How many times can coronavirus prove us wrong?
Image: HakanGERMAN — Pixabay
Right from the beginning of this pandemic, we’ve been wrong.
Many thought the bug was a Chinese problem.
It would probably be contained like SARS or MERS.
We could isolate any cases that arrived in Europe and the UK and stop the disease spreading.
And, in the early days, we assumed that asymptomatic transmission was unlikely.
Wrong. Wrong. Wrong. And wrong again.
Sometimes we’ve been wrong in a good way. One example, beloved of behavioural scientists, is how compliant we have actually been when clear rules are set out by government. The original assumption — perhaps even shared by the Chief Medical Officer and Chief Scientific Adviser in the UK — was that people would tire of restrictions very quickly. That’s one of the reasons the timing of the original lockdown was delayed. So that bored and frustrated pensioners wouldn’t decide to re-emerge from hibernation at a point when the bug was peaking.
But most of the time, we’ve been wrong in a depressingly bad way.
The view that masks were largely useless (endorsed in the early stages of the pandemonium by the WHO) turned out to be wrong. The idea that spraying surfaces and washing hands makes a great deal of difference is probably wrong too, although we have found ourselves trapped in rituals and what is known as ‘hygiene theatre’.
We thought last summer that we could Eat Out To Help Out with impunity. Sure, there were dissenting voices at the time, but it didn’t stop millions taking advantage of the Chancellor’s largesse. We assumed that if it were endorsed by the government, it was probably right. And we were probably wrong.
But all this stuff is in the past now.
What we should be really concerned about is three broader underlying assumptions about the pandemic as a whole. They are all critical to the story we tell ourselves about how we’re going to overcome the coronavirus. And I fear we’re potentially wrong on all of them.
First, the development of variants. Generally speaking, coronaviruses mutate at about half the speed of influenza. We thought we’d have enough time to roll out jabs before significant mutations made Covid-19 more transmissible, more serious or more likely to evade vaccine. In reality, we’ve been progressing through the Greek alphabet faster than Boris Johnson in his Classics class at prep school.
The home-grown Alpha drove our second wave last autumn. Beta originated in South Africa and is now a problem in France and one or two other places. It may be slightly more likely to evade the AZ shot.
And then there’s Delta. We’d better not get started on Delta.
Of course, I’m not a virologist or medic, so I can only speculate about how many mutations the notorious Spanish Flu must have gone through as it rampaged around the world killing 50 million people. I presume quite a large number, although we lacked the science to isolate and document the phenomenon at the time, I guess.
Vaccination levels are incredibly low in some parts of the world. So despite all the hullabaloo in the UK about ‘Freedom Day’ and the huge gamble we’re taking, we’re actually in an incredibly privileged position. Look at what Delta is now doing in South Africa and Namibia, for instance. Look at the speculation over how many people it has actually killed in India. Maybe more than the total number of deaths generally reported for the whole world.
Delta is very bad. But it may not be the worst variant we face. And as we perhaps plan boosters or ‘tweaked’ jabs, we become conscious of just how long it takes to inoculate tens of millions of people. We’ve been at it since last December and we’re still going. The apocryphal painting of the Forth Bridge springs to mind.
Our second fundamental error of judgment?
That vaccine might be able to deliver herd immunity.
It’s important to make clear that I’m not talking about any real or imagined strategy to create herd immunity through infection — the kind of thing that makes people sneer #herdimmunity on Twitter. That was something Sir Patrick Vallance did talk about earlier in the pandemic. It was the policy arguably pursued by mavericks in Sweden (with results which were neither as good as its proponents hoped nor as catastrophic as its critics warned).
Herd immunity through vaccine is something different. It is a policy that many serious scientists would have hoped for. It’s the way we have virtually eliminated the threat of Polio, Measles and other illnesses. Increasingly, however, it looks as if it’s not going to happen with Covid.
The reasons are messy. The first is that the numbers of people who must be vaccinated to achieve herd immunity will depend on the disease. As Adam Kucharski of the London School of Hygiene & Tropical Medicine points out, the famous R number is important here. The more infectious the bug, the harder it is to achieve herd immunity without very large numbers being immunised.
Following the fiasco with Andrew Wakefield and the MMR, we have seen outbreaks of Measles in some areas, even though three quarters of the population have had the vaccine. Three quarters isn’t enough. Delta — and possibly other variants to come — might demand that 85 or 90 or 95% of the population have the vaccine to achieve a real sense of security. We know, after all, the jabs don’t give ‘sterilising immunity’ which completely prevents onward transmission.
Then there’s another problem. The vaccination programme is spluttering now and it’s not to do with supply problems. A proportion of young people in their late teens and twenties — perhaps around a third — have not yet come forward to have their first jab, even though it’s on offer. They may not be particularly slower to respond than those in other groups, but you’d imagine there would be a greater sense of urgency.
Maybe a proportion feel they are unlikely to get seriously ill and are either unaware or unconcerned of the effects of long Covid. Cue the PM’s intervention about proof of vaccines for nightclubs and other venues. (Across La Manche in Paris, President Macron is even more agitated about this because of high levels of French vaccine hesistancy.)
This week, the Joint Committee on Vaccination and Immunisation (JCVI) also said that children under 18 should not routinely be vaccinated.
Between young adult recalcitrants, ineligible schoolchildren, committed anti-vaxxers and people who cannot have the jab for medical reasons, it is hard to see how the maths really adds up. So Covid will continue to circulate and herd immunity only becomes possible through a combination of vaccine and infection.
The final thing we get wrong?
That we can open everything up while simultaneously retaining all the infrastructure that was designed for when everything was shut down.
If we want to use the NHS track-and-trace app in an environment where 1 in 100 people (or more) have corona, it’s not surprising that we face a so-called pingdemic. We are encouraging everyone to go to shops, restaurants and bars again. Youngsters are pouring into nightclubs once more. Trains, buses and tubes are likely to become more crowded.
The app was created for an environment in which we were mostly trying to avoid all these things. In a sense, it was a notification of when we had slipped up or encountered someone with Covid on an essential mission to buy food or collect medicines at a pharmacy.
And how is it that double vaccinated people don’t yet have any more freedom? The elderly and vulnerable, who had the most miserable of times in 2020, were told that they must wait until they got their vaccines to live a fuller life. And when they did get their vaccines, they were told that they should still restrict what they did, as — despite the shots — they were capable of carrying and passing on the Covid bug.
We told ourselves as a society that vaccines were the way out. We were unsure whether we’d be able to develop them at all. Amazingly, the world scientific community rose to the challenge.
We thought we wouldn’t be able to produce them as quickly as we did.
Scientists worried they wouldn’t be nearly as effective as they are.
In fact, we’ve created a whole set of vaccines that are highly effective at stopping serious illness and not bad (after two doses) at disrupting transmission — even of Delta. And yet we are nervous to rely on them. The message seems to be that they will never be enough.
Has there ever, in the history of humanity, been a medical breakthrough that was speedier and more impressive? But has there ever been a medical breakthrough in which we collectively place less trust?
The feedback loops from this confusion are worrying. Because if you’re a younger person being encouraged to get your vaccine, you want to know that it heralds the end of restrictions. Being told it’s just one part of a patchwork quilt of defences against Covid — and that life will go on as abnormal — is sadly not the most inspirational of rallying cries.
