Saturday, 16 May 2020

What now? and I've tried to be gentle


Now many countries are starting to lift the lockdown measures and most of us are looking forward to getting back to normal, whatever that was for you. The pandemic is over in the minds of many and since we have been allowed to make plans to get back to work, school, shopping, and even think about booking up our summer holidays. Except it’s not. The curve has been flattened in some countries while in others it is still heading determinedly north! The virus is still out there, it’s just we have been in here and relatively safe. Going out there again means square one.

Let’s not forget that this all started from one, a handful of cases in Wuhan. There are at present more than 2.5 million active cases (WHO) in the world and estimates should be considered maybe multiples larger than that.

So where do we go from here?

There are only two ways this will end.

  1. A vaccine is developed
  2. Herd immunity is achieved
  3. We all die

A Vaccine

genome sequencing, a process of decoding the virus and taking out the death part
some really tough maths
Since Edward Jenner realised that milkmaids didn’t catch small pox, we have been able to safeguard ourselves against a whole host of viral infections. The simple principle of vaccines is to deliberately infect someone with a very mild form of a virus to let the body do its thing and create lovely antibodies and thus develop immunity to the virus. The milkmaids caught cowpox, a mild form of the more aggressive smallpox, from pustules on the cows’ udders. He basically harvested this puss and infected others and bingo! Antibodies and immunity (Vaccine from vacca the Latin for cow). It wasn’t until the 1960s that this process was synthesized and now with genome sequencing, a process of decoding the virus and taking out the death part, it‘s a cinch! But genomes are very complicated and take some really tough number crunching to work out. This is what is happening now and some really clever people in tweed jackets are frantically scribbling Greek letters on blackboards to figure it out. Thing is, no matter how smart they are and how tweed their jackets are, it is going to take ages. The SARS vaccine took about 18 months to reach viability and that was damn quick. The top people in the world are working this problem from a number of different angles but it is going to take time.

Why?

Well, basically because they need to make something that works and works well. If it is less than 100% effective there will be outrage and panic (clue: No vaccines are flawless). If, as is equally possible, it actually causes some deaths (Clue: it happens), there will be outrage and the antivaxers and flat-earthers will have a party… then die!
Then… there is the little matter of making and distributing the stuff when it’s done. Vaccine is not Coca Cola, it cannot be produced by the gallons per second but we will need similar amounts. In order for a vaccine to be effective there needs to be more than 60% coverage and unless you hadn’t noticed there are around 7.5 billion of us, that’s about 4.5 billion who need to be effectively immunised for the virus to slow down and fade to black. The reason for this is more maths, the present reproductive ratio (R0) of COVID-19 is about 3, now this varies but it is much more than 1 and that is bad. Now, if one person can infect 3 people, and each of those three can in turn infect 3 each and so on you get one happy shopper in a wet market reaching 5 million in 5 months WITH lockdown measures in place. If more than half the population are immune, then 1 person, on average, will not have more than 1 person to infect. When the R0  goes below 1, then it’s end of days for the virus are nigh.
Vaccines are effective after a couple of weeks but what about whoever discovers an effective vaccine, will they play nicely and share or will they capitalise on the golden goose. After all they will have spent ages scribbling Greek letters on a blackboard and shaking test tubes. My thoughts are that they will want a big payday for their labours.
That gives us a timeline of about 18-22 months if, and if all goes well. To date we have over 300,000 deaths.
As epidemiologist Mark Woolhouse at the University of Edinburgh, UK, told New Scientist in early April: “I do not think waiting for a vaccine should be dignified with the word ‘strategy’. It’s not a strategy, it’s a hope.”
Starvation is a known killer for which sandwiches are a known vaccine

Herd immunity

This works similar to the vaccine scenario, well over 60% of the world’s population needs to go through the virus and come out the other side with immunity. And, as we know many do not. The mortality rate for COVID-19 is anywhere between 1% and 3.4% but many of the statistics have been cooked in different sauces. Some countries count those who have died who have been diagnosed positive, some only those without underlying health issues. Let’s say 2% of 60% of the world population, that’s 90,000,000 or there about. And, as health services crumble due to a lack of ICU beds and ventilators, it will rise. Basically those who might have been saved will not.
I’m sure Prof. Woolhouse would agree that this is not really a strategy either.

We all die

Now, there is so much talk about the economy and this always conjures images of designer-suited traders in London or Wall Street, it is you and me. We need to earn a penny and pay our bills, we need people to grow food and roll toilet paper and deliver it and teach our kids and all the other stuff we used to do. Without this we will starve. And starvation is a known killer for which sandwiches are a known vaccine. People like you and me will need to bake the bread and make the cheese. The economy is not Jeff Bezos and Warren Buffett, it is the life support system that keeps us fed.

So, where to from here?

We must get life back on track with the knowledge that it will not be simple. Lockdown has retarded the progress of the virus but it is still out there and so is starvation and bankruptcy. We must find new safer ways to live our lives, we must accept that people will die, we must brace for a whole lot of shit to come. Around 50,000,000 died during the Spanish flu pandemic, it came in 3 phases and blew itself out in 18 months. We should be able to count on not repeating that but bear in mind that the world’s population back then was little more than 1.6 billion, there are 5 time more of us now.
Before lockdown came in March, I said in this article why this would be the most significant event of the 21st Century, as significant as WWI was to the 20th (and not because of the death toll). I missed some bits but I stand by that more than I did then.   
For the time being this is our normal, there is no magic wand, we and our superior brains are the only magic.

Be safe, be smart and be humane to others around you

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