COVID-19: TIER 4 versus FIREBREAK

Over the last few weeks I have suggested that the Government should get on top of the virus to drive down infection rates to #NearZero.  Leveraging the reproductive lifecycle of the virus, by a tough three-week Firebreak.  

That would allow the economy to thereafter be more open, schools not to be so commonly disrupted, and deaths and LongCOVID to be minimised.  We knew that when temperatures dropped as autumn changed into winter, that would favour transmission of the virus.  Then infection rates could be far better controlled.   Health producing wealth.

All the more important now a new variant is spreading rapidly.

I wasn't the only one.  The IndependentSAGE group have been even more ambitious in promoting the idea of ZeroCOVID, for the same reason. Here is Sir David King back in July, explaining the idea.

The Government ignored that advice.  

Sir David was back on the BBC this morning recommending an immediate lockdown, with schools closed.  Today the Government avoided going that far.  Instead putting over 78% of people in England into tier 4, and only delaying some schools going back.

Alternatively a Firebreak could be minimised to three weeks by making it as tough as possible, whilst recognising the community transmission that involves schools. Here is a comparison of the tough FireBreak proposal with what the Government has implemented today as tier 4:

An opportunity missed today.  Too little, too late, again.  Inevitably prolonging the agony of tier 4 restrictions.

 

COVID-19: WHAT SHOULD WE DO NEXT IN ENGLAND? GREAT BARRINGTON OR WHAT?

With hospitals and ambulance services under immense pressure from this new variant, what is the answer:

• Can we actually hold the disease's spread?  Are we being forced to follow the Barrington Declaration of protecting those most at risk and letting it rip in the rest of society?
• Or should we stamp down hard with a very tough Firebreak immediately?

Updated 30/12/20: There's great news that the Pfizer/BioNTech vaccine has started to be provided to priority groups, and that the Oxford/AstraZeneca vaccine has now been approved.  I'm certainly keen to have my jab when the time comes.  With a massive vaccine roll-out expected in early 2021, when can any restrictions be relaxed?  What proportion of the public need to be immunised?

 

These questions are all linked.  Let me explain.

 

THE NEW VARIANT

The new variant of the virus is becoming dominant, showing it is far more transmissable.  For example:

People with the new variant have effectively become more infectious, notably before they display symptoms and know they have the disease.  Why it's important for everyone to wear a mask, to stop as many droplets bearing viruses getting into the air - "My mask protects you, yours protects me".  Just like they have done effectively for years in South East Asia, where everyone does it.  As well as more care on the other basic precautions, Hands and Space.

There are several mutation in the new virus variant's RNA.  The most significant produces a change on the section of the 'spike protein' of the virus, which seems to make it bind more effectively to a target cell, and thereby infect it more easily.  

This can be any cell, whether in the respiratory passages or, once in the bloodstream, any other organ with an ACE2 receptor.   It is infections of organs such as the heart, liver and brain that produce the worse types of LongCOVID, affecting people for over two months and much longer.

CAN WE PROTECT THE MOST VULNERABLE?

In the early stages of the pandemic, measures to protect the vulnerable such as those in care homes were limited, to say the least.  Matters have improved, but that still hasn't prevented hospitalisations and deaths.  There are several reasons:

• Elderly people, who are most at risk, often live in multi-generational households
• Other vulnerable people live with their families
• Those needing care are looked after by younger, fitter people

It is therefore not possible to fully shield the older and otherwise vulnerable.  If the illness is rife in the general population, the chances of vulnerable people being infected is high.

That will result in large numbers of hospitalisations.  Once hospitals are overrun, treatment will not be available for new patients with COVID-19 nor for any other reason.  Of whatever age.  It is in everyone's interest to avoid this happening.

No wonder then that protecting the NHS being overrun has been the Government's number one objective.  The basic principle of the Barrington Declaration of protecting the vulnerable is unachievable and untenable.  The unavoidable conclusion is that we must do all we can to suppress the virus.

 

THE SHADOW OF LONGCOVID

What about the survivors?  There is also the matter of LongCOVID. Studies are showing it can affect 5-10% or more of those surviving the disease, often when not hospitalised, across all age groups including children:

• Long-term lethargy that can happen after any major infection, but is no less debilitating
• Once the virus gets into the blood:
• Micro-clotting of the blood, that can cause strokes and can cause painful damage in other parts of the body
• With the variant binding more easily to ACE2 receptors in cells, it is likely it will be more powerful in attacking any cells with the ACE2 receptor, including in organs such as heart, liver, digestive system and brain
  

The more people get the new variant, the more people will suffer from the various forms of LongCOVID, and the bigger the strain in future on the health service to deal with them. So that too means the number of people catching the disease has to be minimised, of all ages. 

 

In Sweden, where there were limited restrictions, the estimate by Novus of those with LongCOVID over eight weeks by mid September was some 150,000.  15% of those catching COVID-19, compared to 6,000 deaths.  

 

In the UK, the King's College ZOE Symptoms Study has found "...it does occur across all ages. Long COVID affects around 10% of 18-49 year olds who become unwell with COVID-19"!  "...rising to 22% of over 70s."  People "...whose symptoms were not serious enough to land them in hospital yet have persisted for many weeks or months", plus serious long-term issues for people who have been hospitalised.  Overall estimating "around one in seven (14.5%) of people with symptomatic COVID-19 would be ill for at least 4 weeks, one in 20 (5.1%) for 8 weeks and one in 45 (2.2%) for 12 weeks or more. "  

 

The UK's Office for National Statistics estimate "186,000 people in private households in England were living with symptoms that had persisted for between 5 and 12 weeks, with a 95% confidence interval of 153,000 to 221,000." Substantial numbers that will put another enormous strain on the NHS as they consult their GPs and more.  We await their further research and analysis.

 

This means, again, that the level of infections must be minimised.  The Great Barrington approach of letting the disease rip through the so-called 'non-vulnerable population' is totally unsuitable.  Everyone is potentially 'vulnerable'.

WHAT CAN WE DO TO REDUCE RISK OF INFECTION?

Quickly recapping on the basics.  The virus spreads through the air, in water droplets and microdroplets in breath, and to a certain extent via touching and infecting a surface that someone later touches.

Basic precautions have some effect, to protect ourselves and each other:

• As Sir Patrick Vallance said recently "Assume you could be infectious" and that others around you are infectious
  
• Keeping meetings with other people very short, to minimise the amount of virus that can be transferred
  
• Meeting outdoors or in well-ventilated indoor places, so the breeze takes viruses away 
• Wearing a mask to catch as many droplets and microdroplets as possible, in case someone wearing the mask is infectious without knowing it - "My mask protects you, yours protects me"
• Keeping a distance from other people.  Even when masks are worn.  At least 2m but preferably 4m given the risk of clouds of microdroplets (known as 'aerosols') that don't drop quickly to the floor.
  
• Avoiding touching things other people may touch, and washing hands regularly

"Hands Face Space" plus Ventilation and Time.  The less human to human contact the better.

WHAT OTHER ACTION NEEDS TO BE TAKEN?  DO LOCKDOWNS WORK?

But what we have found is that these basic precautions are not enough to stop the spread of the virus, especially the new variant.

We should also remember there is a time delay between someone catching the disease, displaying symptoms, being tested and then being ill enough to need to be admitted to hospital.  We simply can't wait for hospitalisation and death statistics.  Action has to be taken on the earliest available information, however imperfect.  Those early indicators are not looking at all good.

So we have to reduce human to human contact even further.  Some say lockdowns don't work.  But in the absence of a vaccine so far, lockdowns compare favourably to flu with a vaccine.  As if the lockdown restrictions are 'in loco vaccines'. 

We also know from places such as Wales in late October / early November that restrictions reduce transmission, but releasing restrictions increases infections again.  This whilst England's infection graphs were on a consistent upward trend:

We also know that half-hearted restrictions are not effective.  Moving over 40% of England's population to tier 4 has been necessary to try to avoid the new variant spreading.  But the experts are suggesting this is not enough.  Schools and universities should not be allowed to go back in early January:

• At least not secondary schools, according to SAGE
• All schools involve adults, be they teachers, other members of staff, or parents of younger pupils at the school gates
• Even nurseries can be affected.  A friend of mine, his wife and 3 year old are all confirmed with COVID-19, most likely from when the young child was sent home from school where another 3yo was confirmed positive

If we are going to beat this new variant, and keep it suppressed until the vaccines ride to the rescue, restrictions have to be the toughest yet.  Fortunately most of the effect is in the first three weeks with any variant, so schools, universities and workplaces coud go back around 18 January.  As described in more detail here.  Only the absolutely vital care places and workplaces staying open for those three weeks.  Everyone else staying home.

 

 

SO WHEN WILL VACCINES ALLOW US TO GET BACK TO NORMAL?

 

Dr. Anthony Fauci, the most prominent infectious disease expert in the USA, has recently said that 'herd immunity' would need up to 90% of people to be vaccinated.  That is where enough people are immune to reduce infections to an acceptable trickle.  Certainly at least 70%.  That would likely take well into the summer.

 

With influenza vaccination, the principle in the UK has been to vaccinate the most at risk, and let other people catch the disease without too much concern.  That lets life and the economy continue.  After seeing the impact of COVID-19 on lives and livelihoods in 2020, it is tempting to think a 'flu approach' is also applicable to COVID-19

 

Accordingly some people are suggesting restrictions can be relaxed as soon as the vulnerable have been vaccinated, something that could potentially be achieved by around Easter.   That is effectively the Great Barrington approach, using vaccination to protect the vulnerable.

 

But as mentioned above, COVID-19 is far worse than flu, initially and later, as set out here.  In particular the types of debilitating LongCOVID that are not caused by other viruses such as influenza.  So the flu approach to vaccination is not appropriate to when restrictions can be lifted.  A much higher proportion of the population needs to be vaccinated.

IN CONCLUSION

Hospitals are at risk of being overrun, and LongCOVID affecting over 10% of those catching the disease, including the under 50s.  We have no alternative but to try to stamp down hard on the virus.

Whilst we all hate lockdowns, but basic precautions are not proving sufficient to get infection rates right down to let life continue.  A very tough FireBreak, the toughest yet for an initial three weeks, is the best way.  That would involve:

• Only absolutely vital organisations and workplaces remaining open, such as hospitals, care homes, utilities and food
  
• "Stay at home" being the law, minimising any physical contact with other people, such as exercise only with your 'bubble' and minimising the number of supermarket visits.  As close to self-isolation as possible for the three weeks.
  
• All schools and universities being closed until 18 January, except for kids in vital circumstances.  Importantly, so education can then be kept open for the remainder of term.
  

This 'Vital Firebreak' will need to be national to be of full effect.  Preferably the whole of Great Britain, or the whole British Isles including Ireland.

After three weeks, some relaxation should be possible.  But another Firebreak might be expected at Easter.  

By then the level of vaccination should be significant, and our understanding of LongCOVID well advanced.  This will likely mean we will have to be very careful about relaxing restrictions too quickly until a much larger proportion of the population have been vaccinated.  Hopefully by later in the summer.

COVID-19: WITH SO MANY IN TIERS 3 AND 4, WHY NOT A FULL FIREBREAK?

London on the left

Today Matt Hancock announced that more areas would be going up into tier 2, 3 or 4 from Boxing Day.  That means according to the BBC, "taking the total number of people under the toughest restrictions to 24 million, or 43% of the population of England; a further 24.8 million will be in tier three."  A total of nearly 90% of the population.

Nearly the whole country in tiers 3 or 4.

He also indicated that it was worth getting ahead of the virus, by early action.  The questions he was asked included:

• As the new more transmissible variant will likely spread further around the country, why then not get ahead by putting the whole country into tier 4 or full lockdown?  His answer was to be "proportionate".  But isn't this again too little, too late?
  
• What about delaying schools returning in January?  Initially ducking the question, he indicated sticking to the existing phased return, which would be supported by testing
  

 

THE IMPACT OF RESTRICTIONS

It is clear that severe restrictions have major, important and painful side-effects, badly affecting lives and livelihoods  They should only be used as last resort to drive down infection rates:

• To avoid health service being overrun, when patients would be turned away.  That is the Government's overriding objective, it seems
• And preferably to let businesses re-open.  Just as important, but seemingly overlooked
  

Then with any restrictions for as short a time as possible.  

To be short, that means restrictions as tough as possible.  That means closing schools, not just to avoid transmission between schoolchildren.  It's to prevent transmission between the adults involved, that is teachers and other staff and, for younger children, parents at the school gates.  Stopping students travelling across the country to universities too. 

If we are to get ahead of this new variant, that does mean national restrictions.  Not just in England but across the whole of Great Britain, and preferably the whole British Isles including Ireland and Northern Ireland. 

 

THE SURVEY

I had therefore proposed  "We need to stamp down hard on [the new COVID-19 variant] with a short but very tough FireBreak straight after Christmas", as set out in more detail here.  Effectively tier 5.

Over the last two days I have been asking in a Twitter poll whether people agree or otherwise with the proposal.  Given I invited known Lockdown Sceptics and people generally, I am amazed with the result of 3 to 1 in favour of the proposal:

Whilst this is not a proper randomised survey across all demographics, the stark result can perhaps be regarded as 'representative' of people's views.  The result certainly suggests there would be more widespread support for tough measures after Christmas.  More than I had anticipated.

The written comments in support, including from specialist scientists, far outnumbered those against.  The topics were of three types, indicating the FireBreak needs to be toughest:

1. No time to lose.  Do the Firebreak before Christmas.  But realistically people and businesses need at least a little notice, and Boxing Day is the earliest.  
2. Make it tougher, with schools and universities closed.  That is in any case a key aspect of the proposal, to keep them closed until 18 January.  Especially given some new evidence about how this new variant impacts schoolchildren.  Adopting the toughest restrictions possible
   
3. Make it longer.  However:

• The idea is that the theory and past experience is that when restrictions are tough, most of the reduction in cases is in the first three weeks
• We need to get the economy open, so keep the FireBreak as short as possible.  That is three weeks.
  

STOP PRESS:  Just heard of a friend's 3 year old sent home from Nursery because another 3yo has tested positive.  The friend, his wife and their 3yo have all tested positive, and started to display symptoms.  In all likelihood:

• The virus has passed from 3yo to 3yo
• Then from the 3yo to the parents
  

So clearly important to keep schools closed, even for the youngest pupils, if a FireBreak is to work.

 

FINANCIAL SUPPORT

There is one other significant issue, which is financial support for individuals and businesses during the FireBreak.  In particular:

• An estimated 3 million self-employed who have not been eligible for Government support, other than Universal Credit, often referred to as the #Excluded
  
• The other self-employed whose SEISS3 payment is expected to cover January, but were paid nothing for September and October.  This needs to be rectified promptly.
  

 

THE PROPOSAL

So with proper financial support, we need a very intense FireBreak straight after Christmas, with schools, universities and all but vital workplaces not going back until 18 January.  It has to be as tough as possible.  "Stay at Home".

In my view that is the only of getting infection rates down to a level that gets on top of the virus.  That would allow schools and universities to stay open afterwards, plus as much of the economy to re-open as possible through the winter.  Best for lives and livelihoods.

What's your view?

COVID-19: "SOONER, TOUGHER, LONGER". THE POLL RESULT AND COMMENTS

For the last two days I have been asking in a twitter poll whether people agree or otherwise with the proposal "We need to stamp down hard on [the new COVID-19 strain/variant] with a short but very tough FireBreak straight after Christmas", as set out in more detail here.

Given I invited known Lockdown Sceptics and people generally, I am amazed with the result 3 to 1 in favour of the proposal:

Whist this is not a proper randomised survey across all demographics, it can perhaps be regarded as 'representative' of people's views.  The result certainly suggests there would be widespread support for tough measures after Christmas.

The written comments in support, including specialist scientists, far outnumbered those against.  The topics were of three types:

1. No time to lose.  Do the Firebreak before Christmas.  But realistically people and businesses need at least a little notice.  
2. Make it tougher, with schools and universities closed.  That is in any case a key aspect of the proposal, to keep them closed until 18 January.  Especially given the new evidence about how this new strain impacts schoolchildren.  Adopting the toughest restrictions possible
   
3. Make it longer.  However:

• The idea is that the theory and past experience is that when restrictions are tough, most of the reduction in cases is in the first three weeks
• We need to get the economy open, so keep the FireBreak as short as possible.  That is three weeks.
  

There is one other significant issue, which is financial support for individuals and businesses during the FireBreak.  In particular:

• An estimated 3 million self-employed who have not been eligible for Government support, other than Universal Credit, often referred to as the #Excluded
  
• The other self-employed whose SEISS3 payment is expected to cover January, but were paid nothing for September and October.  This needs to be rectified promptly.
  

What's your view?

COVID-19: "ASSUME YOU COULD BE INFECTIOUS"

Sir Patrick Vallance

A key aspect of COVID-19 is that people become infectious before they show symptoms and know they are carrying the disease.  

Sir Patrick Vallance, the UK's Chief Scientific Advisor, made a statement at the Downing Street press conference yesterday that is so important, but has received little media coverage:

"... assumption you could be infectious.  You could be the person spreading it to someone else, and behave accordingly."

Also assume people you meet could be infectious. 

If we all adopt this attitude, interaction that could result in catching the disease would be substantially reduced.

COVID-19: RESPONDING TO THE NEW STRAIN

The new strain of the SARS-COV-2 virus that causes COVID-19 is now well over half the new confirmed infections in the Kent and London area.  That's from a standing start just a few weeks ago.  Clearly it is highly contagious, as confirmed by the NERVTAG "New and Emerging Respiratory Virus Threats Advisory Group".

It helps to explain why cases in Medway, North Kent and elsewhere were rising even during the tighter restrictions in November.

The key mutations are in the protein spikes that the virus uses to attach to cells and enter them.  Whilst indications are that illness is no worse:

• The level of hospitalisations in North Kent indicates it is no better
• It will spread to other cells more easily, so more difficult to fight, and so might be expected to cause problems in a higher proportion of the people exposed to the disease
  
• Once in the bloodstream, it will also attack other organs more easily such as liver and brain. Therefore likely to cause long term pain and debilitation in more people, the more serious forms of LongCOVID.  That would also put increased strain on the health service
• Evidence that it is more likely to affect children.  Indeed leaving schools open in November may be a key aspect of the rampant spread
  

There is therefore no doubt that the new strain puts increased pressure on society.  Even more reason to stamp down hard on it, not let it spread as some would advocate, by getting to #NearZero :

• By the use of vaccines, such as we do for influenza
• Emulating success of countries such as Taiwan and New Zealand

Then it is not a matter of balancing health against wealth, as 'either or', but good for both health AND wealth.  Good for both lives and livelihoods.

 

TIMESCALES

It's great news that the Pfizer/BioNTech vaccine is now being given to those most at risk.  Hopefully the Oxford/AstraZeneca vaccine will be approved shortly, and Moderna's, so the vaccination programme can be accelerated.  

Even so, the huge numbers of people involved means it is likely to be Easter 2021 before most of those high-risk have been vaccinated, and well into the summer before 'herd immunity' has been reached.  The latter is important in the fight against LongCOVID, which is likely to get a far higher profile in 2021 as the various forms are better understood. 

So there is months not weeks before we will be properly on top of COVID-19 using vaccines, so we can't stop action against it yet.

Indeed the risk is that hospitals will be overrun, through lack of suitably qualified staff if not premises and equipment.  That would mean turning away COVID patients and any others needing urgent care, as well as curtailing other hospital treatments.  That is not a risk we can take.

The Independent SAGE group of scientists and academics are reiterating their advice for "towards ZeroCOVID", an elimination strategy.  Whilst this is a sensible target, total elimination is rarely achieved.  The UK does not have the culture nor geographical separation to make it feasible here.

WHAT IS THE PROBLEM?

COVID-19 has been so contagious because studies show people become infectious before they develop symptoms, or even without developing symptoms.  That isn't the case with influenza, making COVID-19 a far more difficult disease to control.  The new variant is now making that even more difficult.

SO WHAT SHOULD WE DO?

The #NearZero concept acknowledges that we can better achieve health and wealth at a very low level of infection.  But that still requires controls on outbreaks, as well as control on people and high-risk products entering the country.

The "All-Party Parliamentary Group (APPG) on Coronavirus", consisting of a wide range of MPs in Westminster, has endorsed the "Covid-Secure UK Plan".  This is effectively a #NearZero plan in that it:

1. Suggests a target of 10 infections per day per million, consistent with the 1000 a day for the country that SAGE suggested back in March, #NearZero
2. Sets out how such low infection rates can be maintained
3. The importance of financial support for those self-isolating or having to close their businesses
4. Many other good suggestions
   

The issue with this plan is that it talks about "reducing the R nunber to below 1".  But R needs to be well below 1 for very low levels of infection to be achieved in any reasonable timescales.  With the new variant estimated to be adding +0.4 to R, action needs to be even tougher than was achieving 0.6 with the original strains.  The plan needs to be tweaked to be tougher.

The Government's "Too little too late" strategy simply isn't enough.  The latest tier 4 and Christmas changes, whilst sensible, are still too little too late.

LEVERAGING THE LIFECYCLE OF THE VIRUS

There is nothing yet to suggest the fundamental lifecycle of the virus has changed.  It is acknowledged that the virus could be eliminated if we had a total lockdown for a month, with a very significant effect in three weeks provided the lockdown only leaves vital services running:

• People tend to show symptoms between 2 and 17 days after infection,  typically after only 5 days
  
• People become infectious before showing symptoms and remain infectious for some days after showing symptoms.
• People will tend to infect their own household, likely within the first few days of becoming infected
• If people and their household were to self-isolate as soon as they believe one of them has been infected, they and their household would no longer be infectious after about three weeks, certainly by a month
  
• If everybody in a geographical area was to simultaneously self-isolate for a month, nobody would be infectious and the virus would be eliminated in that area.  
• Indeed three weeks would be enough to virtually eliminate the virus in that area

Unfortunately not everybody would be able to self-isolate for three or four weeks.  Hospitals, care homes and some other organisations MUST stay open regardless, and staff will need to continue to go to work.  Some people would not be able to store enough food for that period, but many would using what's in their cupboards and freezers.  We have to maintain a minimum of community support.

So if as many people as possible were to self-isolate simultaneously for three weeks, more stringently than in the first lockdown:

• Infection rates would drop by at least the amount achieved in the first lockdown, where they fell by five sixths from the peak in the first three weeks, after which the fall tailed off.  A fall of five sixths would be great news.
  
• Infection rates should drop further to #NearZero levels, allowing much of the economy to re-open, plus a host of other benefits
  

That would be a Mass Simultaneous Self-Isolation.  Let's call it an Enhanced FireBreak.  A full three weeks of very strict restrictions, after which some relaxation would be possible.

The benefits would be:

BUT WHEN?

Schools and universities are now closed for the Christmas break.  The relaxation of rules for Christmas is now only Christmas Day.

The idea is (or at least was) to set up non-symptomatic testing in schools in January, which will be very helpful. But this is unlikely to be ready for when schools start around 4 January.  Nor is it sensible for university students to be travelling around the country before #NearZero has been reached.

With many areas in tier 4 restrictions already, the obvious thing to do is hold an Enhanced FireBreak straight after Christmas.  With schools and universities going back on 18 January, as education professionals have suggested.

I had hoped a further FireBreak wouldn't be needed until Easter, if very low rates could be reasonably well maintained until then using the techniques in the Covid-Secure UK Plan.  But a further FireBreak might need to be a little earlier with the new viral variant.

For the remainder of the winter, if the choice is between a long period of moderately severe restrictions and a very sharp Firebreak, wouldn't it be better to get on top of the virus?  Indeed Sir Patrick Vallance, Chief Scientific Advisor, said "It's important to get ahead of it."

The Government should take the initiative over this new strain, by using a very sharp Enhanced FireBreak nationally for three weeks straight after Christmas.

COVID-19: TAKING CONTROL IN ENGLAND

Yesterday even more areas went into the very high tier 3, with few moving back down to tier 2.  From tomorrow, Saturday some 38 million people, well over half the population, will be in that highest tier.  Pubs and restaurants in tier 3 only allowed takeaway and deliveries, and severe restrictions on other meetings.

Nearly all other areas of England are facing increased infection rates, with the distinct possibility of moving up to tier 3 after Christmas.  Especially as small multi-household meetings are being de-criminalised over 5 days at Christmas.  

The R number in the UK is again estimated to be over 1, reflecting rising infection rates.

Hospitals may not be quite as full with critical patients as this time in previous years, but the risk of many more critical patients is far higher.  That would overrun hospitals making it difficult to treat COVID patients, let alone others.  It's a risk we cannot take.  Tough action is unavoidable.

Wales has already announced a lockdown straight after Christmas, for a minimum of three weeks.  Northern Ireland also, but initially longer.

Vaccination of older and vulnerable people and carers has started.  But with so many millions of people involved, it will take at least until Easter 2021 until most of these people are vaccinated and a second phase of vaccination started for younger people.

Now there is a new strain of the virus behind COVID-19 that could well be more infectious, if not more dangerous.

How are we going to get through the remaining months of winter?  Isn't another lockdown inevitable in England?  Shouldn't we take greater control of how and when this happens?

THE IMPORTANCE OF SCHOOLS AND HIGHER EDUCATION

There is no doubt that education is important.  But senior schools in particular are really struggling to keep year groups open, with some even in tier 2 experiencing 40% or more of staff off ill or isolating.  The disruption to pupils' education, and to parents and their employers, together with rising infection levels in many parts, means the tier system is not working for schools.

COVID-19 is very infectious, and only the harshest restrictions seem to avoid infection rates rising.  A teachers' representative in Wales has said "Covid-19 transmission in schools is a major factor in continuing the spread of the virus".

Sweden has generally adopted a low-restriction strategy.  But Sweden has now realised that high schools for over 16s need to move to online teaching, and be physically closed, alongside reducing the gatherings limit from 50 to 8 people.

In England the new rapid testing is to be implemented, and that year groups should stagger their return to school in January.  But teachers' representatives say that is too early to have testing in place.

Higher education is also an issue, with many students moving around the country for the start of term.  Infection rates amongst students rose markedly back in September when this last term started, and will again be inevitable unless a far lower number return un-infected.  There's then a significant risk for lecturers, as well as the students themselves.

PROPOSAL

Wouldn't it be best to minimise disruption to education, minimise the incidence of death and LongCOVID, and protect hospitals from becoming overrun?  It looks like a lockdown in the new year is inevitable.

The Government should take control and reduce infection rates as low as possible as soon as possible.  For the minimum disruption to education, and the chance to get rapid testing organised.

A very sharp FireBreak of a full three weeks should be considered immediately after Christmas, starting 28 December until at least 18 January.  Everything except the absolutely vital remaining closed.  "Stay at home" being the mantra again.

Nobody likes lockdowns, least of all me.  We all know the nasty economic and life 'side-effects'.  But holding a lockdown before schools and universities return seems to be the path to least disruption and best education.   Best for lives and livelihoods all round.

Here's the scientific rationale for three weeks and how sharp a FireBreak should be. 

COVID-19: DEGREES OF SUPPRESSION. THE ALTERNATIVES

Let's clamp down on COVID

On Monday 14 December, London went into Tier 3, the highest level of the English tiers.  The day before the Times disclosed what happened in September to sow the seeds.

According to the Times article, on Friday 18 September PM Johnson, Gove, Hancock and Cummings had been persuaded by the SAGE scientists that a short Circuit Breaker lockdown was necessary starting the following Monday.  But Sunak the Chancellor, understandably worried about the economic consequences, persuaded Johnson to listen to other scientists on the Sunday.  The Circuit Breaker did not then take place.  An opportunity to stem the increase in infection cases was lost.

At that time the data was looking like this, with rates starting to rise significantly across all age groups:

The SAGE group had just recommended a 2-week Circuit Breaker lockdown to check and reverse the rises, and avoid harsher measures later.  Which is exactly what has happened by not holding the Circuit Breaker, requiring a longer lockdown and punitive tiers.

On that Sunday SAGE was represented by Professor John Edmunds, of the London School of Hygiene and Tropical Medicine.  He presumably extolled the virtues of SAGE's advice.

But there were three other scientists presenting before him:

• Professors Sunetra Gupta and Carl Heneghan from Oxford University, who had been advocating "herd immunity" as formalised in the Great Barrington Declaration
• Anders Tegnell, Sweden’s leading epidemiologist and architect of their strategy

 

HERD IMMUNITY

An infection can produce an immune response in an individual, such that they fight off the disease and do not die.  In many cases that immunity lasts a significant period of time, preventing them catching the disease again.  That is if there isn't a new strain of the disease which the immunity does not fight.  

Where a significant proportion of a community has developed immunity, typically at some proportion over 60%, the infection has difficulty spreading and infection rates stop rising and then start falling as the proportion increases.  

With widespread use of vaccines, infection rates can fall to near zero, and let normal life take place.  That is how we live with influenza, although it still kills thousands a year in the UK.

The alternative to reach 'herd immunity' is to let the infection spread through the community until the required percentage of immunity has been exceeded.

But there is a much better way to get life back to normal before enough vaccinations have taken place, which will likely take months.

 

THE SWEDISH APPROACH 

 

The Swedish approach promoted there by Tegnell acknowledged two key aspects at the outset:

• COVID-19 would be around for the foreseeable future, in that respect much like flu.  So a long-term approach was needed
• Lockdowns cause significant harms socially and economically, so should be minimised.  Indeed restrictions have been light in Sweden, with most school age groups and businesses being kept open throughout

This strategy is best described as 'running hot' within the capacity of its health service, not 'herd immunity'.  Tegnell is on record as saying this was not herd immunity.  Indeed by restricting larger events to only 50 people and keeping older children off school, this was not in pursuit of herd immunity.  Any such effect would be an incidental bonus.

 

As discussed here earlier in September, Tegnell himself said this strategy was not applicable to the UK, primarily due to:

• Differences in culture
• Differences in density of population 

Since September new confirmed cases in Sweden have climbed substantially, making the situation for Sweden very serious.  They have now closed all high schools, with further restrictions coming into effect on 14 December.  Hospitals are being overrun, such that Sweden is now seeking help from neighbouring countries.

Whilst I thought their strategy may prove to be best for them over the course of a year or two, all things considered, this is now looking less plausible.  And certainly not appropriate for England.

Though we don't know what Tegnell told Johnson and Sunak in September.

HERD IMMUNITY AND THE GREAT BARRINGTON DECLARATION

As noted above, lockdowns cause significant harms socially and economically.

One idea is to aim for herd immunity before a vaccine is available.  Though this was not what Sweden was prepared to do.

The Great Barrington Declaration, promoted by Professor Gupta and others proposes "Focused Protection" which they say is "the most compassionate approach that balances the risks and benefits of reaching herd immunity" with two key aspects:

• Better protecting those who are at highest risk
• Allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection
  

There are four significant problems with this idea:

• It is difficult if not impossible to adequately protect those at highest risk, given they often share households and/or contact with others outside that category.
• Hospitals could quickly become overrun, to the detriment of everyone seeking medical care.
  
• LongCOVID can affect 5% (one in 20) for more than 8 weeks, according to the Kings College ZOE study.  This leaves people with debilitating symptoms for weeks if not months after infection.  But it is not clear who is at risk, as it affects the very healthy as much as anybody else, across all age groups including children.
• Basic maths, as follows
  

There are about 68 million people in the UK, of which most are in England.  Let's say 8 million would have to be 'protected', a very large number in its own right, leaving 60 million out and about. 
 
Let's say a significant herd immunity effect would be as low as 60% having been infected, and assuming that immunity lasts.  Gupta suggests achieving herd immunity in 3-6 months.  That's only 90-180 days.  60% of 60 million would take some 200,000 to 400,000 new infections a day on average.  Absurd numbers given high daily UK rates currently less than 35,000.  Even if deaths could be avoided by 'protection' there could be 10,000-20,000 new LongCOVID sufferers per day
 
Cross-immunity from the 4 COVID common cold viruses may exist, but certainly hasn't been enough to stop many COVID infections.  Nonetheless, if say 50% are immune that way, so only 10% more is needed for herd immunity, then still 33,000-67,000 a day would need to be infected with COVID-19.  Still very high, and would also result in thousands of LongCOVID sufferers.

Indeed the Lancet medical journal published correspondence in late October from over 80 scientists insisting herd immunity "is a dangerous fallacy unsupported by scientific evidence."

This is echoed by the World Heath Organisation "Attempts to reach ‘herd immunity’ through exposing people to a virus are scientifically problematic and unethical."

Natural herd immunity without vaccination is therefore not a realistic prospect.

 

DO LOCKDOWNS WORK?

Some people suggest lockdowns don't work, citing that disease graphs for COVID-19 are similar to flu.  But that ignores the evidence that lockdowns do work.

For example, the Welsh FireBreak in October/November reduced infection rates in higher infection areas by half, whilst across the border in England infection rates were rising.  As soon as the restrictions were eased, infection rates rose quickly again, such as in parts of South Wales:

Indeed an alternative conclusion is that if COVID-19 infection graphs under lockdown are compared with flu graphs from previous years where vaccination was in place, lockdowns act 'in loco vaccine'.  Lockdowns providing a similar affect to the size and shape of graphs as vaccines, provided the restrictions are tough enough.

 

THE EFFECT OF VACCINES

Vaccines do two things:

• Protect the individual being vaccinated, though this is not perfect
• By widespread vaccination of a community, enough people can become immune to create 'herd immunity', where infection rates drop to very low levels.  

That is what happens with influenza vaccines.  But as the focus is on the old and susceptible, 'flu still spreads amongst the rest of the population.  This means people often get ill, and infect others.  The result is that thousands die of 'flu each year in the UK.  

 

COVID-19 is a more severe illness than 'flu, with longer nastier initial symptoms for the initial iness, plus LongCOVID.  The idea is to vaccinate a much larger proportion of the population.  This will take months, not weeks, well into 2021.  Easter rather too optimistic.

When that has happened, life will begin to get back to normal.  But there are still months where COVID-19 rates are likely to remain high.

The other aspect of vaccines is that normality is achieved by suppressing the relevant virus.  This is what New Zealand and some other countries have achieved by other means, adopting a policy of "super-suppression".

THE NEW STRAIN OF COVID-19 VIRUS

Publication of this blog article was deferred by news that a significant new strain of the SARS-COV-2 virus that causes COVID-19 had been discovered. The consequences were unclear.

 

First identified in England, it has appeared in Scotland and a few other countries.

Whilst the new strain does not appear to be more lethal, the mutations in the virus cause a somewhat different 'spike protein' that the virus uses to attach to cells and infect them.  This has two potential consequences:

• There is circumstantial evidence that this makes the virus more infectious, as could explain why infection rates have climbed faster in London and the south east than in other places
• If it does infect cells more easily, that could mean more people affected by LongCOVID more severely.  Some long-term symptoms are due to the virus attacking cells in other organs such as liver and even brain

It is hoped that the changes in the spike protein do not make natural immunity or vaccines redundant.  

It is quite normal for viruses to mutate, and up to now this appeared to occur relatively rarely with SARS-COV-2.  One reason there is an annual flu vaccine to cover new strains, so this may also be required for COVID-19 vaccines. 

Laboratory tests and community observations will likely take weeks and maybe months to clarify these issues.  In the meantime we ought to err on the side of caution, and assume that this strain is indeed more infectious and potentially more cause for concern in respect of LongCOVID.

ALTERNATIVE STRATEGIES

As discussed above:

• COVID-19 is a worse disease than influenza
  
• Herd immunity without vaccines is not appropriate
• Vaccines promise low infection rates which allow life to get back to normal, but these will take months to roll out sufficiently to provide herd immunity
  

The response in England, as in much of Europe, has been to suppress the virus by trying to balance two "harms":

• The effects of the virus
• The harm to the economy and life in general
  

We have found that only reasonably tough restrictions suppress the virus, and so far we have avoided hospitals being overrun.  But on an overall scale, these restrictions are only 'light suppression'.  They have not allowed the economy to reopen fully, especially as the colder weather has favoured transmission of the virus, and far too many people still catch the virus.

Whereas super-suppression in countries like New Zealand has acted like vaccines, and allowed the economies to reopen and allow people to hug each other again.

The UK's geographical proximity to Europe and a different culture than countries in Asia means a "Zero COVID" strategy is effectively impossible.

But we can leverage the lifecycle of the virus, including the new variant, to drive down infection rates to very low levels.  Once very low, it is far easier to keep rates very low than if levels only drop to medium levels.  The Welsh FireBreak should have been a full three weeks for schools and businesses.  

This requires a change in mindset from the Government and its advisors to that of super-suppression using short and very sharp FireBreaks which allow the economy to reopen in between.  Details are here.

IMPACT ON EDUCATION

It has been agreed that education in schools and universities is a top priority.  The problem with the current 'light suppression' strategy is that education is being severely disrupted for two reasons:

• School children, especially in senior schools, are becoming ill and they and classmates are having to be sent home.  There is evidence that the disease then spreads to the local adult community
• Teachers are becoming either ill or are self-isolating, making it increasingly difficult to staff schools.  For example, one Oxfordshire school has 40% staff absent, and is struggling to keep open.  The problem exists across the country.
  

When parents and others become infected, that also disrupts their employment, or especially if self-employed.  Livelihoods and businesses seriously damaged.

So the current strategy is not keeping schools open and not benefiting the local communities.

IN CONCLUSION

 

The current strategy is neither letting education nor businesses operate properly.  Natural 'herd immunity' is not an option, yet we have months before vaccines become fully effective.  The new virus strain threatens to make matters worse.

 

It is time we looked more closely at a 'super-suppression' approach for the months ahead.  Especially now a relaxation of restrictions has been confirmed over Christmas.

Ideally a 3-week FireBreak straight after Christmas should be adopted.  Before schools and universities are allowed to return. 

Further details of the proposal here.

 

COVID-19: HOW CAN WE ACCELERATE THE BENEFITS OF VACCINES?

Today has heralded the real prospect of light at the end of the COVID-19 tunnel, with approval in the UK of the first vaccine, from Pfizer BioNTech.

Possibly getting back to a near-normal life by the middle of 2021.  But is there any way of accelerating that?

 

NEWS FROM THIS MORNING'S PRESS CONFERENCE

Dr June Raine of MHRA

It really is great news.  As the vaccine specialists said in this morning's press conference led by Dr June Raine, Chief Executive of the MHRA which authorised the vaccine:

• On safety "no corners have been cut" in their assessment, 
• With effectiveness "across all groups". 

Albeit testing on only about 20,000 people receiving the vaccine (with a similar number receiving a placebo).  

There's no serious adverse reaction even for people who have had COVID-19 before, which could have been a problem given how the body responds to other viruses.  That allows vaccinations to take place without a pre-test, simplifying an already complex roll-out.

 

BUT THE BIG BUT

But then there's a big but.  The roll-out of this specific vaccine will take weeks if not months to reach everyone that's needed for us to reduce the public's general restrictions.  The danger is that people will feel they can relax far too soon.  There's light at the end of the tunnel, but it's still a long tunnel.  We can't relax too early.  

The Prime Minister made that point strongly in the press breifing this evening, 2 December "It will take some months before all the most vulnerable are protected".

We have to remember:

• The Pfizer BioNTech vaccine only becomes properly effective 7 days after the second jab, 21 days after the first.  In other words a month's delay from the first jab.  The first people expected to be vaccinated before Christmas, but not immune until the new year
  
• The UK Government has purchased 40 million doses, enough for 20 million people.  Enough for about a third of the adults over 16 for which this is being licensed.  Assuming no doses are wasted, especially given it has to be stored at minus 70 degrees centigrade, and the very careful way it must then be handled whilst it thaws before injection to remain effective.  Manufacturing that quantity will take some time, let alone distribute it.
  
• No forecast as to when the Moderna or Oxford/AstraZeneca vaccines might be approved, although an indication from Dr Raine that not before the new year
• When there is a mass roll-out to tens of thousands of people, the monitoring may disclose safety or effectiveness concerns, especially in the more vulnerable groups

 

SO WHAT TIMESCALES TO BE EFFECTIVE ACROSS THE POPULATION? 

Vaccines for a substantial proportion of the population will take weeks if not months.  Assuming further vaccines are authorised early in the new year, my estimate would be sometime next summer 2021.  Meaning general restrictions would still be needed for a few months into the new year.

That estimate has been confirmed by experts at London School of Hygiene & Tropical Medicine in a public statement this morning:

• Stephen Evans, Professor of Pharmacoepidemiology, says "We will not be able to change distancing, mask wearing etc for quite some time- months at least, and we don’t yet know when or whether that will stop"
• Liam Smeeth, Professor of Clinical Epidemiology, says:
• "A further circuit breaker in January or possibly February is likely to be needed."
  
• "But, it is realistic to hope that by March or April the vast majority of older people, care home residents, and those with severe conditions will have been immunised."
• "We can then work towards wider immunisation – with ideally much of the population covered in time for next winter."
• In other words, realistically months
  

WHAT SHOULD THE GOVERNMENT DO?

Firstly the Government must be straight with the public about the timescales.  A point also made by some MPs in yesterday's debate on the new three tiers. 

Secondly they need to encourage "the great British public" to continue to follow rules and guidance right through until next summer.  A real challenge.

Fortunately the press briefing this evening Wednesday 2 December made those two points very strongly.  Professor Van Tam, the Deputy Chief Medical Officer talked about "being realistic about it being months not weeks" and "please stick to the guidance until we say it is safe to stop".  Next Spring was mentioned, but that is probably a little early.

But what about accelerating the benefits of very low infection rates arising from vaccines any earlier?  That would also help to address the risk of people relaxing too early.

As Liam Smeeth suggested above, a circuit breaker is needed early in the New Year.  Or preferably to leverage the virus's short natural lifecycle wth a short sharper Enhanced Firebreak in early January could get infection rates down to #NearZero levels until around Easter, when it could be repeated to get through to the summer:

 

Click here for details.  That would achieve these benefits earlier than waiting for the rollout of vaccines:

Wouldn't these benefits be fantastic to improve our lives and livelihoods?!

 

 

 

CV-19: REMAINING ISSUES WITH SEISS FOR THE SELF-EMPLOYED

Today the Government website opens for the self-employed to claim the third Self-Employed Income Support Scheme (SEISS) grant.

Whilst this grant will be very welcome to those people eligible, there are a number of remaining problems by comparison to the Furlough scheme that have not been addressed:

• Two missing months 
• Applicable rates
• Frequency of subsequent payments
• What about the self-employed excluded from the earlier SEISS grants?

 

THE CORE PRINCIPLE OF COMPARABILITY WITH FURLOUGH SCHEME

The SEISS3 webpage says, officially, "The Government are providing the same level of support for the self-employed as is being provided for employees through the Coronavirus Job Retention Scheme.", CJRS,  also known as the Furlough Scheme.  That has been the basic principle from the start.  So shouldn't this be honoured for all time periods since CJRS started in March?

 

TWO MISSING MONTHS

The Chancellor Rishi Sunak originally announced for Furlough "The Coronavirus Job Retention Scheme will cover the cost of wages backdated to March 1st."

 

When the SEISS was first announced, the web page said the payment "...will cover the three months to May."  That is consistent with the start date for the Furlough scheme. 

Then for SEISS2, it was announced it "will be extended", i.e. June to August.

 

SEISS1 and SEISS2 has been paid for two quarters, to cover the six months March to August.  As SEISS3 is for November to January, what has happened to September and October?

 

Two quarterly payments have been made for SEISS, for six months, compared to eight months for Furlough.  Two months lost by the self-employed.  A further payment needs to be offered to the self-employed for those adversely affected by COVID-19 in September and October.

 

 

WHAT RATES SHOULD BE USED?

 

SEISS1 was paid at 80% of trading profits, subject to limits, to reflect the rate applying to Furlough CJRS.  SEISS3 is to be paid at 80% for the same reason.

However SEISS2 was paid at 70%, whereas Furlough continued at 80% for June to August.

The Furlough rates were as follows:

So to provide the self-employed with the same level of support as Furlough:

• Everyone paid SEISS2 for June to August should have their payment topped up from 70% to 80%
• Payment for September and October should be 70% and 60% respectively, for those adversely impacted by coronavirus in that period
  

 

FREQUENCY OF SUBSEQUENT PAYMENTS

We do not know how long the Furlough scheme will continue into 2021, and at what rates they will be paid.

Self-employed people will usually have their mortgage, rent and other major payments made on a monthly basis, just like employed people who have benefited from Furlough.

It has been announced that there will be a further payment of SEISS for February to April.  This would be more appropriate to be paid monthly.

WHAT ABOUT THE SELF-EMPLOYED EXCLUDED FROM THE EARLIER SEISS GRANTS?

Some 'self-employed' run a company, so are not technically self-employed for tax purposes, and therefore not eligible for the SEISS grants.

Those who are technically self-employed are not all eligible, either because they have been earning over £50,000 or started their business since 5 April 2019.  

These situations all have major practical issues to resolve, and the Government's answer has been they should claim Universal Credit if need be.

However there is one group whose exclusion from SEISS has never made sense, and could more easily be amended.  Those with slightly less than 50% of taxable income get no support.  For example I know a teacher who does some work for schools on their payrolls but bills nearly half her income directly to parents, self-employed.  So she has not been eligible for SEISS.  Presumably HMRC can see if total earnings are over £50,000.  Maybe something like 25% would be a more appropriate threshold for claiming SEISS?

 

IN CONCLUSION

The latest SEISS payment is very welcome to those who are eligible.

But there remains several issues for support to be comparable to the Furlough scheme, as the Government says is its intention:

• Payment should for be made for September and October for those adversely impacted by coronavirus in that period, at 70% and 60% respectively
  

• Everyone paid SEISS2 for June to August should have their payment topped up from 70% to 80%

• Payments for February onwards should be made monthly

• Those self-employed earning slightly less than 50%, say over 25%, who would otherwise be eligible, should be eligible for SEISS backdated to the first grant

COVID-19: THE CASE FOR A SHORT, SHARP FIREBREAK

The idea of vaccines against COVID-19 is to get infections down to a #NEARZERO level, much like the vaccines against influenza.  That would allow the economy to fully open and life get back to normal.  But as the Prime Minister has acknowledged, it will take months after a vaccine is approved before it can be rolled out enough to become effective across all our communities.

So what should we do in the meantime?  The three-tier system for England is effectively elongated shutdown, designed primarily to avoid the NHS being overrun.  Which will cause massive economic and wider social and health problems, for only a relatively small reduction in infections.  MPs are rightly worried.  Can these problems be avoided?  Could we get down to #NEARZERO some other way?

THE NATURAL LIFECYCLE OF THE VIRUS

Ian Jones , Professor of Virology at Reading University stated on BBC Radio Oxford breakfast show last Thursday 19 November breakfast show (at 3hours 32min25s) that "If everybody could live for the next month three metres apart.... the virus would become extinct.  There's no doubt about that. "

That can be explained with the virus's lifecycle, as follows:

• People tend to show symptoms between 2 and 17 days after infection,  typically after only 5 days
  
• People become infectious before showing symptoms and remain infectious for some days after showing symptoms.
• People will tend to infect their own household, likely within the first few days of becoming infected
• If people and their household were to self-isolate as soon as they believe one of them has been infected, they and their household would no longer be infectious after about three weeks, certainly by a month
  
• If everybody in a geographical area was to simultaneously self-isolate for a month, nobody would be infectious and the virus would be eliminated in that area.  
• Indeed three weeks would be enough to virtually eliminate the virus in that area

Unfortunately not everybody would be able to self-isolate for three or four weeks.  Hospitals, care homes and some other organisations MUST stay open regardless, and staff will need to continue to go to work.  Some people would not be able to store enough food for that period, but many would using what's in their cupboards and freezers.

In the first lockdown supermarkets remained open.  Hence the lockdown did not achieve complete elimination in the first three or four weeks.  A Lockdown or FireBreak can only be as effective as the level of restriction on people meeting others.

That suggests that if as many people as possible were to self-isolate simultaneously for three weeks, more stringently than in the first lockdown:

• Infection rates would drop by at least the amount achieved in the first lockdown, where they fell by five sixths from the peak in the first three weeks, after which the fall tailed off.  A fall of five sixths would be great news.
  
• Infection rates should drop further to #NearZero levels, allowing much of the economy to re-open, plus a host of other benefits
  

That would be a Mass Simultaneous Self-Isolation.  Let's call it an Enhanced FireBreak.

The benefits would be:

HOW CAN INFECTION RATES BE KEPT DOWN AFTER A FIREBREAK?

We know from the end of the summer and experience abroad that COVID-19 is so infectious that infection rates can quickly soar.   A lid must be kept on the virus by adopting a tough set of controls:

• Continuing with social distancing, using masks and washing hands regularly
• Controls on people and chilled products arriving from abroad
• Bearing down on any outbreak:
• Mass testing as has been adopted in Liverpool, asymptomatic and symptomatic
  
• Strong local test, trace and isolate measures

However even that set may not be enough to stop infection rates creeping up.  So an Enhanced Firebreak may need to be repeated.  If that was after three months, then a three-week investment in am Enhanced FireBreak would have provided around ten weeks of the economy being open.

THE EFFECT ON EDUCATION

The lockdown and tiers are intended to keep schools open.  But Independent SAGE are reporting more than one in five senior school children were off school last week.  The disruption is not sensible for education.

We also know universities have been badly disrupted by COVID-19. 

Am Enhanced FireBreak would need to have schools and universities closed to be properly effective.  But that would ensure that when they did re-open they could function with little or no disruption.  An 'investment' worth making.

WHAT ABOUT THE FIREBREAK IN WALES?

The Firebreak in Wales was 17 days, including three weekends, but only two school and business weeks.  It started at half term in October, but allowed most schools to go back after that week.  

The result was an overall reduction of infections by about a half.  But as that was still quite high in most regions, the virus soon fought back and infection rates have risen again across the country.

An Enhanced FireBreak has to be the full three weeks to be properly effective, with the sharpest of restrictions, including schools closed for the entire time.

WHEN SHOULD A FIREBREAK OCCUR?

Financial support during the Enhanced FireBreak will be vital.  But only three weeks, and the Government would quickly recoup their investment when the economy reopens.

This and other aspects of an Enhanced FireBreak will take a little while to organise.  December is important for retail and hospitality.  University students will generally be going home over Christmas.  

So the obvious thing to do is to hold the Enhanced FireBreak in early January before schools and universities re-open.  Then maybe again straight after Easter.  

It would mean starting with the tiers, and would then look like this:

Worth trying?

 

Further details here.