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British Society for Immunology open letter to Government on SARS-CoV-2 response
- coding123 7y agoThe common hepatitis virus stays in the body forever and may be responsible for countless things we have typically classified as auto immune disorders. So to say the solution is to get most least at risk people infected without even knowing if those 60000 recovered Chinese are all going to die in 6 months, that's just stupid.
- jacobwilliamroy 7y agoThey didnt say that the most least at risk people should get infected. I interpreted their guidence to be more in line with what you just said "Avoid infection, because we do not yet know if this virus induces long-term immunity, as many other similar viruses do not."
- piker 7y agoGiven the ambiguous use of pronouns, it seems you may be talking past one another. GP seems to be criticizing the UK government's approach whereas parent seems to be summarizing TFA's guidance.
- jacobwilliamroy 7y agoWhaaaat? U.K. government health officials are asking strong healthy people to get infected?
- piker 7y agoRather, accepting that people will get infected and proposing that if it's limited to healthy people, the community will develop a "herd immunity" due to the healthy people's new immunity.
- killjoywashere 7y agoThey actually said that? That's some next level fuck-it-I-don-t-want-to-be-in-charge-anymore attitude. Wow. Where's Churchill when you need him? Edit: yes, he said that. And more. Wow. https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea68b5 https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6...
- sgt101 7y agoI can't understand your reading of what is being said. Here is the quote : 'In another interview with the BBC, Sir Patrick said: “If you suppress something very, very hard, when you release those measures it bounces back and it bounces back at the wrong time.” He added: “Our aim is to try to reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it.”'
- vidarh 7y agoChurchill was very much in favour of making callous tradeoffs if he believed it had long term benefits, e.g. the Bengal famine. Churchill incidentally happens to be one of Boris Johnsons great heroes.
- pnako 7y agoChurchill is not exactly a good example of solid decision making.
- dTal 7y agoBit of a trolley problem, when "accepting it" means "not trying very hard to stop it".
- Angostura 7y agoAbsolutely not, there is still strong advice in terms of regular handwashing etc. Rather the government is saying that you have to time strong lock down procedures correctly. They are saying that outdoor gatherings such as you get at football matches don;t present a high risk (as long as you are washing your hands) compared to the risk of catching the disease from family members in doors. Moreover they argue that demanding a long-term lock (14 weeks for schools, according to their modelling) is problematic if you go too early - they want to time it to be just before the peak. Basically is playing chicken with an unrushing truck, but a game of chicken with a purpose behind it. The Chief Medical Officer Chris Whittey is an epidemiologist and I've only heard good things about him. I'm willing to take his advice. They government says it will be publishing the models.
- notahacker 7y agoAlso worth noting that in his previous role in DFID Whitty coauthored papers advising the UK government funding isolation centres in Sierra Leone for Ebola, so it's unlikely that he has any particular radical bias against the efficacy of isolation as a disease prevention method.
- pavelrub 7y agoI think GP was referring to the government's plan, not the suggestions in the letter.
- coding123 7y agoYes I was thanks for the clarification.
- coding123 7y agoYes sorry I didn't make it clear I was bashing the govt response, essentially agreeing with this open letter.
- jacobwilliamroy 7y agoGot it
- buboard 7y agoNot to mention, the high R0 of this virus means the threshold for herd immunity is unrealistically high. Plus, countries that are trying to delay transmission will also eventually get herd immunity , most probably with the help of a vaccine.
- sgt101 7y agoI think people believe that a vaccine is 18 mths away. Certainly it seems implausible that 100's of millions of doses of a new vaccine can be manufactured within a few months. The models and history that I have seen (ie. the 1918 flu) indicate that there will be another bump of infection after quarantine. I expect compliance with social distancing will be reduced in the next wave because people will be under economic pressure and also will have lost focus on the issue. In some places there may be events that mitigate against distancing - for example the presidential elections in the USA. I think that producing a plan that is predicated on something (production of a vaccine to any scale in less that 6mths) that is very unlikely to happen is not the best approach. Here is a discussion including expert comments : https://www.theguardian.com/world/2020/mar/15/when-will-a-coronavirus-vaccine-be-ready-human-trials-global-immunisation https://www.theguardian.com/world/2020/mar/15/when-will-a-co...
- TheOtherHobbes 7y agoThe most effective strategy would be wave isolation. The virus cannot be contained except by clean-room quarantine for everyone, which is clearly impractical. So the next best option is to spread the peak by alternate phases of more or less strict social distancing. The virus will still spread, most people will still get it, but the health care system isn't swamped, so resources remain to treat the elderly and vulnerable. At the end of the season, most people have immunity - assuming it's possible - and you've limited the total number of deaths. The economic cost is huge, but so is the economic cost of forcing your health care system to collapse. It's possibly not obvious yet, but the economics of this are going to be ruinous whatever happens. So it would be wise to create some mitigation for that, and suspend the usual market-eats-everything rules.
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- thinkingemote 7y agoThis idea that the primary aim of the UK Government is herd immunity is plain wrong. The primary aim is to flatten the curve with specially timed interventions and any herd immunity is a by product of that. The aim is to flatten the curve so that the systems are able to cope better. Herd immunity will be a by product in almost every western countries actions today. Ask them and if they are honest they will say the same that it's a long term effect but not the primary driver or the main aim. The difficult non sound bite criticism is about the flattening of the curve based on their models which basically means they need to get both the timings and the interventions spot on for it to work correctly.
- DanBC 7y ago> This idea that the primary aim of the UK Government is herd immunity is plain wrong. You can understand people's confusion when the government have said, repeatedly, that they aim to create herd immunity. https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea68b5 https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6... > Britain’s chief scientific adviser stoked controversy on Friday when he said that about 40m people in the UK could need to catch the coronavirus to build up “herd immunity” and prevent the disease coming back in the future. > Defending Prime Minister Boris Johnson’s decision not to follow other European countries by closing schools and banning mass gatherings, Patrick Vallance said it was the government’s aim to “reduce the peak of the epidemic, pull it down and broaden it” while protecting the elderly and vulnerable. > But Sir Patrick told Sky News that experts estimated that about 60 per cent of the UK’s 66m population would have to contract coronavirus in order for society to build up immunity. > “Communities will become immune to it and that’s going to be an important part of controlling this longer term,” he said. “About 60 per cent is the sort of figure you need to get herd immunity.”
- madaxe_again 7y agoYou just need to be down with doublespeak. They say one thing, but you have to understand that they meant something entirely different. To think otherwise would be to think that our leaders are either dishonest or incompetent - and because they are our leaders they cannot be either dishonest nor incompetent. Therefore, you must adjust your comprehension. Honestly, if their intent is as GP says, I’ve not seen it communicated - I’d love a source other than goodthink.
- nmca 7y agoBrit here: I'm not a fan of Dominic's government, but the response seems to be well motivated by a series of reasonable arguments. As I understand it: 1. We either get herd immunity via infection or cure/end every case of the virus in the world. They discard the latter as impossible given the infection rate and forecast time-to-vaccine. 2. The counterfactual/needless damage done will be deaths due to NHS capacity saturation, which is a function of (maximum simultaneously infected) - (nhs capacity at that time). 3. Most controversially, they argue that people are going to be shit at implementing isolation policies of the needed severity, in the particular sense that the effectiveness of isolation measures will drop over time. That seems quite likely to me, having met some humans before. Hard to tell / interested in studies if anyone can point to some. 4. As a consequence of these things, the goal is to pass severe measures later than now (but perhaps at a relative point in time similar to italy's) such that during the period of these measures many young people will be sitting out the infection without passing it on, and the infection rate will fall to avoid saturating the NHS. Or, put another way, they are going to do everything the US is doing but in about 7-14 days, as opposed to now, because the limited period of effective social isolation will hit a more high-growth period, and more young people will be sitting it out and becoming immune. This doesn't sound super-obviously wrongheaded to me. It's unclear what the plan in the US is. Lockdown for ever? Lockdown-till-cure? Lockdown till herd immunity is pretty equivalent to the UK strategy, and seems likely to be the outcome. But herd immunity takes longer to achieve the earlier you start measures.
- balola 7y agoIt's a gamble of whether this virus will persist like flu, in an era of mobility, pandemics are almost inevitable.
- TheOtherHobbes 7y agoThere's also no guarantee immunity will last long enough to be effective, or that the virus won't be a moving target like flu. Conversely, buying time with isolation makes the odds of a treatment more likely. There won't be a vaccine until next year, but various other possible medical interventions are already being considered and tested.
- dr_dshiv 7y agoHas anyone found any good spreadsheet models that might show assumptions? At a local level, I want to be able to help my mother-in-law. If I and my family got it now, I could help them in a month. That is clear and logical at a local level, but may be counterproductive at a global level. Conflict! At a global level, flattening the curve is about hospitalization. Early infections among those highly unlikely to be hospitalized reduces future risk. But, how does that square with overall growth? While the local scenario is clear, the global involves more assumptions that can't be modeled in ones head. Dying to play with models.
- jackweirdy 7y agoIt remains to be seen whether it will answer these questions, but the government has agreed to publish its own models - https://twitter.com/janemerrick23/status/1238912217921335297 https://twitter.com/janemerrick23/status/1238912217921335297
- nabla9 7y agoThe important point in the letter seems to be >we don’t yet know if this novel virus will induce long-term immunity in those affected as other related viruses do not. Therefore, it would be prudent to prevent infection in the first place. More research is urgently needed on this front.
- chimprich 7y agoIt might not be super long-term but it could be. It seems reasonable that immunity would last long enough until a vaccine was produced. There's no guarantees. You have to balance the risks up, and not taking this approach is risky in itself.
- sorokod 7y ago... to aid efforts, we call on the government to release their modelling data to allow scrutiny from the scientific community to better predict the course of this outbreak It is possible of course that at the moment, no such thing exists to standards expected by members of the British Society for Immunology.
- peteretep 7y agoIt’s possible, but given the calibre of the UK CMO and Chief Scientist, it seems unlikely.
- sorokod 7y agoI watched this https://www.youtube.com/watch?v=2XRc389TvG8 https://www.youtube.com/watch?v=2XRc389TvG8 and in my mind the Chief Scientist is a political and not an academic figure anymore.
- notahacker 7y agoVallance is a medical doctor with quarter of a century in academic medicine and private sector drug research and two years as Chief Scientific Advisor. Chris Whitty, who's identified even more closely with the development of the current strategy, is an epidemiologist.
- hkeide 7y agoI guess science no longer requires scrutiny and discussion. Two guys with credentials worked on it, that's all I need to hear to feel better.
- notahacker 7y agoI guess replying to comments no longer requires paying attention to the context. One person claimed, apropos of nothing, that the position was 'political, not academic' and I pointed out the obvious fact the relevant scientific advisor's academic credentials were impeccable and their political experience rather limited.
- alexmingoia 7y agoIt’s fascinating (and depressing) to watch the difference in response between Asia and the West. I’m an American living in Myanmar. Here’s what’s being done in my city all before there are any confirmed cases: - Cancellation of large events. - Free testing. - TV notices encouraging social distancing and hand washing. - Temperature checks and hand sanitizer dispensed at entrances of indoor crowded places like malls, grocery stores, large retail stores (not doing this really baffles me, since it’s so straightforward and practical). - School closures. - Travel and border restrictions. These are simple tactics that every country should be utilizing. Yet when I talk to my friends in US and Europe, they report no temperature checks or hand sanitizer. My family member just flew through SFO and said there were no temperature checks or hand sanitizer being dispensed. It’s sad and perplexing to me that common sense practical approaches to testing and spread control are not being utilized by many countries, and that closures have been reactive instead of proactive. It’s unfortunate that the UK is focused on actively ignoring practical efforts to control spread.
- stefano 7y agoItaly is doing all of those things.
- chishaku 7y agoNow they are. The key point being made is that these measures were put in place "before there are any confirmed cases."
- sorokod 7y agoCan you share the city name?
- alexmingoia 7y agoI’m in Yangon. I’m sure these measures are less prevalent in much of the country due to lack of development (around half the population lacks electricity, to give you an idea). But that just calls more attention to how apathetic the US and UK response are considering they are very developed with vastly more resources and expertise.
- drenginian 7y agoWhy in the face of absolute emergency do they communicate in such and understated manner open to ignoring and devaluing by politicians? They should state with absolute clarity what they think should immediately happen instead of meekly asking two questions. FFS
- jacquesm 7y agoWHO did the same thing with their oblique, opaque and 'without naming names' bulletins of urgency. Politics at a time like this is a very, very bad idea.
- sorokod 7y agoMaybe because the scientific advice may be ambiguous and leave room for interpretation which the politicians must exercise under the best of circumstances. My reading of the letter is that it challenges the scientific advice, as it has been communicated in the media, and seeks to clarify the "wiggle space" politicians have to work with.
- FartyMcFarter 7y agoThey didn't ask two questions if I read the article correctly. They asked for two specific actions: more social distancing and releasing modelling data behind decisions.
- drenginian 7y agoThere you go. So unclear communication I got it wrong.
- hanoz 7y agoWe've got this slightly weird "soon but not yet" thing going on at the moment, strangely reminiscent of Mark Carney Governor of the Bank of England's infamous and ill fated 'forward guidance' policy. We're being told that some time in the next two weeks all over 70s will be told to self isolate for up to four months. Well if it's going to be four months I think my parents can jolly well start now, thank you very much. Similarly with "not quite but nearly" school closures. It all seems to be predicated on the theory that if we start too early well get bored of it by the time the real pandemonium starts, which sounds like pretty strange thinking to me.
- phkahler 7y agoIf you lock down too soon the spread will simply restart post lockdown. If you wait a hit, there will be some percentage of the population already exposed and immune post-lockdown which will slow the spread. That's my thought on timing.
- hellofunk 7y agoDo you have any evidence to cite for this? The idea of a lockdown is to stop the spread, and during that time treat and isolate the sick, so the virus outbreak basically ends. When it's over, the idea, as far as I've known, is that the risks are gone. Additionally, a lockdown causes the now-famous "flattening of the curve" to maintain the stability of the healthcare system.
- CaptArmchair 7y agoIt's the other way around. You can't stop the spread to a complete halt, only slow it down. If you want to stop the spread, you need to literally quarantine everyone for a months. Why? Because we don't really know yet how long some can infect people. The answer is probably "your mileage will vary" depending on how the disease evolves on an individual level. If you lift restrictions too soon, the few remaining infected will rekindle the epidemic among those who haven't had it yet. > When it's over, the idea, as far as I've known, is that the risks are gone. A highly contagious virus literally comes from Pandora's Box. Once out in the wild, it's extremely difficult to eradicate. We've only managed to willfully eradicate a handful of diseases thus far. Smallpox comes to mind. And that could only happen because of concerted vaccination program one the one hand, and the particular properties of the disease itself on the other hand. Spanish flu disappeared after a year and an estimated 50 million dead - an optimistic estimate because no one really knows the true number. We don't really know why the flu disappeared. One theory simply holds that enough people had contracted the disease and had either survived or died by late 1918. Without vaccination, social distancing and quarantining are the most viable strategies if we hope to slow down the spread in order to avoid the collapse of the healthcare system. Why is that important? Because it's about avoiding as many deaths as we can while this runs it's course. Every young-ish person who ends up in the ICU, is taking up a bed and resources of an older person or someone who suffers a precondition. Or even someone who got into an accident, had a stroke or a heart-attack. It's your individual responsibility to avoid that you get infected, and equally important, that you don't pass it on to anyone else. Elderly and people your age alike. As such, the entire strategy of achieving "herd immunity" is entirely backwards. Herd immunity will be achieved regardless how this plays out in the weeks and months to come. The real question is: At what price? And how many will we allow to die? If the strategy is "let 'em have it", then the second order effect of that decision will be that many will die of causes that would have been treatable in other circumstances.
- etiam 7y ago[T]here are many unknowns in how the SARS-CoV-2 virus interacts with the human immune system and how this might play into current scenarios. For example, we don’t yet know if this novel virus will induce long-term immunity in those affected as other related viruses do not. That was really interesting to me. I didn't know infection with related viruses doesn't confer long-term immunity. Anybody know more precisely how closely related? All of Coronaviridae?