Second wave

The House of Commons Report Ignores the Risks of a Suppression Strategy

One of the main conclusions of the recent House of Commons report is that our first lockdown “should have come sooner”. The authors even take seriously Neil Ferguson’s ludicrous suggestion that if we’d locked down one week earlier, “we would have reduced the final death toll by at least half”.

As I noted in my response, this ignores the fact that suppressing the epidemic in the spring could have led to an even bigger epidemic in the winter, when the NHS would have been under greater pressure.

In other words, even if you only consider Covid deaths (i.e., ignore all the collateral damage from lockdown), suppressing the first wave wasn’t necessarily the right thing to do. The boffins in SAGE were actually aware of this, as the report notes:

Modelling at the time suggested that to suppress the spread of covid-19 too firmly would cause a resurgence when restrictions were lifted. This was thought likely to result in a peak in the autumn and winter when NHS pressures were already likely to be severe.

However, the report’s authors dismiss this very legitimate concern on the basis that suppressing the first wave would have “bought much needed time”. And that’s true, but so is the point about risking a perfect storm in the winter.

The correct way to frame the issue (again, ignoring the costs of lockdown) would be to say: the UK faced a trade-off between the benefits of buying time versus the risks of postponing the epidemic until winter. Acknowledging this (or any other) trade-off was apparently too much to ask of the report’s authors.

As a side note, suppressing the first wave would have probably required us to act in January, and we’d have needed to completely seal the borders, in addition to imposing a temporary lockdown. The horse had already bolted by the time anyone knew what was going on, so this discussion is mostly academic anyway.

One simple way to illustrate the risks of postponing the epidemic until winter is to compare European countries that got hit in the first wave with those who missed the first wave but got hit in the second.

To do this, I noted for each 42 European countries whether the official COVID-19 death rate reached 5 per million before 1st September, 2020. Those where it did reach this level were deemed to have been hit in the first wave. Those where it did not were deemed to have missed the first wave.

I then calculated average excess mortality since the pandemic began in the two groups of countries, using the estimates reported by Karlinsky and Kobak. Note: I’m not pretending this is a comprehensive analysis. But it’s still informative.

If the benefits of buying time outweigh the risks of postponing, you’d expect excess mortality to be lower in the group that missed the first wave. However, it was actually slightly higher in this group: 21%, compared to 19% in the other group.

What’s more, the 42 countries in my sample include places like Iceland and San Marino, which you might say aren’t really comparable to the UK. If we remove all six countries with a population of less than 500,000, the disparity is even greater: 22%, compared to 16%.

Now, there are of course other factors to consider, and it’s possible that once you took those into account, there wouldn’t be any disparity, or there’d be a slight disparity favouring the first group. But there’s no evidence that ‘buying time’ led to substantially lower excess mortality.

Someone might respond as follows: it’s implausible that suppressing the first wave would have made a difference in the second. After all, only about 10% of the population had antibodies by December of 2020, and that’s nowhere near herd immunity.  

There are two points I’d make in response. Some people may have cross immunities to Covid, so the 10% figure could be an underestimate. But even if it’s about right, we know that transmission is driven by super-spreaders, and such individuals will be heavily overrepresented among the 10% who got infected in the first wave.

All else being equal, therefore, transmission would have been greater in the second wave if those individuals had not acquired immunity in the first. (Recall that age-adjusted excess mortality was actually lower in the second wave.)

The House of Commons report is in no sense a disinterested attempt to consider the arguments for and against lockdown, so it’s hardly surprising the authors would brush aside the risks of a suppression strategy. We can only hope that the official inquiry next year takes a less tendentious approach. But I wouldn’t bet on it.

BBC Upholds Complaint; Lockdown Sceptics Vindicated

Readers will recall that on January 1st BBC Radio 5 Live broadcast an interview with Laura Duffel, the matron at King’s College Hospital, about the surge of Covid patients that had been admitted over the Christmas period.

https://twitter.com/bbc5live/status/1345006866829463552?s=20

Among other things, the matron said:

We have children who are coming in. It was minimally affecting children in the first wave. We have a whole ward of children here and I know that some of my colleagues are in the same position where they have whole wards of children with Covid…

We immediately smelt a rat. Children are more vulnerable to seasonal influenza than they are to Covid, so how could this be true? I asked the Senior Doctor to investigate and, sure enough, it looked very unlikely to be true. He wrote a piece for us entitled: “Are there wards full of children in English hospitals?

On December 29th there were 474 Covid inpatients at Kings.

433 patients were in adult beds. A further 41 were in ICU beds (total 474)

If there had been any children with Covid in the hospital on December 29th, one would expect the total number of reported Covid patients to be greater than 474 to reflect the balance of patients in paediatric beds. So, if we assume the figures are accurate, there were no children suffering from acute Covid in Kings on December 29th.

Of course, it was possible that a “whole ward” of children suffering from COVID-19 were admitted between December 29th and January 1st, when the matron was interviewed, but, as the Senior Doctor pointed out, that was vanishingly unlikely.

Delaying the First Lockdown May Have Saved Lives

Dr Raghib Ali, a Senior Clinical Research Associate at the MRC Epidemiology Unit, University of Cambridge and an Honorary Consultant Physician in Acute Medicine at the Oxford University Hospitals NHS Trust, has written a comment piece for the Telegraph in which he argues that if the UK had locked down earlier, it might have meant fewer people dying in the first wave, but that saving would have been more than offset by a greater number of people dying in the second wave.

It is true that two countries – Norway and Finland – who locked down a week before the UK (and closed their borders) have been remarkably successful in having both small first and second waves and no excess mortality to date.

But they are the exceptions – what happened in many other countries in Europe who also locked down (and closed their borders) at the same time is that they did have very small first waves in Spring 2020 but this was followed by much larger second waves in autumn/winter 2021 (and now into spring 2021, too).

And this has happened despite second and third lockdowns in many of these countries as people understandably struggled to maintain compliance with restrictions for months on end.

Dr Ali’s argument is that suppressing infections more effectively in the spring of last year would have meant more people becoming infected in the autumn and winter when the NHS would have been less able to cope. Thanks to the comparatively high number of infections in the spring, the British population had more herd immunity going into the autumn and winter which meant a lower rate of infection than in other parts of Europe.

Worth reading in full.

Fact Check: “Rishi Sunak Was the Main Person Responsible for Covid’s Second Wave”

The Times has published the latest instalment in Jonathan Calvert and George Arbuthnott’s new book Failures of State, an exercise, it seems, in recording the Official Narrative.

In the excerpt the authors lay the blame for the second wave at the feet of Chancellor Rishi Sunak, quoting a SAGE source that he was “the main person who was responsible for the second wave”. The editors picked this incendiary quote as the title of the piece.

Calvert and Arbuthnott write:

The Government had been warned about the consequences of a second wave but, by the end of July, the scientists on SAGE were reporting that they had no confidence that R was not now above the one threshold. The Government’s limited room for manoeuvre was acknowledged by Chris Whitty, the Chief Medical Officer, at a hastily arranged press conference. “We have probably reached near the limits, or the limits, of what we can do in terms of opening up society,” he said.

The following Monday, August 3rd, was going to be the start of Eat Out to Help Out, come what may. According to a Conservative MP source, both Matt Hancock and Michael Gove were concerned about pressing ahead, but “the voices that were prevailing in government, for whatever reason, were those that were pushing a case that was based purely on economic recovery at all costs as fast as possible”.

By mid-August, positive tests had risen to more than a thousand a day. The Commons all-party coronavirus group wrote directly to the Prime Minister. “It is already clear that to minimise the risk of a second wave occurring . . . an urgent change in government approach is required,” said the letter.