The British Reversal on Virus Strategy

The British Reversal on Virus Strategy, by Scott Alexander.

A UK critical care doctor on Reddit wrote a great explanation of their recent about-face on coronavirus strategy.

They say that over the past few years, Britain developed a cutting-edge new strategy for dealing with pandemics by building herd immunity. It was actually really novel and exciting and they were anxious to try it out. When the coronavirus came along, the government plugged its spread rate, death rate, etc into the strategy and got the plan Johnson originally announced. This is why he kept talking about how evidence-based it was and how top scientists said this was the best way to do things.

But other pandemics don’t require ventilators nearly as often as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages. Once someone added that in, the herd immunity strategy went from clever idea to total disaster, and the UK had to perform a disastrous about-face. Technocratic hubris vs. complexity of the real world. …


Britain has 5,000, or one per 12,000 citizens. The US has 160,000, or about 1 per 2,000 citizens …

Elon Musk recently delivered 1,255 ventilators to California from some of Tesla’s Chinese contacts, and promised to make more. Dyson, the British vacuum manufacturer, says it will be able to make 10,000 ventilators in time to help with the crisis …

Ventilators also require trained staff to operate. I never know how far to trust medical people when they say something requires training. You would think doing a lumbar puncture requires training, but the training I received for this in residency was watching one (1) guy do it one (1) time, and then them saying “Now you do it” — which by the way is exactly as scary as you would expect. This is an official thing in medical education, called see one, do one, teach one. So when people say some medical task requires training, I don’t know if they mean “ten years’ experience and a licensing exam”, “watch it once and then we throw you in the deep end” or “we’re going to make you go through the former, but the latter would have worked too”. Hopefully ventilators are more like the latter and someone can train new people really quickly.

Hospitals and ventilators are the big threshold. If the spread can be kept low enough that hospitals are not overwhelmed, and other patients can still use them, then we can wear a bit of the virus. But once the hospitals are overwhelmed, it rapidly goes pear-shaped.