Covid-19: why we have to take the pain

16 Oct 2020 Nick Garbutt    Last updated: 16 Oct 2020

As tough new restrictions are introduced to try to stem the spread of Covid-19 in Northern Ireland a furious debate has ignited as to whether we are doing the right thing.

On the one hand some business interests are in despair.  The Belfast Chamber of Commerce has described the new restrictions an "economy-breaker" not a "circuit-breaker" and Hospitality Ulster said it could be the "end game" for pubs and restaurants.

On the other the BMA says they do not go far enough. Its chair Dr Tom Black said: “This is simply unsustainable. Doctors tell us they feel they are unable to hold the line this time around and that a full lock down needs to be brought in as soon as possible."

There is no question that restrictions have and will continue to cause immense damage, not just to the economy in general but also to peoples’ finances and their physical and mental health. We already know that both the virus itself and the measures to prevent it are having a disproportionate impact on people on low incomes and deprived communities.

Last week a group of scientists led by Dr Martin Kulldorff of Harvard University produced the Great Barrington Declaration (named after the small resort in Massachusetts, where it was signed).

Since then it has gained traction amongst an influential group of Conservatives of the libertarian tradition with Steve Baker calling it a “credible plan B”.

It even has its own conspiracy theory – that search engine giants have been somehow trying to suppress it. If they have they have not done an especially good job. It is here.

The Barrington Declaration argues:

“We know that all populations will eventually reach herd immunity – i.e.  the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity. 

“Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.”

So just how credible is it?

Population Immunity

First of all herd – or more correctly population immunity – is achieved when a large proportion of a community becomes immune to a disease. Because the spread of disease is substantially reduced as a result the whole community becomes protected, not just those who are immune.

It can be achieved in two ways – either by the disease spreading through the population or by vaccination. Polio is the classic example of a condition to which we have herd immunity. It was eradicated through vaccination, although young children continue to have jabs to ensure it does not resurface.

Currently there is no vaccine and it may be years before we get one. We would be relying on immunity after infection to last long enough to suppress the disease. This is not a given. For Coronoviruses that cause colds immunity lasts less than a year and in relation to Covid-19 there have already been cases of reinfection.

For these reasons alone the Great Barrington Declaration appears to be based on dubious assumptions.

An impossible task

However Independent Sage, which works independently of government has gone much further in its demolition of the case for herd immunity.

Central to the Declaration is the proposal that older and vulnerable people need to be protected from the virus whilst the rest of the population go about their normal lives. Independent SAGE describes this as “an impossible task”.

Using the known risk factors of being hospitalised or dying from the illness it estimates that across the UK there are at least 12 million who fit into the high risk category, whether by age, or other conditions such as diabetes, heart and lung disease.

It concludes: “Even if those in high risk categories agreed to isolate, they would, almost by definition, need access to care and health care. They would need regular access to and interact with key workers such as supermarkets/grocery workers, plumbers, electricians, delivery drivers and other key workers, and many would be living with lower risk family who themselves would need to isolate or live a restricted outside life to prevent bringing COVID-19 home with them.”

And that’s before you get to the mounting evidence that Covid-19 is causing long term health problems for people who have otherwise recovered from the virus and even those who suffered no symptoms. This all-Ireland report  for example found that over half of people who had recovered from their initial bout of COVID-19 experienced persistent fatigue 10 weeks later, regardless of how severe their initial illness was.

Deprivation

In addition there is so-called Long Covid where people can experience symptoms such as debilitating fatigue, muscle aches, coughing and breathlessness months after being infected. The New Statesman has published  a very useful summary of the latest research on Long Covid which is a disturbing but must read.

Then there is the elephant in the room. Those most vulnerable to Covid-19 are those who live in the most deprived areas. They are also less likely to be able to afford to self-isolate if sick, more likely to work in unsafe environments and more likely to live in overcrowded, multigenerational and substandard housing.

Therefore the burden of achieving herd immunity would fall disproportionately on people of the lowest socio-economic status.

This part of the population is already suffering more and its plight speaks to the need for more financial support. Nobody should be in a position to choose between self-isolating and feeding their family.

As to fighting the virus, the only realistic strategy is to buy time – and that’s what the restrictions set out to do. Treatments are improving, survival rates are increasing, we need to suppress Covid-19 until better treatments, a vaccine or both are available.

In the meantime we have to hope and pray that Dr Black’s dire warning does not come to pass. It will be some time before new measures start to be reflected in lower infection rates. The question is whether the health system will be overwhelmed before the rates decline.

The saddest fact of all is that we have reached a point where we are being told that we staring into an economic abyss without having checked the advance of the virus. Other countries have managed to do this with the evidence being that those, like Germany and New Zealand who acted rapidly and aggressively have had least impact on their economies. What they have, and we have lacked is an effective track, test and isolate programme.

 

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