COVID-19: ALL EYES ON WALES

On Friday, Wales started a 17-day FireBreak across three weekends.  This is sharper and slightly longer than a 2-week Circuit Breaker.  Here are Welsh rules.

Why have they done that?  What do the scientists think?

THE BASICS OF A FIREBREAK

A real FireBreak

As the term implies, a FireBreak is action to stop the spread of COVID-19, and therefore protect life the other side of the shutdown period.  Allowing most if not all the economy to re-open.

People display symptoms typically after 5 days from infection, although can be as long as 17 days.  They then remain infectious for a week or so. Some people do not develop symptoms, but are thought to be infectious.  It is still early days in our understanding.

In theory, if everybody could self-isolate on their own for 17 days, and if developing symptoms continue to self-isolate, COVID-19 would be eliminated.  

 

BUT REAL LIFE

However there are three key issues with real life:

• People often cannot self-isolate on their own, but with family or housemates. Infection will continue to spread for a few days in a household.  
• Key workers cannot self-isolate.  Even if only vital organisations and businesses stay open, there will be still be a background level of infections after the Firebreak period ends.  The more stays open, the higher that level will be.
  
• There will always be the threat of re-infection from abroad.  New Zealand has found that even with the strictest of immigration controls, new infections can still occur

As a result an Enhanced FireBreak is appropriate, here compared with Wales:

• Slightly longer, say three full weeks
• As tight as possible.  Wales has tightened restrictions since first announced, but is having to re-consider what counts as "essential".  The test should be whether something is "vital" for a FireBreak to be most effective.
• Consider keeping all schools closed for period of FireBreak.  Wales will be allowing up to year 8 to go back after half term
  
• Ever vigilant for fresh outbreaks arising either from the FireBreak not being totally effective or from fresh infection from abroad
• Across the whole of Great Britain, without or without the island of Ireland, so cross-border infection is better controlled

Depending on how complete the FireBreak is:

• How low daily infections will become, and how much of the economy can re-open
• How long it is before a further Firebreak is required.  Wales is expecting to get past Christmas into January or February

The sharper and tighter the restrictions, the lower the infection rate will fall, and the longer it will then take to rise again.  An Enhanced FireBreak should get the infection rate down to a very low level, allowing most if not all of the economy to re-open.  Music, theatre and sports events to re-open, albeit with some basic controls helped by new on-site testing techniques.  

The aim would be to get to the February half-term, and make that longer for a second Firebreak, depending on experience with the first.

WHAT SAGE SAID

Joint chairmen

The Government's group of scientists, the Scientific Advisory Group for Emergencies famously said in their 21 September report that "A package of interventions will be needed... A circuit-breaker (short period of lockdown) to return incidence to low levels..." together with some specifics.

It is clear from other comments that the concern was stopping exponential growth, keeping R below 1.  That would take the pressure off the NHS and reduce deaths and LongCOVID.  But there seemed to be no ambition to get infection levels to a very low levels that would allow the economy to re-open.

Without this benefit, the UK Government couldn't see that a short circuit-breaker would be worthwhile beyond the three-tier approach to restrictions. 

WHAT 'INDEPENDENT SAGE' SAID

Some participants 23 October

Independent SAGE is a group of former SAGE members and academics who hold weekly broadcasts on Fridays.  The last broadcast on 23 October included "how a 2-week circuit break would work and why we think it is needed"

• Get infections down to around 4000 a day. "It is not enough to slow growth, must turn it around"
  
• Provide time to "fix Test and Trace" to help get infections down further and not need further circuit breaks in future
  

They have also published a "6-week Emergency Plan" called "A Blueprint to achieve an excellent Find, Test, Trace, Isolate and Support system" (FTTIS). 

The key point being that without a massive improvement in isolation, the system will not be effective, and that will not happen without support, especially for the low paid who cannot afford to skip work.

But overall, again this is not sufficiently ambitious to get infections down to very low #NearZero levels, to allow the economy to open quickly.  That's what an Enhanced Firebreak could achieve.  

 And is improving FTTIS enough to stop the need for further FireBreaks?  Unlikely.

 

THOUGHTS ON TESTING

Back in early August I reviewed testing technologies and the NHS Test and Trace system.  I said then "At the national level, it is clearly a waste of money, with little chance of getting better the way it is currently organised."  This has been borne out in the last couple of months.

I also said "The current technology simply isn’t the basis for a national TTI strategy, until it can be focused just on local surges."

That means:

• Faster tests are needed, so contact tracing can start more quickly when a  positive test is recorded
  
• Cheaper and easier tests are needed to test everybody, to catch infectious people earlier before symptoms and indeed catch those asymptomatic
  

Although new tests are coming through, with some already out on public trials, these are still expensive.  More than £20 a test. 

It was interesting to hear an expert on BBC radio make essentially the same points.  It is not realistic to think that even the best FTTIS sytem based on the current RT-PCR testing will have sufficient impact on the spread of infection to avoid a further FireBreak.  Indeed a second Firebreak is the Welsh plan for the new year.

Indeed the new test which Boots is launching is to be £120, which is says is cheaper than other publicly available tests, is not going to help much.  The 'Got it' LumiraDx test for Covid-19 antigen protein (not to be confused with 'Had it' antibody tests) is according to the company's website only "authorized for use using nasal swab specimens collected from individuals who are suspected of COVID-19 by their healthcare provider" and then only "within the first twelve days of the onset of symptoms." Reliability prior to symptoms is not disclosed.  Further details awaited from Boots as to how this can fulfil the published objectives for people not displaying symptoms.

 

WHAT ABOUT SCOTLAND?

Both Scotland and Wales have tended to be more aggressive against COVID-19 than England.  The English strategy can best be described as 'too little too late', including releasing restrictions earlier than the devolved governments.

What Scotland has just done is announce a 5-tier strategy from 2 November, where:

• Tiers 2-4 correspond to Engand's 3 tiers, which might have something to do with funding from Westminster
  
• Tier 5 is lockdown, but with schools remaining open
  
• Tier 0 "Nearly Normal" is with a few restrictions on the numbers that can meet indoors and outdoors
  

So why hasn't Scotland followed Wales with a FireBreak over half term?

The clue is probably in what Nicola Sturgeon said  at her media briefing on Friday that Scotland got “very close to elimination” of the killer bug but then “reseeded it from travel across the UK” and overseas.

Scotland shares a land border with both the north-west and north-east of England.  The border cannot be closed despite very high infection levels in these two areas.  This will also be the Achilles heel for Wales becuase of the border with England, but not so much.

Indeed an Enhanced FireBreak would need to be at Great Britain level at least, preferably the whole British Isles with the island of Ireland.  One day perhaps at a global level.

IN CONCLUSION

Let's hope the FireBreak in Wales is successful.  Then England and Scotland can do likewise, with an Enhanced FireBreak.  Though the sooner the better, before infection levels rise even higher.  To unlock the economy and get back to some normality with very low #NearZero infection levels: