Written Evidence Submitted by Karl Simpson, Director at JKS Bioscience Limited

(CLL0002)

PART 1 – where we are

Introduction

Karl Simpson (JKS) first submitted his Covid-19 observations to the Science and Technology Committee on 28 June 2020 (See: https://committees.parliament.uk/writtenevidence/7959/pdf/)

Since then, much has changed, but the substance of that first note remains current.

It is heartening to see that British ingenuity has been a major force in advancing vaccine development, although widespread distribution cannot be expected before 2021. In the UK we have continued to fail on issues relating to detection and contact tracing. On 14 October 2020, it is quite possible that as many as 10% of British citizens have been infected. In some areas this figure may be more important and in others less so. Unfortunately for multiple reasons, continued underestimation of infection ates and a still chaotic track and trace programme have exposed many uninfected persons to risk.

A vaccine will be most welcome, but while we wait, we have failed to impose basic hygiene measures that might control, contain and even stop virus progression.

The availability of personal protection equipment PPE) is now much better, but key foci of potential infection including hospitals, care homes, schools and universities, remain poorly equipped, poorly informed and poorly monitored.

Some messages have worked. Handwashing, with the availability and widespread use of alcohol-based hand sanitizer, has played a significant role in limiting spread. Unfortunately, the wearing of masks and adequate social distancing measures have not been adequately implemented and enforced. From personal experience JKS observes that cafés restaurants and pubs are not implementing  track and trace infrastructure measures (this includes, noting addresses, telephone numbers and code scanning). On the bright side, restaurants do succeed in social distancing measures, whereas cafés, bars and pubs often do not.

The “R” Number

Much has been made of the Covid-19 reproduction number or “R”. Estimates of this following the March 23 lock-down fell to below 1. Above 1, the potential for exponential growth is real. Below 1 the infection will be limited. If 90% of cases are asymptomatic, most new infections will not be noted. Asymptomatic persons may well infect those “at risk” ,who may thereafter show symptoms. A measured “R” of 1, may conceal a real “R” of 1.5 or more. It is now very clear that R has been significantly underestimated for a number of reasons:

• Only those with overt Covid-19 symptoms, and those in immediate contact with such persons, were tested with Nucleic acid tests that demonstrated the presence of live virus. Many were not able to secure tests.

• Those tested positive, were urged to self -isolate (quarantine) for two weeks and to communicate details of possible contacts. Self-isolation was, in many cases not stringently observed, and in others, flagrantly ignored. Contact track and trace has been a continuing fiasco.

• Asymptomatic Covid-19 appears to be the norm among many healthy persons, particularly, but not exclusively the young.

How important are asymptomatic cases?

Some studies indicate that up to 90% of infections are very mild or completely asymptomatic. In January 2020, JKS and his wife (MOS) both experienced mild fever and joint pains (24 hours)  and fatigue (about 2 weeks).MOS also exhibited a temporary loss of smell and taste. Many others of JKS’ acquaintance have recounted similar anecdotes., Nation-wide studies of active infection and those who might have recovered from infection have not been conducted at scale. Some studies of thousands of persons appear to confirm the high percentage of asymptomatic cases. However, regional differences are very significant. What sampling protocols were implemented? Think London, Manchester and Birmingham Compare Southampton, with very low case numbers and Leicester with very high case numbers necessitating lock-down. A study of these two mid-sized cities might offer very useful insight.

The need for antibody testing

In his previous submission JKS noted the importance of both nucleic acid diagnostics (current infections) and antibody-based diagnostics (past infections). Neutralising antibodies might block subsequent infections (the rationale for vaccination). There are three main types of antibody involved in fighting infection:

IgM antibodies appear in blood and plasma within  3-10 days of infection. They will peak about 10-14 days after infection and will then decline to background levels, gradually replaced by

IgG antibodies. These appear in blood and plasma about  5-7 days after infection, peaking about three weeks later and very slowly declining thereafter. IgG will also appear in other fluid secretions.

IgA antibodies are generally found after 7-10 days in mucous membranes and secretions. They play an important role in blocking respiratory infections.

Within the first 2-4 weeks following infection, the ratio of IgM to IgG in blood and plasma might give some indication as to how long ago the infection occurred. As Covid-19 only became a serious problem in early 2020, studies could not previously say how long Covid-19 immunity lasts.

On 8 October 2020, a publication in Science - Immunology, confirmed that Covid-19 immunity is long lasting with neutralising antibody levels little diminished after 79 days. This is strongly supportive of the Covid Passport suggestion promoted by JKS (see: https://immunology.sciencemag.org/content/5/52/eabe0367/tab-pdf).

There have been a very few reports of repeat infections, but it may be assumed that most infected and recovered persons have immunity lasting from months to years. Only time and science will tell. This provides the basis for proposing a Covid-Passport. Good vaccines may well block transmission, but basic hygiene remains very important until they become available. Other treatments for active virus infection are available, but clinical data are not yet definitive, and some treatments are prohibitively expensive for general use, especially among poor populations in nations without a generally accessible healthcare system.

In Conclusion

• We cannot count on vaccines before next year (optimistic guess summer 2021).
• Basic hygiene must continue to be implemented. Face masks, social distancing and enforced Isolation measures, including lock-down and quarantine might be imposed to prevent spread in the immediate future.
• Such activity must be justified by strong diagnostic findings, clearly communicated to the public, avoiding panic and opposition.
• Scientific research is vitally important, as we do not know enough about Covid-19 infection, the development of immunity, and disease transmission.
• Better testing for antibodies might tell us who has had the disease and is now immune.
• Immune persons might be given a “Covid-Passport” valid for perhaps 6 months, that excuses them the obligations of quarantine and isolation following exposure (hand washing, and masks will still be important).
• In the mid-term (November 2020to June 2021 it is essential - even at the cost of some lives – to reboot the economy and PART 2, below, addresses this.
• A lack of clarity and explanation means that for the vast majority of citizens “R” numbers and over optimistic forecasts about vaccine availability are simply “government gobbledygook”. This will encourage suspicion and diminish confidence.

PART 2 – ACTION – getting where we want to be

In his 28 June note JKS wrote:

“ Perhaps now is the time to adopt a pragmatic, dare one say, expedient, approach. Conflicting issues must be resolved: The Economy, Public Morale and Public Health. How many deaths are acceptable to keep a majority of people happy and the economy turning? How many deaths will unhappiness and economic collapse cause?”

Introduction

It is now a year since a new coronavirus was detected in persons who fell ill following visits to a fresh produce market in Wuhan, China. The world has suffered a major pandemic that has infected perhaps 1 Billion people and killed over 1 Million. By the standards of the 1917-19 Spanish Flu pandemic at the end of the First World War, Covid-19 is mild. By 1920 up to and over 100 million people may have died world-wide at a time when the world population was just under 2 Billion.  Yet the economic impact of Covid-19 has arguably been greater than that of the Spanish Flu. The UK has been badly hit, despite the fact that younger persons involved in driving the economy have been less affected than infirm and retired persons who do not contribute. The sad reality is that even without Covid-19, old and infirm people die (of cardio-vascular disease, respiratory disease (including influenza, asthma or COPD)  or complications from a fall). Is it time to reconcile science and pragmatism? We need people back in work and spending their earnings.

Why has the economy suffered so?

Too many economically productive persons – at low risk of severe Covid illness - have been removed from activity. Consumers cannot easily  purchase the products of workers’ endeavour.

What has affected productive workers?

• Getting to  the workplace and physical constraints on activity in the workplace
• Travel restrictions, both nationally and internationally have affected workers who travel and prospective holiday makers who cannot spend to support workers in travel-dependent industries
• FEAR of contaminating co-workers and customers in the hospitality and entertainment sectors
• RESULT: falls in  sales of goods and services means poor liquidity and need to let go employees - mitigated by government’s expensive economic support measures, unsustainable in the long term
•  

What has affected consumer access to spending?

• Central Government and regional government anti-Covid recommendations and legislation have blocked city centres and other shopping centres
• Fear among potential customers and their families has dramatically reduced footfall in sport, hospitality and entertainment sectors,  and.
• Restricted access to shops and services in town centres and other shopping centres
• FEAR 0f getting ill, although for most, the risk is small or very small
• Most consumers are also workers, so the same considerations apply. FEAR of infecting loved ones, family and friends, through contact with infected persons and FEAR of losing income.

Not all is gloom and doom

There are bright spots in the gloom and some of the bright spots may expand to become the economy’s new normal. For example, on-line sales have grown during the pandemic and this has led to  real growth in demand for delivery services. Home-working and family communication has been enhanced by the on-going roll-out of very fast Internet access. Bandwidth has grown since the onset of the pandemic. `provision of on-line solutions by Telecoms providers (including new 5G roll-out), and businesses such as Amazon and Zoom have grown as a direct consequence of Covid-19. These successes have driven demand for IT hardware and infrastructure, from new mobile phones, iPads and PCs to Sat-Navs that guide van drivers to their next delivery of an on-line purchase. Providers of such services and solutions are actively recruiting workers from other areas now under threat.

How do we address production, consumption and fear?

Government support teams are at best temporary. The economy must be kick-started by measures that restore demand for products and services. Government and Scientific Advisors must learn to cooperate. Muddled communication has led to fear and apprehension. Clear and concise guidance, backed by clear and concise legislation, where appropriate, will help everyone.

Employees and the self-employed must get back to work – at home if necessary. Those at lowest risk of poor outcomes may be obliged to live with that small risk. Those at higher risk must work from home if possible or face the need for confinement – in as comfortable a manner as possible. It may be useful to offer separate guidance for those at low risk and those at high risk. See APPENDIX ONE – A points-based risk assessment approach

Back to work

In reality, healthy persons in the Green category described in APPENDIX ONE can and should return to normal work locations, particularly where home working is not an option. This is critical. Enterprises and people must work to restore the economy and allow the government  to earn the taxes that pay for the NHS and other services, such as Care, education, defence, housing, policing and pensions.

The Covid-passport must now be considered. This should be given if:

Low risk factor is satisfied.

High risk factor individuals test positive for neutralising antibodies (see reference in Science-Immunologycited above).

This is not ideal as we want protection for all, particularly the most vulnerable. However, if the government is unable to supply healthcare through shortage of funding, many more will die. Having eliminated many persons in the Covid-Passport category, attention can be focussed on those “at risk” who are not covered. It is to be hoped that by the summer of 2021 those most at risk will have been early recipients of safe and effective Covid-19 vaccines.

What about those that remain “at risk”?

If no Covid-Passport can be issued, “at-risk” persons should be identified and subject to enhanced surveillance for possible Covid-19 infection. The advent of much wider testing for both active infection and neutralising antibodies in the population at large will render this significant task more straightforward. The Chinese have just demonstrated the capacity to test 10 million people in less than a week(See: https://www.bbc.co.uk/news/world-asia-54504785).

PART 1 above,  showed that there are technologies and science available to help. So, what do we do in the  Short-term from November 2020 to June 2021

Low risk persons must be encouraged to re-enter productive work, education  or other occupation. They are at low risk of serious illness and without overt symptoms, are at diminished risk of spreading disease by droplet transmission or contact. Incentives to “stay at home” must be replaced with incentives to “go back to work”. An element of financial coercion might be necessary for both employers and employees.

Those individuals “at risk” must ideally be sheltered from risk of infection, pending availability of vaccines. This might involve introducing government support schemes for clearly defined individuals. When vaccines become available, “at risk”  category persons must be prioritised to receive such protection. Others, without neutralising antibodies, should receive vaccine when available. In the meantime, “at risk” categories must continue to avoid risk of Covid-19 exposure, through isolation or enhanced protection of self and contacts.

A return to work could be phased-in rapidly with enhanced hygiene and spacing in public transport and workplaces. The continuing  transfer of employment to the on-line sales and service sectors, including warehousing and delivery infrastructure will remove spacing constraints from public transport and traditional retail outlets. Access to hospitality, sports and entertainment venues must now be facilitated, and should be markedly improved by the Covid passport and clear guidance.

Short-term confidence-building measures will see a return to the High street and shopping centres. Masks, hand hygiene and spacing measures may continue to be necessary until vaccines are widely available. However, this exercise will be of lasting benefit ahead of the arrival of “the next virus”

Implementation of these measures will go some way to restoring the economy, boosting morale and limiting Covid019 deaths to an unavoidable minimum, that is less than the current level. The long-term benefit of better diet, exercise and lifestyle, could transform the finances of the NHS by reducing risk from several conditions (see APPENDIX ONE)that also  impinge on Covid-19 survival rates.

(14 October 2020)

APPENDIX ONE

A points-based risk assessment approach

Not all 80-year olds are “at high risk” and not all 25-year olds are “at low risk” from Covid-19. Some may be “critically endangered” by a combination of risk factors.  Identification of those at greatest risk demands an analysis of risk factors:

• Obesity and related problems of cardio-vascular diseases, Type 2 diabetes, inflammation of  articulations  (hip and knee for example),
• Respiratory conditions Asthma, COPD and other
• Genetic predisposition (very unclear why some black and Asian communities are particularly affected – we need to know)
• Age – 90-year-old persons are at far higher risk than 20-year olds, generally because 90-year olds have various health issues.
• Dependence, Alcohol, smoking and drug addictions are all significant risk factors
• Other life-style choices may enhance risk through close physical contact.  Frequent participation at Crowd events, bars and concerts are difficult (but not impossible to control
• In the long-term several of the above risk factors could be reduced or even eliminated by measures that favour better diet, exercise and life-style choices.

It may be possible to define low risk and high risk with a points-based system, for example:

           Obesity, moderate 2 point, severe 3 points

           Respiratory Modest 1 point severe 3 points

           Genetic predisposition  (no real understanding, provisionally black and Asian 1 point

           Age; up to 40 years 0 points, 41 – 50, 1 point, 51-60, 2 points, 61-75, 3 points 76-85, 4 points, 85+ 5points (subtract up to 2 points for excellent health, add up to 3 points for poor health)

           Dependence Modest 1 point, severe 3 points(cumulative for each)

           Lifestyle 1  point

Illustrative examples of points calculation (. + 1 point for black/Asian + 1 point for male):

           f55-year-old (2pt), slim, athletic(-2pt), light drinker(1pt), no underlying health issues, a score of 1 point

           for a slim, 20-year-old (0pt) with no underlying health issues and dependencies, but who loves watching football and partying(1pt) a score of 1 point

           for an 82-year-old(4pt), slim, no health issues, very fit (swims regularly -2pt), light drinker(1pt), score 3 points

           for a 50-year-old(1pt), moderately obese(2pt), heavy drinker(3pt) and moderate  smoker(2pt), who likes football and pubs(1pt), score 9 points

           for an 80year old(3pt), moderately obese(2pt). COPD sufferer(3pt), light smoker(2pt), moderate drinker (2pt), modest health, score 12 points

Risk categories:  0-4 points LOW, 5-8 points HIGH, 9+ points CRITICAL                    JKS 14/10/20