Covid#13 - What's the plan?

This weekend started with reasonable concerns about how disciplined people would be as the sun shone, temperatures rose and the Easter holidays began.  There were warnings; if we ignored the social distancing rules that have been imposed, the virus would spread, infections would spike, the NHS would be overwhelmed and more people would die.  It seems that most people have stuck to the rules.  Sure, there have been well-televised exceptions, but here in Cornwall, for example, the car parks have remained empty and beauty spots like Kynance Cove and Lizard Point that would normally be rammed on a sunny weekend like this are completely deserted.

It might get harder the longer it lasts but so far, many of us have adapted surprisingly well to our social isolation.  Perhaps because we daren’t contemplate how long this might actually go on, one thing we’re not thinking much about is how it will end.

There are only two ways this can end and social isolation isn’t one of them.

The first is a vaccine but apparently, even if the testing of a vaccine is expedited, it is likely to be more than a year until one would be widely available.  Maintaining a strict lockdown for that long isn’t practical and the impact on us all individually, socially and economically would be disastrous.

The second is ‘herd immunity’.  This social isolation, however, means that we can not build it; apparently, it requires at least 60% of us to contract coronavirus but in doing so, the numbers of people who would become seriously ill would overwhelm our hospitals and Imperial College models suggested that up to a quarter of a million would die.  In suppressing the virus by ordering this lockdown, the Government’s reaction to that suggestion a couple of weeks ago was rapid; when you’re responsible for life-and-death decisions, a number like that is obviously unacceptable.  It’s not just the elderly and vulnerable who are shielded from the virus now, as was the original plan; we all are.  Consequently, there can be no herd immunity. 

At the earliest opportunity when the curve on that day-to-day graph of new infections firstly flattens and then heads back toward zero, this lockdown will have to be lifted.  The virus will not have gone away, however, and without herd immunity or a vaccine, it will likely resurge and we could find ourselves back in lockdown.  And this could become a pattern: lockdown, release, lockdown, release, lockdown, release.  Crucially, the NHS may just be able to cope with waves of infection controlled in this way, but it’s not an ideal solution. 

The long-term strategy must be to build that herd immunity, which will mean carefully managing the spread of the infection.  There will need to be efficient ways for people to report their symptoms when they fall ill, widespread testing, surveillance and support of those who self-isolate and effective contact tracing to identify others who may have been infected.  In China, one of the advantages authorities had was their everyday culture of surveillance and the access it gave them to data from mobile telephones.  Once a person had symptoms of coronavirus, he was able to use his phone to alert the authorities and a test was then arranged.  Remarkably, they were then able to use data from his phone to identify exactly where he had been and with whom he had been in contact.  This meant that if, for example, he had traveled somewhere by bus, the authorities knew exactly which bus he had been on and who else had been on that bus.  The bus was then taken out of service, the people who had been on it were instructed to self-isolate via their mobile phones, tests were arranged and there was further contact tracing.

In our western liberal democracies, we shudder at the thought of such state-intrusion on our lives.  It flies in the face of our freedom but perhaps in these exceptional circumstances, we need to think differently.  And we already are; understanding that our responsibility to wider society outweighs our individual rights, most of us have readily accepted restrictions on the freedoms we usually take for granted.

If, however, we can’t countenance even temporary Chinese-style surveillance, different means of achieving the same ends will have to be implemented.  Either way, we need to hear more from the Government about its long-term plan.