Lockdown & Control or Herd Immunity? It’s a great deal more complicated and uncertain than one thinks

by Kumar David-May 23, 2020, 4:29 pm

There is a debate going on out there in the big wide world between the advocates of lockdown (Isolation and Confinement - I&C) and champions of Herd Immunity (h-i) as to the better method to overcome the CV-19 pandemic. What’s going on in Sri Lanka is extreme, draconian and excessive harassment, especially of the poorest classes but I will reserve my comments on Lanka for the end. My main objective today is to weigh up the international debate between advocates of I&C and h-i.

Before getting my teeth into details let me summarise the two views. I&C chaps want to identify and quarantine every contact, trace, trace, trace and test, test, test. If infected and asymptomatic (those who show no external signs) carriers are all isolated till they get well (no longer carry the virus), or conveniently conk off, the community can be declared virus free. Restrictions can be lifted and all can get back to having a good time, unless a global depression subsequently turns them into paupers.

The h-i advocates don’t agree. They say let everybody catch the disease, let everybody get it. Antibodies will develop in the body (sic!), the whole community - the whole herd - will become immune and there will be nothing more to fear. If you got chicken pox as a kid you won’t get it again. You grow antibodies (some sort of good chaps) in your system to defeat the first illness and they hang around ready for action if needed again. Though the international web contains much information the local media has, I think, made no mention of h-i. To get clued up I ask readers follow up on the web the world’s leading experts on h-i, Dr Nils Anders Tegnell, civil servant, physician in infectious disease and State Epidemiologist of Sweden, and Dr Didier Raoult, French physician, microbiologist and president of Universite de la Mediterranee, Marseille. An extreme version is Prof. Johan Giesecke: https://www.spiked-online.com/2020/05/15/we-could-open-up-again-and-forget-the-whole-thing/. It’s good to be up to date on the vocal global debate on the relative merits of I&C and h-i.

What’s the case against each school? It’s deadly. The objection to I&C is that try as you may you can never ensure CV-19 will not raise its head again unless everybody in the community goes to live in a cave in the Himalayas forever. When our government says Lanka is CV-19 free, workers will go the Middle East, international commerce and travel will start, tourists will arrive and kids will go to school. The idea is that we can get back to normal life. But aye, there’s the rub. This CV-19 is as vile and virulent as a mother-in-law’s tongue. It spreads like greased lightening – otherwise why all this misery and harassment we are subjected to every day? As sure as the sun will rise in the East each morning it will be back; there will be fresh recurrences.

The crux of the case against I&C is that you can never prevent a second-wave, a third and so on. Are we going to go through the horror of the last 60 days again and again every year? You can see where the critics of I&C are going: "De facto the epidemic stops only when herd immunity is reached after cycle upon cycle. Till then its’s an invincible force; it will not end till h-i is reached". The I&C defence is that numbers must be kept down to a level which hospitals can cope with till a vaccine is found or immunity develops in the community at large. At a minimum one has to buy time.

There’s a number called R which epidemiologists are swooning over. It’s a measure of how rapidly a disease is spreading. Its fancy name is "effective reproduction rate" and signifies the number of people to which one infected person will pass a virus. If R=2 for example, one guy will give it to two and those two will give it to four more and so on. The magic is to make R less than one in which case the disease will wither away, once identified cases are cured. Small R is great, but the problem is that it changes all the time and could rise quickly as lockdown ends or people go out to work or lose patience with restrictions.

What’s the case against h-i? Sweden refused to lockdown, except for the old and sickly, leaving people to catch the infection spontaneously hoping to achieve h-i. But what happened was that the death rate increased enormously. On 20 May, the number of confirmed cases in Sweden was 30,800 with 3,745 deaths (12.2%), compared with Norway 8,264 confirmed cases and 233 deaths (2.8%) and Denmark 11,044 confirmed cases and 551 deaths (5.0%). A study in the Financial Times (UK) said, conservatively, deaths in Sweden would reach 50,000 before heard immunity is reached.

The other point about h-i is that it has, to my meagre knowledge, not been achieved with any previous disease. Smallpox was controlled by vaccination and wiped out ultimately by extinguishing the bacillus itself. Humans have not developed h-i to polio though it has been around for ages – was Richard III crippled by polio? There is no cure or protective vaccine for SARS and herd immunity is not a WHO goal. The medieval Black Death (bubonic plague caused by bacterium yersinia pestis) is still around (most recently in Madagascar in 2017) and humans have not developed herd immunity. What reason is there to believe that CV-19 will be any different?

The debate has political overtones but readers should not take any notice and focus on scientific and epidemiological merits only. Don’t be intimidated by the snooty; if people are real experts, they can explain things in a way that ordinary folks can understand as Einstein and Eddington did with relativity. Political partisanship in broad terms shows that the political right like Republicans in the USA, Brazil’s Bolsanaro, UK’a Boris Johnson and those keen to get the economic engine restarted as soon as possible, oppose lockdown, oppose stopping full participation in work or restricting travel and want freedom of movement. On the other side are liberals, those who want the state to play an interventionist role and are prepared to let capitalism, that is the economy, pay the price.

Sri Lanka is an exception in that a right-wing government with an authoritarian bent is imposing the harshest I&C intervention in all the world. It implements extreme I&C, that is L&C (Lockdown & Curfew). I will explain why in a moment. Another loose cannon screwing up the debate is Donald Trump and his asinine interventions. If only he would shut up, everybody could learn more about costs and benefits and the world would be in a better position to make informed decisions. I will leave it at that and turn to the most unpleasant part of today’s essay, the way the authorities in Sri Lanka are dealing with the CV-19 challenge.

It is unpleasant because one has to be appreciative of the prodigious efforts of the health authorities, nursing and medical staff and the ordinary foot-soldier, unfortunate sailor and the by now fed-up policemen, but at the same time be critical. What is it that one needs to be critical of? The curfew and lockdown have gone over the limit, its just too much harassment – 60,000 citizens arrested and 17,000 vehicles impounded for curfew violations, isn’t this a good barometer that people are fed-up! Gota, his taskforce and the state have to stop playing nanny. Let adults make their decisions, the Director of Health and the army are not God, nor do they know what’s best for the public; the people alone know that. When the populace surrendered its right to make decisions to Adolf, Benito and Joseph the despotic state arrived. Let not this happen in Lanka. I don’t want this essay to deteriorate into a diatribe against Gota so let me phrase my closing paras carefully.

Lanka has been successful in keeping total cases down to just over a thousand and deaths below ten. But many other countries have achieved comparable results without crippling society and the economy with such harsh measures (still the good record is a feather in the cap of the authorities). The Island of 18 May carries a full-page account "How Europe and US are working to prevent a second wave". The piece has nothing to do with prevention of a second-wave but is an interesting summary of the measures currently adopted in the US and about 10 European countries. What is striking is that everywhere else it is far less punitive, grim and disruptive. Lanka’s authorities are also oblivious to the horrifying impact this mindless insensitivity will have on the economy down the road.

Despite a more lenient approach mass demonstrations have broken out in America, Germany and all-over South America against hardship, ‘trampling underfoot" democratic freedoms and damage to the economy. In Lanka, the masses curse the restrictions under their breath but will not openly oppose Gota and military-police over-lordship. The masses last defied the state in 1953. Insurrectionary folly did so in 1971 and 1989, but since then they have got accustomed to the military and police egging them on or turning a blind eye when they rampaged against Tamils and more recently Moors. Defying the state even when oppressed is not for Lanka’s masses anymore. A kept people who enjoy mauling minorities under the approving eye of the state is not capable of asserting their freedom. The Gota regime can go on as it likes, it can tell parliament to go hang, and it can rule by fiat and automatic rifle without a public whimper. This is the upshot of victory in a racial civil war, as it was in Serbia, Sudan, Rwanda and other places.

But in the end, "it’s the economy stupid!" This essay cannot go on for another 1000 words so I direct you to initial coverage by Ranga Jayasuriya (‘Long-term Economic Costs’) and Kusal Perera ("Exit Strategy") in the Daily Mirror, 5 and 15 May, respectively They make a critical, a very critical appraisal of strategic failures to plan ahead on the economic front, and start thinking about what needs to be done. It’s future economic hardship that may induce the public worm to turn.