
British Society for Immunology open letter to Government on SARS-CoV-2 response - 1_over_n
https://www.immunology.org/news/bsi-open-letter-government-sars-cov-2-outbreak-response
======
alexmingoia
It’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.

~~~
dharma1
Interesting. Which city are you in? I used to spend a lot of time in Yangon in
Myanmar, my wife's family are Burmese doctors who emigrated to the UK decades
ago. We live in London at the moment. They also find the difference in
approach between Asia and the UK puzzling.

I think the stark reality is, given how easily the virus spreads, you can play
whack-a-mole with closures for potentially a very long time, but the virus
will eventually spread and overwhelm the healthcare system.

I don't know how many ICU beds there are in Myanmar but I'm afraid it won't be
nearly enough, just like everywhere else. I've been to a public hospital in
Yangon once, and it was full to the brim with very long waiting times. Ended
up just leaving before I come out with something worse I went in with. This
was during a time without any pandemic.

~~~
ValentineC
> _I 've been to a public hospital in Yangon once, and it was full to the brim
> with very long waiting times. Ended up just leaving before I come out with
> something worse I went in with._

Huh, I was down with severe food poisoning in Yangon in early 2016. A local
associate of my friend brought me to the local hospital's A&E department,
where I got an injection of some sort and diarrhoea medication. I was out of
the hospital in probably 30 minutes.

I'm not in the position to assume that their hospitals can handle a severe
outbreak, but their medical system wasn't that bad when I had the unfortunate
chance to experience it.

~~~
dharma1
Could have been timing, or the hospital. I've heard others have had good
experiences also.

Still, I really don't think they have enough ventilators or intensive care
capacity to cope with a coronavirus epidemic. 70% of the population live in
rural areas where they don't even have hospitals

~~~
helij
Nobody has enough ventilators.

Also, people in the West mostly underestimate the rest of the world and their
capabilities. Once you show them that majority of the rest of the world does
not live in caves they are bummed. It's ignorance.

------
thinkingemote
This 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.

~~~
starfallg
There are almost no drawback to the health system by introducing strict
measures sooner rather than later. Studies supporting stuff like lockdown or
containment fatigue is also sorely lacking. Basing our epidemic response on
this is completely bonkers.

The overwhelming consideration is the blow to the economy. The government
should at least have the balls to admit it and not hide behind 'science'.

(The only issue with closing schools which might affect the healthcare system
is childcare for healthcare workers. This is already in place as a mitigation
in other countries.)

~~~
Angostura
> There are almost no drawback to the health system by introducing strict
> measures sooner rather than later

Yes there are, as set out in the chief medical officer and chief scientific
offer's press conference.

> The overwhelming consideration is the blow to the economy. The government
> should at least have the balls to admit it and not hide behind 'science'.

So, to be clear do you think the Chief Medical Officer and Chief Scientific
advisor were simply lying about the science?

~~~
pnako
I'm so glad the tech bros, here and on twitter, are on top of this epidemic. I
don't trust the professors of medicine and scientists advising our governments
either if I can't see some Python code and a condescending tweet about how no
one understands exponential growth.

~~~
zozbot234
The current response to the outbreak in the UK/US is supposedly being driven
by "behavioral modeling", which basically means glorified techbro-Python code.
So your argument is backwards, if anything. The WHO didn't used to think of
"lockdowns" as a recommended approach either, but they're now changing their
mind, as this has _worked_ in China and elsewhere.

------
coding123
The 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
They 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."

~~~
coding123
Yes sorry I didn't make it clear I was bashing the govt response, essentially
agreeing with this open letter.

~~~
jacobwilliamroy
Got it

------
hanoz
We'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
If 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.

~~~
wokwokwok
This is one of those “makes sense to me” kind of things, that the modelling
shows is wrong.

Not “kind of makes sense, but needs a set of specific assumptions, so kind of
true but risky.”

Wrong.

If you wait, you get a different infection rate curve.

That’s it. Flat out, it means more people get infected more quickly and more
people die.

Long term, maybe the results are less clear, but given the best experts in the
field are openly questioning the approach, you can be... pretty sure, your gut
feel about it is wrong.

~~~
kitd
Long term is what they're thinking of. Ie next winter and beyond.

And there are plenty of experts among the uk Gov't advisers too. "Pandemic" is
#1 on the UK's list of national threats, and has been for ages. I'm certain
this will have been modelled to death all that time.

Tbh, the "correct" advice depends mainly on your assumptions and priorities,
not the mathematics.

~~~
TheOtherHobbes
You may be certain this has been modelled, but that doesn't mean it's been
modelled correctly.

I'm having some difficulty believing that a government with a decade-long
track record of stupidity, craven dishonesty, and aggressive contempt for the
poor, weak, and old, has suddenly decided to be a world-leading paragon of
evidence-based health policy - in a way that's making epidemiologists in other
countries say "Huh? What?"

And the question remains - if they're thinking next winter, what difference
does two weeks make?

~~~
phkahler
Two weeks means a significant difference in the number of people infected this
season, which means a lower exponent in the rate of spread next time.

------
sorokod
_... 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
It’s possible, but given the calibre of the UK CMO and Chief Scientist, it
seems unlikely.

~~~
sorokod
I 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
Vallance 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
I 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
I 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.

~~~
sorokod
Apropo _apropos of nothing_ , the point was that an argument from (academic)
authority is weakned when the authority occupies a political role.

------
nabla9
The 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
It 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.

------
drenginian
Why 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

~~~
drenginian
It’s beyond belief that any strategy could even be considered that does not
have its primary goal to save as many lives as possible.

Containment attempts that.

“Herd immunity” is an experiment that the UK government is going to carry out
on its citizens causing massive loss of life for no good reason at all.

~~~
cameronh90
To be brutally cold: the goal is almost never to save as many lives as
possible. Even hospitals don't use that goal. We estimate the economic value
of life and use quality adjusted life years to determine if a potentially life
saving treatment is worth paying for.

We make these decisions constantly. You make these decisions every time you
leave the house. People die every day from things we could have prevented if
we had the inclination.

If the goal is to save as many lives as possible, why are driving and alcohol
permitted? Because of personal freedom and the economy.

Treating this pandemic differently would be emotion driven.

------
etiam
_[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?

------
dr_dshiv
Has 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
It 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)

------
buboard
Not 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
I 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-
co...](https://www.theguardian.com/world/2020/mar/15/when-will-a-coronavirus-
vaccine-be-ready-human-trials-global-immunisation)

~~~
TheOtherHobbes
The 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.

~~~
luckylion
> So the next best option is to spread the peak by alternate phases of more or
> less strict social distancing.

Has this been done before anywhere on a large scale?

How is it done, do they just say "it's safe, you can go back to work now _wink
wink_ ", do they encourage virus parties like new-age-parents? Are they going
to convince the public that everyone should get infected in their allotted
wave for the common good? Will they go door to door and just shoot in a blast
of viruses? Won't people catch on if they alternate between strict and
lessened isolation rules and figure "they're trying to trick me into getting
infected, I'm not going back to working at the office, thanks"?

I absolutely get the idea, but it's not like you're dealing with a population
that has it's memory reset every morning and just acts on the information
available today.

~~~
sgt101
>I absolutely get the idea, but it's not like you're dealing with a population
that has it's memory reset every morning and just acts on the information
available today.

Ahhh... Errm... I am terribly afraid that you can see that happening on
Twitter every day.

~~~
luckylion
I don't know, can you? I believe what you see on Twitter is tribalism in it's
purest and decentralized form. It's many smaller and larger tribes clashing
all the time, because of how it's set up. People don't forget what
$memberOfTheirTribe did or said last week, they fall in line because it's
their tribe vs that other tribe, and consistence or purity or adherence to
tribal values are less important than winning the battle.

------
nmca
Brit 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.

~~~
sarhus
You might want to read this:

[https://giorgio.gilest.ro/2020/03/12/the-uk-strategy-of-
figh...](https://giorgio.gilest.ro/2020/03/12/the-uk-strategy-of-fighting-
covid-19/)

~~~
specialist
Thank you.

This is the first I've read about waves of infection.

What I gleened: UK government is concerned that China may experience a second
wave of infection once the isolation efforts are lifted. So the UK govt is
hoping to have a single, much slower wave.

I also like this article's assessment of the UK's strategy: tough choices
based on data of uncertain quality.

