Experts are weighing in on Matt Hancock’s proposal of “immunity passports ” in the UK. They say antibody tests will NOT prove you are immune to the disease. We don't know enough about this disease yet to say. From our experience with other diseases, it is possible that those with antibodies can be infected a second time (with the same strain of virus), and die of the disease.
Such certificates would give a false sense of security, especially for the general public who might think they are totally safe from reinfection when they are not (or at least, not known yet to be safe). They could also encourage risky behaviour such as people deliberately trying to get COVID-19 in order to pass the test and get back to work - a significant fraction of those people deliberately trying to get COVID19 would depend on ventilators to stay alive, for weeks, and some would die.
Before I go any further, just a reminder, you can protect yourself from this disease. It seems to be transmitted only via larger droplets that come out of your mouth when you cough, sneeze or talk and these fall out of the air in seconds. It is not airborne on smaller droplets in the way flu is [except for certain medical procedures].
You can protect yourself from this disease, if you wash your hands thoroughly, keep a distance from people who cough, sneeze or talk, and get out of the habit of touching your eyes, nose or mouth (except with thoroughly washed hands). If you do that you might still get the flu, and some colds but are protected from COVID-19.
This is another article I'm writing to support people we help in the Facebook Doomsday Debunked group, that find us because they get scared, sometimes to the point of feeling suicidal about it, by such stories.
Please share this to help others who can be helped by it, and especially with scientists, politicians and decision makers in the UK
THE THREE TYPES OF TEST - PCR, ANTIGENS, AND ANTIBODIES
The three types of test are antibody, antigen and PCR.
The PCR test tests for the RNA of the virus. To test for it, they copy this to DNA and then do lab testing. This needs to be done in a lab though there are machines that automate the testing and make it faster to do. This detects the virus directly and is the main one done at present.
(PCR stands for Polymerase chain reaction which is way of rapidly making lots of copies of a small amount of DNA to make it easy to study)
Antigen tests, when ready, test for proteins on the surface of the virus. They are faster than the PCR tests using antibodies that bind to the virus to detect it. They can be done as point of care tests similar to pregnancy tests and detect the virus itself, again.
The antibody test, which already exists, tests for the body's reaction to the virus. IgM is the body's first response, within 5-10 days of infection, peaking at 21 days after. IgG can be found 10-14 days after infection and this is a rapid response, will respond within 24-48 hours of a reinfection and hopefully prevent it.
If you find high levels of both IgM and IgG, then the patient is likely to be within the first month of infection and the patient is probably (but not yet known definitely) protected from reinfection at least for now.
For more details see
The antibody tests have been developed and are already being used to survey populations to see how many have it - and results should be back within a few weeks from studies in China.
The antibody tests are the ones that Matt Hancock has controversially proposed be used as proof that you are safe from the virus. That is taking them way beyond what they were intended for. The main reason for developing these tests is to do studies to find out where the virus is in society and understand better how it is spreading and what we can do to stop it.
ANTIBODIES DO SHOW YOU WERE EXPOSED TO COVID-19 - BUT WE DO NOT KNOW IF THEY PROTECT YOU FROM REINFECTION
The presence of antibodies shows that you were exposed to COVID-19 in the past but they don’t mean that you are immune to reinfection.
We need to know a lot more about the disease to say whether or not antibodies protect you successfully from reinfection by the virus that causes COVID-19, and to what degree.
You even get some diseases where antibodies can make a second infection worse. Dengue is an example. The first infection is usually mild. A second infection, of Dengue can sometimes be fatal. The antibodies in this case actually make the disease worse the second time around.
The NHS explain it like this:
In rare cases dengue can be very serious and potentially life threatening. This is known as severe dengue or dengue haemorrhagic fever.
People who've had dengue before are thought to be most at risk of severe dengue if they become infected again. It's very rare for travellers to get it.
High levels of antibodies protect against Dengue disease but low levels can make it more dangerous.
The belief is that low levels of antibodies cannot neutralize or kill the invading viruses. But they do bind to them and effectively usher them into susceptible cells, where the viruses then replicate.
Many experts have spoken up saying that antibodies for the virus that causes Covid-19 do not necessarily prevent reinfection. Indeed it’s not impossible that the second infection is worse by analogy with Dengue fever.
There is no reason yet to suppose the virus that causes COVID-19 is like the virus that causes Dengue; that the antibodies to it can make it worse.
However the virus that causes SARS also has had a similar effect, so there is reason to be cautious about COVID-19, which is closely related to SARS. It is also a pitfall for vaccine development that we need to watch out for when we develop vaccines for COVDI-19. This quote discusses some examples where animals and people who were given test vaccines against various diseases, actually developed a more severe disease, when they were exposed to the virus the test vaccine was supposed to protect against. There are various ways this can happen. There is a scientific debate underway about whether any of these apply to the virus that causes COVID-19, and if they do, how they might affect the success of vaccine candidates.
Since the 1960s, tests of vaccine candidates for diseases such as dengue, respiratory syncytial virus (RSV), and severe acute respiratory syndrome (SARS) have shown a paradoxical phenomenon: Some animals or people who received the vaccine and were later exposed to the virus developed more severe disease than those who had not been vaccinated (1). The vaccine-primed immune system, in certain cases, seemed to launch a shoddy response to the natural infection. “That is something we want to avoid,” says Kanta Subbarao, director of the World Health Organization Collaborating Centre for Reference and Research on Influenza in Melbourne, Australia.
This immune backfiring, or so-called immune enhancement, may manifest in different ways such as antibody-dependent enhancement (ADE), a process in which a virus leverages antibodies to aid infection; or cell-based enhancement, a category that includes allergic inflammation caused by Th2 immunopathology. In some cases, the enhancement processes might overlap. Scientific debate is underway as to which, if any, of these phenomena—for which exact mechanisms remain unclear—could be at play with the novel coronavirus and just how they might affect the success of vaccine candidates.
COVID-19 is a new disease and much is not known. It is not yet certain that the antibodies do protect you, or for how long, and it is not yet ruled out that in some situations antibodies could make a second infection more deadly.
This is one of many things that needs to be established with more research. Antibodies for coronaviruses often don’t confer lifelong immunity. We might need repeated vaccination and we might need to be careful in the design of the vaccine to make sure it doesn’t trigger the production of antibodies that are actually harmful.
The SARS vaccine development needed this level of care. One early candidate vaccine for SARS stimulated the immune system of vaccinated animals to attack their own lung tissue. They were able to solve this by triggering an immune reaction instead to a small fraction of the virus, one spike, instead of the whole thing:
When SARS, also a coronavirus, appeared in China and spread globally nearly two decades ago, Hotez was among researchers who began investigating a potential vaccine. In early tests of his candidate, he witnessed how immune cells of vaccinated animals attacked lung tissue, in much the same way that the RSV vaccine had resulted in immune cells attacking kids’ lungs. “I thought, ‘Oh crap,’” he recalls, noting his initial fear that a safe vaccine may again not be possible.
But his team revised their approach. Instead of producing the whole spike protein of the virus, they built just a tiny piece of it—the piece that attaches to human cells, called the receptor-binding domain. Subsequent animal tests showed that this strategy did provide the desired protection without the unwanted immune enhancement. With funding from the NIH, Hotez’s team continued on to manufacture the vaccine and were ready for clinical trials.
DOWNSIDES OF THE HERD IMMUNITY IDEA
The whole "herd immunity" idea has been criticized by experts from the beginning for this reason, that it is not yet proven that the antibodies to the virus that causes COVID-19 confer immunity. It might just go through the population again, with each person infected multiple times. It doesn't have to mutate to a new strain of the virus to do this.
"Herd immunity" has also been criticized from the beginning for its ethics. Large numbers die if we got enough people infected for “herd immunity". Those people won't die if it can be suppressed, and we owe it to them to try to suppress it.
Another downside to this idea of letting the virus go through our population until we develop "Herd immunity" is that it makes the UK a source of seeds of infection for the whole world.
Other countries are following a different policy of suppressing the virus wherever it occurs. We can be more effective if we have a global co-ordinated strategy and act in solidarity so that all countries try to suppress the virus.
Instead, what is happening right now is that most countries try to suppress it while the UK, Netherlands and Sweden let it run through their population and only try to delay it.
YOUNG PEOPLE SHOULD NOT DELIBERATELY TRY TO GET COVID-19 - THIS IS A SIGNIFICANT RISK FOR YOURSELF AND FOR OTHERS
The idea of COVID-19 parties to deliberately get COVID-19 to get back to work is especially concerning.
For instance, even if only 1 in 1000 young people under 40 die this still means that that one person in a thousand dies that didn't need to die, because we can stop this disease. The actual numbers that die under 40 is not yet that well known but various figures make it around 1 or 2 in 1000.
- Deaths in Italy from Covid19 - similar to China - higher case fatality rate is due to more elderly patients affected
Meanwhile a few percent even of young people need hospitalization with a disease far more serious than flu usually is for young people (at least 14% for early figures in the US).
A fair number of youngsters need to spend weeks unconscious in a ventilator and most eventually recover. Full recovery of the lungs after weeks under a ventilator likely takes months. A few of those sadly die (at least 2%, or 20 in 1000 need intensive care and at least 1 in 1000 die, from those early CDC figures). When you first get out of the ventilator you still need oxygen, you are released when you can breathe without oxygen but you continue to be breathless easily doing normal activity and very slowly recover.
This is a serious disease. You are talking here about 1000 young people dying in every million. You are talking about 20,000 young people in ventilators in every million! And recovering for months afterwards before they regain full lung capacity. It is not yet known if the lungs fully recover though most people think they do.
Young people getting it endanger their more elderly contacts too. Around 10 in 100 of those over 80 die of this disease. That is 100,000 old people in every million dying.
As one anonymous doctor put it on NewsWeek:
"You're fine, you're barely even sneezing or coughing, but you're walking around and you kill a couple of old ladies without even knowing it. Is that fair? You tell me."
Since COVID-19 is not airborne, then you would likely infect people you know or at least had close or prolonged contact with. They then infect someone else and someone else - and in that way you can kill those two old ladies without knowing it or even knowing them.
A SNEAKY DISEASE
[Just saying the same as the previous section but in a different way, as word painting rather than numbers]
The deceptive thing about this virus is that unlike flu you don't know how bad you have it until the second week usually. Everyone starts off mild. 20% though get a turn for the worse in the second week and hve to go to hospital. 5% end up in intensive care - that's 1 in 20. It's 2% or 1 in 50 that need ventilators of the young folk below 40 - much fewer below 20 but even in that age range some end up on ventilators.
That involves being kept unconscious for weeks with a machine that keeps you alive - if interrupted for even a few minutes you die. Round the world thousands of young people are in that situation, depending on a machine to keep them breathing and alive.
After you recover, if you do, then you likely need several months to restore complete function of your lung capacity - will be a bit breathless if doing strenuous exercise for a fair while.
Once the outbreak is well under way - about 3 weeks in from when the first large numbers of mild cases happen, then you start to have friends of friends who have been through all this and then you will not want to have it but it may be too late by then. So you need to be careful not to get it early on.
And then they will also hear about friends parents and grandparents. Amongst elderly people over 80, then 10% would die of those infected, so once this is well underway many people would know someone who had a grandparent who died of it.
"NOT TAKING THE DEATHS OF THE ELDERLY OR SENIOR CITIZENS AS A SERIOUS ISSUE IS ONE OF THE MORAL DECAYS"
I did a rough calculation of how many doctors we will die if we achieve 50% infection. It's about 1000. That is not including retired ones coming back into service but just based on the population distribution of those already in service as doctors. I make it perhaps 750 nurses would die if we reached 50% infection rates (total numbers are similar but the nurses tend to retire younger so there aren't so many elderly ones). This calculation is approximate, but it is enough to give a ballpark idea.
In one recent article one of these theorists said that though 10% of those over 80 would die - 10% at that age die anyway of all causes during the year. I think some of these theorists need training in basic ethics and moral philosophy. I will redact the professor's name in this quote from the BBC article, as I don't want to single anyone out particularly. But we have had many theorists saying things like this recently. It troubles me a lot.
Every year, about 600,000 people in the UK die. And the frail and elderly are most at risk, just as they are if they have coronavirus.
Nearly 10% of people aged over 80 will die in the next year, Prof [..], at the University of Cambridge, points out, and the risk of them dying if infected with coronavirus is almost exactly the same.
This is not the same. It is deeply unethical. These people matter. They could have lived for a decade or more, and who knows what plans they had, what things they could have accomplished, what people they could have helped if not cut short like this!
Looking at it another way, if you take that 10% chance of dying that year, they have a nearly 50% chance of living to age 87. If they are healthy they have a 75% chance of reaching 87 and a life expectancy of 94 (the older you get the higher your life expectancy because you have survived the things that could have killed you earlier) and they might, for all you know, have lived to over 100. For more about this see my
It is not okay to let someone to die of a disease because they could die of something else instead (but many wouldn't). Doctors do all they can to save lives and they don't reason like this that since the patient is 80 they have a ten percent chance of dying that year anyway.
Dr Tedros put it like this:
No, I think this particular issue, especially about our senior citizens or the elderly is very, very important. If anything is going to hurt the world, it’s a moral decay. And not taking the death of the elderly or the senior citizens as a serious issue is one of the moral decays. And Mike has said it. Any individual, whatever age, any human being, matters. And it pains us to see, actually, in some places, when they want to move into mitigation, because the virus kills seniors or older people only.
That’s dangerous. Whether it kills a young person or an old person or a senior citizen, any country has an obligation to save that person. So that’s why we’re saying no white flag. We don’t give up. We fight. To protect our children, to protect our senior citizens. At the end of the day, it’s a human life. We cannot, I have said this many times by the way, we cannot say we care about millions when we don’t care about an individual person who may be senior or junior. Who may be young or old.
So that’s what WHO is saying. And for all countries, a comprehensive approach, a blended approach, an approach that can help contain this outbreak, is very important, because the death rate from this outbreak is high. We shouldn’t categorise it by young or senior. Of course, to understand the epidemiology it’s fine to do that. But for action I think every life matters. Every individual life matters. If we don’t care about one individual, whether it’s old or young, then we’re not serious. And that’s why we’re saying this is a moral decay, if we try to categorise it that way. A moral decay of the society.
If anything is going to hurt the world, it’s a moral decay. And not taking the death of the elderly or the senior citizens as a serious issue is one of the moral decays."
South Korea, China, and Singapore have all shown it can be suppressed right down and stopped.
YOU DON'T NEED HERD IMMUNITY TO EBOLA - AND THIS IS A MOST UNUSUAL RESPIRATORY DISEASE THAT CAN BE CONTAINED IN THE SAME WAY
We can stop this. The lock down according to the WHO should be part of a combined strategy where we hunt for the virus ,test everyone with symptoms, isolate them all from their households if confirmed, trace all contacts and quarantine them. The numbers of new cases per day then go down rapidly, about 90% in a fortnight in the case of both South Korea, and also China with Wuhan.
Text: South Korea reduced cases per day ten-fold in a fortnight
We can too
Many of its remaining cases are imported from other countries.
It was similar for China
Text: China reduced cases per day 10 fold in a fortnight
We can too
You see the effect of measures up to a fortnight or so later because of the time taken from infection to symptoms then to diagnosis.
Once we get down to a smaller number of cases, we then just need to isolate those, not the whole of society and the lock down can end soon, perhaps as soon as in the next 4 weeks or so (we would notice the effects after 2 weeks, and after 4 weeks we would have significant reductions)
Everyone knows we don’t need to develop herd immunity to Ebola.
However, people are not used to the idea that a respiratory disease can be contained and stopped like Ebola. Experts used to think that this was impossible. But China, Singapore, South Korea and other countries now like Spain and Italy are showing that this one can be contained and stopped.
YOU DON'T NEED TO FIND EVERYONE
Suppose each new person on average infects 2 more for simplicity.
Then 100 cases infect 200 then 400, 800 and now you have a total of 1500 cases already. It doesn't take much longer to reach tens of thousands. If you have a doubling time every 3 days then it's a ten-fold increase roughly every ten days.
If you can break three quarters of those chains of transmission with contact tracing and isolation the outcome is very different.
This time, 100 cases infect 50 (3/4 of 200) which then in fact 25 (3/4 of the 100 cases 50 would infect) which infect 13, 6, 3, 2, 1 and then it is over.
It will be over at around 200 cases. You now have a reduction time of a ten-fold DECREASE in cases per day every ten days.
The UK had 4,450 new cases on the 3rd April. Those are mainly hospitalized cases, so it's likely to be around 22,000 new cases if you include the mild cases (typically there are four mild cases to every one in hospital).
Those are the ones diagnosed on the 3rd April. We are looking back in time here and many of them were infected up to a fortnight ago or more. The number infected today is likely far higher, but we won't diagnose most of those for a week to a fortnight or more.
The UK cases per day have been increasing about ten fold every fortnight. Our increase seems to have slowed down for a few days -but it is hard to be sure as they are mainly testing hospitalized cases (for instance, are fewer cases being admitted as the numbers increase?).
If the cases are continuing to increase ten fold per fortnight (say), and guessing at a delay from infection to diagnosis of 2 weeks, there could be getting on for 200,000 new cases that were infected today. Hopefully it is nothing like that, and the lockdown has indeed reduced those numbers significantly.
Just for purposes of illustration to show how this works (as there is no way to know the true figures), suppose that we had 50,000 new cases infected today.
At that number, if we started the case finding, tracing, isolation and quarantine today and achieve a ten fold reduction per fortnight, then two weeks from now we are down to 5,000 a day, four weeks from now down to 500, six weeks from now down to 50 and then another month and it is over, the only remaining cases are in hospital and isolation and there are no new cases.
Because of the delay between infection and diagnosis we don't see what is happening right away. We'd see the cases per day continue to rise to that number of 50,000 a day a fortnight from now (already locked in as people infected but not showing symptoms) but then decrease to 5,000, 500, 50, 5, none after that.
By the time it is back to a few hundred new cases per day we can likely remove the lockdown.
Once the case numbers are lower and are nearly all identified and isolated and the contacts traced, we can think about ending the lockdown. If the general public is doing hygiene properly to protect themselves, and they are also self reporting to fever clinics then you can turn your focus back to isolating only the ones that are sick with the virus and their contacts.
In practice, isolation, contact tracing and quarantine seems to be able to stop more than 75% of cases. In Singapore nearly all the cases they still have are contacts and they do testing of anyone who seeks medical help for fever or pneumonia symptoms so can’t be missing much (except asymptomatic non spreaders). So, do this thoroughly and you can perhaps reduce the numbers faster than that.
Also there is one way to do this very fast. That is to test everyone, symptomatic or asymptomatic. One Italian town of 3300 people went from 3% infected to 0.3% infected and no new cases in 2 weeks. This is not a ten-fold reduction in new cases per day. It’s a ten fold reduction in the total number of cases still with the disease.
- Good News From Italy: COVID 19 Outbreak Halted In Italian Town Of Vo Euganeo At Record Speed - 90 To 0 New Cases In Two Weeks
This is one small town, only 3,300, but it is promising for small countries too, that have the capability to test all their inhabitants . Some countries might now try the same method and see if it works for them. Iceland is rolling out testing now for everyone who wants it, symptomatic or asymptomatic. See my:
- Spain, Italy, Germany And Iceland On Course To Contain Their Outbreaks Of COVID-19 - With A Change Of Direction UK Can Too
That method is especially useful for hospitals, care homes, dentists or clinics - to clear out an infection by regularly tested all patients and staff, symptomatic or asymptomatic, and isolating anyone with covid-19 until they are all free of it. They did this with a hospital first before using the same idea for Vo Euganeo.
- Good news from Italy: COVID 19 outbreak halted in Italian town of Vo Euganeo at record speed - 90 cases to no new cases in two weeks
I personally think that the UK situation is of such urgency that we should adopt the same method for the UK. I think that one way or another, we should find a way to step up all the way to millions of tests a day. Then using those tests, clear the hospitals, clinics, doctors, social workers, and care homes first. Find and tackle the worst outbreaks first (from experiences of other countries that do testing in hospitals we must have several major outbreaks in hospitals, clinics or care homes by now but we just don't know about them). We need all 1.2 milion NHS workers to be free of this virus.
Then test everyone with mild symptoms in the general community and then as the tests ramp up, test everyone, symptomatic or asymptomatic. That would be the fastest way to ramp down with our cases and contain them also from the rest of our population and from the world.
We can construct a "Nightingale" field hospital in a fortnight, and plan to scale it up to 4,000 beds. How many tests could we do if we use our ingenuity to the utmost, and put the same level of funding into the tests, finding the cases and contact tracing?
The British pride themselves on their inventiveness, resourcefulness and ability to snatch victory from the jaws of defeat. This is a chance to show what we can do! With those numbers of tests we could reduce the numbers even faster than South Korea or China and save many thousands of lives not just in the UK but in the world. I cover this in my
We have to do this. Even if we have a million people already with COVID-19 in the UK, we still need to act as fast as possible to protect the remaining 65 million who are not infected, and also to contain those million potential seeds of infection and separate them to the rest of the world until they get over their disease and are no longer infectious.
See also my
- Yes Your Country Can Stop COVID-19 - Singapore Shows How
- COVID-19 Can Be Stopped - And Any Second Wave Can Be Stopped Too - No Need To 'flatten The Peak'
MANY DIFFERENCES BETWEEN THE SIMULATED FLU THAT GUIDES UK POLICY AND THE REAL COVID-19
From what I can tell they base their model on data for flu, not for COVID-19. All they take from the data from COVID-19 is an estimate of the incubation period.
I summarize the main differences in this graphic:
The UK's quarantine period is also far too short. The WHO say it should be until 14 days after symptoms cease, or through to death for those who don't recover.
The UK say it is only 7 days from symptoms onset. See my
This simulated flu is being used to guide UK policy with almost no input from the real data from COVID-19. See my:
- COVID-19 Does Not Transmit Like Simulated Flu- UK's Policy Fact Checked Against WHO Recommendations And Scientific Evidence
YOU CAN PROTECT YOURSELF
Meanwhile you can do a lot to protect yourself with simple effective measures. If you are in the UK and aren’t doing these yet, I recommend starting on them right away. Our government hasn't explained this clearly enough - at least most that I talk to via private messaging in the UK who contact me scared of COVID-19 do not fully understand the importance of this when they first contact me. They think that they are bound to get COVID-19 eventually and all they can do with physical distancing is to help delay the infection to a time when the health service is under less pressure.
This is NOT TRUE. This virus is transmitted via large droplets that people expell when they cough, sneeze or talk. They fall to the ground in seconds. You can only be infected if these droplets land in your eyes, nose or mouth, or if you touch a surface they fell on and then touch your eyes nose or mouth. It is not a contact virus and can only get into your body that way.
Follow the advice on distancing and washing your hands thoroughly before touching your eyes, nose and mouth, and this virus can’t get into your body.
It is a bit like people not bothering to wear seat belts in cars before "Clunk click Every Trip".
Do you do these four things?
- Wash hands thoroughly
- Stay 1-2 meters from anyone coughing.
- Wash your hands before you touch your eyes, nose or mouth [try to get out of the habit of touching your face in the day]
- Cough or sneeze into your elbow OR cough or sneeze into a tissue and put it into a bin immediately. [this is to protect others]
Do this as thoroughly as the experts, and you can say:
"I don't have COVID-19 - I am very low risk".
Dr Bruce Aylward said that immediately after he returned from Wuhan. He knew he was safe because he did those things.
The WHO stress that these simple measures save lives. They are not hard to do if you make them into a habit. More details here:
- How To Protect Yourself From COVID-19 - And Help Stop The Spread - If Everyone Did This The Epidemic Would Soon Stop
We all need to carefully follow the instructions to protect ourselves and your loved ones and tell everyone else about what they need to do to stay safe. These instructions work. You also help others too, every time you do this you are also helping to break the transmission chain to others.
- COVID-19 Does Not Transmit Like Simulated Flu- UK's Policy Fact Checked Against WHO Recommendations And Scientific Evidence
And reminder again, I don’t think I can say this too much:
SHORT SUMMARY FOR SHARING
This is in criticism of our UK government which is proposing "antibody certificates" that would show you have had COVID-19 and so can go back to work and interact with others normally.
This is not true because having antibodies does not mean you are safe from infection at current knowledge of the virus. At our current state of knowledge, it is even possible that those who have had COVID-19 are more at risk from a second infection than those who don't have it.
It could encourage risky behaviour such as deliberately trying to get COVID-19, risking your life to get back to work.
If you are in the UK - please DON'T try to get COVID-19 - you are endangering yourself and others if you do this.
I also explain the differences in the types of tests and talk about how young people are not immune.