A herd of red herrings

The big political dispute over the past few days has been as to whether or not the UK pursued a herd immunity strategy during the early stages of COVID-19.  It’s a red-herring because the answer is of course we were and still are following a herd immunity strategy. The alternative to herd immunity is to in some way contain the virus in one place until it burns itself out or to set up fortress borders that guarantee the virus can never enter the country. Once the virus had spread beyond Wuhan such options were not open to most countries.  Even if you were able like Australia and New Zealand to well and truly lock down the borders then you were still only delaying the day when the virus got out into your population.

Herd immunity or perhaps better “population immunity” is not some callous approach where lots of people die as the virus rips through a population. This is why it has got a bad name and why everyone denies it now. Rather, it is about people building up antibodies to the virus so that they are no longer vulnerable to serious, symptomatic disease. This in turn cuts transmission. The immune population then provide a firewall protecting those who are vulnerable either because age and underlying health reasons mean that if they catch the disease then it will hit them hard or because they are unable to acquire immunity. Our normal method for developing such immunity is to give the antibodies a helping hand through  the use of vaccines.

Furthermore, the artificial debate about herd immunity misses the very real debate that was happening at the time and to some extent is still in place.  Once the virus was in circulation, we had three options.

  1. We could take the line of least resistance and not impose any restrictions. The hope then would be that the virus would move quickly through the population and people would acquire immunity whilst we somehow shielded the most vulnerable.  People were advocating this for some time, especially on the libertarian right. However, the problem with this approach was twofold. First, we did not know at that stage who the truly vulnerable were and secondly, the elderly and vulnerable are so integrated into society that it is nigh on impossible to segregate them out and fully shield them even with lockdown measures in place.
  2. We could follow a process of mitigation, allowing the virus to move through society with measures in place to delay its spread and to protect the vulnerable. The aim then would be to build up health care capacity during the delays.
  3. We could follow a more stricter approach of suppression through more aggressive lockdowns. Suppression is not the same as mitigation. The virus is suppressed but still active.

The UK pandemic strategy was to prefer option 2 but with the potential to move to 3 as the pandemic progressed.  It seems that having tried to hold the line at option 2 for as long as possible, the Government escalated suppression last March in response to dire projections.  Two other factors probably affected the UK. First of all there was the failure to protect care homes from exposure and secondly, we lacked the test and trace technology and infrastructure to slow down outbreaks. Even still, as a result of suppression, we found ourselves with a mortality rate comparable to other Western countries.

The point is that it never was a choice between “herd immunity” and something else. It was always about how we reached the point where as many people as possible had antibodies with the least loss of lives and without our healthcare systems being overwhelmed. 

This is important because it helps us to think about what is coming next. There is still some uncertainty because of the emergence of the B 167.2 variant first detected in India. The good news is that this variant does not appear any more deadly in terms of symptoms and that it responds to a double dose of the vaccines available. The concern is that its transmission rate is still not fully understood. We are at a touch and go stage where we have fully vaccinated 44.8% of the population and given one dose to 72.9%. This means that if the virus spreads rapidly it could still result in significant levels of hospitalisation.

The good news is that the figures for those who are fully vaccinated are weighted towards the elderly and vulnerable. This seems to be having an impact on the virus at the moment though it is too early still to be confident. We know that case numbers have increased again over the past few weeks though are a long way down from the peak. It seems that alongside that we’ve seen an increase in the past week of hospitalisations. However, at the moment, it does seem that these are mostly in younger age groups and even in Bolton which seems to be the epicentre of the variant, increased admissions does not appear to be translating into fuller capacity. This suggests people are not staying in long term indicate less severe disease. It may even be that people are now taking greater precautions and checking in to hospital to be on the safe side when a few months ago those in those age groups would have “rode out the infection.”  Alongside that, we may also be getting better at treating the virus too.

If all of that proves right, then things should remain positive regarding re-opening but the next few weeks are going to be critical. Clear communication and trust are going to be vital.  There is probably going to need to be a level of contact tracing going on for the foreseeable future and that will need buy in from those who have been suspicious of “big brother” measures such as immunity passports. What we should be able to do then is use contact tracing to quickly detect and control local outbreaks including new variants.

And that’s why it has been so concerning to see the behaviour of our media and politicians over the past few days. The circus show around Dominic Cummings which has once again made this about political survival versus revenge suggests an ongoing failure to take the pandemic seriously.  We have seen people lose their health, their livelihoods and their lives. We have been through pain and grief. We want to avoid further grief and suffering where possible. That is far more important than the red herrings of whether certain politicians survive or fall to the revenge of their former advisors.