The L Word

‘Stay the fuck home’. A less effective means of gaining general co-operation from the instinctively anti-establishment would be hard to imagine. How about you get the fuck out of my face? Our more formal UK government messaging has plumped for the ‘will-no-one-think-of-the-the-children’ emotional arm-twist of ‘Stay Home, Protect The NHS, Save Lives’. This appears at the foot of the rash of notices that has appeared all over my own rural region requesting people to approach a farm gate on a public path as they would open heart surgery, and disinfect or wear gloves before touching. After a day slapping cows’ backsides (I am hazy on the details of the profession!), it would be too much to expect farmers to take responsibility for their own biosecurity, and wash their own hands before dining.


The Government was almost begged by a large proportion of its citizens to imprison them. Their slogan (from the same people who gave us the infamous Brexit slogan-on-a-bus, a pledge they are now in a position to fulfil, but won’t) was taken up as a clarion call by the more rule-based sector of society. Cyclists, runners, walkers out for their ‘permitted’ daily exercise were branded ‘selfish’ for being out too long, too often, in too great a number. “Stay at ‘ome” grumbled one farmer, virtually the only person I saw all day. Inner city types sunbathing in parks were shamed by widely-shared long-lens Daily Mail pictures. You could almost see the Facebook squawk from space. Go for a run, you might as well stab a nurse.

Now after the second of two 3-weekly reviews, Boris Johnson announced on Sunday that we will begin to ease certain measures. The red border of the old slogan was replaced by green, the message now ‘Stay Alert, Control the Virus, Save Lives’. Facebook is furious again. Too soon. They’ve invested heavily in the notion that lives are lost in the act of leaving the front gate. Was the government lying then, or now? Some parents are adamant that their kids won’t return to school this side of a vaccine. I hate to break it to them that that could be years away, or never. The technology, RNA vaccine, is new, and carries no guarantees.

If ‘lockdown’ were a drug that deferred deaths but cost billions, rendered people unable to work or study and had significant further side-effects on physical and mental health, we’d want some clinical trialling done. Compare control groups with and without the intervention, before administering it en masse. Particularly if the only way to get off this addictive substance was another pharmaceutical intervention not even developed. If we shortcut that trialling process, then got something wrong, the consequences for society and confidence in vaccine in general would be catastrophic. But many people are vowing to stick with one untrialled intervention until another comes along, which they’ll seemingly grab both-fisted.

We didn’t have the luxury of trialling, of course. We had to do something to prevent health services being swamped. The government’s early plan was ‘herd immunity’ – a perfectly respectable concept already poisoned by anti-vaxxers, now finished off by attachment to Tory policy. I have learnt to be careful in my use of the term, to try and avoid those knee-jerk associations. Governments the world over, meantime, were administering ‘lockdown’ instead, in varying doses. Our own government, particularly influenced by Neil Ferguson of Imperial College and a vocal sector of our medical profession, did a swift one-eighty and announced our own resort to this new wonder-drug – in lower doses than France, which in turn took less than Italy and Spain. Sweden opted to be the control group.

But the longer we administer it, the more severe the side effects: the relationship is not linear. It’s not just a cold-hearted trade-off of lives for money. Lives are directly threatened by the effect of lockdown on mental and physical health, and economic downturn. Poorer countries tend to have worse healthcare. And in not circulating socially, the ‘learning’ process by which immune systems adapt to the common pathogens in the population is turned off – immunity is not gained solely by noticeable illness, and it isn’t inherited. A newborn gets a starter dose of antibodies through the placenta and in colostrum; after that, you’re on your own.

There are some offsetting benefits. There will be fewer road deaths, while some 40,000 excess deaths annually are due to air pollution – a cost in lives we don’t hear much uproar over; the uproar there is reserved for Greta Thunberg. The unprecedented clear air at the moment will save a significant number of lives, additionally improving outcomes in those catching Covid. And of course if the health service is less swamped, we get better outcomes generally. I must declare a competing interest here: my daughters are respectively on and near the front line. So the longer lockdown proceeds, the less they are threatened, but the longer till we meet again. My eldest soundly rejected my suggestion we meet up outdoors – despite agreeing the risk was minimal, she has seen too much suffering to contemplate bearing the burden of passing it to me, however remote.

There are two fundamental outcomes for a novel virus: eradication, or herd immunity gained through infection/vaccination. Much is made here of New Zealand’s success in eradication. They hit it hard and early; had all nations been able to do the same at a similar stage, we could conceivably be looking at global eradication now. Instead, New Zealand’s victory could prove Pyrrhic. For all the successes or failures of this or that government, the world has gone past the point of eradication. Each nation is surrounded by others; collective fate is sealed by the actions of the worst, not the best. Herd immunity is not a policy but an inevitable – and desirable – consequence of infection. Clumsy, poorly-led governments are moving slowly towards it, at great cost of suffering and lives. Those nations with the best early responses may yet have to bite that bullet, if a vaccine cannot be found, or remain sealed.

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68 thoughts on “The L Word

  1. Schizophora,

    My read, fwiw, is that you and Allan are pretty much in agreement. It’s just that you both tend to focus on the idiocy that is most in-your-face where you live: in Cumbria that’s tut-tutting curtain-twitching “stay the fuck inside”ers who view touching a stile with an ungloved hand as treason, and in SC it’s people who find it necessary to protest the closure of bowling alleys whilst armed…

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  2. petrushka: My observation about US politics is that both sides are hoping to gain political advantage from virus developments. One side is hoping the death rate continues, and the other side is hoping for a backlash against the lockdown.

    Do you have any evidence to support the idea that one side is hoping the death rate continues? Apart from it being a popular Fox News talking point, that is.
    When Donald Jr made that claim (back in February), even Mike Pence could not bring himself to try to defend the accuracy of the claim, rather he sought to excuse it. This was back when Trump Sr was still referring to the virus as a “hoax”.

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  3. phoodoo: Why not?Why can China do it for over one billion people?

    By having a proportionately greater number of enforcers.

    And I still don’t really get how the idea of herd immunity is going to help anything.How are you going to stop the vulnerable from getting it?Just because 80% of the people in a village get it and don’t die, how does that help the others?

    The same way social isolation does. It reduces the effective density of the susceptible population.

    Is there herd immunity for the flu?

    Yes. It’s not a simple binary, since it mutates rendering a fraction susceptible again, but the reason we don’t have a Covid crisis every flu season is herd immunity.

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  4. Entropy: Because the immune person is more likely to touch another immune person than an infected one. Herd immunity doesn’t make it impossible to get infected, just much much less likely.

    I’m not advocating for it. Just explaining the idea. I’d rather see a vaccine, if possible.

    Just a nitpick: herd immunity includes vaccination, if available.

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  5. Allan Miller: Just a nitpick: herd immunity includes vaccination, if available.

    My understanding is that herd immunity is largely a matter of not being exposed to something infectious that nobody around you has. Whether a disease can get a community foothold, is both a function of what percentage of the population can resist it, and how infectious the disease is. So the more virulent the disease, the larger percent of people must have decent resistance. I would expect the resistance level to be very high for COVID-19, well over 90% of people. For some diseases, even vaccination can’t raise populations to this level, and must work in conjunction with quarantine.

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  6. DNA_Jock:
    Schizophora,

    My read, fwiw, is that you and Allan are pretty much in agreement. It’s just that you both tend to focus on the idiocy that is most in-your-face where you live: in Cumbria that’s tut-tutting curtain-twitching “stay the fuck inside”ers who view touching a stile with an ungloved hand as treason, and in SC it’s people who find it necessary to protest the closure of bowling alleys whilst armed…

    Yes, I think that’s fair. I’ve found it’s very easy to be perceived as siding with the gun-toting folk in need of a trim in questioning rationales. But it’s also a question of emphasis: I don’t want people to die (am I actually saying this? 🤣); I just don’t know what other choice we have. If, in an ideal world, x is the minimum number of people that unavoidably die between here and herd immunity, how do we keep as close as we can to x? Bearing in mind that x includes both people who die from Covid and from the consequences of measures taken to slow down the rate at which we approach it. Obviously, how to achieve minimal-x is where the difference of opinion lies.

    However the way some people talk, it is as if they think we can get below x. Somehow, they can beat the baseline mortality odds by slowing down the rate. They can’t. x is a minimum. If you take too long over it, you overshoot x, because you get all the Covid deaths plus ‘measures deaths’. If you do it too quickly, you get x plus ‘overwhelmed NHS deaths’.

    So, when people object to every single easing measure, or shriek at ‘twats’ on the beach – because people will die – they implicitly think that by their actions, people won’t die. Whereas, they just won’t die this week.

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  7. Flint,

    The figure I’ve seen quoted for Covid is around 60%. Herd immunity, though, is just the proportion with antibodies, however triggered: by infection or vaccination. I read a paper urging ‘herd effect for the protection of the non-immune by the immune; I don’t know if it caught on.

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  8. A singer I follow, Gretchen Peters (“On a Bus to St. Cloud”, best song ever!) ended up featured in the Wall Street Journal after a Twitter grumble about runners and masks. I was fascinated by the debate in comments. It’s just not an issue here; even indoors masks are about 1 in 20; outdoors, hardly seen. But it was clear what a big deal it was, to both sides, ‘over there’. I left a light hearted comment on her Facebook link about the UK situation, immediately polluted by a churlish response from a fellow UK citizen. It’s a minefield!

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  9. Allan Miller,

    The key to getting close to that theoretical minimum x is to not overwhelm the healthcare system. One could argue that the sign of an optimal re-opening would be that hospitalizations and ICU occupancy remain at capacity. I would argue for a somewhat slower re-opening, to a) provide a bit of a buffer in case we make a mistake, and b) I really think that the healthcare workers deserve a little bit of a respite at this point.
    From a policy standpoint, I think that Cuomo’s “valve and gauge” analogy is an excellent way of communicating what needs to be done. He reckons you want to have a 30% buffer in terms of hospital capacity, and unlike most of the other (male) leaders out there, Cuomo actually sounds like he knows what he’s talking about. Having reliable gauges is essential. Lots of testing.

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  10. Schizophora: I think this is a case of your bias consuming your viewpoint. There are currently, and there have often been in the past, many countries with leaders who are unintelligent and yet widely popular. I understand you dislike the president; I share those inclinations. However, his negative qualities do not negate those of other leaders. For instance, it is both true that Donald Trump is a bad president and that Calvin Coolidge was a bad president.

    When did I say the idiot made other idiots less idiotic? I didn’t, so I have no idea what you are talking about.

    There has, however, NEVER been a dumber leader of an industrialized country than the turnip. Ever. You can’t seriously think he is even close to the same level of intellect (flawed as he might be) as a Calvin Coolidge. To even consider making such a comparison is totally outlandish. Coolidge could actually read.

    Any comparison of the turnip to a serious person is pure parody. Do you seriously underestimate just how dumb he is? I think sometimes the turnip gets credit for saying anything vaguely true occasionally, as if it is amazing that a baby can say mama, mama.

    “See, that’s the thing about these tests, that are not really that useful, because last week Katie Miller tested negative for the virus, and now this week she tests positive. So you see…”

    Comparing him to Coolidge? Come on. Absurd.

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  11. DNA_Jock,

    The key to getting close to that theoretical minimum x is to not overwhelm the healthcare system. 

    Depends on the costs and length of the measures, to some degree. Hitting the sweet spot has to be a trade off, and the effect of measures is non-linear.

    Your graph of the Scandinavian nations, assuming none is overwhelmed, could be read another way. It shows what excellent progress is being made by Sweden towards herd immunity…

    I take the point about ‘respite’. My daughters are obviously in my thinking, as I mention in the piece. My eldest says, lightly, ‘I’m bored with it now!’. Of course there’s much more behind that, stuff she doesn’t really want to talk about yet. But we owe it to our health service to start getting ill with other stuff again! 😁

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  12. Entropy: I know. That was by the end of my first explanation to phoodoo.

    Fair enough, it just sounded incomplete in the comment. Having been tainted by the Conservatives here, I’m having to do a lot in defence of the broader concept! I’ll turn down the sensitivity on my meter.

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  13. Allan Miller: Your graph of the Scandinavian nations, assuming none is overwhelmed, could be read another way. It shows what excellent progress is being made by Sweden towards herd immunity…

    True. IHME reckons that they hit the ‘sweet spot’, with need for ICU beds only marginally exceeding beds available. However, it is tough to actually measure the effect of overwhelming until all geographies have gotten to herd immunity — the ‘apparent’ case fatality rate is the quotient of two numbers that are packed with ascertainment bias — on this flawed metric, Sweden does look rather bad, up there with Italy, the UK and France.
    My citing of the “Scandinavian experiment” was more to refute the argument (popular with Trump apologists) that policy has no effect.

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  14. Thank you Allan, and everyone else. It’s nice to see some unbiased assessment of the situation for a change. It’s depressing how polarized the debate is out there, just when we need a healthy exchange of evidence based ideas more than ever

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  15. petrushka:
    I have never been blessed with certainty about what other people should be forced to do.

    If we are going with the war analogy ,as you suggested earlier, people are forced to do lots of stuff when their country is at war. Leaders make decisions based on incomplete information. There are unknowns and unintended consequences. People die in bomb shelters . Certainty has nothing to do with it.

    I am, however, certain that I do not support applying the same measures to sparsely populated areas and to densely populated areas.

    In logic of war , sometimes urgency does not allow a fine tuned response.

    I am moderately certain that betting we can survive lockdown until a vaccine is available is a bad bet.

    A majority of states are opening ,what we are now betting is how bad a second wave of inflections might be without very robust ability to test the population in place, and how the population will react to that. Doubt they will be out buying a new car or getting on a plane.

    My observation about US politics is that both sides are hoping to gain political advantage from virus developments.

    Of course, reality is a test of political philosophy.

    One side is hoping the death rate continues,

    My guess is that side knows that death count is actually people, not points scored in a competition.

    What they hope is those who failed to do their job will be held responsible for the consequences of that failure which is still ongoing.

    and the other side is hoping for a backlash against the lockdown.

    And why are they hoping for that?

    Not exactly noble.

    There are lots of people working to help their neighbors ,on both sides.

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