Something significant happens this week. 3,000 New Yorkers will have a pin-prick blood test for antibodies, with the results due at the end of the week. Perhaps then we can get an idea on the level of immunity and put to bed the concept of herd immunity.
I am struggling with this argument. Most including me were shocked when the UK's defacto leader: The Government's Chief Scientific Adviser to the Government, Sir Patrick Vallance said on the Today program, Radio 4 that,
Our aim is to try and reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it. Those are the key things we need to do.
The implication of this strategy is that huge numbers would die and the process of lockdown would go on in phases for 1-2 years. This felt unacceptable. I am not so sure now.
We are now past the peak but we have a spectrum in the range of responses defined by mass-testing. The first wave of the virus caught Italy and Spain unaware and the world scrambled to impose their lockdowns. The virus really was on its way. Some countries went further. The USA and Germany copied South Korea and instigated mass testing programs. It was too late to save New York but there is now a difference in approach between those countries who are adopting mass-testing and those who have not.
The UK we are told now has the virus infectivity rate (R) down to below 1. But are we really trying to depress it down to zero? I don't believe so. If we were, we'd be community testing. The UK deaths are very bad (the graph they show you of deaths is in absolute terms and ignores the fact that the US has a population 5 times the UK), but it's not a simple comparison to make. If you expend huge resources on mass-testing and protect your people from infection in wave one you will have low immunity and will be exposed in the future whereas a country that has experienced controlled infection maybe better protected in the future. This is one of those cases where there are known unknowns whose unknowns will change everything we believe:
- Is there a cure? Tentative suggestions there maybe some anti-virals that show good results
- Will we have a vaccine and when? August is a possibility. Ironically the most advanced vaccine trials will be slowed down by low infection rates (they need their vaccinated blind trial members to get infected to test the vaccine).
If a cure or vaccine materialise this Summer. Then the right approach was to do everything to suppress the virus.
- What is the antibody rate?
New York's antibody survey will open a window on immunity.
We will soon find out if there is a significant trade off between death and immunity (the protection of future death). The UK has had a sustained controlled infection now. That has led to a high death rate per population but if it's been acquired with the benefit of immunity then that would be significant, and indeed be an argument to proceed with surveillance testing alone, but if immunity levels are very low then we should adopt mass-testing, protect the population and hold out for the vaccine.
At the moment I am pretty convinced that Sir P. Vallance still holds the view that it would be a mistake to totally suppress the virus. I am amazed that no one in the media has asked this very obvious and important question. We should soon find out whether the man had real insight or not. Whether right or not his initial opinion was based on his best understanding, and will have been made in good faith. At the outset many people reeled in horror at his comments but in truth there were too many unknowns at the outset to determine what was the way to go. I think a pragmatic approach to responding to events was best.
Had the world paid attention to South Korea we probably would not have had a problem in the developed world but we are where we are, and the general public might actually find out a lot more about what that world really is this week. I suspect the authorities already have a crude idea about immunity levels.
