COVID-19: DEALING WITH LOCAL SURGES

We all want to get back to normal, or at least near-normal.  Given that we want to live with little chance of contracting COVID-19 and suffering its short-term and long-term effects, the idea is to get the daily infection rate under 2 per hundred thousand people.  The risks of COVID-19 are such that we really don’t want to catch it if we can avoid it:

• Typically ill for 2-3 weeks, much longer than for 'flu, which is disruptive and can mean lost income
• Sometimes longer illness, including possibility of needing to be hospitalised
• Death, although this happens mainly to older people, and in any case below about 1% of those people infected
• Long term lethargy, which again is disruptive and may mean being off work
• Other LongCOVID symptoms, where the virus has attacked other organs such as heart liver, kidneys, digestive system and brain, which can go on for months if not a lifetime. 
• Strokes, even in the young

Estimates for people suffering one or more LongCOVID symptoms after three months vary from 20% to over 50%, of all ages.  Apart from being debilitating and often painful for the individuals concerned, LongCOVID is becoming a bigger problem for society even than people dying.

The target of 2 new cases a day per hundred thousand people means:

• For a small town of around 50,000 people, like Melton Mowbray, that’s 1 new case per day, 7 per week
• For a medium size town like Watford with 100,000, that’s 2 new cases per day, 14 a week
• For a city like Oxford with 150,000, that’s 3 new cases per day, 21 a week
• For a large city such as Leeds with 800,000, that’s 16 new cases per day, 112 a week

Other towns and their populations are listed here.

People tend to show symptoms after about 5 days, and then hopefully self-isolate.  To take Oxford as an example, it would have people out and about infectious, at any one time:

• About 15 people 'pre-symptomatic', that is infectious without realising it.
• Plus people who never display the classic symptoms, including children, who are 'asymptomatic'.  Estimates vary, but we ought to double the number of infectious people to say 30 individuals.

So we need to treat everyone we meet as potentially infectious, but I could live with that small a number being actually infectious.

If every town, city and rural community keeps to these numbers as limits, the average for the whole country would keep within that level.

Then we in England can be invited by foreign countries with them having the confidence that very few Brits getting off the ferry or plane will be infectious but not yet showing symptoms.   Likewise staycation areas such as Cornwall can also welcome other Brits at little risk.

Indeed the whole economy can get going again, and schools have little risk of having to close and re-open repetitively. Back to near normal, still taking basic precautions.


WHAT HAPPENS IF AN INFECTION CASE IS SPOTTED?

With towns and cities only being ‘allowed’ a few new infections, as soon as even one arises, the local Test Trace and Isolate team needs to roll into action. 

Test facilities need to be rolled in, and the team put on their shoes to trace contacts and get them tested.  If anyone tests positive or if there's any doubt, get them to isolate.  Then follow up their contacts.  Note that’s more than asking someone to isolate without testing, which has been the basis hitherto the national system.  Fairer for everyone concerned

But in practice, how would an infection surge happen and be tackled?


EXPERIENCE IN NEW ZEALAND

In New Zealand, they have ‘eliminated’ the virus and have been free of any new cases caught within the country for over 100 days, which is over 3 months.  But they have just had their first infection “cluster”.   Starting with  family of four including children.  Because people become infectious before they display symptoms, the cluster is now at least 30 people.

The government there is determined to avoid the cluster growing, and put it out by putting the 1.6 million population of Auckland into lockdown for three days.  That has now been extended by two weeks.

A cluster like this could happen in a town or city of any size.

Indications are that the cluster has arisen because of a breach of New Zealand’s strict quarantine arrangements for anybody arriving in the country, be they returning nationals or visitors.  Though they haven't ruled out a cold store.

There are two implications for other countries such as England:

• Even if COVID-19 is eradicated from a country, there is always the possibility of new cases arising from people entering the country.  Everyone must stay alert
• Even the smallest local surges will quickly exceed the 2 new cases a day target

How should we react?  I can’t see that a town or city can be put into lockdown every few weeks whenever there is one small new cluster.  The best approach in the UK is going to have to develop, on the back of experience with places such as Leicester and Aberdeen.  There are no easy answers.

 
INFECTION SURGES IN FACTORIES

When factories are involved, a new cluster can quickly reach much higher numbers.  In Northampton this last week, some 300 or more became infected before the problem had been identified. 

Similar situations have arisen in other food processing factories in places like Ireland and Germany, that have otherwise had low infection rates.

Nonetheless such a cluster has to be tackled as soon as it is identified, using local Test Trace and Isolate to quickly avoid the cluster getting worse, locally and to wherever people have travelled.


WHAT DOES IT MEAN FOR EACH TOWN, CITY AND LOCALITY?

Because a small number of infections can quickly become a large number, and get out of control, ideally the local target for each town and community and town should be zero.  The first signs of a new cluster needs to be pounced on.



WHAT DOES IT MEAN FOR THE COUNTRY?

To get back to some form of normality, and keep schools open, we need to get infections down below 2 new cases per hundred thousand people a day.

Clearly we have to minimise bringing in infections from abroad.  New Zealand’s approach is very restrictive, and impractical for a country like the UK which traditionally has a lot of major international travel, both for business and tourism.  How to best control immigration is a separate discussion, and certainly not easy.  The current 2-week quarantine approach is becoming ridiculously restrictive. 

Nothing about living with COVID-19 is easy folks!