Today
Thu 6 May 2021

Adam Hamdy argues that a year of fighting COVID-19 has revealed the lazy, superior assumptions of the West and Britain in particular

In January 2020, the people of Wuhan showed the world everything we needed to know about how to tackle the then unnamed coronavirus. We didn’t need scientific studies. We could see medics and public health workers in full PPE, taking precautions against airborne transmission. We saw thousands of people working in contact tracing teams, testing, tracing and isolating the infected in managed facilities. And we got an indication of the potential stakes for public health and the economy when China put roughly 10% of the world’s population in some form of lockdown, and enforced stringent measures at the country’s international borders.

Vietnam, New Zealand and Thailand implemented variations of the Chinese strategy. Others like South Korea and Taiwan relied on community-led responses that emphasised rapid testing, tracing and isolation. Whatever their domestic variations, these countries all implemented strict infection controls at their borders, and as a result, their populations have lived more or less untroubled by the virus for much of the past year.

Instead of emulating these successful responses, Western governments questioned whether they were an overreaction. Even as hospitals in Bergamo were overrun, some scientists and politicians debated the effectiveness of border controls, facemasks, and lockdowns. Some policymakers questioned everything and doubted the veracity of evidence and clinical reports that came from China and elsewhere. As a result, public health measures often came too late and we’ve been playing catch up ever since.


Myopia around Masks, Shortage of Oxygen

It’s hard not to conclude cultural supremacy played a role in our failures. Evidence from elsewhere in the world has been accorded less weight than theories and models originating in the West. Scientists (particularly female and ethnic minority scientists) who’ve suggested we should learn from other countries have been attacked for their views, and practices that are considered mainstream and successful elsewhere have been derided as ‘fringe’ in the West.

Masks, known in much of Asia to be an effective public health measure against the spread of coronaviruses since the 2003 SARS epidemic, are still the subject of controversy in Europe and North America. And when medics in China reported the first COVID-19 reinfections last year, many Western scientists were quick to question the rigour of the testing regime, and asked whether those reporting the phenomenon understood the difference between viral persistence and reinfection.

We now know we probably should have been paying more attention to the issue. South Africa has reported more than 4,000 reinfections, and trials of the AstraZeneca and Novavax vaccines in the country have demonstrated infection by the original strain of SARS-CoV-2 does not protect against reinfection by the B1351 variant (it should be noted that Novavax offered a reasonable degree of protection against the B1351 variant).

A similar phenomenon was seen in Manaus, and now across Brazil. The P1 variant is reported to be responsible for a high level of reinfection, hospitalisation and death. Instead of heeding the troubling warnings coming from doctors and scientists on the ground, some American and European scientists, many of whom were pointing to Sweden as a role model last year, are blaming Brazil’s increased mortality rate on an overwhelmed healthcare system and a lack of oxygen. Brazil’s oxygen demand has followed the spread of P1. In January, when the variant was largely limited to Manaus, it was the only region to experience oxygen shortages, and supply was sufficient in the rest of Brazil.

As the variant has spread, so has the voracious need for oxygen.


Peddling ‘Hopium’

Instead of learning from real-world experience, some scientists and policymakers peddle “hopium”; theoretical models that use false hope to pacify a population and normalise an infectious disease.

Last year, when the authors of the Great Barrington Declaration wanted to shield the vulnerable and let the virus run through the population, hopium came in the form of T-cell cross-immunity, the idea that exposure to other coronaviruses might protect us from the worst effects of COVID-19. This misguided theory has been debunked, and some of its most vocal advocates have disavowed it. 

This year’s dose of hopium also features T-cells. We’re being told not to worry about variants because even if they defeat our antibody response, our T-cells will step in and provide cover. Do the people being hospitalised in South Africa and Brazil not have T-cells? In order for T-cells to function effectively, there needs to be coordination with B cells, but there is already evidence the B1351 variant disrupts this process. Rather than theories that justify exceptionalism, we should use clinical experience in the real world to inform policy.


Johnson’s Big Vaccine Gamble

In Britain, exceptionalism is so engrained we won’t even learn from our allies.

The US Centre for Disease Control has recently updated its scientific evidence and guidance for schools, setting out ways in which they can reopen safely. Measures include masks for all children over 2-years-old, improved ventilation and air purification, as well as recommendations about when to move to online learning. According to the CDC, the red zone threshold is 100 cases per 100,000 people, and once this level is exceeded, in-school learning should be stopped and moved online. England currently has 86.4 cases per 100,000. In America, schools would be starting to think about switching to remote learning. In England, they’re about to fully reopen without the safety measures the US CDC recommends. 

When the state fails to act, the burden of infectious disease falls on the individual. The people of Britain have endured some of the longest restrictions to personal freedom, the greatest economic downturn, and one of the highest rates of morbidity and mortality in the developed world. The public health and economic impact of Long Covid hasn’t been quantified and should not be underestimated in light of the concerning evidence that’s accumulating about the condition.

Vaccines are an extremely powerful tool for managing infectious disease, but they should be rolled out against a backdrop of low community transmission to minimise the risk of escape mutations.

The UK already has eight variants of interest or concern, and the reopening of schools and the economy without proper mitigation measures is likely to lead to greater transmission of those existing variants and increase the chances more will emerge. Studies suggest vaccines are still effective against current variants, but if we don’t do more to reduce transmission there is a risk our luck will run out.

The British government is betting everything on its strategy. Hopefully, the gamble will pay off, because we’ve all had enough of this pandemic and the misery it causes, but we can give ourselves a better chance of success if we overcome our exceptionalism and support the vaccination program by implementing public health measures that have worked elsewhere in the world.

Adam Hamdy is an author and helped to organise and write the ‘John Snow Memo’

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