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Herd Immunity, and the Wisdom of Crowds
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The best intelligence items are usually those at the very end of the test, where only one or two percent of test takers will reach them. Of course, for the very bright these will be too easy, but standard tests are designed for us common folk, not the genius fringe. Facing the coronavirus, it is that smart fraction on whom we depend for survival. Will we pay the cost of losing at least 1% of our citizens, or can we manage ourselves intelligently to lower that rate?

The strategy taken by the UK government, somewhat different from other countries, is based on a paper “UK Influenza Pandemic Preparedness Strategy 2011” recommended to me by a reader, dearieme, and I have been reading it.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213717/dh_131040.pdf

I have copied out some bits which caught my eye:

Ensure that we are able to detect the emergence of a new virus and its arrival in the UK as quickly as possible and to determine the severity of illness, age groups and populations most affected and how transmissible it is.

Modern mass global transit also affords opportunities for the virus to be rapidly spread across the world, even before it has been identified. The short incubation period of influenza means that within a relatively short period of time a significant number of cases will appear across the globe. It is likely to take at least four to six months after a novel virus has been identified and isolated for an effective pandemic influenza vaccine to become available from manufacturers. 2.12 This means that it almost certainly will not be possible to contain or eradicate a new virus in its country of origin or on arrival in the UK. The expectation must be that the virus will inevitably spread and that any local measures taken to disrupt or reduce the spread are likely to have very limited or partial success at a national level and cannot be relied on as a way to ‘buy time’.

It will not be possible to stop the spread of, or to eradicate, the pandemic influenza virus, either in the country of origin or in the UK, as it will spread too rapidly and too widely. From arrival in the UK, it will probably be a further one to two weeks until sporadic cases and small clusters of disease are occurring across the country. Initially, pandemic influenza activity in the UK may last for three to five months, depending on the season. There may be subsequent substantial activity weeks or months apart, even after the WHO has declared the pandemic to be over.

The plan envisages up to 50% of population getting infected, and 2.5% dying if there is no effective treatment. Assumptions are not predictions.

It is a carefully written document, based on the knowledge of the time, and with an good understanding of strategic choices to be made. The authors have an understandable wish to achieve proportionality: using measures which meet the severity of the threat and at the time at which they can have maximum effect.

In summary, it accepts that viral infections cannot be stopped (the bomber will always get through) and that measures taken must be proportionate in terms of costs and benefits in the broadest sense. It is a sensible document, but hardly a radical one.

As Greg Cochran has pointed out, the only way to defeat the virus is to lower its reproductive index below 1. Whilst more than one person gets the virus, even at an R0 of 1.3 we have a problem. Victory is to deny the virus its stepping stones. This simple fact highlights a paradox: stern measures work best when they appear to be unnecessary. Banning plane flights stops the spread globally, and works best when there is no need for it, because no cases have presented themselves. This requires the ability to conceive of future events, and plan to avoid them. It requires high intelligence, and even higher political courage.

A week ago, Uruguay had no cases. Why is this country worth talking about? Apart from personal reasons, it had kept itself virus free because at this time of year it is relatively little visited. Even in tourist season it has relatively few flights. It now has 4 cases, 3 of these visitors from Milan, 1 from Barcelona. Letting them fly in has created the possibility of an epidemic in a country thousands of miles away from the original focus of the disease. From Wuhan the virus got a lift to Milan, and now to Montevideo. In addition, friends tell me of a lady who trades in leather, well known in Milan, who on her second trip back (she already had a fever on her first trip a month ago) has reportedly been diagnosed after coming to a 500 person wedding in a suburb of Montevideo. These friends wonder if there was any surveillance of passengers arriving from Italy, and also wonder why she did not consult a doctor about her previous bout of fever. Today I find that Uruguay now has two new cases, and they had not traveled abroad, so they are autochthonous.

A remark by a UK scientific advisor has led people to believe that it is Government policy to rely on herd immunity. The best herd immunity is vaccination. Second best by far is people getting the disease and surviving it, which is called acquired immunity.

What the document says about herd immunity mostly refers to vaccination and the priority groups once a vaccine is ready. It does not appear to be a deliberate policy that people should get the disease, rather that there is no way of stopping it, in an open world. Now, however, countries are severely restricting air travel, closing the stable door after the horse has bolted.

If it is not possible to limit the spread by achieving herd immunity 21, where so many people are immune that the disease cannot continue to infect people to maintain itself in the population, it is important to reduce the impact of the pandemic.

They explain the concept:

The primary aim of vaccination is to protect the individual who receives the vaccine. Vaccinated individuals are also less likely to be a source of infection to others. This reduces the risk of unvaccinated individuals being exposed to infection. This means that individuals who are not vaccinated will still benefit from the routine vaccination programme. This concept is called population (or ‘herd’) immunity

So, where are we now with the UK response? The Government is trying to be as measured as possible, taking only those steps which they believe are proportional to the threat. They cannot follow Singapore, because it is already too late to do so. Until very recently, the airports have been open, all too open. The virus cannot travel, but airline passengers are ensuring that it gets to the next available host, wherever on earth it can be found.

The Government fears that instituting severe quarantine and social distancing now may be too soon, given that it must be sustained for about 4 months. This is a slightly odd argument, since as a rule of thumb prevention works best before the event, which in this case means before there are sufficient cases to warrant it. However, having given up avoiding getting the virus, they are now trying to manage the distribution of cases, prolonging the event but reducing peak cases so that health systems can just about manage them.

Absent a prompt vaccination or secure treatment method the aim is to hope that a substantial fraction of the population gets only minor symptoms, and then recovers with a good degree of acquired immunity, able to help manage basic services while the more vulnerable (usually the 70+ age range) are kept out of harm’s way as much as possible, and released out into the open only when the disease is on the wane.

So, like any general mustering insufficient forces against a much stronger enemy, the strategy is to keep some powder dry for when it is most needed.

The only time I tried to advise a Government was when I gave very occasional advice to the Prime Minister’s Policy Unit under Tony Blair. I told them that policies were of two sorts: instrumental and symbolic. Like them, I favoured the instrumental approach, based on the best available evidence. Sometimes, of course, politics being what it is, human nature leans towards the symbolic.

For example, the Government bravely argued that it was premature to close large public sporting events and meetings, because the main likely spread of disease was within a household. However, in making this argument they used a standard average figure for the number of people a carrier can infect. That is wrong, precisely because that average is based on people who, normally, don’t have a chance to interact with large crowds. For example, most of my meetings are with three or four people, but when I go to local community lectures roughly once a month I will probably greet 30 people, and interact with most of them after the lecture. If I were infectious I would have more chance of passing on the virus at the 30 people meeting than my usual 3 person meetings.

However, not banning public meetings is probably wrong from a symbolic point of view. Such closures are dramatic, and will drive home to people that the crisis is real, and that they had better concentrate on instrumental policies like social distancing generally, and more frequent hand washing.

A word about hoarding: the problem is that people do not hoard enough. In a just-in-time economy most kitchen cupboards a bare of essential foods. Societies would be more resilient if they had some rice, flour, pasta and a few tinned goods available, as farmer’s wives did in former times. The expenditure is minimal, the space required likewise, and 7 days worth of food would keep households more tranquil, and a little less likely to panic buy.

Meanwhile, self-isolation continues. It is very much like a standard winter mode of living, continued into early Spring. The streets are relatively deserted, so a bit of walking is always possible. Family doctors can no longer be visited in their surgeries: contact is only by phone. Pharmacies are very busy, and don’t always have the medicines required. Hospitals are to be avoided.

Compared to the Great Pestilence, this is a small affair.

 
• Category: Science • Tags: Coronavirus, Disease 
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  1. LondonBob says:

    Raise the limit of chip and pin to seventy pounds or so, that way we don’t have to type in our pin every time we buy groceries for more than just ourselves.

    In future passenger airlines should have been shut down globally straight away. So many cases you see are from people who just arrived back from somewhere. Holidays are not a necessary and business can be conducted by conference call.

  2. This requires the ability to conceive of future events, and plan to avoid them. It requires high intelligence, and even higher political courage.

    If better data were more readily available on the internet this would provide a better basis for making intelligent decisions.

    The constantly updated compilation of statistics at the sometimes overloaded Worlodmeter for the coronavirus, from which you extracted the current case and death numbers at the top (now 6663 deaths), is missing important data that are not even being compiled everywhere, namely the number of people in every featured country that were already tested for the virus.

    Furthermore, in order to get a better understanding of the outbreak, it would be nice to have an updated map showing the number of cases for each city or region, as the NYTimes did a few days ago for Italy, South Korea, and Iran, and which the Johns Hopkins dashboard has done for regions in the USA. For instance, from detailed maps it became apparent that Bergamo had more than twice as many reported cases as the nearby city of Milan, or that the vast majority of cases in Korea are confined to one city in the center of the country.

    From such information one can better estimate which regions will incur a higher death rate, because the number of available respirators is insufficient to meet the demand, and which need to be quarantined more stringently.

    • Replies: @for-the-record
  3. @Been_there_done_that

    . . . Worldodmeter . . . is missing important data that are not even being compiled everywhere, namely the number of people in every featured country that were already tested for the virus.

    It is there for 18 countries (as of 9 March):

    South Korea . . . 210,144
    Italy . . . 60,761
    US . . . 8,554
    etc.

    https://www.worldometers.info/coronavirus/covid-19-testing/

    • Replies: @James Thompson
  4. LondonBob says:

    Clear to me reading the government document for dealing with flu pandemics that potentially they were so wedded to open borders and the movement of people that they would not even contemplate closing our borders, a move that would have given us a better, less economically damaging, chance. It might not, still, be the optimum course of action but it does not feel as if it has been fully considered.

    Also surprised at the reference to a vaccine, all the expert literature on this is very downbeat.

    • Replies: @James Thompson
  5. That only 2.2 percent of individuals will get the “best items” correct is a consequence of test construction. All pseudoscientists push their own pet grift for this and, of course, IQ-ists are no different.

    • Replies: @James Thompson
  6. @LondonBob

    Yes, my impression is that closing borders was not given proper consideration. The cost may be very high, but not doing it can lead to even higher costs. Difficult call, however, since most of these infections are relatively manageable.

    • Replies: @LondonBob
  7. @for-the-record

    Thank you. Interesting. Pity no data here on Singapore, which has done very well.

  8. @RaceRealist88

    Try a general knowledge test, maths test, science test, to see if it is only IQ tests which get that result when tested on the general public.

  9. LondonBob says:
    @James Thompson

    Even then I am not entirely sure the cost is that high, sure it would be devastating to airlines and airport operators but in theory some form of internal tourism would support the domestic tourist sector. They are in trouble anyway, as someone who lives under the Heathrow flight path it is very peaceful, this should have been explored more. Certainly I was shocked that the three flights from Wuhan had not been stopped immediately.

    “This royal throne of kings, this sceptered isle, This earth of majesty, this seat of Mars, This other Eden, demi-paradise, This fortress built by Nature for herself Against infection and the hand of war, This happy breed of men, this little world, This precious stone set in the silver sea, Which serves it in the office of a wall Or as a moat defensive to a house, Against the envy of less happier lands,–This blessed plot, this earth, this realm, this England.”

  10. dearieme says:

    “There are no plans to attempt to close borders. … Modelling suggests that imposing a 90% restriction on all air travel to the UK at the point a pandemic emerges would only delay the peak of a pandemic wave by one to two weeks. …

    During 2009 it became clear that the pandemic virus had already spread widely before international authorities were alerted, suggesting that in any case the point of pandemic emergence had been missed by several weeks. The economic, political and social consequences of border closures would also be very substantial, including risks to the secure supply of food, pharmaceuticals and other supplies.”

    Thanks to the cover up by the Chinese government once again the point of pandemic emergence has been missed by several weeks. And of course when the oaf Trump shut down flights from China he was abused as a racist, xenophobic, wicked … blah, blah, blah. Given the remarkable incompetence of the relevant parts of the permanent government – CDC, FDA – the oaf was the only part of fedgov that did any good, even if it was of only small advantage.

    The fact that much of the population initially under-reacted can be attributed to their difficulty in grasping exponential growth. (Counter-argument: they grasp it well enough when the subject is house prices or breeding rabbits.) Now they are over-reacting – the stoical virtues are desperately unfashionable.

  11. dearieme says:

    And Another Thing: actions have costs. “You Fascist” people will say “are you really going to put the economy before people?”

    To adapt a rather more impressive political leader than the oaf: “And, you know, there’s no such thing as an economy. There are individual men and women and there are families. And no government can do anything except through people, and people must look after themselves first. It is our duty to look after ourselves and then, also, to look after our neighbours.”

    Is there any point in moving might and main to achieve some temporary victory over the virus if one consequence is a people plunged into poverty? Real poverty, I mean, not the deceit currently passed off as poverty. Real poverty kills. It’s a pity that economics is such a primitive discipline that nobody is able usefully to calculate the likely economic outcomes of different pandemic policies. But it’s not an unreasonable guess that a really bad policy could shorten more lives than the virus will.

    Well, well, Boris wanted the job and he’s been wildly successful in it for six months. We’ll see how he does now. Thank God that this virus didn’t arrive in the time of Blair.

  12. dearieme says:

    Three last (?) points.

    (i) The UK phraseology sounds carefully worded e.g. “A further 19 people have died after testing positive for COVID-19”.

    (ii) Having been accused in the early days of taking a minor problem too seriously, I now wonder whether y’all are exaggerating the problem and treating it in an unnecessarily extravagant way. I’d like to see someone publish a careful analysis on the unfortunate experiment imposed on the passengers and crew of the Diamond Princess.

    (ii) Emboldened by my ignorance of cell biology and virology, I feel obliged to make a wild conjecture. Is it possible that statins make people more vulnerable to death by COVID-19?

    • Replies: @dearieme
  13. Today I find that Uruguay now has two new cases

    And today it has twenty-three more (total of 29). Flights from Europe are to be suspended beginning this Friday and the border with Argentina will be completely closed as of midnight tonight.

    https://www.elpais.com.uy/informacion/politica/gobierno-decreta-cierre-fronteras-coronavirus.html

  14. In a just-in-time economy

    JIT has a lot to answer for. When nobody carries stock, all supply chains become fragile.

  15. Factorize says:

    Hmm, I think this is what they call a natural experiment: There is widespread school closures– some locations will rotate to online learning, others not. Going without school over a multi-month time period probably would have measurable impact on development perhaps even over the medium term. Would be beneficial if online providers could step forward and fill the gap if others are unwilling or unable to do so.

  16. A word about hoarding: the problem is that people do not hoard enough. In a just-in-time economy most kitchen cupboards a bare of essential foods. Societies would be more resilient if they had some rice, flour, pasta and a few tinned goods available, as farmer’s wives did in former times. The expenditure is minimal, the space required likewise, and 7 days worth of food would keep households more tranquil, and a little less likely to panic buy.

    It would also help if people could actually do more than open a tin and heat it. The running joke back home is that whenever a hurricane might hit, everyone stocked up to make French Toast, because eggs, milk, and loaves of bread would sell out; meanwhile there was plenty of flour on hand. On this side of the pond, my local grocer went stock-out on flour and yeast.

    • Replies: @Reactionary Utopian
  17. An interesting one to be panned out in a next one, Dr. Thompson, how the elites compare in their private attitudes as opposed in their conceptual thinking as to the larger context of their considerate environments and importance as wheelers and dealers. Without bias, low-key, as usual from you, infusing a substantial restraint, this would be an interesting follow up.

    Are Wall Street king-pins testing, quarantining, mingle with the crowds?

    Should we quarantine the White House after testing all inside? Is it most probably done yet! Is it included in the “herd-immunity” lab environment?

    Does the numbers game of “herd-immunity” include the ready dip into the given, as participating lab-rats, of our “Billionaire elites”? Jets versus commercial airliners, who gets to use them, number of flights?

    What has become of the governing systemics globally as different from only weeks ago? Can the world be run from a quarantined container as the Berlin Hitler bunker, the Berghof, the Forbidden City, some Nuclear-Proof-0 shelter in the Nevada desert?

    Is Global Fascism warranted, when restricted to relevant issues (as Covid-19, SAR-CoD-2), and with relative time-lines, as “till containment”, “till under control”? What would be the run-of, would we see Putin and Xi in leading roles, or even a Trump? A Biden, a Boris a Rutten?

    Would a distinct corps of outliers relatively untainted by complicities and corruption be an alternative? Who gets to vet the top dogs, after all, Hitler got to power by Germany´s commoners consent.

    How would parasitical sub-groups of society respond to compete with Coronaviruse(s)?

    We count on your relative independent position in the food-chain, to let your expertise and grand thirsts, career personal incentives to be minimal if not detached. Is real science not in the interest of the larger context, hence Global Fascism not something not to be discarded up front? “Democracy” obviously created a lot of noise, even after summary analysis into what is the first two months of the “CoroVir” phenomenon. When the epistemology of governing and science, where they meet, is flawed, how then to expect ready outcomes, further efficient analysis?

    Just a suggestion, the scope is probably too large to throw into the public domain, as is the “surplus population” string, but “Black Swans” as a factor of risk-estimation, catched on quite nicely. So all hope is not lost to weed out some of the sprawling noise in journalism. Get all the help you can! we guess that in the current circumstances, your acquaintances must constitute an interesting environment to source into.

    Again thanks for your detachment, and useful pings of formal knowledge and intuition.

  18. der einzige says: • Website

    to read for all authors and readers

    You Cannot Catch Bugs, Germs, Bacteria or Candida/Fungi
    https://www.healingnaturallybybee.com/you-cannot-catch-bugs-germs-bacteria-or-candidafungi/

  19. Mr. Ron Unz might be hesitant about answering ones own posts because whoever does so could, via 3-d-chess-effects, support the atrocious secret US-military actions, which might well have initiated the worldwide spread of Corona. So dearieme – beware.

    Oh – your cruise ship analysis is interesting indeed. – I’ll have a close look after work – in about 13 hours or so.

  20. Good observations, Dr. Thompson.

    We create a model with a multitude of differential equations. Prior to the event, without any data, they just sit there even when we try to compute. We have to start the engine up with some tentative values. Thought experiments held in advance will always result in wishy washy solutions because there is no real data to get the ball rolling and the prognosticators don’t want to be too wrong when things really happen.

    Now we have data. We know the gestation period and the means of transmission. We know that the virus survives outside the body for up to 3 days etc. Now we can run our simulations and get some meaningful results.

    If we quarantine and scrub public surfaces for two weeks, then we shall have pushed the rate of transmission down dramatically. Then we rerun the equations with the new values. And so on.

    The point is, we don’t have to eradicate this thing at one blow. We run an iteration and see where we stand. Then we take the next logical step, one that will make itself evident to us at that point.

    Many people use the argument that amounts to saying “since everything can’t be done at once, we should do nothing” or “it’s just too complex and overwhelming” but if we just fix the most pressing thing first and keep that principle in mind, then we can work through this thing.

    Always fix what’s most broken first. This is often the least desirable thing to address because it is the most neglected. It is the dirtiest and hardest work.

  21. @The Alarmist

    The running joke back home is that whenever a hurricane might hit, everyone stocked up to make French Toast, because eggs, milk, and loaves of bread would sell out; meanwhile there was plenty of flour on hand. On this side of the pond, my local grocer went stock-out on flour and yeast.

    I was, oddly enough, a bit encouraged when I went to the store and found the shelves empty of flour. “Hmmmm,” I thought, “maybe people are contemplating doing some actual cooking and baking.”

    It wasn’t an immediate concern to me, as I’m a bread-baker and tend to keep a decent little stock of flour on hand — mostly because I buy a big sack when it’s on sale at an attractive price.

  22. The death number is highly misleading. Before it makes any sense at all, it must be broken down into age groups, groups of people with exacerbating factors, groups who were going to die anyway but just tested positive, groups who also have the flu, and about 20 other categories I haven’t even thought of yet.

    Ah, statistics. Don’t this website love them. They’ll throw any kind of crap at you. As long as it is in statisticular form.

    • Replies: @James Thompson
  23. @obwandiyag

    All measures have a range of convenience. Overall death rates are excellent when comparing death rates from other causes, say traffic accidents against accidents in the home, endemic diseases against new ones. Then, to look at all the risks in more detail one can drill further down into demographics, life style risk factors and so on.

    It is misleading to say “the death number is misleading”.

  24. What, are you playing semantic games with me.

    OK, fine, the death number may be “excellent”–an obviously technical term–but it still doesn’t tell us anything, which is the point I made and you elided.

    • Replies: @Commentator Mike
  25. @obwandiyag

    It says what it says it says. I haven’t noticed if the numbers update regularly. Also, the hyperlink to “view by country” doesn’t seem to work for me.

  26. dearieme says:

    What we want isn’t death numbers but cause of death numbers. Unless we believe that countries are using reasonably consistent ways of assigning cause of death then our data may be hopelessly misleading. This is a well known problem in epidemiology.

    Another thing we don’t know is whether the apparent dependence of the risk of death on age is a true dependence, or whether it is confounded by the dependence on health condition or even, indeed, consumption of medicines.

    Much is not known. To put it another way, much that is purportedly known is biased info.

  27. SafeNow says:

    “What we want isn’t death numbers but cause of death numbers.”

    I have not heard a multivariate analysis that assigns so-called “hazard ratios” or “odds ratios” to the various worrying elements. Such a quantitative breakdown is standard in the medical literature. Instead, for coronavirus, they merely say “if you are old, or, if you have preexisting conditions” your risk of death is increased. And not only would we want to know that for ourselves. I would think that the triage doc at the hospital would need to quantify the impact of age, and of the various comorbidities, in order to assess a particular patient’s (or would-be patient’s) risk.

  28. AaronInMVD says: • Website

    It should not be much of a surprise to you, but the Uruguayos are enthusiastically taking to the QuedateEnCasa meme. The testing here is about as aggressive as testing anywhere gets and they’ve since confirmed as many cases as Argentina did around the time Argentina initiated their forced lockdown.

    A couple super spreaders, Carmela and an unnamed Argentine “joven” working his way home ill from Holland via Uruguay have been identified.

    Provided Luis Lacalle Pou manages to hold his line on trusting the Uruguayos to continue self isolating on their own instead of giving into the hysteric school marms that want a mandatory quarantine that could not in practice affect greater change than the people have already done, Uruguay may come out of this relatively less scathed.

    There were a few hours of hysteric buying the Friday evening after news of the first case came in, but… shelves are stocked. People make their purchases infrequently, and life goes on…. en casa.

    • Replies: @James Thompson
  29. @AaronInMVD

    One of my friends has got it so far. Her son works in an office with a woman colleague who attended the fatal wedding, so he got it and passed it on to his mother. She knew she had it, self-isolated, was very ill with body aches, fever, diarrhea, very sore throat, and now tiredness. Testing confirmed Covid 19. She is getting better. Others at reunion mostly well, though an American friend at the same reunion was very ill, but was unable to get tested in Texas.

  30. AaronInMVD says: • Website

    Well, the President just wrapped up the nightly press conference. Only 4 new cases and the ban on public spectacles and closure of schools is extended to April 13th. He’s not sending the police out to arrest folks for being outside, but there’s going to be more police asking people to politely not group up and keep the distance.

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