It’s a crisis that many have long feared and even grimly predicted – but may have secretly hoped or never quite thought it would happen. Not here. Not to us. And yet, here we are. The coronavirus pandemic is rising to a peak in Britain. The deaths this weekend are over 700 a day – and life has come to a standstill, with our own and the world’s largest economies on a knife.
In the midst of this, Deputy Chief Physician Jenny Harries sent a chilling warning – that life may no longer return to normal for at least six months.
At the moment, there does not appear to be an exit strategy, no clear way out. There are no drugs that have been proven to work; no vaccine that could protect us for at least 18 months. Leading experts advising the government are clear: once the block is lifted, infection rates will – cannot, will – rise again. “We should not suddenly return to our normal way of life,” Dr. Harries told the nation, in the most grim terms. “That would be quite dangerous.”
Britons have been told to stay home for almost two weeks as part of social distance measures, but how long will it be?
Dangerous means more lives lost. But the prospect of a long-term closure, with no end in sight, is – to put it mildly – uncomfortable to imagine.
Companies decimated. Thousands of jobs were lost. A recession that would make The Great Depression look like a dress rehearsal.
Still, there are sparks of hope – “green shoots,” as they have been described – that suggest the number of infections is starting to slow down.
It means that although the peak of the British crisis has passed in a week or two, the government’s strategy on social distance is taking effect.
A study from the London School of Hygiene and Tropical Medicine suggests that the average number of daily contacts – how many people we all come in contact with on a given day – has fallen from 2.6 to 0.62 since the blockage. This theoretically means that the virus has nowhere to go: if none of us pass it on, no one will be infected again.
Not that this means that the lock restrictions can still be lifted – far from it.
Robert Jenrick, housing and community secretary, has warned that “no one claims this will be over in a few weeks.” The BBC announced on Friday that it will run a new series of educational programs from April 20 for 14 weeks – the surest sign that schools are not expected to return until after the summer break.
The lock works, experts say – but due to the nature of the virus, we won’t immediately see the full benefit. This weekend is central. One of the country’s top epidemiologists, Prof. Neil Ferguson, who advises the government on the outbreak, told the Today program yesterday: “We can [expect to] see two possible options: a very slow plating decay of infections over time or perhaps a little faster.
“It’s critical to determine how well people behave outside the household and how well they limit their contact with others. And it’s pretty finely balanced at the moment. ‘
He said that moving in the sun this weekend would “move us into a slightly more pessimistic scenario,” leading to “high infection levels for weeks and weeks instead of a rapid decline.”
For the time being, we must wait until the death rate and the number of infections start to drop. The big question is: what then? At the heart of the government’s strategy was the need to protect the NHS from being overwhelmed – and this will be the next step as we try to get back to normal.
Deputy chief physician Jenny Harries, in the photo, told the nation: “We shouldn’t suddenly return to our normal way of life, that would be pretty dangerous.”
The key to any decision was our NHS intensive care capacity: at the start of the outbreak, 5,000 beds across the country.
When those beds are full, people can die because those who need critical care support, such as fans, cannot access it.
But initially, the government seemed to approach the virus in a gentle, gentle way.
All traces of the new coronavirus on raw food are destroyed when cooked at a temperature of 70 ° C or higher.
People with symptoms and those who had been to countries where the virus was more common were tested and isolated.
For most of us, life just went on. In early March, Italy – the first European country to be severely affected by the virus – had joined China to deal with the crisis. France, Spain, other European countries and some American states soon followed.
South Korea, Singapore and Germany engaged in aggressive ‘test and trace’ tactics – screening people with symptoms, quarantining the infected and detecting and isolating their contacts. But the UK – only in Europe, apart from Sweden – was firm and did not.
On March 12, despite protests from many in the scientific community, the government stopped testing everyone except those hospitalized with suspect Covid-19.
In the photo, Regent Street, one of London’s biggest shopping attractions, was abandoned after shops were told to close
Anyone with a cough or fever – the main symptoms of a Covid-19 infection – was told to stay at home and isolate themselves for seven days. But children stayed in school.
Health officials said they would “ move on ” perhaps soon, but they waited until strictly necessary. Introducing a ban on public gatherings and events too soon could cause “fatigue” – and people would find ways around them. It would also be better economically.
Government advisers reasoned it would be better to save such measures for when Britain was closer to the peak of the epidemic. But this strategy changed overnight with the publication of a report by the Imperial College Covid-19 Response Team, led by Prof. Ferguson, on March 16. It suggested that doing nothing would lead to a demand for intensive care beds that would be 30 times the capacity and cause more than half a million deaths.
Crucially, the modeling also showed that existing social distancing measures would make demand eight times greater than capacity and would cause approximately 250,000 deaths.
Within hours, Boris Johnson announced “drastic action.” All Brits should work from home and avoid travel and social contact. Days later, schools were closed, pubs and restaurants had to close, and closure started.
The success of the initial gentle approach will become apparent early next week in the number of infections and deaths.
Two small children visit their grandparents in the photo, but because of the social distance rules, they can only touch the glass between them
A few days later, the first signs of the lockdown impact will also be seen in the numbers. But neither will give the government any indication as to what to do now, leading epidemiologists say.
“It’s all a bit muddy because these changes and interventions all came in within a few days of each other,” says Dr. Michael Tildesley, an expert in infectious disease modeling at the University of Warwick. “It is impossible to predict the effect of each measure individually.”
Now there are too many unknowns to simply lift the restrictions, he says. We don’t know how many people are infected because the government doesn’t routinely test people with symptoms.
Prof Keith Neal, an infectious disease epidemiologist at the University of Nottingham, says the global estimate is that there are about 1,000 infections for every mortality – bringing the total in the UK to 4,313,000 at this time. But we’re not sure if those who’ve had the virus are actually immune from getting it again.
While experts have said they have ‘every reason’ to think they can be, there are concerns. Other coronaviruses – including the four that cause colds – do not cause lasting immunity. So there is no model to continue. The only option is for officials to carefully analyze what is happening elsewhere.
That starts with China. Travel restrictions in Hubei Province – with the exception of Wuhan, the epicenter of the outbreak – were lifted last week. The closure in Wuhan, where there have been no new cases since last Monday, officials say will be partially lifted on April 8.
Firefighters prepare to decontaminate Wuhan Tianhe International Airport in China, as shown, with travel restrictions to be lifted soon
However, we already know that shutting down alone is not enough to fight the virus. As experts have noted, “we have to learn to live with it.” In China, some stores, cinemas and businesses have been closed ‘abruptly’ again, suggesting that relaxed measures may have led to further infections.
A second wave was also reported in Hong Kong after the two-week quarantine for travelers to the region was lifted and students returned at the end of the school period. Azra Ghani, Professor of Epidemiology of Infectious Diseases at Imperial College, says, “Every country faces exactly the same challenges. We are closely following the situation in China. They have reduced transmission to a very low level and are now starting to open up their society again.
“We’ll see what happens in the coming weeks.”
The Imperial report shows that – ironically – the more successful the attempt to curb the spread of infection is, the more likely it is that there will be a significant second peak later in the year.
Some experts hope that a way out lies in the batter’s immunity. This is when a sufficiently large part of the population has had an infection or has been vaccinated. The disease no longer spreads easily – and essentially dies out. But this, of course, depends on infection leading to lasting immunity, which, as we said, is not yet known.
Prof Neal said if the herd’s immunity theory was correct, “countries like Spain and Italy, which struggled to control their outbreaks, or Sweden and Singapore where shops and bars remained open, could have a lower second wave of infection.”
Despite being one of the hardest-hit areas in the UK, the infection rate in London is currently estimated to be only between two and five percent, he said.
If a second wave comes to the UK – as predicted in late fall – it could be even more catastrophic, coinciding with the annual flu season, which is already putting enormous pressure on the NHS. Many experts say that apart from the herd’s immunity, the only other definitive way out is a vaccine – nor quick fixes.
A possible exit strategy, modeled by Prof. Ferguson and supported by a Harvard study last week, involves turning the restrictions on and off intermittently for two years – or until a vaccine becomes available. The goal would be to manage the demand for health services by having multiple smaller spikes of infection instead of one big one.
The ‘on’ switch would be caused by the number of patients admitted to IC testing positive for Covid-19. Prof. Ferguson’s simulation suggests that if that were more than 200 – four percent of the UK’s capacity before the outbreak – measures for social distance and school closures could be reintroduced.
Dr. Tildesley explains, “It will take time for interventions to take effect, so if left later, peak ICU demand will exceed capacity even with suppression.”
Herd immunity would continue to increase during the periods when lockdowns were eased, so that the infection rate would decrease and longer periods would exist between restrictions. But many are reluctant to impose lockdown strategies intermittently simply because people would have a hard time sticking to them.
Ivo Vlaev, Professor of Behavioral Sciences at Warwick Business School, says, “Intermittent closure is not a good idea. We are creatures of habit and ever-changing guidelines can cause problems. If the government suddenly lifts the current restrictions and we are all free to do what we want, in many ways we will flow back into our old way of life as our ingrained habits will reappear. ‘
A policeman moves a member of the Brighton Beach public on Saturday after ministers urged people to stay home despite the sunny weather
Dr. Harries has already suggested that the government could ease restrictions in stages, according to the Chinese model. “Over time, probably in the next six months, we’ll have a review [every three weeks],’ she said.
“We have to keep that lid on, and then hopefully we can gradually adjust some of the social distance measures and gradually get us back to normal.”
A study of the effects of ending the closure in Wuhan, at the London School of Hygiene and Tropical Medicine, recommended this diversified approach. It was found that reintroducing the workforce in four weeks, then reopening schools, could delay a second infection peak by two months and make management easier. Prof Neal says: ‘I think we will experience a phased relaxation of the measures. That may mean continuing to work from home if you can, reopening pubs and restaurants but keeping tables 15 feet away, like in Singapore, or banning gatherings of more than 20 people, so there’s still some degree of social distance.
Football matches could be played behind closed doors. Schools would most likely not go back until September, which could increase the spread. Universities may need to teach online.
“In the end, we may find that the limitations need to be restored.”
By the time we have a vaccine, we have probably also achieved herd immunity – or close to it, he also suggests.
Covid-19 is distributed in small droplets from the nose and mouth of an infected person. A cough can produce up to 3,000 drops.
Another solution is to lift measures in less affected regions by up to six months at a time, as recommended by the Scientific Pandemic Influenza Group on Modeling. But ultimately, lifting restrictions depends on knowing who is infected.
This could mean testing for antibodies en masse and even issuing “immunity certificates” already used in Germany. However, reliable antibody tests are not yet available: the government said they want to buy 17.5 million “when they are at work.”
But the most likely approach was outlined yesterday by Prof. Ferguson. He said there is “ a lot of work going on ” to see how we could replace some social distance replacement measures with “ less intensive ” ones by the end of May, testing any new cases with a swab and rigorous detection and their test contacts in an attempt to isolate the remaining virus’
He added, “The most important thing is to reduce the number of cases, and then I hope we can move to a regime that won’t be a normal life in a few weeks – let me emphasize that – but that will be some more relaxed in terms of social distance and economy, but more dependent on testing. ‘
To achieve that, the swab tests – currently 12,000 a day – need to be scaled up to 50,000 a day, and technology like mobile phone apps can be used to track people’s contacts if they get infected.
It is not clear what approach the government will take – prof.dr. Ferguson says it is “driven by the data.” And it remains to be seen if any country can really claim that it is right.
Anders Tegnell, the Swedish epidemiologist, said to BBC Newsnight last week, ‘I don’t think anyone can seriously trust that this will be all right since it has never happened before.
Who gets it right? I am not sure if we will ever know, because it seems that most countries are going through the same thing regardless of the measures they take. ‘