This remarkable photo, apparently first published by The Spectator, begs a thousand captions, none of them polite. In the interests of least offence, Dr No suggests, ‘When I say jump, you jump!’, but really it almost works better without a caption, because it is the expression on the faces, and the fist about to thump the table, that tell the story. Cummings looks as if he has just been shot in the back with a poison dart, and is about to fall face down on the table, Boris looks like a truculent schoolboy, up before the head after being caught having yet another dump in the College rose garden (‘I couldn’t help it, sir, I had to go’), and Mancock looks like the truculent schoolboy’s hanger-on, who knows he too will get flogged, on a charge of common purpose. Or maybe he’s wondering whether the head knows about the spliff he had behind the College bike shed. But whatever the words and thoughts at play as the photo was taken, surely the most remarkable thing is the insight we gain of the disarray at the heart of government.
That much, at least, we know. As we approach the autumnal equinox, and leave spring and summer behind, and move on into autumn and winter, what else have we learnt over the last six months about covid–19, and our response to it? In short, where are we now? What follows is a summary, with posts passim (use the search box top right) often providing further and better particulars, followed by a review of where we might go next.
We know much more about the disease. We know in its fatal form it is overwhelmingly a disease of the elderly, and of the already unwell. 75% of all deaths occur in those aged 75 and over (and almost half, 44%, were aged 85 and over), yet you can all but count the total deaths among young people on the fingers of one hand (six in England in those under 15 years old). Data recently released by CDC (America’s nearest equivalent to PHE) show that almost all deaths occur in patients with pre-existing conditions: only 6% of deaths with or from covid–19 occur in those who report no pre-existing conditions. For the vast majority of well people under 75 years of age, covid–19 is trivial, and this matters, as we shall see. Dr No uses vast majority, because there is some evidence of ‘long covid’, with prolonged debilitating symptoms, but the epidemiology of long covid has yet to be determined, and it may or may not turn out that long covid is a variant of the post-viral fatigue syndrome.
We know — in fact, we have known for decades — modelling doesn’t work. Dialling digits in and getting telephone numbers out isn’t science, it is forecasting, and it is almost always wrong in predicting the future. Its failure to predict the course of the covid–19 pandemic is just another failure to add to the long list of past failures. On a more positive note, we do now have real data about the course of the pandemic, not perfect by any means, but it is a thousand times more useful than a set of telephone numbers.
We know test track and trace doesn’t work. It’s an appealing option on paper, but in practice it is hopeless. Not only is Dildo Harding’s test and trace all talk talk and no track record, because the logistics are simply not up to the task, but even if it could be got up to the task — no mean feat — then the very concept of mass testing is fatally flawed. Even with a high specificity of say 99%, that still leaves a 1% false positive rate, which if Operation Moonshot were ever to come to bear, with its ambition to test every one of us once a week, then each weekly UK wide round will generate a staggering 680,000 false positives. That’s each and every week, with the overwhelming knock on effects of quarantine, not to mention further trashing an already imploded track and trace system. Operation Moonshot itself has a better chance of hitting Pluto than landing on the moon.
We know that while we have treatments that can mitigate covid–19 in those with serious disease, we do not have a cure, and may well never have one. This should not surprise us: most viral diseases do not have a cure, for a reason: a virus is not of itself alive, and only becomes active once it is within a cell, so blurring the boundary between us and them; bacteria, on the other hand, exist as their own living entity, making it very much a case of us and them, so we can target them, for example with antibiotics. With very few exceptions, the treatments we have for viral diseases only suppress the disease, they do not cure it. Suppression, when available, and supportive care, while our highly sophisticated immune system fights and in time clears the virus, is the only available option for most viral illnesses, and there is no reason to suppose covid–19 will be any different.
Much the same applies to a covid–19 vaccine: we do not have a vaccine, and may never have one. Indeed, Dr No believes he is correct in saying we have never developed a safe effective vaccine — which is the only sort of vaccine that should be used for mass vaccination — for any human coronavirus disease. This is partly because we have never really needed one, as either the disease is minor, or on more serious cases it has fizzled out for some other reason, making commercial development unattractive, but also because character of the coronaviruses make them tricky targets for vaccines. Dr No is no virologist, so he is not going to dabble too far in that which he does not understand, and readers are very welcome to add further info in the comments, except to say that he believes there are at least two problem areas. The first has to do with the ‘lock chemistry’ of the antigen-antibody lock-key combination — maybe it turns out the lock or the key is made of play dough or something like that — and the second has to do with the role of T cell immunity to covid–19. T cells include the ‘killer’ T cells which do as their name suggests, killing infected cells, without themselves using antibodies. Vaccines tend to focus on generating an antibody response, so if our main immune defence against covid–19 relies chiefly on killer T cells, then an antibody provoking vaccine is most likely barking up the wrong tree.
We also know that, while some less intrusive ones do work, the more intrusive so called non-pharmaceutical interventions mostly do not work. Hand washing works, individual distancing and isolation work, but hard mass lockdowns do not work, and there is growing evidence that in the long run they actually do more harm than good, though collateral damage to health care, education and the economy. Hard lockdowns also suffer from another major flaw that makes them a dumb option: they are not sustainable; not, that is, unless you fancy a long slow death through economic asphyxiation. More than that, if that is not enough, hard lockdowns are profoundly toxic to society. They destroy normal familial and social interaction, they create a climate of fear, which is both harmful in and of itself, and, even worse, the fear creates a clamour for safetyism, which in turn opens the doors to authoritarianism — giving up essential liberty to purchase a little temporary safety — and if that is not enough, then in the fevered brows of the fearful lie the seeds of the Covid Stasi, the self-appointed state endorsed covid wardens, net curtain in one hand, mobile set to police speed dial in the other, ready to do their duty, and protect the state from the misdemeanours of others. This is not the sort of dystopia we should want for ourselves.
Much the same can be said, though not to the same extent, about facemasks. Despite many a desperate attempt to get them accepted, ranging from bonfires of the straw men, through moral blackmail — I wear my mask to protect you, so you’d better wear yours to protect me — to reductio ad trafficis luminaria, the only facemasks that are worn with purpose and pride are the ones that work in much the same way as the arm band works for the brownshirt. For the rest of us, they are an infernal abomination — or worse. Dr No is partially deaf, and struggles all the time to understand the faceless muffled mumblings of the facemask devils. Light relief, if there is any to be had, can be found in the enduring image of the lunacy of facemasks in the photo of members of the wind section of an orchestra, elegantly yet absurdly attired in black masks, complete with zippered orifice through which they play their instrument, or Dr No’s favourite #staysafe can’o’beans video.
So far, we have a rather grim account of where we are. We know more about the disease covid–19, and that is useful, but we also know that our attempts test, track, treat, vaccinate against and forcefully control the disease have so far failed, and most if not all of these efforts and measures are likely to continue to fail. Are there any positive developments we can throw against this litany of negatives? Well, yes, there are.
The first has already been covered: we know serious and fatal covid–19 targets the elderly and those with pre-existing conditions, which also means we know that for the vast majority, covid–19 is a trivial illness. This is good news: the vast majority of us do not need to be in mortal fear of covid–19. It also means we know who to offer protection from the virus to; and note, it is offer, not impose, as it is for the individual to decide what level of risk they will accept, not for the state to impose.
The second positive development is the appreciation that the herd immunity threshold for covid–19 gained through infection is lower than that required by mass vaccination. While the threshold needed by the latter is of the order of 60-70%, for the former it is likely (the science is emerging) to be around 20%. Even better, it is increasingly likely that many countries are already at or approaching this level, bearing in mind that the seroprevalence surveys only measure antibodies, and not the possibly more important T cell immunity, so effective immunity may well be higher than the surveys suggest.
The first positive is clear cut: we know to whom we need to offer protection. All the money and effort wasted on lockdowns and mass testing programmes simply needs diversion to offering protection to the vulnerable, through normal but rigorous hygiene and the highly focused use of testing. The rest, all social activity, all education and all the economy, can get back to normal. And normal means normal: even the mask genie goes back in the bottle.
Which brings us to the second, more conjectural, positive, that we only need a relatively low level of population immunity gained through natural infection to get effective herd immunity. Carried to its logical conclusion, this means that instead of focusing on the distinctly anally retentive raft of policies rules and regulations intended (often hopelessly) to control the spread of the virus, we should, to stick with the metaphor, sit back on the throne, relax, and let things happen naturally. This is not a call, as some would have it, to ‘let it rip’ — staying with the metaphor, such a course might prompt an urgent appointment with a proctologist; instead, it is to allow the virus to run its natural course, and in so doing bring us up to the effective herd immunity threshold. Not only is such a course of action entirely doable, it is also, just as importantly, sustainable. But most of importantly of all, it gets us back to normal.