As any experienced applied scientist is well aware, it is folly to use loose analogies to describe complex processes, and subsequently rely on such analogies to develop real world policy. The Covid-19 pandemic is not a war between man and virus in which one side will be eliminated by superior force—as it has been characterized by the UK government—it is the playing out of a complex ecological interaction in which, after viruses spread through the human population, the two will come to coexist. This scenario of epidemic development and decline has been seen, analysed using empirical data, and thoroughly understood many times before. It is the bread and butter of experienced public health epidemiologists. In the past, it is to such individuals that we have turned for advice. We should have listened to them in the present situation, in order to implement sound policy.
Instead, the UK has chosen a scorched earth approach, involving a total lockdown of society, in the hopes of preventing anything but minimal transmission of the virus. The aim has been to suppress the natural epidemic, and the aspiration has, until recently, been to eliminate the virus on each occasion on which it resurfaces, through contact tracing and local suppression. This strategy appeals to those who seek to dominate. It suggests that we are in control of the situation, and that, through clever modelling and digital technology, we can exert mastery over undesirable members of the natural world. Unfortunately, it is highly unlikely that we will ever have either the resources or the infrastructure to implement a policy of continual surveillance and suppression. And, to remain economically viable, the UK needs to maintain continuous interchanges with a world in which the virus has already become established.
The total lockdown policy was presented to government as the only possible solution by the much lauded epidemiologists of Imperial College. They put their faith in models that simulate the complex interactions between human and virus, believing that these models can be used to make real world predictions. To generate such predictions, they modified models originally developed for existing influenza viruses. These models are likely to be inappropriate for predicting the behaviour of Covid-19, whose transmission characteristics differ significantly from those of influenza viruses. To run the models required the input of multiple parameters, some of whose estimated values contained huge errors due to scanty data, while others were merely guessed at. This is critically important because the results of models depend on the input parameters: rubbish in, rubbish out. The computer code that underlay these models was not available for critical scrutiny by other scientists at the time when the predictions were made. Now that it has been released, massaged into some semblance of order by Microsoft and others, its lack of rigour has aroused dismay in the professional programming community. At the time when the advice was given, the output of the models could not be tested against empirical data from Covid-19, because such data did not yet exist. Accordingly, there was no evidence that the models could simulate the behaviour of Covid-19 in the UK. There was only blind faith. Yet the results of the modelling—that, in the absence of epidemic suppression there would be half a million deaths in the UK due to Covid-19 and that the National Health Service (NHS) would be overwhelmed—were confidently put forward by the Imperial College team, who made a clear recommendation on that basis:
We therefore conclude that epidemic suppression is the only viable strategy at the current time. The social and economic effects of the measures which are needed to achieve this policy goal will be profound. Many countries have adopted such measures already, but even those countries at an earlier stage of their epidemic (such as the UK) will need to do so imminently.
So the UK’s war against Covid-19 began with a total lockdown of society, on the flimsiest of uncorroborated evidence, against the advice of experienced medical health epidemiologists from around the world. There was apparently no cost-benefit analysis of the overall public health effects of this policy. The number of deaths from Covid-19 was not weighed against the increase in deaths from other causes, resulting from locking down society. There was also no long-term plan for managing the situation once the epidemic had been suppressed. The crippling economic costs of an extended blanket lockdown should have been immediately apparent. Yet, when confronted by a scientist supremely confident in his own abilities, the government meekly capitulated and imposed the lockdown.
To impose the lockdown, the government has employed very skilful tactics and acquired some unexpected allies. To the British public, the National Health Service is a sacred cow. Saving the NHS is therefore an objective that few dare to question, and using this as a major justification for the lockdown was a masterstroke in securing the support and tolerance of the British people. But what did the use of this slogan imply? The real message was an admission that the NHS lacks the necessary resilience for coping with a major outbreak of a respiratory disease. Moreover, in a nation in poor general health, due to obesity and related underlying health conditions, it signalled a lack of government confidence that patients could rely on their immune systems to ward off the disease, in the absence of pharmaceutical protection.
In this situation, imposition of lockdown to temporarily suppress the virus and provide time for the ramping up of acute care facilities was a reasonable public health response. However, the government has since continued to impose, and acquired unexpected public support for, economically, culturally and educationally crippling long-term lockdown measures. Their support is based on unfounded levels of fear in the general population, generated by the mainstream media and reinforced by the intolerance of social media towards rational argument and the expression of opinions that run counter to the norm. The BBC, the second of our sacred cows, has perhaps been the greatest culprit in instilling fear. With a few notable exceptions, BBC journalists have sensationalised the Covid-19 outbreak, concentrating on the very real suffering of badly affected patients at the expense of providing a balanced picture of the overall situation—in which the vast majority of those infected manifest few or no symptoms. One particularly stark headline proclaimed “Coronavirus ‘as deadly as Ebola in hospital.’” With journalistic standards as low as these, the BBC has been a powerful weapon in the government’s armoury.
So, how is the war going? Lockdown has shattered our economy, deprived non-Covid patients of vital treatments and produced a divided nation: either frustrated at the folly of the lockdown or cowering at the spectre of a disease that the trusted BBC has portrayed as being as deadly as Ebola. Despite the lockdown, we have a per capita death rate equivalent to or higher than that of Sweden, which didn’t impose total lockdown. Until very recently we have had very little idea how many people have actually encountered the enemy and fended off the virus because there has been a huge delay in conducting a random antibody survey of the population—a measure so simple and so vital to public health policy that it beggars belief that it was not expedited. The antigen tests that we have developed have not been used effectively, to screen the section of the population that is mixing daily with the very vulnerable in care homes, where lethal outbreaks account for a high proportion of the total Covid-19 related deaths.
According to those who favour the lockdown measures recommended by the Imperial College team, we have now reached a dangerous phase in the conflict: having suppressed the epidemic, we now have to release it in small doses by alternately ramping up and then restraining our economy. However, if the models were incorrect in the first place, it is sheer folly to use them as the basis of an exit policy from lockdown. It is time for the government to acknowledge that the lazy analogy of a war against the Covid-19 virus is far too simplistic to deal with a complex real world situation that will have profound consequences for all of us in Britain. Instead, we must learn to live sustainably in the presence of the virus. The government should also learn that scientists who base their policy advice on models that are unsubstantiated by empirical data and lack verification should be treated with the utmost circumspection.
Developing the correct public health policies for tackling the effects of a new respiratory virus is not easy. However, the spread of a novel respiratory virus in the UK is not a unique event: it has happened many times in the past and appropriate responses have been forthcoming. The annual mortality rates have increased when new respiratory diseases have emerged in the UK, but the NHS has not been destroyed. We should turn to the assimilated historical understanding of these outbreaks, the analysis of empirical data from the present outbreak, and the public health epidemiologists versed in this knowledge, to develop policies to extricate ourselves from the current situation. Such measures may involve a gradual return to normality for the less vulnerable, the build-up of immunity in that section of the population—if indeed it is currently lacking—and continued shielding of the vulnerable until this has occurred. Whatever decisions are made, the cumulative economic, educational and cultural damage of over nine weeks of total lockdown, in pursuit of unattainable levels of continuous virus suppression, will mean that the ultimate end to the Covid-19 crisis can only be hailed as a Pyrrhic victory.