OF SUBSTANCE AND SPIRIT
One thing we cannot ascribe to the British is the propensity to secrecy.
In monetary policy, the Brits could not be more than transparent. The Bank of England for over 20 years has been publishing the minutes of its meetings on monetary policy held eight times a year. While many inflation-targeting central banks have subscribed to transparency, not all have taken to publishing their policy decisions and voting by their board members. The British monetary authorities are very open to the public. They even have a score sheet showing the Board members’ vote to increase, maintain or reduce the policy rate. They prefer to uphold their accountability to the British public rather than remain anonymous in the Board minutes.
It is not, therefore, surprising that even in medicine and science, the British can be so forthright they are prepared to show their hand in pandemic mitigation. Recently, a new mutant of COVID-19 virus appeared in UK leading to harsher restrictions on mixing during the holidays in England, Scotland, and Wales. It is more disturbing because the latest variant is rapidly replacing its old self. The process of mutation is affecting the very structure of the virus. The mutant has greater ability to spread and infect human cells.
The Brits contemplated immediately on how they performed in their attempt to arrest the virus on their part of the Channel.
London School of Economics (LSE) Department of Philosophy, Logic, and Scientific Method’s Jonathan Birch assessed the minutes of the meetings and documents used by UK’s Scientific Advisory Group for Emergencies (SAGE). What struck Birch was that “the advisory process in the UK has been impressively transparent.”
The LSE professor focused on the role played by what SAGE called “reasonable worst-case scenarios” or RWCS. This is a set of worst assumptions that could possibly happen; hence, “reasonable.” It is considered “worst case” because among the range of serious possibilities, it is the most pessimistic.
The underlying idea is that if one assumes the worst, then he must also be prepared for less serious cases. What is interesting in the assessment by Birch is that the Brits turned out to be rather ambivalent about assuming the worst.
On March 6, 2020, the RWCS involved 80 percent of the population getting the virus over nine weeks, with 50 percent showing symptoms and an infection fatality rate (IFR) of 1 percent. That would translate into 520 thousand additional deaths within three months.
Alas, but that was not the worst-case scenario. An earlier exercise assumed there was no effective treatments or vaccines in the face of the pandemic. While this helped guide strategic planning, this was removed from the March 6 scenario.
Additional background assumptions were also considered in the assessment. Contact tracing was assumed to stop if there were more than 50 cases per week. Health protocols would include physical distancing and using face shields for 13 weeks instead of the 26-week result of some models. Most important, it was also assumed that compliance would be 50 percent. Instead of assuming a lower compliance, the 50 percent level was actually deemed by SAGE as “high levels of compliance.”
Elsewhere, the UK strategy was anchored on excessively optimistic assumption, according to Birch. A reproductive rate (Ro) of the virus without mitigation was placed at 2.4 or a doubling time of 4-6 days. This was in the lower end of the serious estimates.
To provide some dimension, different studies estimated Ro at between 2.7; others at between 4.7 and 6.6.
Finally, bad surveillance was not assumed while in fact, surveillance turned out to be really bad.
Because RWCS was rather anchored on less pessimistic outcome, there was a delay in their pandemic response between March 2 and March 23. Cumulative infections in England surged to around 1.6 million. An optimistic Ro estimate, an assumption of good surveillance and a 13-week assumed maximum duration for any intervention—instead of longer—made social-behavioral interventions rather late in the game.
Somebody dropped the ball in UK!
The idea of maximum aggressive suppression was rather remote to the UK because SAGE earlier advised against it. More moderate measures were preferred.
People must have been perplexed at this pandemic response that they thought the official strategy was to induce herd immunity. But there was actually no recommended strategy as late as March 9. SAGE must be thinking of the trade-off between lives and livelihood, flattening the curve was the marching order without suppressing it completely. It was only after one week that SAGE reconsidered and stepped up the strategy to maximum response including school closures.
But it was too late.
Birch wrote: “We have been left bitterly regretting our failure to take these measures soon enough. If SAGE had unambiguously recommended maximally aggressive suppression on March 2, when its SPI-M sub-committee first reported that ‘It is highly likely that there is sustained transmission of COVID-19 in the UK at present,’ then many lives would have been saved and the epidemic would have taken a different course.”
The one single lesson was indeed hard to swallow. Preparing for the worst is also preparing for everything else. Preparing for something less serious is not preparing for the worst.
Of course, the worst happened.
Now we know COVID-19 and its two new variants do not discriminate.They affect all vulnerable souls. While the vaccines may be able to handle the three of them, or perhaps some other variants in the future, the issue is whether the vaccines are available, effective, safe and affordable. Sustained adherence to the usual health protocols remains vital. The pandemic continues to stalk UK and the world.
For future public interventions, the LSE professor proposes the following:
- Assuming the worst should be global in that the worst should be assumed for all relevant respects, and not just for some. Omission could be costly.
- Worst assumptions should not dominate strategic planning because possibilities come in a broad range. The availability of vaccines and reliable tracing system can change the equation.
- Scientific advisers should highlight the circumstances under which their recommended actions might lead to serious regret. In the case of SAGE, their failure meant thousands of lives that could have been saved if the worst was assumed.
Postmortem assessment in the Philippine experience with the pandemic can be done in the near future, but even at this stage of the game, it would help us if we assume the worst. We are no longer fighting one type of virus but probably two more. They spread rapidly so the demand for health logistics and vaccines will multiply. Our budget is limited to providing vaccines to only 70 out of over 108 million Filipinos. We are left with only 20 percent of the available vaccines in the world because the other 80 percent went to the richer nations. There is wide disparity in the pricing structure of vaccines and we might end up paying more than we should because of regulatory capture. Congressional hearing might be protracted. Spokespersons of government could turn away public support. Compliance with health protocols and the public’s willingness to get themselves vaccinated could be lower.
If the Brits managed to critique themselves while mitigation is in progress, it would also be a good idea to do thisin Manila. Definitely, key lessons could be drawn. More lives and more resources could be saved.