As The Observer notes this morning:
Covid should be treated as an endemic virus similar to flu, and ministers should end mass-vaccination after the booster campaign, the former chairman of the UK’s vaccine taskforce has said.
With health chiefs and senior Tories also lobbying for a post-pandemic plan for a straining NHS, Dr Clive Dix called for a major rethink of the UK’s Covid strategy, in effect reversing the approach of the past two years and returning to a “new normality”.
They note that he added:
We need to analyse whether we use the current booster campaign to ensure the vulnerable are protected, if this is seen to be necessary. Mass population-based vaccination in the UK should now end.
I was asked last night if I might comment on this story on LBC this morning, but two hours later was told that the story had been dropped, despite which during the intervening period I had inevitably given the issue some thought. Is Dr Dix right, or is he simply displaying the type of Tory thinking described by Nick Cohen in the same paper today when he says:
It is Conservatives who cannot respond to change. The 21st century baffles them. They don’t know what to do about it. This is why, for all their apparent self-confidence, so many speeches by Conservative politicians and articles by Conservative thinkers sound more than a little unhinged.
As he had noted in his argument:
All viable responses to global warming, vaccination, the job losses artificial intelligence will bring and failing public health enhance the role of the state. It must provide jobs and benefits to society’s losers, protect their health and drastically reconfigure markets to sustain the planet. Small states that allow sovereign individuals and companies to decide for themselves now feel as antiquated as Margaret Thatcher’s handbag and pearls.
So, what is Dr Dix really saying? Is he simply a baffled Tory, or has he something to actually say?
Let me stress when I ask this question I am basing my comments upon this press report the one that I read in The Times. These may not, of course, fairly represent what Dr Dix thinks, but I am presuming that he spoke deliberately and imparted the message that he intended. In that case I cannot help but say that he is confused, albeit not necessarily for what might seem glaringly obvious reasons.
First, it is entirely true that we have to learn how to live with Covid. After almost two years of this disease there is no point in pretending that it is going away. I am well aware that there are a great many people spreading the fantasy that omicron is supposedly mild and might therefore suggest that this crisis is coming to an end. None of the serious epidemiologists whose work I read would appear to agree. The likelihood that we will face another wave quite soon, or much worse, an outbreak of a new virus, appears to be high. In that case, living with this disease cannot mean, as many Tories seem to imply, pretending it is no longer there and accepting the consequences in terms of illness, disruption, havoc in the NHS, disrupted education and so on. Those costs are far too high to tolerate. It does instead mean that there must be proactive management of the disease and its spread.
Second, in that case Dr Dix is right to suggest that this does imply that some of the existing strategies for disease management might need to change. I do, for example, think that the levels of testing that have been undertaken have become absurd for three reasons. Firstly, testing systems have been overwhelmed by demand created by instruction that we must test whenever possible. Second, in that case, the processing of results has ceased to produce any meaningful information. Third, as has become very apparent, the use of lateral flow tests as a negative indicator has not worked in preventing the spread of disease, so to continue with them for this reason is pointless.
I am not suggesting that this means that all the testing that has taken place today has been meaningless. Very clearly, in the early stages of this pandemic it was essential that information was collected so that the nature of the threat that we were facing was understood. However, what we now know is that we now face versions of this disease that are more virulent than earlier versions where counting the number of cases has become utterly meaningless because it does not assist management of the consequences, particularly for the population as a whole.
This is hardly surprising. When underlying rates of infection within the population were growing relatively slowly (i.e. with an R of more than one, but not massively so, as was the case with earlier variants) then testing and isolation made sense because this could stop transmission. With omicron this has not and cannot work because the rate of transmission growth is so high. Testing now merely identifies symptoms and does nothing to deliver a cure. To that extent, Dr Dix has a point.
Third, thereafter I have no idea what he is suggesting. The suggestion that we should treat coronavirus like flu is meaningless unless it is properly explained. That explanation requires that it be noted that flu is not, just like many other endemic diseases, something that public health ignores. It actually requires considerable active management to constrain it at the levels at which it is suffered, and contrary to what he is suggesting, this also requires a mass vaccination program for all those who are at risk so that the spread of the virus is curtailed, which has been the exact same basis for the Covid vaccination programme. For an explanation see this excellent Twitter thread that will take a while to read but is well worth the effort:
Everyone keeps talking about covid becoming endemic, but as I listen to the conversation, it’s becoming more & more clear to me that very few of you know what “endemic” means.
So here’s a thread on how pandemics end. pic.twitter.com/uuYinUcynb
— Dr Ellie Murray, ScD (@EpiEllie) October 1, 2021
So what does living with Covid really mean in that case? I addressed this pretty comprehensively earlier this week. I set out an eight-part programme then. In summary, this said:
- Acknowledge that this disease is airborne.
- Create a plan for clean air to stop transmission. This requires widespread HEPA filtration installation.
- Until clean air can be supplied make mask-wearing compulsory in all public spaces and require that these be of type N95 or FFP2.
- Deliver vaccination to the world
- Continue vaccine development and require that it be patent-free.
- Provide the resources required to police these measures.
- Invest in the NHS so that it has the capacity to deal with any future crisis.
- Commit to public health in the future.
All of these require government action. There is no solution to this crisis without that.
And that is my fear about what Dr Dix is saying. As I read it his suggestion is that the government should simply walk away from this crisis, let Covid rip, and see what happens. As a recipe for disaster, whether for individuals, but that health, society and the economy that would take some beating, but that appears to be exactly what is being suggested by Tories now. If so their bafflement, as described by Nick Cohen is going to be very, very costly to us all.