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Why the UK's reliance on 'herd immunity' is being condemned as 'wrong' and 'letting the fire burn'

“Their view really is to let this fire burn, and they will try and damp it down where they can,” Dr Gabriel Scally said today.

Waterloo Station.
Waterloo Station.
Image: Isabel Infantes

THE UK HAS adopted a different approach to tackle the coronavirus Covid-19, opting so far not to shut schools or ban mass gatherings – which is out of step with the rest of Europe.

Instead, it has a dual approach: it aims to stagger demand on the health service by asking people with Covid-19 to stay at home to recover, and by developing ‘herd immunity’ in the British population by letting the virus run its ‘natural course’ of infecting people.

This has been controversial, with critics of the strategy expressing concern that it relies too heavily on the assumption that those who recover from the virus will develop some sort of immunity that will be strong enough to prevent them getting it again.

Dr Gabriel Scally, a leading investigator into Ireland’s CervicalCheck controversy and a public health physician from Belfast, said on RTÉ Radio One that the UK’s strategy was “wrong, completely inadequate, dangerous” and “way out of line” with other European countries, and with the World Health Organization’s advice.

Their view really is to let this fire burn, and they will try and damp it down where they can, and spread it out over a period of time.
But we know if communities act fast… then this can be kept under control and it can be knocked back. This isn’t happening in the UK. If the UK has got it right, the rest of the world has got it wrong.

The UK argument for: continuing mass gatherings

For a long time, the UK did nothing to prevent the spread of Covid-19: it didn’t cancel Cheltenham Festival, a four-day racing event with over 250,000 spectators.

Patrick Vallance, the government’s chief scientific adviser, has argued that the reason for this is that you’re more likely to get coronavirus from your family or friends, than from a mass gathering of people.

He argued that people who went to a pub to watch Cheltenham were more likely to get it than those at the racing event, as it’s thought that face-to-face close contact, particularly when indoors, increases the likelihood of transmission.

But the UK did cancel its St Patrick’s Day Parade in London, and the Six Nations rugby game between Scotland and Wales – meaning there are some measures being taken to slow the spread so that the health service can cope.

The local elections planned for 7 May have also been pushed back by a year = after the Electoral Commission warned of “real risks” to holding the vote as planned.

Despite a dramatic increase in confirmed cases and deaths in the UK, with 3,807 cases and 69 deaths, Prime Minister Boris Johnson said it was not yet time to follow other European countries in closing schools or banning large events.

Today, new guidance given to schools advises any pupil or staff member with a new, continuous cough or a high temperature to stay home to avoid infecting others.

If pupils become unwell at school they should be isolated while they wait for their parents to collect them – ideally in a room behind a closed door, with a window open.

But Johnson’s government is hoping to stretch the outbreak to avoid overwhelming the UK’s NHS, which is already struggling with staff shortages and a seasonal flu outbreak.

They’re doing this by presuming people with Covid-19 symptoms have the virus without testing them, and asking them to stay at home and recover there. 

Seven-day self isolation

coronavirus Source: Isabel Infantes

The UK government is asking those with symptoms to self-isolate for one week, as long as you don’t have severe symptoms or underlying conditions. You won’t be tested for the virus: you’ll simply be assumed to have it, told to stay home and recover there.

In Ireland if you have symptoms, you’re urged to isolate yourself and call your GP by phone, who will arrange for you to be tested. If that test is confirmed, you’re asked to self-isolate for two weeks (not one), and those with underlying conditions or complications will be hospitalised. This is based on advice from the WHO and ECDC.

In the UK, those with severe symptoms will be prioritised for testing, and hospitalised.

A reminder: The main symptoms are a fever, any kind of cough, shortness of breath, or breathing difficulties.

To be extra careful, the Health Secretary Matt Hancock announced at the weekend that they would be asking for anyone aged 70 and over to self-isolate for a period of time – possibly for months.

Hancock also told Sky News that herd immunity was “not our goal” and that “our policy is to protect lives”.

People with mild symptoms are being asked not to visit or call a doctor unless their condition worsens, to allow medical staff to focus on giving care to those most in need.

The logic behind ‘herd immunity’

Johnson’s government says it is being led entirely by scientific advice, but that is different to the scientific advice Ireland is following from the European Centre for Disease Control (ECDC) – an EU agency.

Central to the UK’s scientific strategy is the aim of achieving ‘herd immunity’.

There are a number of reasons for this, as explained by the UK’s chief scientific adviser Vallance:

  • If the UK imposes a lockdown, “behavioural fatigue” will set in and people won’t comply, meaning the virus will spread anyway
  • If the UK imposes a lockdown, that once that lockdown is lifted, the virus will surge again as it would have now (others would argue that buying time is worth this risk)
  • If they suppress the virus completely now, there is concern that it would come back stronger and deadlier in the autumn, as was the case with the Spanish influenza.

The strategy heavily reliant on the assumption that those who get Covid-19 and recover will be able to fight it off if they contract it again, or won’t be able to contract it again once they’ve had it before.

Here are the criticisms of the strategy:

  • Herd immunity is usually achieved through a vaccination programme; as is the case with measles, mumps and HPV, to name a few. Herd immunity isn’t normally administered through letting the virus run its course
  • The UK is instructing people to isolate only when they show symptoms – even though there is significant evidence to support the theory that the virus spreads before someone shows symptoms
  • If the assumption that people who get coronavirus do become immune after they recover, we still don’t know how long that immunity lasts. This could risk a complacency among those who recover, who could spread the virus again.

Thomas House, a senior academic in mathematical statistics at the University of Manchester, said: “Whether we aim for it or not, herd immunity will happen at some point in the future.

“Neither a growing epidemic nor social distancing measures can continue forever, and the aim of policy should be for this to happen with the minimum human cost possible.”

Martin Hibberd, professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine, said the UK measures would help in treating the sickest patients.

“The current aim of the social distancing put in place by the UK government seems to me to be to delay and ‘flatten’ the peak so that those people who suffer the more severe forms of the disease are able to be cared for properly,” he told AFP.

This might mean that by winter, when the disease might be expected to get worse, those who had not had the disease would be in the minority and would be protected by herd immunity.

“I think that the delay techniques promoted by the government are likely to achieve this aim.”

The UK’s argument

“We want to suppress it (the virus), not get rid of it completely,” Patrick Vallance has argued.

He said that the reasoning for suppressing it slightly, but largely letting it run its course, is so that some people develop an immunity, and this would mean that it doesn’t come back stronger in the winter – as was the case with the Great Pandemic in 1919.

“You can’t stop it, so you should end up with a broader peak during which time you’d anticipate that more people would get immunity to this,” he said.

That in itself becomes a protective part of this process. This is quite likely, I think, to become an annual virus, an annual seasonal infection.

Vallance said this kind of immunity would only work if 60% of the population were infected – which risks a high number of deaths, too.

Criticism: ‘Risky’, ‘complacent’, ‘dangerous’

Speaking to Sarah McInerney on RTÉ’s Today Show, Dr Agoritsa Baka of the European Centre for Disease Control (ECDC) said that it’s the expectation that if 60% of a population gets the virus, that it should be enough to build up ‘herd immunity’ – but that we don’t know for sure. 

“At this point, [the UK strategy] is kind of risky, but as a European centre we cannot oblige the countries to do something, we can only advise them on the best way forward,” she said.

Former health minister Jeremy Hunt said many Britons would be “surprised and concerned” that more was not being done to tackle the spread.

The editor-in-chief of The Lancet medical journal, Richard Horton, accused London of “complacency” and demanded “assertive social distancing and closure policies”.

Devi Sridhar, professor of global public health at Edinburgh University, added: “Now is the time for the UK government to ban large gatherings, ask people to stop non-essential travel, recommend employers shift to home working and ramp up the response.

The curve can be shifted, like South Korea and Singapore, but only with government action.

- with reporting from AFP

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