A Warning for the United Kingdom: Covid19

© Alessandra Tarantino / AP. Critically ill COVID-19 patient on bio-protective stretcher, March 2020 (Rome, Italy).

⏱ 9 Minute Read ✍🏻 21st March 2020
🔗 Copy + Paste: jukes.in/covid

My girlfriend Katie and I are currently locked down on the Spanish island of Mallorca, watching from afar as the COVID-19 crisis unfolds in the UK.

I have now studied a great deal of credible information about the Coronavirus situation in Europe and have become convinced that people in the UK are dangerously misinformed.

I am not trying to cause panic. This is simply information that I believe the public need to know in order to make the right choices. Generally speaking, I believe people are morally correct, but nobody can make the right decision without the proper information.

Having seen the bars of Osborne Road in Newcastle packed for St Patrick’s Day, with NHS Accident & Emergency departments overloaded with alcohol and drug-related injuries, it is clear that there is a false sense of security and a lack of understanding of the reality of this situation – the UK is heading for disaster as a result of this ignorance.

Recently, I’ve heard many British people saying that it is absolutely fine for the young and healthy to go out socialising, apparently believing that contracting Covid19 poses no more threat than a common cold or flu, and that we need to ‘build up immunity’. This is missing the point completely.

It is scientific fact that Coronavirus can be transmitted before the onset of symptoms or even if someone never becomes ill at all. An infected person spreads the virus to an average of 2.6 people. This means that after 10 generations of transmission, with each taking about 5 or 6 days, that one infection has generated over 3,500 more. Most of those will have mild symptoms. Many will have no symptoms at all. But they will still be highly contagious.

If you believe that simply washing your hands for 20 seconds or staying away from your elderly relatives is enough to prevent a significant number of people dying, you are wrong. Of course, these health advisories should be strictly followed, but there is now good evidence that the virus can survive for up to 3 days on many surfaces and could be being transmitted through the air under certain circumstances (and not just by sneezing or coughing in someone’s face). I will post a link to the relevant study at the end of this article.

This means that the more virus there is in the general environment, the more likely it is that the elderly and vulnerable will be infected. This simply boils down to percentages and population density. Transmission does not necessarily require you to touch a person, or even visit them – the latest science suggests that they could catch it from something like a cardboard box or a food container that has been untouched for 24 hours (possibly longer). This may well explain why the virus is spreading at such an alarming rate, causing European governments to panic to such an extent that they have closed airspace and turned commercial flights around in mid-air.

Please understand that I am not playing keyboard warrior here; I have quite literally put my money where my mouth is. As soon as I understood what the information I am about to explain means, my company took the decision to transfer our entire office of 90+ people to homeworking. Not because the government told us to (they didn’t) but because we realised we had a moral responsibility to take action. We therefore decided to do the right thing by our staff and country, without waiting to see whether our government would force us to. Obviously, this will have a direct and significant financial impact on both my business and my own livelihood.

Economies can be resurrected. Dead people cannot. Families destroyed by grief will never be the same. My brother and I know this very well – we were at my father’s bedside when he died of viral pneumonia, despite being on a ventilator. That was back in 2016, in the ICU of one of the best NHS teaching hospitals in the UK. Even then, before the world had even heard of ‘Coronavirus’, the health service was badly overstretched. My father had a chance, but the odds were stacked too highly against him. Anyone admitted to ICU with Covid-19 today has half a chance. Anyone who cannot get access to a ventilator basically has no chance at all. What we have seemingly failed to grasp is that the severity of the outcome is largely within our control. That means you.

I am referring specifically to the report released by Imperial College London on Monday 16th March. The content of this report is largely the reason that we are now seeing a dramatic change in the way both the UK and US government is responding to the Covid-19 crisis. Its conclusions are also the reason we have seen Spain declare a State of Emergency, mobilising its military to enforce a lockdown on a par with Wuhan. Here in Mallorca, the local government have closed the air and sea ports, while Guardia Civil patrol the streets to prevent people from leaving their homes. However draconian it may seem, I fully support the approach, as do the majority of people here. The Spanish public understand that their government are doing everything they can to protect them.

The Imperial report is complicated and requires a lot of parsing, but I have done my best to extract the basics of what I believe it means at its core. Again, I will post the link to the original report at the end of this article.

Essentially, they have used raw data from the infection and death rates already seen in badly hit countries (China, Korea and now Italy) to build an accurate simulator which shows the outcome of different government strategies. The first thing it shows is that if the UK did nothing whatsoever, i.e if people just carry on as normal—believing that this is all ‘over-hyped’ and that protecting the economy is more important—then around 80% of the UK would get the virus. That is more than 54 million people infected. Of those, about 1% would die (mostly the elderly and the already ill). That would amount to at least half a million people dead. This is the scenario that the authors refer to as an ‘unmitigated epidemic’.

The 510,000 figure for this scenario comes from a very basic calculation which does not factor in increased deaths from overwhelmed hospitals. Consequently, the likelihood is that much more than half a million people would die under these circumstances. This is mainly because people who become critically ill with Covid-19 need a ventilator. Once someone is on a ventilator, their chance of survival is basically 50%. In an ‘unmitigated epidemic’, however, the requirement for ventilators would be 30 times the number currently available in the UK. Critically ill Covid-19 patients who do not have access to a ventilator almost always die – the death rate is practically 100%. The net effect of this is that the death toll in the UK would be closer to three quarters of a million people, maybe more.

This Armageddon-like ‘do nothing’ scenario is unlikely to play out in full, because the government is trying to do something (as opposed to nothing). The Imperial simulations show that in an ideal world—in a country where the NHS isn’t already close to capacity, where there are only around 4,300 ICU beds (80% of which are currently occupied anyway), and where there is a dire shortage of ventilators—the most effective combination of actions would be case isolation, home quarantining of the infected, and voluntary social distancing of high risk people (those over 70 years of age and those with the relevant pre-existing health conditions). This protocol was the ‘Flatten the Curve’ approach that was in effect until the 18th of March.

Then, the government added the closure of most schools, because (quote) “The spike of the virus is happening at a faster pace than anticipated.” Just two days after that, they closed all cafes, pubs, bars, clubs, restaurants, gyms, leisure centres, nightclubs, theatres and cinemas. To many right-minded people, it seemed obvious that this was done the wrong way around, and far too late.

The problem with the government’s strategy up until late March was this: on the trajectory the UK is on, and as more information is gathered about how the virus spreads, the NHS will still have around eight times more people who need intensive care than it has the capacity for. This means 350,000 (three hundred and fifty thousand) people in the UK would likely die under the ‘Flatten the Curve’ strategy, on the current trajectory.

In fact, given the particular challenges faced by the UK, what the Imperial College projections recommended was (quote) “a combination of case isolation, social distancing of the entire population, and either household quarantine or school and university closure.” Obviously, the key point here is the one I have underlined – the one that the government did actually ask people to do, but which the public largely ignored.

Although the recommendations of the report may sound drastic and unpleasant, the simulation clearly shows that it has a very good chance of success (certainly the best chance we have). If everyone were to follow these recommendations strictly, the projection is that the death rate would peak around 3 weeks from now at 1,500 – 2,000, then begin to decline. It also means that the demand for ventilators has some chance of being roughly in line with supply. Most importantly, it would buy time for a publicly available vaccine to be developed, which is 12 months away at the very least, but more likely to 18 months.

The good news is that this strict social distancing and self-isolation probably would not need to be continuous. This is important in terms of it being achievable over the long run, particularly given the grossly ignorant and selfish behaviour displayed by public already. The Imperial model proposes ‘breaks’ to allow people some periods of normal life and to allow some infections to be built up in a controlled manner, at a level that the NHS could actually cope with. This also looks like a morally responsible way of fostering ‘herd immunity’. Such breaks would probably be coordinated city-by-city, in a staggered approach.

Many will say that a strategy like this will never work in the long term because of the ‘second wave’ theory. While it is true that scientists generally agree that this is a real risk—it happened in the influenza pandemic of 1918—it is also true that has yet to be proven with Covid-19. The theory cannot be tested until China has been back to normality for several weeks. It is however possible that relaxing all the strict measures in the UK (before a vaccine can be developed) would result in a rebound effect whereby the death toll could even exceed the original estimate over time. The key therefore is for everyone to begin proper social distancing and self-isolation immediately, accepting that life may be very, very different for the next 12 to 18 months, but that it will be worth it in the end.

To put it simply, if the UK wants the same outcome as China, the people of the UK need to do of their own accord what the people of China were forced to. Anything else will most likely lead to the same outcome (or worse) as Italy, which is only now approaching its darkest days. On March 20th, 627 people died in Italy in one day. That is more than 4 times higher than the worst day China had throughout its entire outbreak.

For those who argue that “Italy is only that suffering so badly because its population is old”, consider this: Iran’s death toll stands at 1,556 as of 21st March, where well over 100 people are dying each day, with no sign of slowing down. The fatality rate there is 7%, mostly because its health system has basically already collapsed. This is a country where only 5% of the population are 65 years old, and half the population are below the age of 35. Again, their final death toll will make China’s look small by comparison.

Even if you are the type to disregard evidence that doesn’t suit what you want to believe, it is worth bearing in mind that the UK population is not vastly different to that of Italy. The two countries are of similar population size. In fact, the UK has a greater population density – something that does not bode well. Age-wise, about 18% of the UK population are 65 or above, whereas in Italy it is 22%.

One large and very important difference is that Italy’s health system is one of the best in Europe; it is much better funded than the NHS. Italy also does more testing, and it has been locked down for some time now. The UK on the other hand is not testing anyone unless they are so ill that they need to be hospitalised, meaning that the UK government actually has no idea how many cases there are in the population today – at the time of writing, their best guess is between 50,000 and 100,000 (many Chinese scientists who were in Wuhan believe it to be much, much higher).

Now think about the fact that the Chinese government—having learned valuable lessons from the SARS outbreak of 2002—were testing aggressively from Day 1 and locked down Wuhan completely when they had just 450 confirmed cases. Do you really need to be an epidemiologist or a statistician to see that the trajectory of China, particularly when contrasted with Italy and Iran, proves that the biggest factor in influencing the death rate is how aggressively and quickly the government responds? In the absence of the correct government response, what will make all the difference is how community leaders and the public enforce social distancing and self-isolation for themselves.

Please, please, please do not blindly rely on the government. At the end of the day, a government is just a group of people with opinions, operating in a convoluted system of political pressures and vested interests, all of which have a tendency to blur the lines of what is morally right for the public. The government may or may not be correct in their approach – nobody knows, and only time will tell. In my opinion, debating government policy is just a distraction from the unilateral action we urgently need to take.

Finally, there is some other modelling—based on what happened in China—which several public health experts are now taking very seriously too. While it isn’t an academic paper, it is based on solid data and is therefore well worth considering. The model shows 3 different hypothetical communities: one that doesn’t take any social distancing measures at all, one that enforces it 20 days after the first case is discovered, the other the day after that. All the figures are based on what actually happened in Hubei Province, with 6,000 new cases being the one-day peak. In the simulation, waiting one more day created 40% more cases. In other words, it shows that if the Chinese government had locked down on 22nd January instead of 23rd January, they could have reduced the number of cases by at least 20,000, or 180 deaths. Again, the true death rate would likely be much, much higher, because that calculation does not factor in the extra pressure on the healthcare system, which we know multiplies the death rate. What this strongly suggests is that even a one-day delay in proper social distancing measures will cause the eventual number of deaths to skyrocket.

You must take action yourself, independently and collectively. You are not sheep; the government is not your shepherd. The information is clear and available to all; you do not have to wait dumbly for the government to force you. Doing the right thing—making the necessary personal sacrifices and putting others first—will lead to an outcome that the whole country can be proud of. The alternative is unnecessary death and suffering that will ultimately be the fault of the people, irrespective of government strategy.

Now that you have this information, please understand that if you continue to go out unnecessarily; if you continue to go out socialising, walking around town, browsing around the shops, or if you go anywhere at all that there are other people when doing so is not absolutely unavoidable, then a growing body of evidence suggests that you will be contributing to countless avoidable deaths. There is just no other way of saying it. You cannot choose who this virus affects, and it is not at all clear how it is transmitted, or at what rate – the tragedy you now see unfolding in Italy, Spain, France and Iran is proof of that. And those in the UK who die as a result of stupidity will include not only the ill and elderly, but also the NHS workers who are fighting the disease on the front line – the very best of our society who put the safety of others before their own.

The only solution here is a major shift in values. Armed with the right information, it is high time for the people of the UK to get real and get their priorities straight. In fact it is almost too late. Forget about socialising, enjoying yourself or even physically going to work unless your job absolutely cannot be done remotely and your work is required to protect society. If your employers give you a hard time, perhaps go to the media, but certainly do not go to work.

Knowledge is power, but the power is in the people – please share. You can use the buttons below, or copy and paste the shortlink jukes.in/covid

🔗 Imperial College London COVID-19 Response Team, Report 9, here.
🔗 Neeltje van Doremalen, Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1, here.