Wednesday, March 3

Coronavirus Latest: To Lockdown or not to lockdown?

- March 13, 2020

As Italy’s number of coronavirus cases soars over 15,000 (at this point in time) with over 1,000 deaths, questions are being raised in the UK as to whether the current national policy is the correct and safe approach.

Many European countries have closed schools, sporting events and mass gatherings; they have imposed travel restrictions and domestic lockdowns. Italy has legislated for all of these. The UK has so far not done any.

The Prime Minister, Boris Johnson flanked by the Chief Medical Officer, Professor Chris Whitty and the Chief Scientific Officer, Sir Patrick Vallance today explained their reasoning for focussing on a “delay” approach to the spread of COVID-19. They reasoned that the UK is approximately 4 weeks behind Italy in experiencing the peak of this epidemic and that many more cases would be expected in 2-3 months time, in the summer months.

The trio explained that a good approach is for the UK to build up herd immunity whilst protecting the most vulnerable such as older people and those with underlying health conditions.

Herd immunity is more often used in relation to vaccination, whereby a high percentage of the population is vaccinated in order to confer immunity on the highest number of people. As the vaccine for coronavirus is still around a year away (following development and clinical trials), then herd immunity in this instance, means allowing people to become infected, and to build up natural immunity to the virus.

For some, this sounds risky, but scientists who are promoting this approach also advise self-isolation for those with symptoms, even mild symptoms, and protection of vulnerable people so that transmission amongst older people for example is minimised.  They hope this approach will mean a large number build up antibodies to the virus, and the most vulnerable are protected from exposure to it.

Due to this approach, it is unlikely for there to be school closures and ‘lockdowns’ of cities or regions in the UK at the present time, and more emphasis on health education around identifying symptoms and encouraging self-isolation where necessary.

We’ve never seen and heard from so many epidemiologists and public health experts and I think it is encouraging to see that there is a huge raft of expertise in the UK. One of the top experts, Professor Peter Piot, is the Director of the London School of Hygiene & Tropical Medicine, who was also one of the scientists who discovered the Ebola virus. Professor Piot says coronavirus is a lot more worrying as it is so infectious, “you can catch this by literally talking to someone” and in some ways “It’s like back to the times of the Spanish flu – however we are better equipped to deal with it. I estimate that by April we will have an effective therapy. Vaccines will take longer.”

There are a number of measures to keep a check on transmission. School foreign trips will be stopped. Another reason for not shutting schools is that children would then likely be looked after by grandparents which could cause more problems. In addition, health service workers with children are needed at work.

There is also difference between nations regarding how to deal with mass gatherings. Nicola Sturgeon has banned events of more than 500 people in Scotland, whereas in England and Wales, the thinking is that small gatherings can be just as infectious and the advice is not to cancel events yet.

The updated guidance asks people to self-isolate at home for 7 days if they have a new and persistent cough and a high temperature (above 37.8C) People do not need to ring 111 unless their condition dramatically worsens. This could delay the number of cases. This guidance is always subject to change so people need to keep abreast of the current national position and advice.

Another aspect of the approach in this country is to bring in measures along the way responding to the changing situation. There is a worry that too stringent measures could mean the virus is suppressed for a short time, and then peak much higher later.

There are so many aspects to this now declared pandemic, such as global travel restrictions, and the difference in testing between and within countries.

The UK’s priority appears to be pacing the epidemic in this country so that the NHS can cope with the numbers and in the meantime, not panicking in the face of new cases. There are 5,000 ventilated beds and the NHS is looking to increase this number. The main treatment is oxygen therapy.

It is reassuring that the government is explaining its approach throughout this process and as it is a developing situation, our responsibility is to heed the advice and look after each other (within a safe distance!)

Angi Mariani

Originator of Immunos Versus Pathos

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