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Herd Immunity, Reinfection and the Great Barrington Declaration

14 October 2020

After eight full months of the global pandemic, the pressure to keep the economies open and let the chips (or rather, the elderly) fall where they may is growing strong.

The ‘Great Barrington Declaration’ of 4 October was signed by three medical professors from Oxford, Harvard and Stanford universities and by tens of thousands of other people. It demands a return to “life as normal” – no mention of masks, social distancing, contact tracing or Covid-19 tests – for everybody except “the vulnerable”, who would presumably self-isolate semi-permanently.

Never mind that the sponsor is the American Institute for Economic Research, a libertarian think-tank funded by the Charles Koch Foundation and other hard-right American groups whose main business is climate change denial.

Never mind that the declaration advocates ‘herd immunity’, a blessed state that is normally achieved by mass vaccination, not by exposing the entire population to a disease with a 3% mortality rate.

Never mind either that re-infections with Covid-19 are now a documented fact, which means that ‘herd immunity’ is not really possible with the various strains of this coronavirus. Forget the ideology and look at what is really happening with Covid-19 death rates.

The leading indicator for vulnerability to Covid-19 is speaking Spanish. Among the countries with the highest death rates per million people, six out of the top ten are Spanish-speaking: Peru (1,010 deaths per million), Bolivia (711), Spain (710), Chile (699), Ecuador (691), and Mexico (649).

If you include Portuguese-speaking Brazil (709 deaths per million), then seven out of the worst ten speak the languages of the Iberian peninsula. Two others are English-speaking countries with populist governments: the United States (666) and the United Kingdom (633). The tenth, mysteriously, is Belgium (880).

How weird is this? Well, no other country on the planet is above 600 deaths per million. And equally curious is the fact that none of the other developed countries that speak English have exceptionally high Covid death rates: New Zealand (5 deaths per million), Australia (35 ), and Canada (255).

You can account for the very low Australian and New Zealand death rates by the sheer geographical isolation of these countries, but you could not find two countries closer or more alike (except in their politics) than Canada and the United States. Yet the US death rate is almost three times the Canadian rate. How can we explain all this?

The great majority of the countries with under 100 Covid deaths per million people are Asian and African nations with fast-growing populations and a median age of well under 30. Covid-19 selectively kills elderly people, and such people are very scarce in these countries.

A few richer East Asian countries in this under-100-deaths-per million group have much older populations (China’s median age is 37.4 years, Japan’s is 43.4 years). But these are all countries with well developed medical systems, strong social discipline, and recent experience with similar pandemics.

Then there is the broad group of countries with between 100 and 500 deaths per million. Most are rich countries with relatively old populations and good medical systems, but lower social discipline (or, if you prefer, more social freedom).

They range from Germany (117 deaths per million) and Russia (157) to Ireland (369) and France (500). Elderly people are a big chunk of the population, and how many actually die seems to be determined mainly by how well each government manages the pandemic. The wrong policy or a few days’ delay in acting can make a huge difference.

And the final group are the Latin American countries (almost all over 500), where median ages are as high as in the rich countries but medical services and government competence tend to be worse. Lots of old people die, and even many younger people who would have survived in better run and less unequal countries don’t make it.

How did the United States and the United Kingdom end up in the same sad group? Both countries have populist governments so obsessed with their own popularity that they reflexively delay or avoid unpopular but necessary decisions. Too little, too late on the way into lock-down; too fast on the way out.

And what about Spain and Belgium? Maybe that was just poor management: there are always a few outliers. But the general conclusion is clear.

What really matters is the age profile of the population. In poor countries with fast-growing, very youthful populations, the economic cost of lock-down probably outweighs the harm done to the relatively few elderly people. In Uganda, only 2% of the population is over 65: protect them by wearing masks and so on, but don’t close down the economy.

In Germany, half the population are over 47, and almost a quarter are over 65. Taking the Great Barrington Declaration’s advice could cost half a million lives. Horses for courses.*
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To shorten to 700 words, omit paragraphs 3, 11 and 16. (“Never mind…denial”; “A few…pandemics”; and “And what…clear”)

Boris Johnson’s Cunning Plan

13 September 2020

“I’ve got a plan so cunning you could put a tail on it and call it a weasel,” said Blackadder’s sidekick Baldrick in the BBC’s brilliant historical comedy series ‘Blackadder’. In fact, he said “I have a cunning plan” in almost every episode, but the plans hardly ever worked, and it became a popular catch-phrase.

So the question in the United Kingdom today is this: if Prime Minister Boris Johnson is Blackadder, who is his Baldrick? Who actually put Johnson up to passing a new law that says Britain can unilaterally change the Brexit Withdrawal Agreement he signed with the European Union less than eight months ago?

Did he not understand what the treaty said? Unlikely. He negotiated it with the EU himself.

Does he realise that a treaty is a legally enforceable international agreement? Presumably, because even his own cabinet minister for Northern Ireland, Brandon Lewis, admits that plan “does break international law in a specific and limited way.”

Did he plan from the start to break the treaty? Probably not. This is Boris Johnson – well, Al Johnson, really; ‘Boris’ is just his stage name – and he regards worrying about next week as long-term planning.

Johnson was well aware that the problem that brought down Theresa May’s government last year and made him prime minister was the Irish border. Peace in Northern Ireland depends on there being an open border with the Irish Republic. EU trade with the United Kingdom, post-Brexit, depends on controlling that border so that there is not a massive smuggling problem. Square that circle, if you can.

May tried to square it by agreeing that the customs border would effectively run down the middle of the Irish Sea, between Northern Ireland and the rest of the UK. That way, no customs controls would be needed on the border between the two parts of Ireland.

She never got that through parliament, because so many MPs from her own Conservative Party saw it as an unacceptable breach of British sovereignty. Eventually her government fell, and Johnson won the Conservative leadership and a large majority in an election last December by promising to fix that problem and ‘get Brexit done’.

But he couldn’t fix it, of course. Instead, he just accepted the same withdrawal terms as May had when the negotiating time ran out, with a few extra concessions to the EU and the border still firmly in the middle of the Irish Sea. But he went around telling everyone in the UK who hadn’t read the text that it wasn’t true.

On the strength of that ‘victory’ he won a big majority in last December’s election. How could he imagine that this would not come back to bite him?

By following standard Boris operating procedure: bluster and lie to win time, and hope something magical turns up in the end to save the day. If that doesn’t happen, then stage a disguised last-minute surrender, because without a trade deal with the EU, its biggest trading partner, the UK is heading for a massive economic crash.

Johnson has been on course for that surrender for some time now, but a new trade deal doesn’t cancel the existing Withdrawal Agreement, so the border controls will still appear in the Irish Sea next January. His instinct would be to blame it all on Johnny Foreigner and his tricky ways, and maybe he could ride out the storm.

Instead, he has announced that he is going to tear up an international treaty with the EU. This is most un-Boris-like behaviour.

We are asked to believe that Boris Johnson – BORIS JOHNSON – has belatedly realised there will be a crisis in the Irish Sea next January, and decided to push through a highly controversial law right now to give himself cover for an illegal act next year. It’s so out of character that it begs the question: who put him up to it?

Not exactly Baldrick, but Johnson’s senior political adviser is Dominic Cummings, whose passionate and scarcely concealed desire is to crash the United Kingdom out of the European Union with no deal at all.

The other man who truly wants that outcome is Michael Gove, the most powerful person in Johnson’s cabinet, who used to be Cummings’s main patron in government. Together, they have somehow talked Johnson into doing something so stupid that it may make a trade deal impossible and end his prime ministership.

They probably just told him that such a grave threat would bring the spineless foreigners to heel. The EU would let Johnson have his way, forget about putting an Irish-UK border anywhere (even though the Irish Republic is an EU member), and all would be well.

And the poor mug believed them.
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To shorten to 725 words, omit paragraphs 3 and 4. (”Did he not …way”)

The Plague: Saving the Old

The basic choice all along with Covid-19 has been: do we let the old die, or do we take a big hit economically? So far, the decision almost everywhere has been to take the hit and save the old (or most of them), but in some places it has been a very near-run thing.

Today or tomorrow, for example, the number of deaths from coronavirus in the United States will surpass the total number who have died in China (3,304 people) from what Donald Trump generally calls the ‘Chinese virus’.

China has four times the population of the United States, but in the end around fifty times as many Americans will die from the coronavirus. That is according to Trump’s own prediction on Sunday, in the speech where he finally did a U-turn, that ‘only’ 100,000-200,000 Americans will die because of his wise decision to extend the national lockdown to 30 April.

It was a decision he took long after the last minute, if ‘last minute’ is defined as the last moment when the right decision would have held American deaths down to the Chinese level. But Trump was not alone in this dereliction of duty: his Mini-Me equivalent across the Atlantic, Britain’s Prime Minister Boris Johnson, also waited much too long, and the United Kingdom will be lucky to escape with 20,000 deaths.

Why did they wait so long before imposing the restrictions on movement that will break the chain of transmission of Covid-19? Because locking down the people also means locking down the economy: huge numbers of people will lose their jobs, at least temporarily, and the stock market will crash.

Whereas if you don’t impose the restrictions, perhaps on the plausible pretext that you are pursuing an alternative solution called ‘herd immunity’, then the economy will keep ticking over nicely. However, achieving herd immunity requires 60%-70% of the population to have had the disease – and with this particular coronavirus, about one or two percent of those people will die.

But who cares? Almost all the victims will be over 70, two-thirds of them will be male, and at least half of them will also have ‘underlying conditions’ that are already forcing the health services to spend a lot just keeping them alive. They are entirely dispensable to the economy. We would be even richer if they did die.

Did Johnson understand that this was the real strategy? Possibly not: he’s never been a ‘detail’ man. But his Svengali and chief political advisor, Dominic Cummings, certainly did understand it, and seems to have been perfectly OK with it.

What forced Johnson into a thinly disguised about-face two weeks ago was one or both of the following facts. One: almost everybody his policy was condemning to death was somebody’s beloved father or mother. And two: it amounted to carrying out a cull of Conservative voters, since two-thirds of British people in the over-70s group vote for the Tories.

He was late, but not too late. Even the strictest measures now will not keep the British death toll under 20,000, according to the Imperial College London group that did the key calculations two weeks ago – but half a million would have died without them. And exactly the same equation applies to Donald Trump.

It’s always tough to know what Trump really believes, because he will say whatever he thinks works best politically at this precise moment. If it flatly contradicts what he said yesterday, he doesn’t care. And if some journalist calls him on the contradiction, he just denies what he said yesterday. It doesn’t matter if the statement is on the record; it’s ‘fake news.

We cannot know if Trump ever really understood the choice he was making when he condemned lockdowns and repeatedly promised the imminent ‘reopening’ of the economy. And then, two week after the Imperial College group published its prediction that without lockdowns 2.2 million Americans would die, he finally read it and reversed course. Or so we are supposed to believe.

He even claimed credit for saving two million American lives by abandoning his old strategy (if that’s the right word for it). His real calculation, at some level of his conscious or unconscious mind, was that his re-election in November would be even more damaged by two million needless American deaths on his watch than by a deep recession and huge unemployment.

But at least half of the Americans who will still die would have survived had he moved two weeks sooner, when he already had ample evidence that it was the only sane course. Exactly the same criticism applies to Boris Johnson. But here’s a consoling thought.

Everywhere from China and India to Spain and Russia, and even in the United Kingdom and the United States (after stalling as long as possible), governments are putting the lives of the ‘useless’ old ahead of the alleged needs of the economy. Because that’s what their people really want.
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To shorten to 725 words, omit paragraphs 8 and 11. (“Did…it”; and “It’s always…news”)

Gwynne Dyer’s new book is ‘Growing Pains: The Future of Democracy (and Work)’.

Covid-19: The Exit Problem

Most of the countries in Asia, Europe and North America are now in lockdown to slow the spread of the Covid-19 virus. This is the ‘suppression’ strategy, and it should keep the death rate from going exponential for a while. The unanswered question is: what do we do next?

There is no exit strategy. “This type of intensive intervention package [‘social distancing’ of the entire population, home isolation of Covid-19 cases, and household quarantine of their family members] will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed.”

That’s from the executive summary of the key Imperial College London report that on Monday forced the British government to abandon its insane policy of letting the infections grow and hoping the population (or what was left of it) would achieve ‘herd immunity’.

The 30-strong Imperial College team estimated that an ‘unmitigated epidemic’ – no closure of schools, shops, restaurants and bars, no household quarantines of suspected coronavirus cases and their families, no ‘social distancing’ – would directly cause 510,000 deaths in the United Kingdom in the first wave of infections (now to July or August).

Infections would grow rapidly through March, and the demand for beds in intensive care units (ICUs) would exceed supply by the second week of April. At the peak of the first wave of infections in mid-May, demand for ICU beds would be thirty times greater than supply.

They did the same calculations for the United States, and concluded that 2.2 million Americans would die in the first wave of infections. (This number was instrumental in jolting the Trump administration out of its ‘deny, distract and downplay’ strategy last weekend.) Such huge case loads would inevitably crash the health-care systems in both countries, causing further ‘secondary’ losses of life.

So the team moved on to consider the ‘mitigation’ model. This concentrates on ‘flattening the curve’ of infections, which would now peak in late June. Suspected cases of infection are confined to their homes and their families are also quarantined, schools are closed, over-70s are required to self-isolate – but shops, bars, restaurants, etc. stay open, and the economy staggers on more or less intact.

The mitigation policy’s outcome is slightly better, but the peak case load is still so high that it crashes the health system. Total deaths in the first wave are reduced only by half: i.e a quarter-million die in the United Kingdom, and a million in the United States. So the Imperial College team moved on to examine the third option: ‘suppression’.

Suppression, or ‘lockdown’ if you prefer, drastically reduces human contact in order to reverse the rate at which infections are spreading. ‘Social distancing’ applies to everyone, not just the over-70s, and almost all public venues except food shops and pharmacies are closed. It does the job – after a few weeks death rates drop sharply – but the economy also goes into decline: probably 6% down or worse by the end of the year.

This is now the policy in most developed countries: mass death is no longer on the doorstep. The United States as a whole is still in ‘mitigation’, because it takes a long time to turn a supertanker like Mr Trump all the way around, but New York and some other big American cities and states have already moved on to suppression.

It has all happened very fast, and governments are just starting to realise that we will be in this mode for a long time. In fact, unless this particular coronavirus fails to cause a second wave of infections next winter – it isn’t certain – we will probably be stuck in lockdown most of the time until an effective vaccine becomes widely available, probably no sooner than eighteen months from now. August of 2021, let’s say.

In the meantime, the best we can hope for is a few breaks when new infections have fallen so low that the controls can be “relaxed temporarily in relatively short time windows” for a month or two. But the virus will still be at large in the population, and we’ll probably have to re-impose the controls as the number of infections starts to spike again.

Economically, it will be as big a hit as the Great Recession of 2008-9. Saving everything from shuttered shops, theatres and restaurants to passenger-starved airlines from bankruptcy will be a huge challenge. Keeping their laid-off employees out of poverty will be just as hard. There will have to be mortgage and rent holidays and maybe ‘helicopter money’ (dropped from above by central banks).

But here’s a silver lining, if you want one. In every country we have collectively decided, without even an argument, that we care more about the lives of our fellow-citizens than we do about the damned economy.
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To shorten to 700 words, omit paragraphs 10 and 12. (“This is…suppression”; and “In the…again”)

Gwynne Dyer’s new book is ‘Growing Pains: The Future of Democracy (and Work)’.