Neil O’Brien: The virus and the lockdown. Let’s keep calm and carry on – for there’s reason to believe that a vaccine is coming soon.

2 Nov

Neil O’Brien is MP for Harborough.

Sarah Thomas is a lunatic. And amazing. About a year ago, she became the first person to swim the Channel four times in a row without stopping. It took 54 hours.

Between booking her slot, and getting in the water, she survived cancer. Setting off, she was immediately stung in the face by a jellyfish. On her fourth crossing, strong tides pushed her off course, turning 83 miles of swimming into 134, forcing her to sprint-swim to break free from the current.

She’s inspiring. And swimming the channel isn’t a bad metaphor for our fight against coronavirus. Metaphorically, we’re somewhere in the middle, when you can’t see Britain, but can’t quite see France either.

The national restrictions announced by the Prime Minister on Saturday underlined that we will still be slogging through this for a while yet. Polls suggest the public strongly back his decision: given the alarming data, it is definitely the right one.

Yet everyone’s tired of the restrictions and not seeing loved ones and friends, and the good things we look forward to once this is over remain a way off.

As we go through this marathon ordeal, what can we learn from Sarah Thomas?

First, most top athletes are taught to visualise success.

Regarding Coronavirus, the finishing line is becoming more visible, with progress on vaccines looking good. The New York Times runs a Vaccine Checker which lets you follow progress.

Eleven different vaccines are in final-stage “Phase 3” clinical trials, with half a dozen or so now seeing limited use outside trials.

There were always reasons to be optimistic about a vaccine: when the whole world wants something really badly, it’s likely to get produced. Producing a vaccine for coronavirus isn’t like inventing the atom bomb or putting a man on the moon, which required oodles of new technologies. A Covid-19 vaccine is a sideways-step from existing technologies. Several categories of vaccines look like they will be ready to roll in the coming months:

  • The Oxford / AstraZeneca vaccine is basically a weakened version of a common cold type virus, modified to carry a protein which Covid-19 also shows, so that your body can learn to seek and destroy it without exposure to the real thing. Trials found it produces a good immune response including among older people, and doesn’t have side effects. The UK, US and EU have signed for hundreds of millions of doses.
  • Other vaccines based on a similar approach in final stage tests include China’s CanSino vaccine, Russia’s Gamaleya Research Institute and Johnson & Johnson in the US.
  • Another promising approach is based on the use of messenger RNA: a blueprint for making proteins. The Pfizer / Biontech vaccine works like this and may well be the first to go into non-trial use in the US. There was some speculation last week that we could start using it here in the UK before Christmas, which seems a bit soon, but it isn’t far off. Another similar vaccine from the Gamaleya Research Institute is also final stage trials.
  • Finally, there’s a bunch of traditional vaccines based on inactivated versions of Covid-19 (like the Hepatitis B vaccine, which has been around since the 1960s). China’s Sinopharm and Sinovac both offer vaccines like this – the Sinovac one is already being used outside clinical trials and you can buy it in some cities for $60. The Indian Council of Medical Research is also in final stage trials of an equivalent.

So the shore’s not so far away.

The other lesson from Sarah Thomas is about listening to the right people. She says she nearly quit halfway, but her team egged her on.

Contrast that with the British commentariat, large parts of which are dishing out terrible advice. If they’d been in Sarah Thomas’s support boat they’d have been telling her to give up, harping on about how cold it was. They’ve been hopeless throughout.

First, they dismissed the problem. Richard Littlejohn wrote in the Daily Mail on March 2nd/

“My default position on all these health scares is weary scepticism. We’ve been here before. Sars, Mers, Ebola, Bird Flu, Swine Flu… All passed in Britain, at least without the catastrophic death toll the so-called ‘experts’ confidently predicted”.

Wrong.

Then they declared the problem over. In the Daily Telegraph, Allison Pearson wrote in May that that, by June: “a scientist friend assures me the coronavirus will have petered out.” Sunetra Gupta, one of the authors of the Great Barrington Declaration, (and who the media fawns over), predicted in May that “the epidemic has largely come and is on its way out in this country”, which she said was “due to the build-up of immunity”.

Wrong.

The commentariat want to shout down wiser voices. In September, Sir Patrick Vallance faced a torrent of abuse for saying that there might be 200 deaths a day from Covid-19 by mid November. “Project fear,” thundered one Telegraph columnist. Piers Morgan blasted the Government’s “scaremongering.”

Wrong.

In fact we hit that grim milestone sooner, in late October, and hit 326 by the last day of October. We need to start listening to the right coaches – not hopeless people who get it wrong time and again, but face zero accountability.

Finally, top athletes learn from the best. In terms of Coronavirus, the best performers are Japan, Korea and New Zealand. France has had 19,800 cases per million people. The UK 14,800. Japan has had just 795, and Korea just 512 and New Zealand 325.

New Zealand is rural, but Japan and Korea are heavily urban. How did they do it?

Partly it’s about near-universal mask use. As the Lancet notes: “In Hong Kong, Japan, and South Korea, the habit of mask wearing by people with respiratory conditions was already widespread before the pandemic”. Part of it is that all these countries also have tough virus border controls.

There are other factors. Japan locked down Tokyo at a very early stage. South Korea’s super-duper test and trace system uses records of credit card transactions, mobile phone and global positioning system data, to fill in gaps in what coronavirus patients can remember in interviews.

The most important lesson from Asia is that success breeds success. A low rate of cases makes it easier for test and trace staff to isolate and shut down chains of infection, and contain local outbreaks. Too many cases and such approaches are overwhelmed.

To use an analogy, it took us a long time to work out how to conquer inflation. The key discovery was that the only way to have stable inflation is to have very low inflation.

The same’s true of coronavirus. Either you are beating coronavirus, or it is beating you. It doesn’t want to go in a straight line or rise gently, but to streak exponentially upward. Korea, Japan and New Zealand have got it pinned to the floor, so can get on with their lives. Instead of surrendering, as let-it-rippers in the commentariat advocate, they’ve decided to win.

Unlike Sarah Thomas we don’t have to swim for 54 hours. But we’re all enduring hardships. To get to the other side of this we need to keep thinking straight. It’s easy to be seduced by the idea that there’s some easy way out. There isn’t.

When she was far out to sea, her team called to her: “Just keep swimming.” At first, I thought that sounded really dumb. But when you are out in the middle of the Channel, it’s not such bad advice.

Robert Sutton: The Coronavirus. We must stop pinning our hopes on a vaccine – and learn to live with it

14 Sep

Rob Sutton is an incoming junior doctor in Wales and a former Parliamentary staffer. He is a recent graduate of the University of Oxford Medical School.

The phase three trial for one of the leading contenders for a Covid-19 vaccine has been paused. The collaboration between Oxford University and AstraZeneca has been put on hold after a patient became unwell.

The official line from the Government and developers has been that this is perfectly normal procedure – such setbacks are common in clinical trials, and we should not worry prematurely. Matt Hancock has described it as “not necessarily a setback,” while an AstraZeneca statement said it “is a routine action…In large trials, illnesses will happen by chance.”

This is true, and we do not have any reason to believe the incident is a significant issue for the trial. But it highlights a disturbing vulnerability in the Government’s current strategy.

That a pause has prompted so much speculation shows how heavily we have become invested in the idea that a vaccine will be the solution to the current pandemic.

The development of a number of promising candidates has been used to justify the economic and social disruption which has been imposed to counter the virus’ spread. That we will be promptly able to eradicate Covid-19 once we have a working vaccine is assumed by many, including those in Government steering the response, to be a given. Boris Johnson has said he expects a “significant return to normality” by Christmas.

While never explicitly stating it, this Government’s entire coronavirus response has been based on this assumption that the Coronavirus is a short-term problem to which a vaccine is the solution. Hancock reiterated only a few days ago that “the best way out of this coronavirus pandemic remains a vaccine.”

If it were to be condensed into one of the three-line stanzas which attempt to communicate to the public the ever-changing guidance, it might be: “Lock everything down; get everyone vaccinated; beat the coronavirus.”

But what happens if we are not able to achieve that second step?

The technical, social and political challenges in producing an effective vaccine over such a short timeframe are myriad. Even if the Oxford vaccine does prove to be safe and effective and enters mass production by early next year (which is a big if), getting the public to accept it widely will be a challenge at a time when faith in the Government’s handling of the response is low.

A programme to vaccinate the majority of citizens across the UK will be extraordinarily difficult. Achieving sufficiently high coverage to prevent further spread and to protect vulnerable individuals requires a high level of compliance. If too low a fraction of the population is vaccinated, it will have little effect in preventing further spread. But many younger citizens will not be interested, as the threat to them is so minimal. Others will be concerned about the possible side effects of a vaccine which has been rushed through production at breakneck speed.

Yet for vaccination to be successful in protecting vulnerable populations, these groups must be included. And with many on the Conservative backbenches already uncomfortable with the Government’s growing encroachment on civil liberties, it seems unlikely there will be sufficient political capital available to force citizens to comply.

Even if we manage to produce a safe and effective vaccine and achieve mass inoculation, return to life as normal will not be as simple as flicking a switch back on again. Disruption to industries and supply chains will take time to subside, and in some cases the damage will be permanent.

The Government should spend less time thinking about life after Covid-19 and more time planning how to safely life and work alongside it. The coronavirus is unlikely to be gone by Christmas, and in the meantime, we must consider if the self-inflicted damage caused by this government’s response could begin to outweigh the threat of the virus itself.