down the rabbit hole with the government’s ‘scientific advisory group of experts (sage)’

Boris Johnson’s coronavirus adviser calls for a way out of lockdown
Chris Smyth, The Times, Apr 4 2020

Boris Johnson, applauding the NHS on Thursday night, has been
urged to consider the cost of the lockdown. Photo: Pippa Fowles/PA

Britain has “painted itself into a corner” with no clear exit strategy from the coronavirus epidemic and needs to reconsider herd immunity, according to a senior government adviser. A prolonged lockdown risks causing more suffering than the virus itself, Graham Medley, the government’s chief pandemic modeller, has warned. He said that the country needed to face the trade-off between harming the young versus the old. Professor Medley, a member of the key scientific body that is guiding the government’s response, told The Times that Britain must consider allowing people to catch the virus in the least deadly way possible rather than letting unemployment, domestic violence and mental ill health mount indefinitely. His modelling showed that letting people return to work or reopening schools would allow the pandemic to take off again and no way had been found of easing the lockdown while controlling the virus. Only those working outside might be safe to go back to their jobs, he found. An antibody test, which the government is hoping will prove a “game-changer,” could help but was not working and such a method had never previously been used to manage an epidemic, he said. His warning came after 684 more people were confirmed yesterday to have died from the virus in Britain’s biggest daily rise, taking the total to 3,605. Professor Medley, professor of infectious disease modelling at the London School of Hygiene and Tropical Medicine, is a member of the government’s Scientific Advisory Group for Emergencies (SAGE). He is chairman of SPI-M, the SAGE committee overseeing mathematical models. he said:

This disease is so nasty that we had to suppress it completely. Then we’ve kind of painted ourselves into a corner, because then the question will be what do we do now? We will have done three weeks of this lockdown so there’s a big decision coming up on April 13. In broad terms are we going to continue to harm children to protect vulnerable people, or not?

It is understood that work is under way to quantify health harms caused by lockdown, although this has not yet reached ministers. They have said this trade-off has not featured in government decision-making and Downing Street is giving all its attention to social distancing and building NHS capacity. While declining to comment on SAGE discussions, Professor Medley said:

It’s certainly been a concern from the outset and something that is increasingly being considered.

Nearly a million people have applied for benefits in the past two weeks and millions more have been furloughed. Professor Medley said:

The measures to control COVID-19 cause harm. The principal one is economic, and I don’t mean to the economy generally, I mean to the incomes of people who rely on a continuous stream of money and their children, particularly the school closure aspect. There will also be actual harms in terms of mental health, in terms of domestic violence and child abuse, and in terms of food poverty. If we carry on with lockdown it buys us more time, we can get more thought put into it, but it doesn’t resolve anything. It’s a placeholder.

The introduction of the lockdown on Mar 23 is on course to avoid a catastrophic peak, but the virus will start spreading again once it is eased, it is believed. In the absence of a vaccine, viruses only stop spreading when enough people have been infected that they can no longer pass from person to person, a concept known as herd immunity. Although never a government goal, this was tacitly accepted as inevitable by an initial strategy designed to manage a peak in the summer, when the NHS would be better able to cope. Headlines suggesting that ministers wanted 60% of people to get the disease to protect the economy led to the idea being sidelined. Latest estimates suggest that almost 70% of the population need to contract the virus to ensure herd immunity.

Boris Johnson urged to reconsider lockdown strategy by virus adviser
Peter Stubley, Independent, Apr 4 2020

Boris Johnson’s key adviser on the coronavirus pandemic has urged the prime minister to find a way of ending the nationwide lockdown, according to a report. Graham Medley, an expert in the spread of infectious diseases, suggested the government had “painted itself into a corner” by imposing widespread restrictions on movement that he claims may cause more damage than the epidemic itself. He suggested the potential harm caused by the restrictions included economic damage. he told The Times:

I don’t mean to the economy generally, I mean to the incomes of people who rely on a continuous stream of money and their children, particularly the school closure aspect. There will also be actual harms in terms of mental health, in terms of domestic violence and child abuse, and in terms of food poverty.

He argued that the UK may still have to reconsider the herd immunity strategy to “allow people to catch the virus in the least deadly way possible,” the newspaper claimed. This would involve accepting the heightened risk to the elderly rather than harming younger generations with rising unemployment, domestic violence and mental illness, it suggests. Professor Medley, of the London School of Hygiene and Tropical Medicine, also reportedly claimed that the epidemic would inevitably peak again once the lockdown was loosened and people returned to work. He has previously argued against rushing into banning football games or closing schools, saying that it “feels good but isn’t necessarily evidence-based.” He told The Atlantic magazine in early March:

My problem with many countries’ strategies is that they haven’t thought beyond the next month. The UK is different. We’re at the beginning of a long process, and we’re working out the best way to get there with the least public-health impact.

It followed reports that the prime minister was relying on the strategy of creating natural immunity among the population by allowing the disease to spread, rather than impose lockdowns of the kind seen in China and Italy. Amid widespread criticism of the government’s approach, health secretary Matt Hancock insisted that herd immunity was “a scientific concept, not a goal or strategy.” Professor Medley himself described herd immunity as a side-effect of the main goal of delaying and reducing the peak of infections, often referred to as “flattening the curve.” A week later, the prime minister ordered the closure of pubs and restaurants. The national lockdown then followed on Mar 24. Hancock predicted on Friday that the UK’s outbreak could peak over Easter, with more than 1,000 deaths in a day. He urged the public to remain indoors during the warm weather over the weekend, warning the public: “People will die.” The latest figures released on Friday afternoon revealed the death toll had risen by nearly 600 to 3,605. It was also confirmed that two NHS nurses, Areema Nasreen and Aimee O’Rourke, had died after contracting coronavirus. The UK’s chief nursing officer, Ruth May, on Friday urged Britons to comply with the lockdown, commenting:

This weekend is going to be very warm and it’s going to be very tempting to go out and enjoy those rays but I ask you to remember Aimee and Areema, please stay at home for them.

Professor Medley Talks To The Atlantic Magazine, Early March:

The UK’s Coronavirus ‘Herd Immunity’ Debacle
Ed Yong, Atlantic Magazine, Mar 16 2020

There was a time when it seemed possible for the world to contain COVID-19—the disease caused by the new coronavirus. That time is over. What began as an outbreak in China has become a pandemic, and as a growing number of countries struggle to control the virus, talk of “flattening the curve” is increasing. That is, a lot of people are going to get sick, and delaying infections as much as possible is imperative, so that cases occur over a long period of time and health systems aren’t suddenly inundated. Almost every country is trying to achieve this goal through the standard arsenal of public health, testing people and tracing contacts, and through more restrictive measures that include instituting quarantines, closing public spaces, banning mass gatherings, and issuing strong advice about social distancing. But on Thursday, at a press conference, Boris Johnson seemingly revealed that the UK would adopt a different strategy. The government would no longer try to track and trace the contacts of every suspected case, and it would test only people who are admitted to hospitals. In lieu of any major social-distancing measures, Johnson instead offered a suite of soft advice, people with symptoms should stay home; no school trips abroad; people over 70 should avoid cruises. With the peak of the pandemic still weeks away, the time hadn’t come yet for stricter measures, Johnson and his advisers said. They worried about “behavioral fatigue.” If restrictions came into force too early, people could become increasingly uncooperative and less vigilant just as the outbreak swings into high gear. And while suppressing the virus through draconian measures might be successful for months, when they lift, the virus will return, said Sir Patrick Vallance, the UK’s chief scientific adviser. To avoid a second peak in the winter, Vallance said the UK would suppress the virus, “but not get rid of it completely,” while focusing on protecting vulnerable groups such as the elderly. In the meantime, other people would get sick. But since the virus causes milder illness in younger age groups, most would recover and subsequently be immune to the virus. This “herd immunity” would reduce transmission in the event of a winter resurgence. On Sky News (above – RB), Vallance said that “probably about 60%” of people would need to be infected to achieve herd immunity. Almost immediately, the supposed plan came under heavy criticism, coupled with confusion that public-health and science advisers would recommend this strategy. Akiko Iwasaki, a virologist at the Yale School of Medicine, says:

Herd immunity is typically generated through vaccination, and while it could arise through widespread infection, you don’t rely on the very deadly infectious agent to create an immune population.

And that seemed like the goal. In interviews, Vallance and others certainly made it sound like the government was deliberately aiming for 60% of the populace to fall ill. Keep calm, carry on and get COVID-19. That is not the plan. Graham Medley at the London School of Hygiene and Tropical Medicine says:

People have misinterpreted the phrase herd immunity as meaning that we’re going to have an epidemic to get people infected.

Medley chairs a group of scientists who model the spread of infectious diseases and advise the government on pandemic responses. He says that the actual goal is the same as that of other countries: flatten the curve by staggering the onset of infections. As a consequence, the nation may achieve herd immunity; it’s a side effect, not an aim. Indeed, yesterday, UK Health Secretary Matt Hancock stated:

Herd immunity is not our goal or policy.

The government’s actual coronavirus action plan, available online, doesn’t mention herd immunity at all. Petra Klepac, who is also an infectious-disease modeler at the London School of Hygiene and Tropical Medicine:

The messaging has been really confusing, and I think that was really unfortunate.

Devi Sridhar, a public-health specialist at the University of Edinburgh, says:

It’s been a case of how not to communicate during an outbreak.

Since Thursday, news of stricter impending measures, such as a possible ban on mass gatherings, has been drip-fed to the media piecemeal. For example, yesterday, ITV News reported that the government will soon tell people over 70 to isolate themselves for four months, either at home or in care facilities, “under a wartime-style mobilization effort.” But absent any details, critics were quick to point out flaws in the plan. Bill Hanage, a British infectious-disease epidemiologist based at Harvard University asks:

Who do you think works at those nursing homes? Highly trained gibbons? It’s the people who are in that exact age group you are expecting to be infectious.

The delay in calling for stronger measures is also perplexing. The government has thus far recommended that people with mild symptoms isolate themselves, even though people can clearly spread the virus before symptoms appear. That’s why social distancing is so important. The government’s own action plan even says that it will consider distancing measures “such as school closures, encouraging greater home working, reducing the number of large-scale gatherings.” Klepac says:

I think there will be a ramp-up of measures. Very soon, we’ll be asking people to reduce their contacts.

(Sure enough, in a press conference on Monday, Johnson said that it is time for everyone to stop non-essential contact with others, and that the government will no longer be supporting mass gatherings.)
Why didn’t Johnson just roll out those measures on Thursday? Why wait, when cases are growing exponentially? Medley says the government is taking the long view. He says:

My problem with many countries’ strategies is that they haven’t thought beyond the next month. The UK is different. We’re at the beginning of a long process, and we’re working out the best way to get there with the least public-health impact. That means not rushing into panicked decisions about banning soccer games or closing schools in a way that feels good but isn’t necessarily evidence-based.

But making a decent long-term strategy is hard when there are still two big unknowns that substantially affect how the pandemic will progress. First, we don’t know how long immunity against the new coronavirus, SARS-CoV-2, lasts. When people are infected with OC43 and HKU1, two other coronaviruses that regularly circulate among humans and cause common colds, they stay immune for less than a year. By contrast, immunity against the first SARS virus (from 2003) holds for much longer. No one knows whether SARS-CoV-2 will hew to either of these extremes, and according to one recent study, its behavior could mean anything from annual outbreaks to a decades-long quiet spell. We don’t know how the virus will behave across the year either. Other human coronaviruses tend to peak in the winter, while lying low during the high humidity and temperatures of the summer. But it’s unclear whether SARS-CoV-2 will do the same. One study showed that, across the globe, the biggest outbreaks have occurred within a narrow band of climate. But a more granular analysis across Chinese provinces showed that the virus can still easily spread in humid areas, and a third modeling studyconcluded that “SARS-CoV-2 can proliferate at any time of year.” The bottom line: There’s a very wide range of possible futures. For that reason, critics of the UK strategy argue that swift, decisive action matters more than future hypotheticals do. The country’s current caseload puts it only a few weeks behind Italy, where more than 24,000 cases have so overburdened hospitals that doctors must now make awful decisions about whom to treat. South Korea, by contrast, seems to have brought COVID-19 to heel through a combination of social-distancing measures and extensive testing. Hong Kong, Singapore, and Taiwan have been similarly successful. Hanage says:

That’s what you need to be doing. You go all in, or not at all. And not at all ends up like Italy. Making plans for what you are going to be doing in six months when you have a catastrophe awaiting you in three weeks is just stupid.

Devi Sridhar says:

Even if the virus surges back once social restrictions are lifted or winter descends, let’s buy time. We can use that time to get personal protective equipment in, to get beds ready, to get trainees trained properly. In Pindostan, there’s a vaccine trial. There are trials of antivirals in China. We shouldn’t give up hope.

Much of this controversy stems from a lack of transparency: The models and data that have influenced the government’s strategy haven’t been published. And yes, these are trying and busy times, but throughout the pandemic, researchers have generally been quick to share their findings on preprint servers, allowing their peers to assess and check their work. Sridhar says:

If your models are not ready for public scrutiny, they shouldn’t be the basis of public policy.

She and her colleagues wrote a letter calling on the government to share the evidence behind its decisions. Two other letters have also been issued, one from the British Society for Immunology and another from more than 400 scientists. The models will reportedly be released within the coming days, although no firm time frame has been disclosed. In a similar letter, more than 500 behavioral scientists called on the government to disclose the evidence behind its contention that the public will experience “behavioral fatigue” if restrictions are put in place too early. This concept reportedly comes from the Behavioural Insights Team, or “Nudge Unit,” a company that uses psychological science to advise the government on policy matters. But how reliable is that science? In the past decade, it has become clear that many psychology studies produce results that cannot be reproduced (the replication crisis), or that are irrelevant in all but a narrow set of circumstances (the generalizability crisis). In their letter, more than 500 signatories wrote:

We are not convinced that enough is known about “behavioural fatigue” or to what extent these insights apply to the current exceptional circumstances. Such evidence is necessary if we are to base a high-risk public health strategy on it. In fact, it seems likely that even those essential behaviour changes that are presently required (eg handwashing) will receive far greater uptake the more urgent the situation is perceived to be. “Carrying on as normal” for as long as possible undercuts that urgency.

Without strong guidance, British institutions and citizens have begun making their own decisions, going well over what the government recommends. Universities haven’t been told to close, but many have, sending students home, moving classes and exams online, and postponing graduations. Many care homes will not be admitting visitors. Soccer leagues have been suspended. The Queen has canceled public engagements. The Scottish government is planning to close schools and expand testing. Hanage says:

When you cannot rely on your government, there are still things that you can do. You are able to limit your contacts, which will not only protect you but also your community. If you don’t start to isolate yourself as much as you can, they’re more likely to die.

Klepac adds:

We really need people to engage and to sustain individual control measures, like social distancing, for months at a time. We’re in this for the long term and we need everyone to do their part. It is a very big ask.

Coronavirus: Inside the UK government’s influential behavioural ‘nudge unit’
Kim Sengupta, Independent, Apr 2 2020

A commuter wears a face mask as he walks at Lambeth North station to
a Bakerloo line train on the London Underground, Apr 2. Photo: AFP

A senior figure from the world of intelligence and defence, who specialised in China and cyber warfare, has been appointed to one of the top posts in the government’s “nudge unit”, which is involved in the campaign against the coronavirus outbreak. Rachel Coyle, who has received an MBE for services to defence, is the new managing director of the Behavioural Insights Team (BIT) helping to develop strategy for the pandemic at the Cabinet Office. The work of the “nudge unit” was relatively little known until its role became more widely publicised over Covid-19, especially over the concept of “herd immunity“ to combat the virus and the effect this had on the timing of the eventual lockdown ordered by Boris Johnson. Ms Coyle, who has a masters in Chinese studies from Cambridge, spent six years at the Ministry of Defence, where she started as analyst with Mandarin language skills before being promoted to policy advisor at the Permanent Joint Headquarters, then private secretary to the deputy chief of defence staff (military strategy & operations) General Sir Richard Barrons, and finally assistant head of cyber-operations policy. After receiving her MBE in 2013, Ms Coyle joined Salamanca, a business intelligence and investigations group, where she became head of corporate intelligence in charge of the company’s international offices. Starting her job with the “nudge unit” at the end of last month, Ms Coyle stated in a social media post:

I’m really proud to have started a new role as managing director for the Behavioural Insights Team.

General Barrons, who went on to become chief of joint forces command, said:

Rachel was one of the sharpest civil servants I have ever come across. I found her very impressive and she will no doubt do a very good job at a very difficult time.

As deputy chief of defence staff, General Barrons was in charge of the military support for national resilience and security in natural or man-made disasters as well as conflicts. He told The Independent:

The potential risk of global pandemic has been with us for a very long time. Questions have to be asked of the government, industry and civil society on the level of preparedness when this pandemic occurred. We can’t have been completely surprised. In the future we obviously need to be better prepared. But we must not make the mistake of thinking that it’s all just about pandemics. There will be a whole range of challenges ranging from climate change, the rise of China and the role of Russia. There needs to be a focus on strategy.

The strategy of “nudging” is based on the premise of changing behaviour through coaxing and pointing out positive outcomes to actions rather than through coercion. It was set up 10 years ago by the Cameron government and ownership is shared between its staff, the Cabinet Office and the charity Nesta (Cass Sunnstein territory – RB) which deals with innovations. David Halpern, BIT’s chief executive, and a member of the Government’s Scientific Advisory Group for Emergencies (SAGE) outlined to the BBC on Mar 11 the approach of shielding vulnerable people until enough of the country’s population had been infected with Covid-19, and immunity would be acquired to halt its spread. he said:

There’s going to be a point, assuming the epidemic flows and grows as it will do, where you want to cocoon, to protect those at-risk groups so they don’t catch the disease. By the time they come out of their cocooning, herd immunity has been achieved in the rest of the population.

On the same day Dominic Cummings, the chief advisor to Boris Johnson, is reported to have brought up the issue of herd immunity in a discussion with tech industry leaders. Two days later the government’s chief scientific adviser, Sir Patrick Vallance, told BBC Radio 4 that one of the key things we need to do is to “build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission.” Matt Hancock, the health secretary, insisted a few days later that achieving herd immunity was not a stated policy. Instead, he said, “in the coming weeks” people over the age of 70 will be told to self-isolate. Richard Horton, editor-in-chief of the medical journal Lancet told the Commons Science and Technology Select Committee at the end of last month that SAGE, despite being chaired by the chief medical officer, Chris Whitty, and the chief scientific officer, Sir Patrick Vallance, had little input from public health doctors and medical officers. The dominant voices advising the government, he said, were mathematical modellers and behavioural scientists, including Dr Halpern. Dr Horton said:

There is evidence on modelling and on behavioural science, but I don’t see the evidence from the public health community or from the clinical community. We thought we could have a controlled epidemic. We thought we could manage that epidemic over the course of March and April, push the curve to the right (sic – RB), build up herd immunity and that way we could protect people. The reason why that strategy was wrong is it didn’t recognise that 20% of people infected would end up with severe critical illness. The evidence was there at the end of January.

A senior Whitehall official involved with COVID-19 planning held that Dr Halpern was explaining the theory of “herd immunity,” not advocating it. He said:

A lot will come out in the future about what happened, not just the role of advisers, but politicians as well. I have no doubt that a lot of it (will be) very interesting for the public.

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