Call for evidence:
UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks
Prof. Robert MacKay, Director of Mathematical Interdisciplinary Research, University of Warwick, Coventry CV4 7AL; R.S.MacKay@warwick.ac.uk
Disclaimer: The views expressed here are personal and do not necessarily represent those of others at the University of Warwick.
1. The contribution of research and development in understanding, modelling and predicting the nature and spread of the virus;
Epidemiology is highly advanced in the UK: there are strong research teams in several UK Universities and research laboratories. It would take me some work to document this objectively but I expect others will have done so. More sophisticated models could be used but the bottleneck is good data. Without that, there is little value in more sophisticated models.
On the other hand, an important feature seems to have been missed in some of the modelling such as the Ferguson et al paper of 16 March, namely heterogeneity in susceptibility and contact network means that perhaps a much smaller fraction of the population suffices for herd immunity:
https://www.nicholaslewis.org/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought/
Gomes et al, https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v2
Britton, Ball & Trapman, http://arxiv:2005.03085
Why was this not factored into the decision process? Gabriela Gomes and two of her co-authors are UK-based. She is well-known to the UK epidemiology community. Frank Ball is also and has been for a long time.
And what about Sunetra Gupta’s view that it is likely that many of us were infected before the rise in reported cases and in deaths, e.g.
2. The capacity and capability of the UK research base in providing a response to the outbreak, in terms of:
The UK epidemiology groups have good communication channels to the government, principally via SPI-M. What concerns me is why the government made a sharp turn in policy on 16 March. Had the scientific advisors changed their minds or did the government decide it had to change policy? I was dubious about the reason given, namely that we have to “get the timing right”. If the goal was to reach herd immunity (as Vallance had proposed a few days earlier) with minimal deaths then I agree, e.g.:
https://benjaminmoll.com/wp-content/uploads/2020/05/SIR_notes.pdf
but if it was to not overwhelm the health service or to minimise economic damage then a weaker measure of social distancing should have been taken earlier (though in the event it seems there was adequate hospital capacity except that to achieve it some long-term patients were sent to care homes, some carrying the virus, with bad consequences). In conversation with some others, I advocated asking everyone to reduce their contacts by a factor of 2.5; this would entail significant change, e.g. increasing hygiene, reducing social activities, putting up screens where workers have to meet many customers, but not necessarily anything as drastic as the lockdown. The request could of course be fine-tuned in many ways to enhance the outcome, but I believe it was a simple to understand and effective message, which would have ”flattened the curve” without causing such economic and social damage.
The scramble to source or manufacture ventilators was a farce. Furthermore, at least in the public media, little distinction was made between providing supplementary oxygen and putting people into a coma and using mechanical ventilation. Furthermore, it seems ventilators may have done more harm than good:
https://time.com/5820556/ventilators-covid-19/
https://www.atsjournals.org/doi/pdf/10.1164/rccm.202003-0817LE
https://off-guardian.org/2020/05/06/covid19-are-ventilators-killing-people/
The development of a test for those who have had the virus has been too slow; as emphasised by Gupta, knowing how many of us are still susceptible is essential to knowing how to act next:
medRxiv preprint doi: https://doi.org/10.1101/2020.03.24.20042291,
But it needs to take into account also those who have had close enough variants (like a significant fraction of common colds) to be unsusceptible. Do the recently launched tests take this into account? See
SPI-B on behavioural science has shown itself to be capable of giving detailed advice to the government, which in itself is a good thing, as the social behavioural side to an epidemic is indeed crucial to managing it, but one can ask whether the recommendation to “Use media to increase sense of personal threat” in its 23 March document 25-options-for-increasing-adherence-to-social-distancing-measures-22032020 on
is fit for British society. Many have indeed become fearful about the virus, I would say irrationally so, and one has to ask whether this is a good way to treat the population.
3. The flexibility and agility of institutions and processes to respond on the above during a crisis including:
The principal constraint on researchers at Universities is that they have many other obligations (teaching and administration) that cannot easily be turned off at will. The result is that in rising to the challenge they end up working round the clock, as I see with my epidemiologist colleagues. The government could support a number of fellows to be on research contracts with an agreement to be on call in a relevant crisis.
4. The capacity to manufacture and distribute testing, diagnostics, therapeutics and vaccines:
It seems that the UK was woefully underprepared for testing to determine those who have the virus and those who have had the virus. Without this information, particularly the latter, the country is acting blind.
The hope that a vaccine will solve everything is misplaced. Although the principle of vaccines is good, most vaccines are reported to do more harm than good:
Why did the UK dismiss chloroquine as a treatment? There is evidence from other countries that it significantly reduced the duration of illness of patients to whom it was given early on, preventing the serious effects of the virus that we have seen in some. In particular in Marseille: see interviews on https://www.mediterranee-infection.com (in French)
5. The capturing during the crisis of data of the quantity and quality needed to inform:
As in 4, the UK was woefully underprepared to capture the data required to inform decisions.
6. The mechanisms for communication of scientific evidence internationally, within national governments and with the public:
With the internet, it is now very easy to release scientific results and for people to read them worldwide. The questions are on which to focus and how much trust to put in them. All scientific work comes with assumptions that may be satisfied to a greater or lesser extent.
Handling conflicting scientific opinions is hard, even for scientists, let along politicians. One has to acknowledge that there is disagreement and then make the best decision one can, but be ready to change it in the light of new evidence. In general, there is too much dogma in science and it flows over into policy. For example, it is now politically incorrect to question vaccines, it is politically incorrect to prescribe homeopathic medicines (despite the principles being similar to those of vaccines), it is politically incorrect to question whether humans are making significant changes to climate and whether the policy of reduction of CO2 emissions makes sense, it is politically incorrect to ask whether there is a genetic contribution to homosexuality, it is politically incorrect to ask if there are differences in abilities between men and women, or between black and white. I am reminded of the days when it was heresy to question whether the heavens go around the earth. We have made progress, largely due to the Age of Enlightenment, but there is still too much tendency to declare that some view is the truth and it must not be challenged.
To what extent have the views collected on
https://swprs.org/a-swiss-doctor-on-covid-19/#latest
been taken into account?
How are conflicts of interest handled? Some epidemiologists receive substantial funding from the Gates Foundation or pharmaceutical companies. Although it would be nice to believe these are benevolent grants, even if there may be no explicit strings attached, there are plenty of implicit ones. For one view of the matter, see
https://www.ukcolumn.org/article/who-controls-british-government-response-covid19-part-one
7. The UK’s readiness for future outbreaks, including a consideration of:
It is remarkable to me that despite various government exercises over the past few years to prepare for such a pandemic and a conclusion that the NHS was not prepared:
we were still unprepared. The government also dithered at the beginning, instead of immediately charting a plan of action. The WHO announced the problem on 31 December. Yes, we had advice about travel to China and then 2 Feb advice about handwashing, but the 4-part plan wasn’t announced until 26 Feb and the necessary work on designing tests and data collection was thereby behind schedule. The timeline is helpfully summarised on
https://www.health.org.uk/news-and-comment/charts-and-infographics/covid-19-policy-tracker
The first SPI-M-O document is dated 2 March https://www.gov.uk/government/groups/scientific-advisory-group-for-emergencies-sage-coronavirus-covid-19-response
25 May 2020
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