How low are infection levels?

The level of infection in the UK has fallen significantly from the highs of early April. The Office for National Statistics (ONS) estimates that only 1 person in 1700 currently has the virus which means, at an individual level, the risks of catching Covid-19 are very low. This is clearly great news but if we look at case data from countries in the EU, we are far higher than all of them.

Cases per million

These countries had waited until infection levels were far lower than we did before they eased restrictions. This is because the higher the level of infection, the greater the risk of a widespread and rapid outbreak. As an individual it may appear much safer now, but that does not mean as a society it is also true, and so our individual risk might quickly rise again if easing restrictions leads to a rise in R.

If we look across the world, there are places with far worse infection levels. These are the countries with policies of very limited restriction and gives an idea of what the results of those policies are.

Cases per million

The US initially attempted to bring down infections with some form of lockdown, but some States gave up on this approach in early May and reopened despite levels of infection remaining high. In the US there are vast differences between States according to their policies and timing of first cases, with places such as New York seeing declines down to UK with others still seeing rising levels.

Cases per million

The chart below looks at Texas, Florida and Arizona together, a combined population of just below the UK. Case numbers in May were similar to the levels we see currently in the UK, and since reopening in May you can see the result with a rise to 10 thousand per day and rising ever more rapidly.

This is exactly what the UK needs to avoid.

Some anti-lockdown arguments

Government policy has been a catastrophic muddle in countries like the UK and US. With eradication now impossible and proper control far less likely, the trade-offs associated with lockdown are far more difficult.

I want to examine more closely some of the relaxation arguments I outlined previously, it may be that no lockdown is a better policy than a mismanaged one.

  1. Free-rider

One could as an individual, including perhaps your friends and family, act as you like while everyone else stays in lockdown. You have the freedom and no risk of infection. From the outrage as Cummings’ behaviour and the clear selfishness, I think it is clear this is not a common viewpoint.

  1. Let’s all do it

If you are happy to take the risk and also happy for everyone else to do the same, this seems much more reasonable as you get the benefit of freedom but the cost is that you are likely to be infected with Covid.

How risky is COVID?

I have previously written about how the Infection Mortality Rate is around 1%. As we have received more information about the disease, this remains a decent estimate, but it is also potentially misleading as it’s an average across a population, disguising a huge skew in the risks across age. The risks of dying are very low for anyone under 60 and climb sharply for older people.

A young person’s view

The most common cause of death for people in their 20s is accidents. In fact the risk of someone in their 20s dying from Covid if they catch it this year is about the same as them dying in an accident in the next year. The risk of dying in an accident is not something to ignore so we try to minimise risks through the wearing of seatbelts etc, however it does not stop young people from driving or going to work, school or university.

Given the low risk it is not immediately obvious why young people are so in favour of lockdown. It may be that younger people are more inclined to focus more on care and society than on individual liberty. It may also be the case that they overestimate their personal risks as the large death toll and confusing presentation of the numbers creates the impression that the virus would be just as deadly for them. They are young and a 1% chance of dying sounds far too high to live with as it is perhaps 50 times higher than your chances of dying this year from other causes.

In fact, for anyone under the age of 60, the risk of dying from Covid is lower than the risk of dying from other causes this year. I would like to find a poll which asks people under the age of 60 about this risk to Covid. Do they feel it is higher than other causes or perhaps feel it is low but in a similar way to being scared of flying, it is the perceived randomness and lack of control that drives the anxiety.

How about older people

It is striking that the people most at risk from the virus are in the age category most against lockdown. It may be more driven by issues of civil liberties, but it might also relate to an acceptance of the risk of death. Their risk of death for older people from catching Covid is high but so is their risk of death this year from other causes. In fact, they are remarkably similar.

Opportunity costs

Perhaps the costs of lockdown are not the same for people of different ages either. If you have a life expectancy of 60 more years, then losing 6 months to lockdown may seem reasonable. If you have a life expectancy of 6 years then perhaps losing 6 months to lockdown being isolated from your family is a much higher price to pay.

The problem

What I have tried to outline is a case for why younger and older people might both choose to exit lockdown. Despite this, I do not think people are in favour of lockdown because they misunderstand their personal risks. It is because they feel a sense of responsibility to others. From the chart below, we can see that people put the risk to others as far higher than to themselves. People are aware that if they break guidelines, it is not just themselves they put at risk but also everyone else. The outrage at Cummings showed many people feel that it was not acceptable.

Consent and Confidence

Imagine we had a large majority in favour of retaining much looser restrictions and willing to take the increase in personal risk. The problem is that they are imposing a higher risk of death on a significant number of people who have not consented to it.

A possible route for dealing with consent is a policy of shielding those who are vulnerable and who wish to be shielded. I would like to read a paper that explains how this might be possible as I have not come up with a way to do it. As I wrote previously Sweden was the country closest to pursuing this policy but effective shielding proved very difficult to achieve, with large numbers of care home deaths.

Confidence is perhaps even harder to achieve in divided countries like the UK and US with low levels of trust in the government. It might be more possible in countries with higher levels of cohesion and trust but most of those have already chosen the path of controlling the virus.

Can we go down this path?

As I wrote in my May 23rd post there are ways a society can choose to move forward without lockdown. There is no reason that Pakistan (average age 24) should necessarily take the same path as Germany (average age 47). But the key to success for either a lockdown or a herd immunity strategy is ongoing consent and participation.

The policy mix in the US and the UK appears to be to back into the herd immunity approach by muddled incompetence without consent. The rhetoric of public health with the actions of a libertarian leads to the worst possible outcomes for both public health and the economy.

Is a Second Wave coming?

The very good news being reported in many countries is that we are past the first peak, especially in those which have enacted lockdown type restrictions. Even better is that we have not seen a rapid move to a second peak as restrictions have started to be lifted.

What is a Second Wave?

I only recently understood that this term has two different meanings, a medical definition and one which most people mean, and this can cause a lot of confusion.

Medical definition:

“Second wave: A phenomenon of infections that can develop during a pandemic. The disease infects one group of people first. Infections appear to decrease. And then, infections increase in a different part of the population, resulting in a second wave of infections”

Spanish flu is a well-known example of this. In the spring of 1918, in the first wave, it is estimated that 75% of the French military were infected. The virus spread peaked and then declined due to the internal dynamics of the virus – the susceptibility and immunity of the population. One theory assumes it then mutated to a far more deadly form returning in the autumn with a much higher mortality rate which is the “second wave” we see in the chart below.

What most people mean:

“Second wave – rising infection and death rates to a level similar to or greater than what we saw in early April.”

What is the difference?

In the current situation, measures were implemented to stop the spread of the virus. This created a peak but not from the internal dynamics of the virus, such as growing levels of immunity in the population. We could easily never see a “second wave” using the medical definition whilst having a new peak in infections and deaths many times larger than what we have seen so far as the first wave continues after interruption. This “second peak” in infections could be defined as the completion of the “first wave”.

A simple projection would be that the rest of the country reaches infection levels seen in London and New York. The results of the antibodies tests last month in the UK were that 17% of Londoners had had the virus and only 3% of people in the rest of the country.

It could of course be far higher if the lockdowns in London and New York had prevented far larger outbreaks there.

Let’s look at the question we really want to be answered

Will there be a second peak?

Some people are arguing that we will not see a second peak in COVID-19. Let’s look at the key arguments.

  1. Why should there be?

This is the view of Prof Pennington, a retired microbiologist, whose opinion has received a great deal of sympathetic coverage in the Telegraph and Daily Mail. “I think it’s very unlikely that there will be a second wave” as people are relying on models based upon flu which are not relevant to Covid.

This is an interesting point as flu mutates very quickly which is why we have so little resistance every year. Mutations then expose new parts of the population which drives a second wave. For COVID-19 so far, there has been a very limited mutation of the virus which is a good reason to think that there may not be a second wave.

If this is what he means then I likely agree, but it is not what people care about. What people care about is a second peak. This does not require the virus to change but simply for people not yet infected to become exposed.

  1. The virus is getting less deadly

Some researchers in Italy have suggested this but it has been widely discounted. It may resurface as a theory as it would be great if it were true, although it is worth noting it runs opposite to the logic from the previous point that the virus is not mutating.

I have heard a few people confident that viruses get less dangerous over time, but I have not found any evidence to support this. For example, as mentioned in the introduction, the second wave of Spanish flu had a much higher mortality rate which is potential because it mutated into a more deadly form.

  1. The Lockdown policies we have relaxed so far are safe.

This seems a pretty reasonable idea. The main source of transmission comes from being indoors and spending time close to others and we have adapted our behaviour to social distancing and handwashing. The main easing of restrictions so far has been in areas which are the least dangerous, for example socialising outside.

Looking at infection data it is likely that the R number has risen a little with these measures, to perhaps just under 1 in the UK, perhaps around 1 in much of the US and still perhaps below 1 in some EU countries.

A best-case theory to support this would be that the big driver of transmission is a few “super-spreaders”. It is a few people who pass it to perhaps hundreds, not the vast majority passing it to a few. In this case the restrictions on mass gatherings such as sporting events would make an outsized difference allowing other activities to carry on largely unaffected.

If this hypothesis is correct, it is important to carefully track what happens as we relax the restrictions. In the UK, it is critical but made difficult by the number of simultaneous easings we are seeing at the moment. For the US and UK, we also need to be vigilant as we are relaxing restrictions with infection rates far above other countries who are doing the same.

  1. We are already immune

This remains rather a fringe view that we have already reached herd immunity, notably pushed by Professors Gupta, of the Oxford study, and Friston.

Prof Gupta is extremely optimistic and expects a release of lockdown to not lead to a resurgence in case numbers. She thinks the fall in case and death numbers “the driving force was the build-up of immunity” not lockdown and the first wave was completed with a massive spread of the virus and a majority of non-symptomatic cases.

Unfortunately, her view requires several important leaps which I cannot follow. For example, the antibodies test data suggest that only 7% of the population have been infected but she conjectures that more people have been infected but for some reason do not have the antibodies. In addition, I have struggled to understand how the Infection Fatality Rate can be “definitely less than 1 in 1000 and probably closer to 1 in 10,000” since more than 1 in 1000 people has ALREADY died from COVID in the UK.
Furthermore, if all of the countries has already been infected why is it overwhelmingly Londoners who have been ill?

Prof Friston has been getting a lot of press for this model recently. It is rather complex, hidden behind some fiendish maths adapted from physics. In essence, his model does not conclude that lockdowns had no effect, it assumes it. After assuming lockdowns and policy are irrelevant, he has to find other variables to cause the peak in infections and his proposal is slightly different from Gupta’s. It is not that we have all already been infected by the virus, it is that perhaps 80% of us were immune already. He looks at the UK and Germany and concludes there is an immunity difference in the populations that makes lots more Germans immune to COVID than British people.

I have not seen his opinion on why Brazil’s death rate keeps rising but since it cannot be their lack of lockdown it must be because Brazilians are naturally less immune than everyone else or we are about to see a rapid spontaneous fall in Brazil’s cases.

  1. Summer makes a difference

It seems certain that this is true to some extent. We still see outbreaks in warm countries, but there is some indication that warm weather and higher humidity affects the virus and, of course, in hotter climate behaviours are likely to be different anyway in terms of socialising outside.


Unfortunately, I do not agree with the most optimistic arguments that there is no risk of easing lockdown. Since we are so much safer outside than inside, and as approach summer it may well be that we will not see a rapid resurgence of the virus which will give us all some respite and time to reassess our approach.

Anti-lockdown – Interesting arguments

I have previously written how often the popular arguments against lockdown are made poorly, relying on a misleading interpretation of the data and science.

I do think there are interesting arguments against lockdown to be made. To add balance, I want to share seven arguments which I may not agree with, but I think entirely valid to debate, and I give a few links to articles

  1. The risk to life that Covid poses is outweighed by the need to preserve the economy

This is the most common argument presented and you will find plenty of examples. I have explained why I think this is a false choice.

  1. The risk to life that Covid poses is outweighed by the need to preserve civil liberties

A straightforward ethical argument which I think is likely a widespread factor driving opinion. Younger people and those from the left are far more likely to think in terms of care, protection for society and the involvement of the state. Older people and those on the right are more likely to think in terms of individual liberties and freedom.

Here is an article in the Telegraph that makes this case

  1. I am willing to take the risk

This is similar to the above argument but here the emphasis on individual wants, not a judgement on what society should do. This could be a young person who does not want to have their life infringed upon for no gain to themselves, or older people who value their freedom over reducing their health risks. The Cummings case is an example of someone prioritising themselves and ignoring the impact on broader society. Here is an article in the Independent making this case.

  1. Covid has been prioritised and it has led to an overall worse health outcome for the population

    Lockdown has seen numbers of people attending GP and hospitals fall dramatically. This is leading to many serious conditions being missed or diagnosed late and with fewer ICU beds available, treated less successfully. The overall health outcome to the population has not been considered on balance.

Here is an article from the Guardian with an example of the negative consequences

  1. Too blunt a tool

In the UK, it is hard to defend the lockdown as a well thought through set of policy measures so it’s very much open to criticism on this front.

  1. Shield the high-risk people

The idea here is that for a lot of the population the risks are far lower and if the at-risk people could be separated and kept safe, then the larger population could possibly achieve herd immunity. This sounds very reasonable in theory, but I have not yet seen a proposal of how it could be done in practice. For example, separating old people to live apart from their families is basically care homes which we have seen does not work, and there are issues with mandating only a portion of citizens to be not allowed to leave their homes.

I have read lots of articles advocating this policy but have not found one which explains how it might be done.

  1. No vaccine coming

If we do not believe that we are likely to get a vaccine, then what are we locking down for?
Either we should go much harder and act like New Zealand and eradicate it.
Or we should accept that this is a virus we will live with for a long time and that life is just a lot riskier than it used to be. This is a key factor which gets very little attention.

Where science can help

What I observe are far too many arguments where one person argues that the mortality rate is very high and we are likely to see a second wave, and the other argues that it is very low and that there will not be a second wave. They have each found “experts” on the internet who support their view. I do not think they are having a legitimate debate about the science but instead using it as a proxy battle for their underlying ideological differences.

For example,

  • If you believe that the risks of Covid outweigh the cost to civil liberties because the mortality rate is 10% then the science can say that you have incorrect starting assumptions. What do you think if the mortality rate is 1% with a large skew to older people?
  • If you believe that the cost to civil liberties are greater than the risks of Covid because the risks are similar to seasonal flu, then the science can say that you have incorrect starting assumptions. What do you think if the mortality rate is 1% with a large skew to older people?

Can we just follow the science?

I hope this had made clear that following the science is important but only takes us so far. What remains are all the ethical, logistical and political issues that science can inform but never resolve. These are the debates we need to be having as a society.