Avoiding the 3Cs: closed spaces, crowded places and close contact
We have the virus on the ropes. It will fight back, but if we keep pummelling, we will beat it, writes Prof Luke O’Neill
NO deaths were reported for Covid19 last Monday. A milestone has been reached. The planned loosening of the lockdown will continue, broadly following the Government’s roadmap. Aspects might even be pushed forward. We just have to keep an eye on the numbers.
Once most of us are back out in the community, cases will rise again. That is the experience from other pandemics. It’s highly likely there are pockets of virus out there, lurking somewhere, and the vast majority of us are not immune.
WHAT WILL WE DO WHEN THE NUMBERS START TO GO UP AGAIN?
We need to ensure they don’t, as it’s the only way to be guaranteed there won’t be another lockdown.
WHAT DO WE NEED TO ENSURE THEY DON’T?
Luckily, we can be guided by science. We’ve learnt an awful lot about Covid-19. We needn’t worry too much about children as sources of infection. They aren’t major spreaders of Covid-19. Family clusters rarely start with children. If infected, the vast majority of children have a mild disease that may even be symptom-free.
WHAT DOES THIS KNOWLEDGE ABOUT CHILDREN MEAN FOR THE NEXT PHASE?
There is no justification for keeping schools closed. We can watch what happens in countries where schools have reopened, but the prediction is that schools will not contribute to an increase in spread. It’s sensible though in this next phase to maintain social distancing in schools, and observe all the hygiene rules, just in case. This may present difficulties, and parents may worry about sending their children back to school, so it will probably have to be optional initially. But keeping schools closed is not justified on health grounds, and may harm children who can’t be schooled at home and who want to be with their friends. And closing them again if numbers climb is not justified.
We also know a lot more about the kinds of places where people pick up the infection. It turns out that 80pc of cases of Covid-19 are caused by 20pc of infected people. Most infected people infect no one. Why is this the case?
Some people may be super-spreaders. They may release more virus than others, for reasons unknown. More importantly, however, is where people become infected. This turns out to be indoor places where large crowds gather for prolonged periods of time, and where there is a lot of close contact and also talking or shouting or singing. If you’re infected and don’t go to those places, you are much less likely to infect anyone. And who would have thought of all occupations, that working in a meat factory would be dangerous? This is because they are loud places, so people shout, in close proximity. They are also cold and this virus likes the cold (although it can live in the warmth as well, so won’t be going away in the summer because it’s warmer). The workers often live together in cramped conditions, promoting even more spread.
Zumba classes but not Pilates have also been shown to be dangerous, the reason being that Zumba is more intense. A study in a restaurant revealed that multiple infections happened from a single person because of proximity to others and poor ventilation. A fascinating study on buses revealed that in a bus where air was recirculated, one person infected many, whereas in a bus with better air circulation, one infected person infected very few.
Being on the wrong bus increased your chances of being infected 40-fold. A study on conferences revealed that being in a stuffy conference room with someone who was infected gave you a 50/50 chance of becoming infected, which is high risk. What all this means is businesses that aren’t crowded with people (and who can maintain social distancing), and where there isn’t much noise, and which have good ventilation, should be safe.
Sadly, pubs and restaurants present a challenge unless they can operate outdoors, or have adequate social distancing and ventilation. Businesses which involve closer contact (for example, hairdressers) can operate if masks are worn, good hygiene is practised (especially handwashing), there is space between customers and the length of time people spend together is as short as possible.
If a business can be run outside, all the better. This is because studies have shown that simply being outside reduces the risk of infection 19 fold. This is a substantial reduction in risk. The reason for it is the virus is diluted outdoors and a breeze blows the aerosols away. Religious ceremonies should move outdoors.
Masks are another weapon to use with all the other things that must be continued. This is akin to having a seatbelt and an airbag in your car. Guess who invented that? The Swedes. Why need both? Because having both decreases risk of fatalities in road accidents more than just having one of these. The same goes for combining mask wearing with all the other measures we are following.
WHAT ABOUT AIR TRAVEL?
Planes have not been shown to be sites of super-spreading events. This is good. It might, however, be because fewer people travelled once the pandemic began. Or it might be because most flights are relatively short.
Or it might be because we haven’t found evidence for it. If careful studies show that aeroplanes aren’t major sites of infection, then it’s likely to be safe to restart them. Again, wearing a mask will be essential.
The best solution however is to test people before they even enter the airport, and then many worries about travel go away. This depends on a rapid enough test, however. Emirates in Dubai is claiming to have a 10-minute blood test. The jury has to be still out, however, on whether the days of planes full to capacity can return in the immediate future.
Japan has led the way in defining where risks are. They call them the 3 Cs: Closed Spaces, Crowded Places and Close Contact. Having all three is especially dangerous. Health experts in Japan have said avoiding these settings “has been the most important component” of their health strategy. Bars and restaurants didn’t close in Japan, although fewer people went into them.
Mask wearing is ubiquitous. Japan is substantially back to normal. It pushed its relaxation of the state of emergency it had declared from May 31 back to May 4. In June it will allow sporting events to restart (although without spectators) and will allow gatherings of
100 people for concerts and cultural events, with a stepwise increase to 50pc capacity.
The only effective way to mitigate against the 3 Cs is to have fewer people in a given space, which should be as big as possible or even better, outdoors, with masks an important shield.
If we keep all of this in mind, and issue the right instructions, we won’t have to go back into full lockdown, because there will be less spread of the virus and it will be containable. We need to have in place comprehensive testing, tracing and isolating procedures, and as good a healthcare system as possible to look after those who get infected and develop severe disease. If numbers climb, businesses or venues that can mitigate against crowds and ensure ventilation can stay open, as can schools.
The real risk will come in the autumn when we are mainly back indoors, and the flu season begins, because that will put pressure on our health service. If we don’t adopt all of these measures, the rate of infection will climb to unacceptable levels, which will mean another lockdown. I am optimistic that this will not be the case. We just need to buy time over the next few months, ahead of the medical advances that will surely come. We have the virus on the ropes. It will fight back, but if we keep pummelling, we will beat it.
‘The risk comes when we are mainly back indoors’