Herd immunity could now be our least bad option

Societies tend to learn from bitter experience. So in retrospect, it shouldn’t have been a

Societies tend to learn from bitter experience. So in retrospect, it shouldn’t have been a surprise to find out that despite years of rhetoric claiming that our health system was “well-prepared” and “world-leading”, the UK was woefully unprepared to handle a pandemic. Still, it seemed reasonable to expect that, six months into this crisis, we would have started to catch up with societies in the eastern hemisphere that have dealt with new viruses before.

Alas, it looks instead like we are going to bludgeon our own path through this jungle. Not for us the efficient test-and-trace systems, ample hospital capacity, centralised quarantines and scrupulous social distancing seen in much of Asia. It had seemed possible, before the first lockdown, that our Government could make the case to its citizens for these systems, set them up and operate them effectively – it just needed to buy time.

This was the path I favoured and argued for. But despite high hopes, the Government has failed. The argument in favour of intensive data collection, strict quarantine and contact-tracing was lost as soon as the second wave grew beyond a certain point, because these systems struggle to operate beyond a certain scale. In order to implement them now, we would have to shrink the epidemic back down, probably by means of a national lockdown, and start again. It is hard to argue for that path anew, because our state (and perhaps our society) has revealed that it is currently incapable of implementing such a policy, for reasons we may understand better in future. So we must operate on the assumption of the state’s incapacity.

That leaves two options for managing Covid. The first is the ever-tightening cycle of lockdowns we are entering, knowing they cannot be sustained forever but in the hope that a vaccine is just around the corner. The second is to develop a strategy to achieve herd immunity while trying to minimise deaths. We are lucky, in a sense, that Covid has the risk profile it has, or we wouldn’t really have any options at all. If Covid were as deadly as Sars or if it killed children over adults, the Government wouldn’t be able to open up society even if it tried.

There is little doubt that the political debate and public opinion – if polling is accurate – favour the lockdown option. But the public’s mood and behaviour suggest a growing feeling of impatience with restrictions on normal life and a vocal minority of scientists and politicians against lockdowns have coalesced around a policy outlined in a document called the “Great Barrington Declaration”, which proposes isolating vulnerable people and allowing “normal life” to resume for everyone else.

The biology of the virus means there is a logic to this approach. A recent Oxford study suggests that the average age of a patient who dies from Covid in the UK is 82 – just over the country’s average life expectancy. The risks rise sharply with age and comorbidities like obesity, diabetes, and so on.

In the UK, nearly nine million people, or 13 per cent of the population, are aged over 70, the age at which estimated Covid fatality rates reach at least 1 per cent. Official figures show that 44 per cent of those people live alone. A further 47 per cent live with one other person, most likely a partner of a similar age or someone else highly motivated to isolate to protect them. Roughly another 4 per cent live in care homes. About two million people are on the Government’s “shielding” list, many of whom will overlap with the over-70s population.

So our society is already highly segregated according to vulnerability. Many will rely on health visitors or younger relatives to provide care. But it should be possible and, compared with the cost of lockdowns, highly affordable to offer all carers an enormous bonus if they are able and willing to isolate and take regular Covid tests to reduce their risk of passing on the virus.

None the less, Barrington fans have to admit their plan is risky. If Covid were to become widespread in the general population, the risk of it leaking into the shielded population inevitably rises. Government policy is driven not by some attachment to lockdowns, but by the belief that preventing this is not feasible. So Barrington advocates have to be up front: the policy runs the risk that more people will die and that hospitals will be overwhelmed. Nor does this policy mean a return to full economic or social activity, given that roughly a sixth of the UK population would still be isolating.

By the same token, lockdown advocates ought to be honest about the risks of their approach. The costs to health, mental health and our economy from blanket restrictions will emerge more slowly than the direct costs of Covid, but they too are devastating. Lockdowns mean that thousands of businesses built up over years will go bust. The unemployment that will follow is still masked by government support schemes, and so the cost of it, like family breakdown, stress and suicides, is currently invisible.

What’s more, the whole policy of virus suppression is predicated on the assumption that people still trust government strategy enough to obey the rules until the discovery of a vaccine. This may be the case. Perhaps a vaccine will emerge soon and justify it all. But what if it doesn’t? What if it takes a few years? What, then, is the plan? Either Britain will discover some hitherto hidden ability to implement the systems that are broadly working in Asia, or else we will find ourselves in a long, drawn-out slog towards herd immunity, which may end up killing more people than a shorter epidemic would have done. Lockdown advocates, then, need to admit that their favoured option could also end up killing more people.

Western societies are discovering the costs of failing to learn from others and adapt to new problems. The awfulness of the choices we face is a direct result of denialism, state failure, social rigidity – and perhaps, to be fair, a big dose of bad luck. Having now veered from the original herd immunity strategy towards lockdown, then in and out of track and trace, we are back in the cul-de-sac of lockdown cycles. It wouldn’t kill advocates of this devastating virus suppression strategy to admit that they, like the Barrington scientists, are advocating for something that carries enormous risks. They are, in short, betting the farm on a vaccine. Fingers crossed.

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