Herd immunity was in everyone’s plan at first

Something else that seems very significant looking back. The whole paradigm we had in the beginning, of having a “contain” phase that is fairly quickly abandoned and moving on to a “delay” phase. This apparently was developed in planning for a flu pandemic:

“Scientists are used to seeing flu spread through populations very fast, then become milder as it mutates, and to seeing people indeed develop immunity and populations become resistant.“

“[The flu strategy’s] first “detection and assessment” phase (seemingly an analogue for the “contain” phase of the coronavirus response) describes how the focus would shift away from “actively finding” and isolating confirmed and suspected cases, and instead turn to treatment of the disease once there was “evidence of sustained community transmission of the virus”. It even anticipates that detection and assessment could itself be a “relatively short” phase, depending on the circumstances. The flu strategy bluntly concludes: “It will not be possible to halt the spread of a new pandemic influenza virus, and it would be a waste of public health resources and capacity to attempt to do so.”“

It wasn’t just the UK that used this concept – it was everywhere. That cute animation gif showing the curve flattening – that was from New Zealand! (Full article) And wrapped up in that curve-flattening, peak-delaying concept is all the stuff that became abhorrent and governments had to distance themselves from – herd immunity, letting the infection spread in a managed way, accepting that people will die. It was all there in the world’s pandemic flu preparations. (Maybe a pandemic flu instead would have been a bit slower to spread and a bit less deadly. Would that have meant societies did not reject this paradigm? It’s hard to imagine.)

Clearly, New Zealand moved on from that model pretty quickly. Our government was one of the slowest to let it go. But we all moved on to suppression (and I think East Asian countries basically started there, having had the experience of SARS 1). Even Sweden doesn’t talk much about herd immunity.

I guess those countries that moved on to suppression fastest, were able to have the option of actually eliminating the virus and then closing borders / setting up managed quarantine to keep it out. In one of my earlier posts, I sort of dismissed this idea as “having its own problems”. I’m sure New Zealand tourism and economy as a whole has taken a massive hit, but as a price to pay for keeping the population safe AND getting to live relatively normally, I’m sure most would agree that it now looks like the best of a bad bunch of choices.

Wouldn’t it be great if we had all started from a point of view where we believed it could be stopped and eliminated? Maybe it could have been! I guess we can only hope that these lessons will save us all this pain the next time.

Because of course once it’s spread so far, we start to face these awful dilemmas between the harms of letting it spread and the collateral harms of the humongous heavyweight and continuous measures it now takes to suppress it. A lot of my frustration with our governments in 2020 has been the lack of transparency – and lack of public debate – on where we position ourselves in this balancing act. Sweden at least was clear that its measures were designed to be evidence-based to avert disaster and be sustainable for a long time. Here, we seem to have flip-flopped all over the place. In the summer the Scottish government was talking about pursuing elimination – yet they aren’t able to close Scotland off, and they have allowed cases to rise an awful long way in the autumn before putting in heavy restrictions… so I guess they don’t really know what they are trying to do.

Then again, why should I expect them to? In the early months it felt impossible to stomach either option: letting it spread, or the prospect of indefinite continuous suppression. At least now, there seems to be light at the end of the tunnel with these vaccines being rolled out.

And the vaccines will help us get back to normal, but not everyone will be able to get them, not everyone will want to get them, and they will not work for everyone – and even when they work, the immunity perhaps won’t last forever. Endemic equilibrium seems the inevitable (and relatively benign) end-point but how much more pain before we get there?