COVID-19: HOW CAN WE GET BACK TO NORMAL MORE QUICKLY?

It's been said that "There's light at the end of the tunnel.  But we're still in the tunnel."

There has been great news on vaccines from Oxford/AstraZeneca, Pfizer/BioNTech and Moderna.  Safety and effectiveness from their final phase 3 trials look good enough for the regulators to authorise their use, especially for the elderly who are more vulnerable to COVID-19.  Looks like a game-changer in the fight against the disease, by getting the infection rate down to very low levels, to allow life and the economy to re-open.

But it will then take weeks and indeed months for vaccines to be manufactured and rolled out to the public. The need for two doses means the vaccine isn't fully effective until three or four weeks after the first dose.  

The UK Government is hoping that many of the most vulnerable people will be vaccinated by Easter in early April 2021.  But that most other people will follow later in the spring and summer.  Realistically months before we reach the end of the tunnel.

The Prime Minister was at pains to point out at Monday's press briefing that "It will be months before we can be sure that we have inoculated everyone that needs a vaccine, and those months will be hard..." and "the challenge now as we face this difficult winter ahead is to fight down any over-optimism, to master any tendency to premature celebration of success."  These sentiments have been echoed by his key scientific advisors.

So how could we get to the end of the tunnel more quickly?  How else could infection rates get down to very low levels that would allow life and businesses to re-open, and allow the economy to recover?

 

EXPERIENCE IN UK AND WORLDWIDE

The SARS-COV-2 virus that causes COVID-19 is highly infectious, with people becoming infectious before displaying symptoms.  Someone infectious will not initially know it, allowing the virus to spread easily.

Symptoms are serious, worse than influenza:

• Typically two weeks very unpleasant initial infection, compared to a couple of days
• Chance of second phase of infection, such as PM Johnson experienced, which can be due to a "cytokine storm" where immune system over-reacts
• Death after unpleasant hospital treatment, at all ages but more common in older people
• Strokes, as virus causes micro-clots if the virus gets into the blood
  
• LongCOVID, often for people who did not require hospital treatment:
• Long-term lethargy, such as can happen with any major infection
• Long-term damage to lungs and breathing
  
• Pain and damage to other organs when virus gets into the blood, including the brain, either due to damage from micro-clots or the virus's direct action on cells with the ACE2 receptor 
  

The virus has been found to spread primarily through the air on water droplets and micro-droplets termed "aerosols".  Still air indoors being easier for the virus to infect another person than being outdoors.  

Various techniques have been found to reduce transmission:

• Keeping a distance from people.  That works well outdoors.  But aerosols can spread in a still-air room well beyond two metres, be that a shop, workplace or classroom.
• Masks catch droplets, and so by everyone wearing masks or fabric face coverings, those people becoming infectious will not spread the virus as much.  Though even a surgical mask provides little protection against being infected. 
• Washing hands, as viruses can also be transmitted via surfaces such as door handles if someone then touches their mouth or nose  
• Test, trace and isolate.  But up to now the reliance on inherently time-consuming RT-PCR testing means it has been slow to identify contacts of infected people.  Improvements are also needed to tracing and isolation. 
  

But not everyone adopts these techniques, and in practice in the UK infection rates still rise when a combination of these techniques are used.  Improvements in test technology, tracing and isolation will help, but unlikely to lead to massive reductions across the country in the coming months.

As a society, there are two types of risks of letting COVID-19 infection levels rise:

1. The NHS would be overrun, meaning people needing treatment for COVID-19 would not get it, and other treatments would be curtailed. 
2. The higher the infection rate, the less of the economy can be open, and the more disruption there is to education and daily life.  

What has been found to dramatically reduce infection rates, to avoid both types of risk, is a Lockdown or Firebreak.  People are right to be concerned about the hideous side-effects of such measures, which is why any such action should be kept short by being sharp.  As we found in this analysis:

• The original UK lockdown reduced national infection rates by five sixths in three weeks, with a little more in the fourth week, before the impact tailed off

• The recent 17-day FireBreak in Wales reduced infection rates by half, more effective in areas with higher infection rates.  The measures were not as strict as the original lockdown, and 17 days was not long enough

• Indications from early stages of the latest English lockdown, for which restrictions have been less than the original lockdown, are:
• The tier 3 and lockdown restrictions can reduce infection rates in high infection areas by about half in three weeks
• There has been little impact in areas with medium infection levels
• Infection levels have even risen in some areas with lower infection levels
  

 This all means that:

• The impact of a lockdown or FireBreak is dependent on the severity of the restrictions
• Most of the impact is in the first three weeks, as would be expected from the virus lifecycle
  

BACK TO FIRST PRINCIPLES OF THE VIRUS LIFECYCLE

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, but 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.

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
• Infection rates should drop to #NearZero levels, allowing much of the economy to re-open, plus a host of other benefits:
  

 

THE UK GOVERNMENT'S APPROACH FOR ENGLAND

In England the plan is to have a three-tier system of restrictions from December to March, with some relaxation agreed between the four UK nations for the Christmas period.

As discussed here, this is likely to achieve the first objective of avoiding the NHS being overrun.  The second objective of opening the economy is very limited, looking like:

• Some businesses re-opening such as hairdressers, gyms and non-essential retail
• Hospitality re-opening to a certain extent, depending on level of infection in an area 
• Entertainment and sports venues re-opening with limited numbers in areas of lower infection

There will also be relaxation across the UK for five days at Christmas.

THE ALTERNATIVE APPROACH

As discussed above, we can leverage the lifecycle of the SARS-COV-2 virus behind COVID-19 to hold a short, sharp FireBreak of three weeks to cut infection rates dramatically.

That would need to be followed by reasonable constraints:

• Test, trace and isolate:
• With infection rates much lower, the testing regime would be far more effective
• Mass testing of asymptomatic people will help
• Financial support for isolating needs to be far wider than at present 
• Fast testing is being developed for entrances to venues
  
• Restrictions on arrivals from abroad
• People, with testing reducing need for self-isolation
• Products, such as chilled foods, where packaging can be contaminated
• Continuation of social distancing, masks and washing hands
  

The overall result would be to get infection rates down to #NearZero levels, as if there was a vaccine, with a host of benefits as shown above.

WHEN TO DO A FIREBREAK?

We would have been in a far better position now if a short, sharp FireBreak had been done in England in October, to take advantage of the October half term.  Just as Wales did. But a full three weeks and with sharper restrictions of only the vital organisations being open, and people as far as possible self-isolating.  

That would have driven infection levels across the country to low and probably very low #NearZero levels.  That would have allowed much of life and the economy to re-open, and would have been far better preparation for a Christmas break. 

But the opportunity wasn't taken in October.  It isn't practical to do a FireBreak in England in December, straight after the national lockdown, and when retailers and hospitality venues are usually at their busiest.

However January is when many businesses are quiet.  To provide the benefits of #NearZero infection levels in February, March and beyond, the right time to do a FireBreak would now be in early January.  

Schools would return after the FireBreak.  The concern has been that education has been disrupted by classes or entire schools being sent home due to coronavirus infections, in a haphazard manner.  Higher education too.  The FireBreak would virtually eliminate such disruption, and therefore be better for education overall. 

Likewise businesses and other organisations will have little disruption, and those that have been closed can re-open.  People can plan ahead again.

Deaths and the incidence of LongCOVID would be dramatically reduced, and the economy re-opened and strengthened.  All to the benefit of lives, livelihoods and the Treasury's finances.

With the use of reasonable constraints on transmission, infection levels should stay reasonably low, though will probably tend to rise. It may therefore be necessary to repeat a FireBreak immediately after Easter, but that would have provided ten weeks or more of open economy for an investment of a 3-week FireBreak.

Note that this plan is unaffected by the length of the Christmas relaxation.  The FireBreak is not payment for that relaxation, but rather an investment in the future because infection rates have generally been too high in the last quarter of the year.