The Precarious Influence of Influenza

31 May 2020

by Guy de la Bédoyère

Peter Openshaw, Professor of Experimental Medicine at Imperial College, popped up on Andrew Marr this morning. His comments included the revealing opinion that “health is the ultimate decider… the ultimate priority”. Presumably what he meant is that it outweighs all other considerations and should come first at the expense of everything else. “We do need to proceed with great, great care at this point.”

That sort of bias is quite understandable in a profession, but it’s also precisely why easing the lockdown has to be a political decision. We have all seen to our cost that prioritizing the response to COVID-19 at any price has been at the expense of general healthcare, as well as our economy and social wellbeing. The time has come, perhaps, for some scientists to hold their counsel, rather than carping at the government for going ahead with easing measures.

However, Openshaw went on to make some more revealing and interesting observations that show how so many assumptions made about COVID-19 and the recommendation for a lockdown, including the latter’s specific provisions, were based on the false premise that infection rates and related factors would be similar to influenza.

Asked about infectivity outdoors, Openshaw said:

There have been some quite big surveys done now of where infectivity happens. There’s been mapping of hundreds of outbreaks, over 320 outbreaks were traced in one particular paper which came out from China, and they looked for where those transmissions were happening and they could only find a single example where transmission appeared to have occurred in the wide open air. It was mostly domestic transmission within enclosed environments. And some transmission on transport. But essentially if you’re sitting in the open air at a safe distance and not speaking close-up to somebody and particularly not shouting or singing loudly then that seems to be very low risk.

Sounds suspiciously like a tacit admission that locking people up in their homes might have been a cast-iron route to increasing infection rates rather than reducing them.

Marr next asked Openshaw about the infectivity risk of touching parcels and surfaces. Openshaw conceded that while the genome of the virus can be detected on a parcel or a surface, that was completely different from whether an infectious virus was present. “There is great confusion,” he said, explaining that detecting the virus’s RNA is not the same thing as detecting a shedded infectious virus, which is very difficult, and that “great confusion” had been caused by “equating” the two. “We know a lot of what is detected is not infectious.”

It’s very hard to measure the infectious virus. I think we need in part to be guided by known transmission events and what we’re actually observing with COVID, particularly, rather than inferring what transmission might occur by our knowledge of influenza.

In other words, terrorising the public with the idea the virus is lurking on every surface is a gross exaggeration.

Marr asked him about the dangers of reopening schools. Could it push the Ro number up?

“We know that children are basically exempt from severe disease,” said Openshaw, apart from an “extremely rare” inflammatory condition. He went on to point out a critical difference between COVID-19 and influenza:

We don’t know that [children] amplify the disease in the same way that they do with influenza. We knew that school transmission was a major driver of epidemics of influenza, and that’s why school closures were so important in 2009 in the early stages. That really seemed to have a big effect. There’s much less evidence that that’s going to have a big effect here. And I think until we’ve got really well-documented amplification of outbreaks in schools, my personal feeling is that it is cautious school openings might be justified.

I don’t know about you, but that reads suspiciously like a face-saving homage to previous advice while simultaneously implying that there never was a good reason to close schools in the first place. Indeed, one might ask why the entire nation isn’t locked down annually to protect the vulnerable from the seething influenza death-pits schools apparently are?

Once more we are confronted with the bizarre world of COVID-19, where parents won’t send their children to school in case they are subjected to a negligible risk but have happily sent their offspring in to catch influenza annually, amplify it and bring it home to wipe out their grandparents and any other vulnerable person they encounter.

Marr asked about the two million shielded vulnerable people who have been confined to barracks for months now. Openshaw’s reply included:

At the moment, the order to shield has been based on a presumption of sensitivity to coronavirus. But there are some huge studies coming out now and I think with this new information it may seem that many people whom we thought might have been vulnerable in fact are not vulnerable, in particular, say, people who have recovered from cancer five years previously who may think they are susceptible but in fact it looks quite clear people who have recovered and are now well and are not on any anti-cancer drugs are actually relatively safe. And the same for asthma, which we knew to be a major risk factor for influenza but now seems not to be a risk factor unless you’re on oral steroids… we’re going to be able to fine tune the advice now and assure some people who we feared might be susceptible that they’re not as vulnerable as we thought.

In short, just because influenza is dangerous to some people, the assumption was made that COVID-19 would have a similar or even identical effect for want of any other advice or guidance.

It’s easy to carp with the benefit of hindsight, but one theme came across painfully clearly from Professor Openshaw’s comments. Some of the scientists who exerted so much influence over the government were operating like car mechanics who had no workshop manual for the model they’re trying to fix and instead just used the nearest one to hand, regardless of its relevance: in this case, the Influenza Workshop Manual, which looks as if it may have been the chocolate teapot of ways to deal with COVID-19.

Science has made for phenomenal improvements in all our lives, but in cases like this the other side of the coin is revealed. If scientists don’t have an answer to hand it would be a great deal better for everyone if some of them hadn’t just plucked something off the shelf to save face to make it look as if they know what they were talking about, rather than admit to ignorance. It’s not unique to science. Historians love to pluck what they think are parallels from the past and present them sagely (pun intended) as evidence for what will happen now or in the future. It’s a fatal flaw in human nature and predicated on our desperate desire to know and control the future.

Openshaw’s candid comments showed that it is only now, as COVID-19 begins its slow drift into the past, that we can begin to understand the reality and truth – rather than fixating on false assumptions, guesses and ill-considered analogies. What he said may turn out to be one of the first chapters in facing up to the galling prospect that – far from helping us fight COVID-19 – some scientists may have made things dramatically worse than they ever need have been. Perhaps some of that humility would have become them in the earlier stages of this monumental fiasco.

But that’s no surprise to readers of this website.

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