Tobold's Blog
Monday, July 19, 2021
Freedom Day - Going Endemic

Today, according to the UK government, is “freedom day”, the day where many of the existing Covid lockdown measures are being dropped. Not because the UK is Covid free, in fact it has one of the highest rates of new infections per million of inhabitants, about 10 times as high as the USA or France, and the case numbers are already quickly rising. But the goverment is responding to the will of the people, who are mostly fed up with those restrictions. And by doing so, the UK is launching a nationwide public health experiment which will be an example to the world, either because it is a success, or because it is a failure. Basically the UK wants the pandemic to go endemic, that is to say reach a steady state in which it is managable. There is science behind that, but it is hard to understand, and riddled with uncertainty, so things certainly could go very wrong.

Over a century ago, the Spanish Flu killed between 20 and 50 million people world wide (in the aftermath of World War I, medical record-keeping wasn’t great). If you think that the Spanish Flu is long gone, you’d be wrong. It still kills people every year. But it has become endemic, part of the mix of viruses causing seasonal flu. Serious enough for your doctor to advise flu shots, but not deadly enough to justify lockdown measures. Between flu shots and antibodies humanity acquired over the last century, the Spanish Flu has gone from mass killer to seasonal nuisance.

With 190 million cases of known Covid-19 cases and probably over 100 million undocumented ones, the idea to completely eliminate the corona virus from earth is probably farfetched. The most likely future is the corona virus joining the club of seasonal flu viruses and staying with us forever. In a probably misguided attempt of appealing to your civic duty, governments worldwide have told you about vaccination stopping the spread of Covid-19. The haven’t emphasized that the track record of vaccinations stopping such a virus is spotty at best, but that vaccinations actually do a pretty good job of lowering the intensity of the disease when you catch the virus, and have a pretty good probability of stopping you from dying. We just need all of humanity to be either vaccinated, or full of natural antibodies from an infection, for Covid-19 to become what some people have tried to sell it as before, just another flu. Of course we don’t know that for certain, as the virus is different from regular flu viruses, and we don’t know how it might evolve further. But an endemic future for the corona virus sure is a possibility.

While other countries have tried various things to get a larger percentage of their population vaccinated, from vaccine passports to lotteries, the UK is doing something radical: It has a relatively high percentage of people vaccinated at least once. And “freedom day” is basically a declaration that if you are in the UK and didn’t want to get antibodies by vaccination, well, there is always the natural way to get those. Remove all lockdown restrictions, count on the vaccinated people only getting the sniffles, count on the unvaccinated people needing hospitalisation being low enough to manage, and presto, half a year later you have an immunized country free of restrictions. If it works like intended, that would certainly be a big boost to the economy.

The obvious downside of the experiment is that even in the best of cases it will result in thousands more deaths than mandatory vaccination strategies. And in a supreme case of irony, most of these deaths will hit exactly the people who would prefer this “freedom” strategy to mandatory vaccinations. Which might actually be an act of political brilliance, because a strong belief in individualism makes it less likely that these people blame the state for those deaths. Remember “flatten the curve”? The UK believes that the curve will now be flat enough to handle, due to the vaccination rate. People will die, but if everything goes according to plan, they will be hospitalized and die in low enough numbers to not be a political embarrassment.

Some weird side effects of this strategy is that the UK just implemented travel restrictions to the UK from France, in spite of France having 10 times lower infection rates currently. But in France a different mutation of the virus, beta rather than delta, is in the mix, and that might mess up the hoped-for resistance by vaccination. And of course the UK goverment isn’t actually telling their citizens that their plan is to let thousands die so that the rest can live without restrictions. With already over 100,000 deaths from Covid-19 in the UK, it is hoped that these human sacrifices won’t be noticed. Grisly as that is, it might just work. If it does work, the approach will be copied.

My personal advice: Get vaccinated. It stops you from dying when your government decides to celebrate “freedom day”. Have a nice celebration, UK!

100% agreement with what you wrote. Saying that as a US non-specialist physician who was hanging out with an infectious disease specialist physician friend recently and hearing what he thought.
This is not a UK wide strategy rather an England only strategy. Wales, Northern Ireland & Scotland do not proscribed to the “freedom day” rhetoric..this is very much a Tory, Boris Johnson play with lives.
Lots of places are effectively doing the same, just in a slightly more half-hearted way with a little more continued mask theatre.

Everyone who wants to get vaccinated has been vaccinated, except the very young who don't need it. Governments can't do much more without rounding people up and jabbing them by main force. That might be accepted in some of the more authoritarian Eastern countries, and may even be a case where authoritarianism has its benefits - but it won't wash in most places.

Lockdowns are not going to make the virus go away. If we don't intend to stay cooped up forever, whispering about the latest terror variant or how a mild case supposedly turns 40% of people into zombies, while an increasing percentage of the population tip towards open rebellion - then we have to transition to an endemic state and the time to do that is with a vaccinated population in summer.

If this is wrong and deaths shoot up much more than would be expected from accelerating the inevitable exposure of any susceptible people who have somehow never been exposed, we can think again. But it's time to rip the bandage off.

And in a supreme case of irony, most of these deaths will hit exactly the people who would prefer this “freedom” strategy to mandatory vaccinations. Which might actually be an act of political brilliance, because a strong belief in individualism makes it less likely that these people blame the state for those deaths.

A blunt but honest way of putting it..... Not that I disagree, but when a virus circulates a lot you get loads of variants, so it's a gamble. Probably not a very risky one, but it can still end up killing quite a bit of people.
At the same time, it's evident that nor the people nor the economy can deal with continued more or less harsh lockdowns, so I can understand the logic. Time will tell, and then we'll get the usual load of after-the-fact experts telling us what we should have done :)
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