Thread by @patrickgaley

I've finally had an hour or so to go through the Imperial #COVID19 modelling study

There are a number of things within that I don't think governments, and certainly not the public, have given sufficient consideration

(1/n)

The study weighs up two options for #COVID19 response:

- Mitigation (i.e. slowing but not stopping virus spread)
- Suppression (i.e. reducing infections and maintaining that)

(2/n)

The UK government has for the past 7 weeks or so pursued the mitigation pathway, despite knowing #COVID19 transmission and mortality rates (-/+ R2.4 and 3.4% respectively)

The Imperial paper concluded this approach would kill hundreds of thousands of people

(3/n)

The best - perhaps we should say "least bad" - course for the UK, a rich, developed nation with an above average health system, is therefore suppression

This comes at almost unimaginable social and economic cost, which the study doesn't consider #COVID19

(4/n)

The thing I think people really aren't grasping currently is that suppression using extreme social distancing would need to last as long as it takes to find a vaccine in order to be effective

That's up to 18 months. Imagine being held at home for a year and a half

(5/n)

Imagine 18 months of closed shops, businesses, schools, universities, public spaces, airports, museums etc

Self-employed, zero-hours workers left for dead

The markets would collapse, insurers would collapse, a global depression to make 1929 look like a blip #COVID19

(6/n)

And people don't stop getting sick during this time. They still have cancer and heart attacks and falls and diabetes and domestic violence incidents and overdoses and chronic joint pain and arthritis etc etc

(7/n)

Not mitigating/suppressing #COVID19 predicted to kill 510,000 people in UK and 2.2 million in the US

I don't have expertise of health systems/regional dynamics to extrapolate that worldwide, but suffice to say it's not good

It can't account for behavioral change, though

(8/n)

Also worth pointing out at this point this is an analysis for imperfect but wealthy countries. I shudder to think how #COVID19 may yet spread in the global south

But sticking to this study, here are Imperial's models

(That red line that never moves is bed capacity)

(9/n)

So: Even if mitigation was drastic, sweeping, and impeccably upheld, ICU capacity would be outstripped dozens of times and hundreds of thousands of people would die

It was this that forced the UK government to change tack (remember, this is after 7 weeks of bungling)

(10/n)

So it's suppression, right? Extreme social distance, possible school/uni closures etc

China, SKorea and others have shown that extreme social distancing flattens new infections very effectively

But what happens when the measures are relaxed? We don't yet know #COVID19

(11/n)

But those people who have yet to contract the virus don't suddenly become immune because they stayed home for a month or so.

Here's Imperial's suppression scenarios. As you see, cases predicted to rebound fast once social distancing is eased

(12/n)

So imagine you're into month 4 of WFH with your partner/kids/relatives etc

You've just about staved off madness and, if the govt has kept its "whatever is need" promise, destitution

Then you go outside to frolic. And this happens all over again in October #COVID19

(13/n)

This is where the whole "herd immunity" issue comes up. Never in fact a UK govt strategy, it is simply a state that will eventually need to be reached, either by managed infections and/or vaccination (again, at least 12 months away)

#COVID19

(14/n)

The study even simulates an "adaptive triggering" approach that turns infections "on" and "off" throughout the coming year #COVID19

(15/n)

"A minimum policy for effective suppression is therefore population-wide social distancing combined with home isolation of cases and school and university closure"

(Compare this with UK/US response, several weeks into this) #COVID19

(16/n)

"To avoid a rebound in transmission, these policies will need to be maintained until large stocks of vaccine are available to immunise the population -- which could be 18 MONTHS OR MORE"

(Emphasis added) #COVID19

(17/n)

There are a number of unknowns and local staggering (with restrictions of movement) could help things.

But: "For a national GB policy, social distancing would need to be in force for at least 2/3 of that time until a vaccine was available" #COVID19

(18/n)

Even with my poor maths I can tell you that means that if #COVID19 suppression is going to work - and by work I mean avoid unnecessary additional deaths - we will need to social distance for at least 9 of the coming 12 months

I hope you like your front room how it is

(19/n)

The study comes with a VERY BIG caveat:

"It is not at all certain that suppression will succeed long term; no public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time" #COVID19

(20/n)

So, many many unknowns. Very early days. But let's apply the extreme suppression scenario, which is predicted to limit strain on the NHS and limit avoidable #COVID19 deaths

How will the world cope with 9-18 months of isolation? It's not possible right?

(21/n)

No govt can prop up an economy that essentially stops for a year. Perhaps if factories are requisitioned to make stuff to aid the #COVID19 fight (ventilators, PPE, alcohol gel, stress balls etc) that would help

Even if it were practical, is it *desirable*? Who chooses?

(22/n)

Just one of countless hypotheticals. Let's say the US takes suppression seriously but not perfectly

Restaurants close, right? That's pretty "non-essential", no?

That's 4 million people out of work overnight cbsnews.com/news/restauran…

(23/n)

I'm not an economist but I cannot see how the global economy can withstand months and months of near total pause.

If there's a way to decouple "suppression" from "depression", please get in touch with our world leaders

(24/n)

Forgive my simplicity, but recessions make people poorer and being poor is deadly, even in rich economies with sophisticated healthcare

The 2008 Financial crash caused 250,000-500,000 additional cancer deaths #COVID19

(25/n)
weforum.org/agenda/2016/05…

TL;DR

At some point someone is going to have to work out whether it's better to have a lot of people die from a virus, or lots of people die from an economic meltdown/mental illness epidemic/healthcare collapse

And then someone will have to decide #COVID19

(26/ends)