15 votes

'Herd immunity': Why Britain is actually letting the coronavirus spread

23 comments

  1. [10]
    Loire
    Link
    While I don't agree with the UK's decision to basically let it burn through the population, especially because there is no evidence of immunity post infection, I do have to sympathize with this...

    Professor Donald says the Italian lockdowns aimed at trying to stop as much infection as possible are appealing, "but then what?" He warns such restrictions are not sustainable for months and will have to be relaxed, leading to a new surge in infections.

    "So they will have to reintroduce the restrictions each time infection rates rise," he says. "That is not a sustainable model and takes much longer to achieve the goal of a largely immune population with low risk of infection of the vulnerable."

    Researchers from Imperial College and Oxford University seem to agree. They recently released a chart using red, blue and green lines to show three possible options for the next six months.

    While I don't agree with the UK's decision to basically let it burn through the population, especially because there is no evidence of immunity post infection, I do have to sympathize with this particular comment.

    The question of "then what" constantly hangs over the new social distancing fad, especially because we don't know if reinfection is possible or even likely. Even if we "flatten the curve" there is no guarantee that upon lifting the quarantines, the travel bans, etc, that infections won't just shoot back up. It only takes one negligent infectee.

    Then what?

    Do we start it all over again, and again, until the vaccine is completed? Do we paralyze the world for the 18-24 months it take for the vaccine to complete testing and enter mass production? What happens the next time a strain of coronaviruses or influenza shocks the world?

    I think the question posed by this article is at least valuable to discuss. We are out on a lark here and we have no idea how it ends or how we recover.

    11 votes
    1. [7]
      mundane_and_naive
      (edited )
      Link Parent
      Then we do it again, only next time, the situation would not be as severe since the majority of initial infected cases are already taken cared of, immunity already built, border control is already...

      Then what?

      Then we do it again, only next time, the situation would not be as severe since the majority of initial infected cases are already taken cared of, immunity already built, border control is already in place, the population are already used to the new pace of life, and the vaccine is one step closer to being realized before the entire population is exposed.

      I find this question particularly disingenuous because it frames controlling the spread as if a pointless exercises, that it's only delaying the inevitable (notice how in their red-green-blue illustration, the blue resurgence is drawn as big as the green, which we have no way of knowing for now. Part of the benefit of immediate restriction is also that the resurgence wouldn't have been as bad as it could have been had we not done so, i.e. the green line).

      Well it's not. Slowing down the spread means reducing the chance that the virus can jump to a new host. Any reduction in hospitalization and/or loss of life is a good thing. Preventing the virus from jumping to a new host too quickly also mean allowing the current host enough time to build up immunity and kill off the virus before it could spread, i.e. the "herd immunity" thing that they're banking their whole strategy on, which by the way, is a natural phenomenon and is always a thing whether the government implement quarantine or not. It's the bare minimum as to what could be counted on. Saying there's no need to worry about infection because herd immunity will protect you is like saying there's no need to worry about the lion attacking your village because once it's full it will go away. This is just using a scientific term to confuse the public.

      Officially, the government won't say that herd immunity is official strategy: "Herd immunity is not our goal or policy. It is a scientific concept," Health Secretary Matt Hancock said on Sunday.

      Because they know they're full of shit.

      Edit: I know it's not your opinion that the decision is right, hope you wouldn't take it personally, just want to take the opportunity to voice my frustration.

      18 votes
      1. [6]
        Loire
        Link Parent
        I don't disagree with the rest of your post, I just want to hang onto this one point. I don't think "then we do it again" is as easily feasible as some might make it out to be especially if there...

        I don't disagree with the rest of your post, I just want to hang onto this one point.

        Then we do it again, only next time, the situation would not be as severe since the majority of initial infected cases are already taken cared of, immunity already built, border control is already in place, the population are already used to the new pace of life, and the vaccine is one step closer to being realized before the entire population is exposed.

        I don't think "then we do it again" is as easily feasible as some might make it out to be especially if there is no immunity (apparently previous corona viruses like SARS don't build immunity post infection). Right now we are doing okay economically (we aren't but civilization isn't collapsing either) but we also have a buffer in logistics and production that we haven't worked through. We're moderately comfortable at this "pace" as you put it. But if we have to shut down again and again and again eventually we will start seeing the reprecussions. Hell, this comfort is dependant on working class peoples at grocery stores, logistics companies, and civil services, essentially sacrificing themselves in order to keep the wheels turning so the rest of us can hide away. Is that fair and sustainable?

        I think everyone here would agree that the preservation of life is important, but eventually we have to start asking the question of where we find the balance between life and the economic realities of the civilization we have created. Eventually a lot of people will need to resume work, the unemployment insurance/short term welfare will run out, then savings accounts will run out, now people are questioning how they are going to pay for their food/whatever other supplies I am not considering.

        Of course this is all hypothetical and the entire pandemic may blow over in a couple months, once we have 70+% infection. But that doesn't seem likely at this point.

        8 votes
        1. DanBC
          Link Parent
          If there's no immunity there's no point to the UK's policy, which was explicitly about developing herd immunity. (Although politicians are walking that line back a bit because it's deeply...

          especially if there is no immunity

          If there's no immunity there's no point to the UK's policy, which was explicitly about developing herd immunity. (Although politicians are walking that line back a bit because it's deeply unpopular with the public.)

          7 votes
        2. [4]
          Omnicrola
          Link Parent
          Isn't this why they recommend people get a flu shot every year? Even the existing flu strains continue to mutate and change enough that your antibodies from last year's flu won't quite work as...

          apparently previous corona viruses like SARS don't build immunity post infection

          Isn't this why they recommend people get a flu shot every year? Even the existing flu strains continue to mutate and change enough that your antibodies from last year's flu won't quite work as well against this years?

          1 vote
          1. [3]
            Loire
            Link Parent
            It seems in some infected individuals the antibody response is not strong enough to prevent reinfection by the same strain.
            5 votes
            1. [2]
              patience_limited
              Link Parent
              This isn't fully established - there's evidence that "reinfections" may be due to faulty testing.

              This isn't fully established - there's evidence that "reinfections" may be due to faulty testing.

              8 votes
              1. vektor
                Link Parent
                Nevermind that the cases I've read of are also in the elderly - not the population you want to rely on to build the herd immunity.

                Nevermind that the cases I've read of are also in the elderly - not the population you want to rely on to build the herd immunity.

                2 votes
    2. skybrian
      Link Parent
      I think it's madness because there are so many unknowns. It's like driving fast in a blinding snowstorm rather than hitting the brakes, because "if we stop, then what?" The answer is that we...

      I think it's madness because there are so many unknowns. It's like driving fast in a blinding snowstorm rather than hitting the brakes, because "if we stop, then what?" The answer is that we decide that after we stop, if we even manage to.

      12 votes
    3. NaraVara
      Link Parent
      I would guess the assumption is that this is based on previous experiences with the spread and containment of SARS. I doubt they’d hinge an entire epidemiological response if the WHO wasn’t fairly...

      especially because there is no evidence of immunity post infection

      I would guess the assumption is that this is based on previous experiences with the spread and containment of SARS. I doubt they’d hinge an entire epidemiological response if the WHO wasn’t fairly confident. Coronavirii are apparently fairly stable and slow to mutate.

      2 votes
  2. [2]
    Comment deleted by author
    Link
    1. post_below
      Link Parent
      I think this is the most important argument against the plan. If you let it run wild, your healthcare infrastructure is going to get overwhelmed and you find out how high the mortality rate can...

      I think this is the most important argument against the plan. If you let it run wild, your healthcare infrastructure is going to get overwhelmed and you find out how high the mortality rate can really go.

      Another point: According to Chinese scientists this virus (as with so many others) doesn't like warmer temperatures. Spring and summer may not stop it completely, but they will almost definitely slow it down. Even if you want to run an experiment on public health, it would make sense to at least wait until it warms up a bit first.

      6 votes
  3. [3]
    psi
    Link
    I've posted about this elsewhere and there's a decent enough discussion at HN. Having said that, I think this is an absolutely horrible idea. Let me start by quoting a particular comment on HN...

    I've posted about this elsewhere and there's a decent enough discussion at HN.

    Having said that, I think this is an absolutely horrible idea. Let me start by quoting a particular comment on HN which resonated with me:

    Here is a rule of thumb that will be familiar to many who manage risk in a professional capacity:
    The time to get creative is when you face a capped downside on the one hand, and an uncapped upside on the other. The time to get conservative is when you face the opposite condition.

    The reason for this rule is that creative policies almost never work; but when they work, they have a much higher chance of working extraordinarily well than conservative policies do.

    The UK is facing a capped upside and a huge potential downside. The UK is choosing to handle this situation with a creative experiment. This experiment will, in all likelihood, not succeed. And unfortunately most values of "not succeed", in this context, map to catastrophic outcomes.

    Time, as always, will tell.

    Obviously a maxim is not proof. But let's consider some of the possible catastrophes that could eventuate:

    1. The NHS is overrun with coronavirus. With an unmitigated spread, most cases will peak around the same time. Many young people will not be able to receive the treatment they need to survive; doctors will be forced to triage, choosing who gets access to necessary care and, therefore, who lives. Frankly, calling this a "possible catastrophe" is an understatement. In my mind, this is almost certain if the UK proceeds with their plan.

    2. Vulnerable people get sick anyway. How can you reasonably expect to limit the risk of infection if most people are infected? How would that even work? Do you ship all the healthy young people to England, the rest to Scotland, and build a great, hulking wall between them? The idea that you can cleanly separate the vulnerable from interacting with the young and healthy is laughable. Again, in my mind this would almost certainly be inevitable.

    3. The virus mutates. Right now the disease the virus causes, covid-19, has a case fatality rate (CFR) estimated somewhere between 0.1% and 4%. This is rightfully terrifying, but not nearly as bad as it could be (compare with SARS and MERS which have CFRs of 9.6% and 34.4%, respectively). Currently what makes the novel coronavirus so potent is its transmissibility. Were it to mutate and become more deadly, the UK would become the epicenter of an even more dangerous epidemic.

    4. Reinfection occurs. If so, this would preclude herd immunity from ever forming. The only means to fight the virus, in this case, would be to either quarantine everybody, or wait it out until a vaccine is created (if possible). Fortunately, evidence so far suggests that reinfection is unlikely.

    Now let's consider some potential upsides of the UK's plan:

    1. The blow to the GDP is lessened. Perhaps a tanking GDP would indirectly lead to deaths. But now we're trading a known threat (coronavirus) with a nebulous, questionably quantified one.

    2. People can pretend things are normal. Well, they won't be. See (1) and (2) in the previous list.

    In conclusion, the plan's fucked.

    9 votes
    1. Loire
      Link Parent
      The cost of living in London may come down a little...

      Now let's consider some potential upsides of the UK's plan:

      The cost of living in London may come down a little...

      8 votes
    2. DanBC
      Link Parent
      Especially since part of the plan involves isolating anyone over 70. This is a group of people who rely on social care, which is provided by mostly young poor people on terrible zero hour...

      The idea that you can cleanly separate the vulnerable from interacting with the young and healthy is laughable. Again, in my mind this would almost certainly be inevitable.

      Especially since part of the plan involves isolating anyone over 70. This is a group of people who rely on social care, which is provided by mostly young poor people on terrible zero hour contracts with not much sick pay. We're forcing this group to go to work, we're forcing them to get infected, and their work is "spend time in intimate contact with vulnerable people".

      3 votes
  4. [7]
    ibis
    (edited )
    Link
    I really hope that this method works for the UK and then the rest of us can adopt it. It sounds a lot more appealing than a year of event cancellations and no travelling.

    I really hope that this method works for the UK and then the rest of us can adopt it.

    It sounds a lot more appealing than a year of event cancellations and no travelling.

    4 votes
    1. [6]
      cfabbro
      (edited )
      Link Parent
      Me too... but this sure seems like a hell of a risky thing to gamble on though. And given what's happening in Italy right now, with their healthcare system getting completely overwhelmed and many...

      Me too... but this sure seems like a hell of a risky thing to gamble on though. And given what's happening in Italy right now, with their healthcare system getting completely overwhelmed and many more people dying than should be as a result of that, I don't think it's a particularly safe bet or wise decision. :( Time will tell if it pays off for the Brits in the end though, I guess.

      15 votes
      1. [5]
        DanBC
        Link Parent
        The UK only has 5000 ventilators at the moment. There's talk of requisitioning car factories to get them to build more ventilators. tl;dr: we're fucked.

        The UK only has 5000 ventilators at the moment. There's talk of requisitioning car factories to get them to build more ventilators. tl;dr: we're fucked.

        6 votes
        1. [3]
          vektor
          Link Parent
          At 5000 ventilators, assuming you can use all of those, you can sustain 220000 concurrent coronavirus cases, maybe more if you can effectively shield high-risk populations. Let's assume that use...

          At 5000 ventilators, assuming you can use all of those, you can sustain 220000 concurrent coronavirus cases, maybe more if you can effectively shield high-risk populations. Let's assume that use of ventilators for other uses and shielding of high-risk populations approximately cancel out. If you want to get 47 million cases, you're going to have to stretch them out such that you can use every ventilator 213 times. One use is 2 weeks, but let's be generous, 1 week. 4 years. They're going to have to stretch it out for 4 years.

          TL;DR: You're mega fucked.

          6 votes
          1. [2]
            Comment deleted by author
            Link Parent
            1. vektor
              Link Parent
              Well, from the way exponentials go, we can be almost certain that if containment is not done, almost all cases will occur in a relatively brief window. Maybe a month? Two? Let's go with two....

              Well, from the way exponentials go, we can be almost certain that if containment is not done, almost all cases will occur in a relatively brief window. Maybe a month? Two? Let's go with two. That's very generous I think, considering we usually see a duplication in cases every 2 days. In that timeframe you get 8 uses out of a single respirator, being very generous again. If we assume we have 40 million cases during our window, we get 1 respirator per thousand people. The chinese needed 23 times that. And I've given the most generous numbers at every corner here. I don't know how many respirators they needed for the different age groups, but I could easily imagine that no amount of protecting the old will make the need for respirators that low.

              1 vote
          2. cfabbro
            (edited )
            Link Parent
            In looking into Italy vs the UKs healthcare systems with regard to this epidemic, I found this article from Financial Times: European countries search for ventilators as virus cases surge (hard...

            In looking into Italy vs the UKs healthcare systems with regard to this epidemic, I found this article from Financial Times:

            European countries search for ventilators as virus cases surge
            (hard paywall, but can be gotten around by clicking on the google result

            And this image from halfway down the article is very telling IMO. Even ignoring ventilator numbers, Italy has twice the UKs number of critical care beds per 100,000 people and yet they are still struggling. So... yeah, the outlook is really not good for the UK if they go through with this.

            1 vote
        2. cfabbro
          Link Parent
          Given how often Jags and Aston Martons tend to break down, I dunno if that's such a good idea either!! j/k ;)

          Given how often Jags and Aston Martons tend to break down, I dunno if that's such a good idea either!! j/k ;)

          1 vote
  5. Tygrak
    Link
    I am not an expert at all. But this feels like the worst idea. There's no way to make sure the vulnerable people won't get infected. Even if just 0.2% of the young people die that's quite a lot if...

    I am not an expert at all. But this feels like the worst idea. There's no way to make sure the vulnerable people won't get infected. Even if just 0.2% of the young people die that's quite a lot if they let basically everyone get infected. Not only will things most likely go very bad in the UK, it might even screw the rest of the world if the UK becomes a gigantic hotbed of infection.

    4 votes
  6. Eric_the_Cerise
    Link
    Well, then, the UK is just doing it wrong. Nutshell ... the issue is ability to provide health services. Some people will die, no matter what. But the slower the disease spreads, the better...

    Well, then, the UK is just doing it wrong.

    Nutshell ... the issue is ability to provide health services. Some people will die, no matter what. But the slower the disease spreads, the better hospitals will be able to handle the influx.

    Just letting it spread will quickly lead to over-crowded hospitals telling people (who could have been saved with proper care) to go die at home.

    It's also a good way to get all travel to/from your country banned.

    3 votes