UKC

Lancet Letter - please do not unlock on Monday

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1,200 scientists and various governments ask Boris to delay "freedom day" as it is an irresponsible experiment risking vaccine resistant strains which could have disastrous effects globally.

Who do we trust on this one, the above signed or Boris? 

(I would sign the letter myself if I could....seems idiotic and selfish to relax arbitrarily on a date, just because you pulled it out of the air, but par for the course with this shambles in no.10)

Be interested in others thoughts on this.

Post edited at 07:32
13
In reply to Bjartur i Sumarhus:

> Be interested in others thoughts on this.

Horse bolted on 17th May. Stable door, currently flapping in the breeze, to be held fully open from tomorrow.

 wintertree 17 Jul 2021
In reply to Bjartur i Sumarhus:

My take:

The decision to drop restrictions and let the virus spread unimpeded in the unvaccinated and those with ineffective vaccination is what exposes us to the risks ahead including the total number to become seriously ill and around a vaccine evasion strain.

That decision is reflected in the mid-May unlocking and everything that has happened since. Horse, stable door, bolted.  We were committed to this two months ago.

With the rate of first doses of vaccine have slowed to a crawl, assuming this is down to demand limits, there's not much more stalling for time re: vaccination other than second doses running through.

So, having further unlocks happen faster or slower doesn't change the net total risk, it changes how quickly it's realised.  If one of the people yet to be infected is going to generate an evasion variant, it's going to happen regardless of how much we spread the curve.]

The horse bolted in Mid-may. Reversing that and telling people we're now keeping restrictions indefinitely would be a hard political sell (to say the least) given that the restrictions were brought in specifically to protect healthcare against the solid, tangible threat of exponentially rising hospitalisations.

So, the key issue now to me now is that the next unlocking runs the risk of having too many infections happen to quickly, locking in enough infection to put healthcare under unreasonable strain before there is time to evaluate the data and put the breaks on infection.  That is a real risk and I think we're moving too fast to properly account for the risk.  The counter-argument is that if we delay this process until winter it could be worse for various reasons.  My sense from the data and the most recent models suggest that we could take another month to drop these restrictions more progressively, with a result of slightly  fewer total hospitalisations (mainly second doses following through) and giving time to evaluate each restriction in time to delay future ones if the healthcare situation gets worse than expected.  This is how we handled earlier unlocking steps and seems sensible and proportionate to me.

In terms of variant generation, the UK may be heading for the highest number of cases, but cases ≠ infections, and we have much better surveillance than other countries.  There's also a lot of suggestions chronic cases are more likely to be responsible for variant generation, and we're seeing much lower case fatality rates than other countries with similar rising cases  (and likely even lower IFRs).

I'm much more worried about foreign variant generation, and the "amber list vaccinated > no quarantine" rule change building a lightning rod to effectively draw home and spread and vaccine evading variants that emerge.  

I'm not sure what letter in the Lancet you refer to?  I'm aware of this one but it doesn't have so many signatories:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01589-0/fulltext

My thoughts on that letter are here - 

https://www.ukclimbing.com/forums/off_belay/friday_night_covid_plotting_33_continued-736730?v=1#x9487620

Rallying against the consequences of a not-really-announced-with-clarity policy we've been committed to for two months is not going to change anything, but there are details of the policy that should be challenged and can make a real difference - getting a determination from government about why first dose rates are almost stalled, pushing for a progressive dropping of control measures over the next 4-6 weeks (to give time to evaluate their effects on rate constants) and accelerating more second doses.

I've got a "worst case" hat on for the above, as that's how we should evaluate the risk.  Perhaps we're much closer to the wave breaking and it's a case of "third time lucky" going for unrestricted case growth.  Or at least "third time we manage to avoid breaking healthcare".

Edit: Found it, there’s a separate declaration open to singing that derives from the article I linked above - https://www.johnsnowmemo.com/

I personally am cautious about interpreting all the signatures on that as full agreement with the lancet article rather than as strong disagreement with the idea of dropping all restrictions on Monday; two very different propositions - but I can’t speak for any of the signatories.

Post edited at 09:19
4
 Sainigh 17 Jul 2021
In reply to Bjartur i Sumarhus:

> 1,200 scientists and various governments ask Boris to delay "freedom day" as it is an irresponsible experiment risking vaccine resistant strains which could have disastrous effects globally.

> Who do we trust on this one, the above signed or Boris? 

> (I would sign the letter myself if I could....seems idiotic and selfish to relax arbitrarily on a date, just because you pulled it out of the air, but par for the course with this shambles in no.10)

> Be interested in others thoughts on this.

The scale of the resurgence in hospital admissions after 19th July is highly uncertain, and we clearly can't rule out a wave of a similar or even larger scale than Jan 21.

So it's a high risk bet with public health, common sense would dictate a slower, more cautious approach.

But if you look at it from a political angle, it's a much safer bet.
Any such wave is almost certain to hit the non-vaccinated disproportionately (around 40/60% according to the various modeled scenarios) and those people won't get much political capital.

Sure many who are vaccinated will be caught as well, but at least, if anything goes wrong, the Tories have got a scapegoat to point to. The "personal responsibility" narrative they are starting to push is all part of that blame-shifting exercise.
And in fairness, they'll be partly right, it's a bite more difficult to empathize with those who end up in in hospital because they refused a vaccine.

Post edited at 21:13
3
 Jim Fraser 18 Jul 2021
In reply to Bjartur i Sumarhus:

The bastard boris is out to kill us all.

5
In reply to Sainigh:

> And in fairness, they'll be partly right, it's a bite more difficult to empathize with those who end up in in hospital because they refused a vaccine.

Not fully vaccinated isn't the same as refused a vaccine.

My 18 year old daughter got the first dose the first day she was offered and she won't be getting her second for a few more weeks.  Plus another 2 or 3 for it to be effective.  So they are exposing her to risk before she has a chance of vaccination.

Same with kids under the age where vaccination is being offered.  They have near zero chance of not catching it if they go to school and if they don't go to school they'll call it truancy.

And then there's the people with compromised immune systems where vaccination will not be effective.

3
 Count Dracula 18 Jul 2021
In reply to tom_in_edinburgh:

> Not fully vaccinated isn't the same as refused a vaccine.

The respondent didn't say it was.

7
In reply to Bjartur i Sumarhus:

Every time the uk unlocks too much, too quickly, it's like they've learnt nothing in 18 months. Boris is still treating it like a popularity contest and didn't want to be the nasty man making pubs close over the euros and have Wembley empty. Any delay in so called freedom day is way too late now. 

In reply to tom_in_edinburgh:

> Not fully vaccinated isn't the same as refused a vaccine.

> My 18 year old daughter got the first dose the first day she was offered and she won't be getting her second for a few more weeks. 

If Freedom Day goes ahead, this will prove to be excellent conditions for a vaccine-proof variant to evolve.

1
 Offwidth 18 Jul 2021
In reply to wintertree:

I'd pick you up on two small points. Firstly we don't know the overall population risk is the same, in lower waves many more might escape exposure and sit things out until risks are much lower. Also as variants change people do catch it again (after vaccination or much worse after previous infection, as Manaus showed us). Secondly, vaccine escape risk relates to an evolutionary advantage in someone with high viral load in competition with some protective measure. It's why I think a partially vaccinated population is higher risk than waiting for a month to get a much higher proportion in double jabbed status. Vaccine supply also seems to be good enough to double jab faster (it would be good to know this for certain).

 wintertree 18 Jul 2021
In reply to Offwidth:

Edit: I disagree somewhat with your points although not in full, but I don’t want to derail this thread so I’ve deleted my comments; it’s all stuff I’ve said on the plotting threads.

Regardless, the intangibles and unknowns make it hard to have a definitive view on almost any of this; that’s why I favour a data driven approach not modelling driven, and the data right now says that if we have a big spike in the exponential rate after unlocking and the wave doesn’t break almost immediately (a reasonable worst case scenario and worryingly close to a median one from the models), by the time we know this then healthcare overload is likely to be locked in.  So regardless of picking over the arguments in that letter to the lancet, we just shouldn’t drop all restrictions tomorrow as it doesn’t give the time needed to safely manage a reasonable worst case outcome.

Post edited at 16:12
 Offwidth 18 Jul 2021
In reply to wintertree:

I agree entirely with that second paragraph. 

On the first maybe email me. It does seem likely a bigger part-vaccinated population gives a higher risk overall of variant generation. Plus we don't know from data if restrictions just lead to the same overall risk over a longer time. I can see possibilities why it will reduce risk, short term and increase it if we end up heading into autumn running hot.

One other factor: if your weather correlation is true (as I suspect it is), we may well get slightly more risk if the weather is very hot, as meeting outside is too hot for many and there will be more reliance on air con in indoor public places where people mix.

 wintertree 18 Jul 2021
In reply to Offwidth:

Yes, I’ll drop you an email later on.  I don’t think we’ll reach a full agreement because there’s so many unknowns.  So, all the more reason to err on the side of caution.

On the weather front; yes some non linear responses.  Also impromptu “sunny day” parties that end up inside as the night wears on.  It’ll all be lost I think to conflating factors from the end of school term and what one usually pro Tory paper has called “Freedum Day”.

In reply to Longsufferingropeholder:

> Horse bolted on 17th May. Stable door, currently flapping in the breeze, to be held fully open from tomorrow.

Agreed, 17th May should have been delayed in favour of an outdoors summer to get cases down.

I am wondering how much difference it will actually make.  Anti maskers are already not wearing masks, social distancing is already not really a thing in most circles and most people who aren't COVID deniers are saying they will be sensible even after tomorrow, and some might compensate by e.g. upgrading to FFP2/3 masks.  And vaccination continues.

If measures are to be called for to bring cases down, it needs to be a call for indoor hospitality to close again and for people not to meet in homes.

Post edited at 16:30
 Offwidth 18 Jul 2021
In reply to wintertree:

If you're convinced I'd lay odds it's me that's wrong, probably due to something I overlooked

A true sign of a proper scientific approach is to look at the information rationally with a sceptical eye and if proved wrong, to quickly admit errors.... too many scientists don't do that.

 wintertree 18 Jul 2021
In reply to Offwidth:

In brief:

>  Firstly we don't know the overall population risk is the same, in lower waves many more might escape exposure and sit things out until risks are much lower

  • If we can't reach herd immunity thresholds for this virus with no restrictions, it's irrelevant
  • If we can reach such a threshold, then that threshold (a function of R0 and restriction levels etc) defines the fraction of people who must either be vaccinated or infected (perhaps symptomatically so) to achieve the threshold.  So, if one person sits out the next few months, either someone else gets infected in their place or they get infected eventually - reaching the threshold is a numbers game.  With first vaccinations all but stalled...

In terms of variants and vaccine escape; if chronically ill people are the main source of variants, the greatest risk seems to be having them butted up against vaccinated individuals who will amplify and evading variant that appears.  Basically healthcare.  Again, flattening the curve doesn't reduce the area under it, and it's that area that represents the risk.  Letting more second doses run through would reduce it, but I think minimally so, as people awaiting second doses are mostly from the lowest risk cohorts for vaccination, and the subset of those who would be chronically ill after one dose but not after two and who haven't had a second dose yet is the difference made by waiting, and is I think going to be small compared to those in hospital with no vaccine, and those from higher risks groups with full doses but weaker immune systems.  Which in turn pales in to insignificance compared to what's going on abroad, where cases are rising in many places where healthcare staff in particular are vaccinated but many other people aren't and fatality rates look an order of magnitude or more higher than here.

I think we can argue these points either way till the cows come home, but there's no solid predictions of what's going to happen - far from it, wide bounds of uncertainty and lots of unknowns.  

There is enough concern IMO in the immediate data to be cautious about the unlocking, and that case stands alone.  

Edit: 

> A true sign of a proper scientific approach is to look at the information rationally with a sceptical eye and if proved wrong, to quickly admit errors.... too many scientists don't do that.

I'm starting to think there's a lot of people who think that working in science makes them or others in to scientists.   Other than in very specific areas - typically around healthcare - there're no professionally regulated standards over being a scientist.  

Post edited at 17:53
In reply to Bjartur i Sumarhus: Opening up is like the US leaving Afghanistan, we know the result!


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