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.