Winter Covid plan: not the sharpest tools in the toolbox
The Prime Minister has announced his plan – a toolbox – for dealing with Covid-19 over the upcoming winter period. Split into a Plan A (if things go well) and a contingency Plan B (if they do not), they contain a mix of sensible measures and… not so sensible ones.
Some of the language used by the PM and his advisors yesterday hints at an underlying irrationality in the government’s approach – it seems contingencies will be adopted if it is not possible “to keep the virus at manageable levels”. What does this mean? There is now no point in attempting to artificially suppress spread of the virus for evermore, otherwise we are accepting that both vaccine-induced and natural immunity do not exist, and would call into question both the cost of the vaccine rollout and the justification for the economic damage inflicted by 18 months of on-off restrictions.
That aside, Plan A almost sounds like an appropriate way to balance the risks of living while protecting the vulnerable – “stay at home if you are ill” being the stand-out piece of common sense in this section, as well as an encouraging section on antivirals and therapeutics.
What is still not clear is why certain quack measures based on flimsy evidence still feature – for example those related to the highly suspect droplet theory of transmission. Presumably this is to justify the inevitable cheerleading for that most pointless of non-pharmaceutical interventions, cloth face masks. In the absence of any real-world examples of them making a demonstrable difference, perhaps the nation is destined for this to become a tribal matter of disagreement for months and years to come.
It is also unclear what the point of ongoing mass testing is. A little-known fact is that an excellent leading indicator of Covid-19 hospitalisation has been the government’s Respiratory DataMart system, established after the Swine Flu epidemic in 2009. The rest of the mass testing infrastructure that we have put in place at huge cost just seems to generate lots and lots of case counts. Surely this could otherwise be spent on tooling up “our” NHS to cope with winter demand? What is the point of ascertaining asymptomatic infections if most people have now been exposed to the virus, and all vulnerable people have been offered vaccination?
Overall, while Plan A is not unreasonable, I have various concerns:
· Booster vaccines. Everyone aged 50+ is going to be offered a mRNA booster vaccine – even those who previously got the AstraZeneca vaccine. This mix-and-match approach has not been extensively tested, and in any case goes against the opinion of Professor Dame Sarah Gilbert, one of the developers of the Oxford/AstraZeneca vaccine. This fast move to mRNA boosters – already underway in Israel and being proposed in the US – also led to the resignation of the senior vaccine team at the FDA at the end of August. Marion Gruber and Philip Krause, formerly director and deputy director of the Office of Vaccine Research and Review, have just published a letter in The Lancet that casts doubt on the wisdom of pushing the booster button now: “There could be risks if boosters are widely introduced too soon, or too frequently, especially with vaccines that can have immune-mediated side-effects (such as myocarditis, which is more common after the second dose of some mRNA vaccines)”. These are strong words, spoken by revered experts. Note that the Pfizer booster is exactly the same formulation as was designed for the Alpha variant and potentially – as per the July SAGE long-term evolution document – makes vaccine escape more likely. It is always worth looking at the canaries in the coalmine, and data from Israel is showing rampant growth in case load “despite” its booster programme.
· Vaccinating children. I have written about my objections to this policy previously, but it is worth scotching the idea that vaccinating children will be of overall benefit. In fact, there is likely to be a lot of school disruption due to adverse effects (let us hope that disruption to girls’ menstrual cycles will not cause lasting damage). In any case, it is more diversion of resources – these vaccines do not inject themselves. And why are we doing this anyway? Rates have plummeted since the English schools went back. Another failed forecast from the doom-mongers and their models.
· For some inexplicable reason, Covid Passports have not been completely and finally abandoned. Why? The House of Commons Constitutional Affairs Committee is dead-set against, and it would be an appalling travesty for the government to push them through using emergency powers. They would alienate people and add cost, complexity and red tape to an already overburdened economy. And as we saw from the “Boardmasters Affair”, it is not as if they help hamper transmission. Consider the Marek’s Disease disaster: vaccinated people can be just as infectious (if not more so!) than unvaccinated people.
However, it is Plan B – the contingency plan – that seriously worries me. It is almost as if the government is itching to redeploy interventions that previously did not work particularly well. Still there is no attempt to outline a credible cost/benefit plan. It may be fine for those that quite like working from home, but tell this to those that are still being forced – inhumanely – to stay apart from family in their final days. To turn the evangelical catchphrase on its head, we must believe in Life Before Death.
And why should restrictions be on the cards in any case? Their effectiveness has surely now been debunked after 18 months? Look at Sweden. Look at Denmark, which has just removed all Coronavirus restrictions and gone back to normal life. Many participated in the vaccination programme to allow the country to return to normal, and the Prime Minister should keep that bargain.
The root of the problem is obvious – the country is operating in a very bizarre way, which is putting services (and social care) under massive pressure. In the summer, respiratory disease typically results in deaths of 800 people a week, and that rises to around 2,500, or even 3,500 a week (out of around 10,000 deaths per week from all causes) in winter. Those passing away will often “test positive” for the respiratory disease of the season, be that influenza-like illness, Covid or respiratory disease caused by one of the other coronaviruses. They might well go to hospital and then subsequently pass away “with Covid”, much as many do “with vaccine”, as per ONS data. We must accept that some people will come to the end of their lives over the course of the next months, and we have a moral duty to ensure that they can live this life to the full. Grandparents must be free to choose to see their grandchildren. And those that need healthcare should not be excluded from hospitals, or have treatment delayed, because of an obsession with a particular virus.
Finally, the winter plan magnanimously talks of relinquishing “legal provisions [of the Coronavirus Act 2020] that are no longer necessary or proportionate”, but allowing the government to retain its emergency dictatorial powers. This is a sop. We need the checks and balances on executive power more than ever – it is high time there was a return to full democracy. MPs should politely decline the offer to extend the Coronavirus Act 2020 and start debating how we can get people’s lives back to normal.
Dr Alex Starling is an advisor to and non-executive director of various early-stage technology companies. Follow him on Twitter: @alexstarling77