of different measures for achieving this (hygiene, social distancing, etc) is still being evaluated, as a range of measures are being tried around the world.
5. The whole world is engaged in this struggle, and the number of people and the amount of money being spent on it is unprecedented. That must help speed up processes significantly, for example by "falsifying" scientific theories more quickly, in order to arrive at conclusions that are most likely to be correct. Obviously the more transparent and cooperative countries are, the better. Unfortunately in that respect we're not as well served as we might hope. Nevertheless, better an imperfect group endeavour than one country going it alone. This should help with all steps 1 to 4 above.
6. Antibody tests aren't 100% effective. And it doesn't take much deviation from 100% accuracy to produce potentially very misleading results. As Tom Chivers has explained, if there was a test that is 95% accurate, and 3% of the population have had the virus, about two-thirds of those who test positive won't actually have had it. (One reason, among many, why "immunity passports" seem a daft idea.) So a great deal of care needs to be exercised in how such tests are used, even though there's widespread agreement that they are needed to move from widespread lockdown to targeted containment.
7. Comparing death rates between countries is of limited, if any, use in comparing how effective their Governments have been at dealing with the crisis. Governments record deaths in different ways (e.g. whether the virus was a primary cause, or one factor, and whether occurring in hospital or anywhere), and even if some consistent measure could be found (e,.g. excess deaths), it's clear that countries were exposed to the virus in markedly different ways, and have very different conditions in which the virus has operated (for example, age of populations, make-up of households). It doesn't follow that for example the UK and Italy have "done worse" than Germany and Greece simply because of the different reported death rates. (They might have done worse for other reasons, of course.)
8. The side-effects of dealing with the virus always need to be considered alongside measures to tackle it directly. These side-effects include other medical conditions, both physicial and mental, that aren't treated properly (including those people not getting treated at all, either because hospitals can't cope, or people won't go). They also include economic and social effects, particularly of lockdowns. There should be no pecking order here - of which lost and damaged lives are more important. There is an unfortunate tendency for views on this to polarise along politically ideological lines (at times in the UK it's felt like the Brexit debate carried on by other means). Any approach that prioritises one type of harm, and seeks to minimise others, should be viewed with suspicion.
9. Containment measures vary in social and economic cost. Assuming equal effectiveness, low cost measures are preferable to high cost measures. An obvious point, perhaps - but it sometimes gets lost in the noise; and fairly simple, minimal cost measures, which may be highly effective (such as encouraging homeworking) hardly get a look in, because the debate is often around high cost measures.
10. Working out which groups (if any) are more or less likely to spread the virus, and which groups are more or less vulnerable to its effects, is clearly important in targeting containment effectively. There needs to be continuous reassessment of assumptions on this. For example, older people appear to be much more vulnerable - but exactly to what extent, and does this vary within age groups according to any particular characteristics? I was surprised that the death rate for over 80s was lower than 20%. It's still awful, of course - but suggests that many elderly people will be okay. So simply isolating all elderly people may go further than is needed. And there's mixed evidence as to whether children are not only less vulnerable, but also less contagious. It is only by continuing to adapt to such evidence as it emerges that containment measures and healthcare resources can be most effective.
11. Studies indicate that non-surgical masks are likely to reduce the spread of the virus, though not by much. The virus can be spread by release of droplets by coughing, sneezing, and simply speaking, so anything that inhibits the droplets helps. The objections to encouraging such masks are a) it might encourage complacency, b) it might inhibit the supply of surgical masks. As yet, there is no evidence to back up either objection.
12. The benefits of being outdoors ought to be considered alongside the risks. There are physical benefits (some evidence that the virus doesn't thrive in sunshine, vitamin D helps the immune system, people are likely to exercise more) as well as social and psychological benefits (mental health, reducing scope for abuse). On the face of it, these benefits are significant, and it's not clear that Governments are properly taking them into account.
13. Studies indicate that air conditioning may help spread the virus. If so, offices, restaurants, planes and trains may be more dangerous environments than, for example, parks.
14. The latest research indicates that the peak of infections in the UK might have been around 18 March. (New data might cause a revision of course.) If so, this suggests some of the measures prior to the lockdown were quite effective. (Which isn't to say the lockdown wasn't necessary as well.) And if so, it's worth trying to understand which of those measures were particularly effective in deciding on a long term containment strategy..
!5. I've no idea whether, overall, the Government is making the right decisions. I don't envy such a difficult set of choices, and it seems to me too early to tell. My own expertise is in law, and the one aspect I've looked at in depth is the lockdown regulations. There, despite the drastic nature of the provisions, the Government has deliberately avoided Parliamentary scrutiny, and has issued guidance that conflicts with own laws. That doesn't bode well.