Since various anti-lockdown sentiments and the paradox relating to self-defeating prophecies are causing me to rant plenty these days, I'll probably have to do an occasional bit of rebalancing so that I dont end up misrepresenting my own feelings on the subject as a whole.
Are there some countries that, especially with the benefit of hindsight could have avoided full lockdown? Probably, if conditions in those countries were not ripe for the same sort of epidemic we faced in the UK, or they did much better at keeping the numbers down in early phases of the pandemic. Did many of those countries have the luxury of seeing which combinations of measures were actually enough at the time? Mostly not, so I wont give hindsight-based stuff too much prominence.
But beyond that, are there any facts that could emerge which would change my overall thoughts on lockdowns everywhere? The possibly does remain. I was ready for that possibility back in February when it came to stuff like serology (antibody) studies from Wuhan, but instead the data showed that only a low proportion of people there had antibodies so far. This rather went against expectations, including my own, that asymptomatic cases would be a bigger, previously mostly overlooked, part of the picture. The WHO highlighted this lack of asymptomatic cases/wider population disease prevalence a lot at the time, and its a big chunk of the reason why lockdowns started to look like the only option as time went on and situations became dire and urgent. Since then, we have had antibody studies, often fairly small or very localised in nature, which have tended to show a similar thing. eg no more than 15-20% type ranges of population infection in the worlst hit locations, and considerably less elsewhere.
But is that the end of the story? I'm not so sure. For example, there is the following study which seems to show a much higher level of asymptomatic cases, far more along the lines of what people like me would have been expecting to hear about all along:
Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription–PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients). We conclude that the prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission after disembarkation.
I would not be looking to data from a relatively small ship as if it would mirror the levels of infection seen across whole countries. But the proportion of asymptomatic cases is the thing of note to me here. If only that study had also then later done antibody testing of all the people on the ship, we would have had some guide as to whether everyone who actually tested positive but were asymptomatic went on to eventually produce antibodies. And that in turn could give us clues as to whether some of the antibody data we are starting to get could be misleading us about the scale of population infection during the first wave.
Because if it did turn out that vastly more people were infected with no real consequence in the first wave, that would have all manner of implications for past and future strategies, and some of my tunes would change as a result. But I cannot go down that path without answers to some of these questions, and that time does not yet seem to have arrived. All the same, I do keep it in mind even whilst ranting about a range of anti-lockdown positions that are crappy. But plenty of those theories so far just seize on some small detail that they think is helpful to their cause, treat it like the main fact and build their case around it with little care for the full accurate picture.
If it did turn out that there had (and will be in future) many more asymptomatic cases than has been presumed so far, then this has implications in both directions. On the one hand it would change the calculations about remaining population susceptibility and ultimate disease burden, and implications for healthcare capacity etc. At the extreme end of things, it could even demonstrate that lockdown was so late it didnt make much difference to epidemic progression in some places, that the size of wave we got with lockdown wasnt so different from what the disease would have done when left to its own devices. But on the other hand, asymptomatic transmission is one of the reasons we had to resort to heavy, crude measures in the first place, since on paper there are lots of more nuanced measures that are partially thwarted if lots of the people involved dont even know they are carrying the disease. Which is one of the reasons why crude stuff like a lockdown and general social distancing for all was deemed necessary in the first place.
