Boris Johnson in intensive care

By Christopher Monckton of Brenchley

Boris Johnson’s transfer to intensive care for Chinese-virus symptoms is bad news for lovers of liberty on both sides of the Atlantic. Very sadly, on current data, he is more likely to die than not. Being ill has hit him doubly hard. Not only has he continued working 15 hours a day when he should have been resting: he has never been ill enough to be admitted to hospital before, and has always thought of illness as a sign of weakness.

His Health Secretary, Matt Hancock, just a decade younger, threw off the disease in a week. Hancock had formerly suffered from two of the commonest comorbidities that kill Chinese-virus patients: overweight and diabetes. However, some years ago he altered his diet so as greatly to increase his intake of fat and to reduce his intake of carbohydrates, which are not only the primary cause of overweight, obesity, diabetes and its complications but also a significant cause of hypertension.

This permanent lifestyle change has brought him down to a normal weight and has eliminated Mr Hancock’s diabetes, just as a similar lifestyle has eradicated mine. During his tenure as Health Secretary, the National Health Service has been creakily revising its previous catastrophic guidelines for diabetes patients that had recommended patients to reduce their fat intake and keep their cholesterol low.

Mr Trump, who is working closely with chief executives of drug corporations seeking either to repurpose existing licensed medications or to develop new ones to attack the virus, has said he has put some of the chief executives in touch with Boris Johnson’s doctors so that, if he is willing, he can try out some of these medications.

In three respects, Mr Johnson’s handling of the emergency placed him at great risk. First, when he visited hospitals he shook hands with staff and patients long after it had become apparent to other nations that very great caution should be exercised. Secondly, he was one of the last leaders in the developed world to introduce first social-distancing measures and then a lockdown.

Thirdly, and most importantly, the social-distancing advice was in one grave respect flat wrong. The recommendation was that people should keep 6ft 6 (2 meters) apart. That is all very well out of doors, where the volume of air dilutes the viral density and the chaotropic effect of sunlight kills the virions. Indoors, however, 16 ft is the minimum distance necessary to be reasonably sure of interfering with transmission.

I wish him a speedy and complete recovery.

Meanwhile, here is today’s updated graph of the lockdown benchmark test. The graph shows that the daily compound percentage increase in total confirmed cases continues to fall. This is very good news. Provided that the falling trend continues for a few weeks more, and provided that the capacity to test the entire population is achieved in that time, enough will be learned about the rate of transmission and the case fatality rate to begin ending the lockdowns.

Fig. 1. Mean compound daily growth rates in confirmed cases of COVID-19 infection for the world excluding China (red) and for several individual nations averaged over the successive seven-day periods ending on all dates from March 14 to April 6, 2020.

Since WordPress has not yet updated its system to allow for the fact that most computers have landscape screens, some commenters have complained that the graph is not easy to make out. It is easy to see that the trend in the case growth rate is firmly declining, but it is not easy to distinguish the curves for the individual nations. So a .pptx file is accessible here.

There are still a few commenters who would prefer that analyses such as this should not be carried out. The value of a reasonably objective benchmark, however, is that it gives all of us some real hope that the lockdowns can be progressively phased out in the not too distant future.

But it ought to be clear to anyone who has even an elementary understanding of exponential growth that, at the 20% mean compound daily growth rate in confirmed cases worldwide that had obtained over the three weeks to March 14, when Mr Trump declared a national emergency, the 67100 confirmed cases that day would have become billions by the end of April, or, allowing for the reduction in the number of susceptibles, at the latest by midsummer.

Since the confirmed cases are at present chiefly serious cases, but bearing in mind that there is considerable under-reporting of recoveries, the death rate in closed cases – those confirmed cases who have either recovered or died – is some 27%.

Given these figures, it would simply not have been responsible for governments to allow unrestricted transmission of the virus. That was why lockdowns were necessary. Yes, Sweden and some other countries took the risk of not introducing lockdowns, and Sweden, as the graph shows, has kept its compound daily case growth rate quite low with partial restrictions, just as South Korea has.

Stephen Mosher, who is in South Korea, has been kind enough to supply some details of the control measures by which the public health authorities were able to avert lockdowns:

Testing, testing, testing. Anyone who feels ill calls a central number to arrange a free drive-through test. Results are available not in 24-36 hours, as in the UK, but in just six hours.

In emergency, anyone can show up at the drive-through without an appointment, but then the test will cost $140.

No one goes to doctors’ surgeries for testing, for that would make the surgeries a focus for transmission.

Anyone flying into South Korea is tested and quarantined at home, where the authorities will telephone thrice a day to make sure you are there. Everyone coming in through the airport has a temperature test and those with fever are admitted immediately to a health centre.

South Korea has carried out close to half a million tests, representing almost 1% of the population. Of these, 10,000 were positive, or about 2%. Contrast that with the State of New York, where 30% of tests are provinjg positive.

In South Korea 20,000 people with no symptoms – contacts of those found to be infected – are awaiting tests even though they are asymptomatic.

Tracing, tracing tracing. The contacts of everyone found to be infected are actively traced. At the outset, some five cases in six were successfully tracked back to a known source, the index patient.

Recently, the average success rate in contact-tracing has risen to 95%.

If anyone is found to be infected, his whole family, contacts, church and workplace will be tested.

If anyone in a nursing home the nursing home gets sick, all residents, all staff , all family members and all visitors are tested.

If a co-worker gets sick, the whole business will be tested, together with those who share the building. All their contacts and family will be tested.

If a hospital patient gets sick, all staff, all patients, all family and all visitors are tested.

The cellphone data of all who are infected are collected. To make sure South Korea was ready for this, it has long had a policy that to obtain a phone number, receive mail or connect to the internet one must have a national identity card. Data about the location of infected people are published.

Searching, searching, searching. Beginning in Daeugu, where a large church congregation was the original focus of infection, all churches, nursing homes, mental institutions and other places where infection might pass readily are tested.

Distancing, distancing, distancing. All mass assemblies were cancelled as soon as China, having at first lied to the effect that the virus cannot transmit from human to human, admitted – catastrophically late – that it could.

Churches do online broadcasts. Churches that refuse to comply are fined, and are made to pay the medical bills of anyone with the infection who is traceable to them.

It is still possible to go to work, and most do, but any form of work that involves mass gatherings is prohibited.

Schools are closed, and an online school will open soon.

Protecting, protecting, protecting. South Korea’s chief medical officer – far and away the most impressive of the health officials I have seen interviewed – says that wearing a mask, however homemade, makes a significant contribution to controlling the spread of infection in public. When I go out, I wear a full-face motorcycle helmet, for the virus can enter the body not only through the nose and mouth but also through the mucous membranes of the eyes. Around nine-tenths of the South Korean population wear masks in public.

To prevent panic-buying of masks, they are rationed to two per person per week.

Hand-washing in South Korea is already standard practice, because the nation has had so much recent experience of epidemics originating in the squalid, filthy conditions that prevail in Communist China – SARS, MERS, swine flu H1N1 etc., etc.

All unnecessary trips outside the home are forbidden. Go to work or to the food shop, but otherwise do not go out.

Since even this partial lockdown may cause psychiatric problems for some, mental health professionals are at the other end of a hotline, waiting for anyone to call them for reassurance or advice.

Informing, informing, informing. The South Korean civil defence organization are known as the yellow-jackets (for they wear hi-viz jackets). The yellow-jackets provide factual briefings to the public twice daily. No politics: just the numbers and the facts. The sharing of information with the public is known to have an immensely reassuring effect. If there are difficulties, the yellow-jackets admit to them openly and explain exactly what is going to be done to overcome them.

A recent daily briefing is at https://www.youtube.com/watch?v=D-WyK0uKuWI&t=639s.

Encouraging, encouraging, encouraging. The dead are honoured, The public are given encouragement. All are thanked for their efforts and their understanding.

I am most grateful to Mr Mosher for that information, which I have not seen anywhere else. It is important that we should all learn from the country that has achieved the most successful containment of the pandemic.

Some commenters here have questioned South Korea’s approach, saying that the very effectiveness of the control measures will leave most of the population without what the British chief medical officer of health (still suffering from Chinese-virus symptoms) has called “herd immunity”.

As I shall explain in my next posting, this is not the case. Confirmed cases represent only one-tenth to one-hundredth of the true number of cases. We do not yet know exactly, but, as I shall explain and demonstrate in a later post, we know that those who die today will have contracted the infection about three weeks previously, but we also know that the total number of reported cases three weeks ago was far less than the number of deaths reported today.

Therefore, much more population-wide immunity is being acquired than the official confirmed-case count shows. Particularly in the absence of widespread testing, the confirmed-case count inevitably highlights only those cases serious enough to have come to the authorities’ attention.

However, anyone who has worked at a senior level in government will know that, when there is insufficient information to be sure that population immunity is being acquired, and when the confirmed-case count is rising at a compound daily rate of 20%, as it did on average during the three weeks to March 14, it would be irresponsible to bet that that rate would not persist. That is why the lockdowns were introduced.

Finally, some commenters have pointed out that even if the daily compound case growth rate is falling, the actual growth in cases may well be stable, or even rising. Yes, of course. That is self-evident. But the purpose of control measures was to prevent the rampant, exponential growth in confirmed cases, and eventually in deaths, that could have overwhelmed the capacity of the hospitals to provide intensive care.

Already, the British National Health Service has had to lay off a quarter of its staff because they or those close to them show signs of infection and there is not enough testing capacity to check whether they are free of infection (it is believed that five-sixths of those off work are not infectious). Huge emergency hospitals have had to be built to cater for the expected number of cases, and similar steps have had to be taken in New York, for instance.

At the Porton Down facility in England, detailed serological research on thousands of blood samples from randomly-chosen members of the public is now being conducted, and will be ramped up in coming weeks, to reveal the extent of the population immunity.

As always, keep safe. And please understand that lockdowns have not been introduced as a way of extending the police state. They are a temporary measure, and the results of the benchmark test are beginning to suggest that the lockdowns can begin to be carefully dismantled a great deal sooner than HM Government had at first feared.