TAKING THE GREAT BARRINGTON DECLARARTION SERIOUSLY – a thread.
1 or 2 MPs have advocated the ideas in the “Great Barrington Declaration”: that we should get back to normal, go for herd immunity, & try to shield the elderly & vulnerable. Rather than dismiss this out of hand I've tried to crunch some numbers on what it would mean in practice.
First, how many people would need to totally isolate as the virus accelerates through the rest of the population?
There were 12,374,440 people aged 65+ in the UK in 2019.

But there are 14,843,119 people who lived in a household with someone aged 65+

Additionally (in England alone) there were 2,240,850 patients on the Shielded List - though some of these over 65, so there's some overlap)
Trying to isolate and supply food to all these 15-16m people while the virus spiked would be a monumental undertaking, & much like a hard (6 month at least) lockdown for a large part of the population. It’s not clear how we’d safely supply them with food as the virus spiked.
Second, how many people would likely die? If we look at English mortality rates from this Nature article and apply them to the UK population, we can get a range of answers.

nature.com/articles/d4158…
Everyone accepts that the isolation of old and ill people couldn't be 100% complete: some will choose not to isolate, some will have to go to hospital or see carers, or live in care homes, or the young people living with them will not fully isolate and they’ll get it.
About 8% of people have had the virus (call it 10% to be generous). Lets say we need to get to 60% for herd immunity. So we’d need a bit over 50% of the younger population to get it (and somehow avoid overshooting, which seems unlikely, but lets assume we could do that for a mo)
Using data from England suggests that if only half of the younger population got it and (miraculously) only 5% of pensioners (because isolation is near complete), that would mean 90,000 deaths. If 10% pensioners get it, that would be 130,000. If 15% then about 175,000.
…That’s a lot of deaths. But that’s still assuming that healthcare is not overwhelmed, and so all those who need treatment for Covid are still getting it. It’s also assuming there are no non-Covid deaths caused by the NHS being overwhelmed. Both assumptions are very unlikely.
Let’s look at data on hospitalisation rates from this paper in the lancet. And apply them to the UK population.

bmj.com/content/369/bm…
If we again assume 50% of younger people get the virus and 5% to 15% of pensioners, that means between 860,000 and around 1.1m hospitalisations. Given the geometric way the virus grows without interventions, they would likely come at roughly the same time in a pronounced spike.
In England there are 4,123 adult critical care beds (up from 3,550 in 2010). Not everyone in hospital would need critical care, but even a small % of hundreds of thousands of people into 4,000 beds doesn’t go. Liverpool is already at 95% capacity.

dailymail.co.uk/news/article-8…
So the likely spike in admissions would likely wash over the NHS like a tidal wave over a tiny sandcastle. So we should add to the directly-caused deaths two additional large numbers...
... first, the covid patients who would die because they won’t be able to get treatment, and second, the patients with other diseases who would die because the health service is knocked out. It's likely to add up to hundreds of thousands dead.
There is then a further cost in terms of people who get the disease, don’t die but will have long term health problems. We don’t know how large this would be. The KCL study suggests 60,000 have been seriously ill for over three months. Scale that up and it is a large number.
To go with the GBD, you’d have to be 100% certain than NONE of the three permanent solutions will arrive: no vaccines, no mass rapid testing & no medical improvements such that ppl get the virus but don’t die. It seems pretty likely that several of these will arrive next year.
Vaccines are getting close, and various countries like China have started rolling out experimental vaccines before end of clinical trials...

biopharmadive.com/news/coronavir…

theguardian.com/world/2020/oct…
The US is starting to roll out mass rapid testing:

So good solutions are coming.

Lets look at the track record of the people behind the GBD.
One of the lead authors of the GBD predicted in May: “I think that the epidemic has largely come and is on its way out in this country.” She said the decline in cases was “due to the build-up of immunity.” This prediction proved radically wrong.
This matters because they make the same argument now: that SAGE are wrong because many more people out there are immune to Covid-19. The exact reason they say this will work now, is the same reason they said it was all over and fizzling out in the summer.
As a kicker, because people can get reinfected, it is not even sure we'd ever get to herd immunity, even if you think an elected government could somehow ride this out for the duration.
No countries are currently following the strategy suggested in the Great Barrington Declaration. The countries doing best have followed completely different approaches. Germany has local lockdowns. Japan has massively high mask use. Korea sacrificed privacy for great tracing.
We should learn from them, rather than embark on a route which, I'm sad to say, would definitely see the NHS overwhelmed and would be likely to lead to hundreds of thousands of unnecessary deaths.

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More from @NeilDotObrien

7 Sep
Quick thread on our "levelling up" report today & new Taskforce.

Most people know there's a big gap in earnings and incomes between London, the SE & Scotland on the one hand and the rest of the country on the other (map below). But lots turns on how you measure things... (1/15)
My report looks at how subtly different ways of measuring performance can tell VERY different stories about what's happening in different places. (2/15)
For example, if you look at the employment rate for 16-64 year olds, London is in the middle of the pack.

But look at 16+ employment, and London (in red) is zooming ahead - pension age employment is much higher there. (3/15)
Read 15 tweets
6 Mar
Here's a strange thing. Certain types of spending, transport, R&D, housing, culture, are vital to boost productivity. Yet in Britain we spend more on these things in places where productivity is already high. @guymiscampbell and I have a report out exploring why. Thread ahoy!
First, transport. London is the big winner, followed by two other high-productivity places. Between 2007/8 and 2018/19 capital spending on transport in London was around £6,600 per head, nearly three (2.75) times the average in the rest of England (£2,400).
There are multiple reasons for this. Places with strong devolved governments (London &Scotland) have more capacity to bid. We spend a big chunk of the budget on rail, which is a big share of journeys in London, but v small elsewhere. London makes out like a bandit on rail spend:
Read 18 tweets
25 Jun 19
My Spectator piece on why we should put low and middle income families at the front of the queue for tax cuts - a quick thread (1/)

blogs.spectator.co.uk/2019/06/boriss…
Raising Higher Rate threshold benefits a bit over 4 million people.
Raising the starting rate for National Insurance would benefit 32 million people.
Cutting council tax benefits 27 million households.
We must focus on cutting the taxes people on average incomes pay.
(2/)
The CPS, polled the idea of raising the national insurance threshold to £12,000 a year – and found that 76% approved.
In contrast, raising the top rate threshold polls badly. A Populus poll found that 58% of voters said they were against, and only 21% in favour.
(3/)
Read 13 tweets
31 May 19
Here's the argument of my new paper in graph form.

First, after 9 years of difficult decisions, debt is set to fall from 83 to 73% GDP. If we reduce it more slowly or even keep it flat, that unlocks up to £190 billion to cut tax or increase spending over the next 4 years (1/)
But we can't go crazy. We just had a big increase in debt. Britain is an ageing society. Financial repression doesn't cut debt 3-4% every year as in the postwar years. As OBR has pointed out, borrowing costs are more likely to go up than down. OBR debt projection looks scary (2/)
Hence the suggestion in the paper of an expert-led Commission on Sustainable Public Services, running over the next SR period. The solutions to our long term debt problems have been discussed for years, but haven't landed. 2017 election showed how not to do it. (3/)
Read 22 tweets
15 May 19
At PMQs Corbyn claimed we are "seeing the rich get richer while the poor get poorer".

It's literally the other way round - income growth since 2010 has been strongest for poorer households because of record employment + Living Wage + tax cuts. Only fall was in top 10%. (1/)
The whole implication of Corbyn's attack was that inequality has increased. But actually it is down compared to the last Labour government, however you measure it (2/)
I welcome the IFS work on inequality, but there is currently no sign that UK levels of inequality are converging on the US. On World Bank data it looks like they are diverging (3/)
Read 4 tweets

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