I have started wading through the SAGE papers and there is perhaps more in there on some specific issues of interest than I was expecting.
Take for example the crucial period leading up till mid-March when the whole herd immunity thing exploded and u-turns were made. For various reasons it was not previously possible to be completely sure what policies would actually have been implemented under their original plan, or what exactly drove various public statements made by the politicians and medical/scientific authorities before and immediately after the u-turn.
Well, I have some answers. and will probably find some more when I look at further documents later. But for now:
Meeting 12, 3rd March 2020:
Potential impact of behavioural and social interventions on an epidemic of COVID-19 in the UK (4 Martch 2020)
We can see that they did have a look at most of the possible measures in detail, and knew that a combination would be required. A graph that has shapes I broadly recognise from later public Imperial College papers that we got to see from March 16th is present.
But most of the words which are of interest are from a different document from March 4th that was presented in a March 5th meeting. Why am I not surprised that its from the behavioural sub group?
SPI-B insights on combined behavioural and social interventions (4 March 2020)
I cant be quoting the whole thing so some select highlights:
- SPI-B have a consensus view that school closures will be highly disruptive and likely to present an unequal burden to different sections of society. Our understanding of reports from Japan is that there is growing discontent around the policy. Isolation of entire households also poses a substantial, and unequal, burden on those affected.
- Given this, the combination of interventions most likely to be socially acceptable involves isolation of symptomatic cases and isolation of at-risk members of the public. These are also the most closely targeted, and therefore obviously legitimate, strategies.
- Following this, social distancing and prevention of public gathering measures are the next ‘easiest’ to add to the mix.
- School closure in conjunction with isolation of those aged 65+ will reduce the ability of grandparents to engage in childcare. This may be beneficial in terms of morbidity of those aged 65+, but will reduce the ability for parents to work. This may be particularly problematic for lower income families and single parents. Consideration should also be given to the impact on workers for critical national infrastructure.
Now then, get those facepalms ready, here comes the source of the herd immunity public comms disaster:
- SPI-B have divergent opinions on the impact of not applying widescale social isolation at the same time as recommending isolation to at-risk groups. One view is that explaining that members of the community are building some immunity will make this acceptable. Another view is that recommending isolation to only one section of society risks causing discontent.
Oops!
They also saw what was coming in terms of the backlash against us not doing the same thing as other countries:
Expectations of how the Government will react will be set by media reports of public health strategies in other countries. This increases the risk of public concern if interventions that are perceived to be effective are not applied. A clear explanation as to why expected interventions are not being implemented may be necessary. Data from the Department of Health and Social Care weekly polling suggest that this may be particularly true for banning mass gatherings.
Regardless of the decisions that are made, members of the public will have questions about all strategies listed in the table. Where policies are not applied, Government should be prepared to provide clear, honest advice that takes account of concerns in that area and suggests behaviours that reduce risk. For example, how will the risk to children within schools be managed.
School closures does seem to be the measure they were least keen on, they had some additional points about it at the end:
The importance of schools during a crisis should not be overlooked. This includes
o Acting as a source of emotional support for children
o Providing education (e.g. on hand hygiene) which is conveyed back to families o Provision of social service (e.g. free school meals, monitoring wellbeing)
o Acting as a point of leadership and communication within communities.
Further clues as to what measures they were hoping to combine and which they werent, may be partially deduced by looking at some of the tables in this document. There was an earlier version of the document that only looked at each measure on its own in the tables, but by this version of 9th March, they also had entries where several measures were combined.
Specifically, they looked at just 'home isation of symptomatic cases' and 'social distancing for those over 65' combined. And the same but with whole household isolation (when someone else in that household has symptoms) also added to those two. Missing from these combinations was closure of schools, stopping large events, and social distancing for those not over 65. There is quite a large degree of consistency between the combinations they mentioned, what was left out, and what was being said publicly in press conferences around the same time (eg 9th & 12th March), where they spent considerable time and energy saying why they didnt think school closures or the cancellation of mass gatherings were the way to go at that point.
Potential impact of behavioural and social interventions on an epidemic of COVID-19 in the UK (9 March 2020)
Next time I post about this, we will be into the period where some of this already blew up in their face and a hasty rethink was underway.
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) word is asymptomatic,.
