‘Visit elderly relatives before they must isolate’
Ministers warn that older people will soon be told to stay put as social distancing starts
ELDERLY people will be warned to stay at home as the coronavirus crisis worsens, with advice to visit relatives now before “social distancing” policies are introduced.
Next week, ministers are expected to announce that Britain has reached the point where all hope of stopping an epidemic has been lost.
It is feared that the outbreak could follow the pattern seen in other European countries. In France yesterday, where there are 613 confirmed cases and nine people have died, Emmanuel Macron, the president, urged people to limit visits to the elderly.
Italy still has the highest number of infections in Europe, with 4,636 cases. The number of deaths jumped yesterday from 148 to 197. Germany has 534 confirmed cases and Spain, where centres for the elderly in Madrid were closed yesterday, has 374.
As the UK moves into the “delay” phase, efforts will focus on measures to be taken in coming weeks in an attempt to slow its spread. Policies are likely to focus first on protecting the elderly, as the virus has a mortality rate of 15 per cent among the over-80s. It comes as:
The UK saw the greatest jump in cases in a single day, with 164, up from 115 on Thursday. Two deaths have been linked to the virus
The FTSE 100 plunged 3.62 per cent, its biggest fall since August 2015 and the fourth drop of more than 3 per cent in a fortnight. The fall wiped more than £60 billion off the value of Britain’s blue chip companies.
In the US, the government is reportedly considering imposing travel restrictions on cruise passengers, after the Grand Princess became the second ship to suffer a suspected outbreak.
British pensioners are likely to be advised to avoid crowds, and could be asked to stay at home entirely. The Premier League is reportedly considering banning people over the age of 70 from attending matches.
Other measures under consideration include encouraging people to work from home and avoid all but essential travel. Bans on mass gatherings, closures of schools, nightclubs, gyms and pubs could be introduced later, but ministers and health officials remain cautious about taking any such actions.
Health officials are concerned that policies relating to the elderly must be handled carefully, to ensure that vulnerable pensioners do not end up neglected and isolated for long periods.
Last night, Government sources suggested that families should visit elderly relatives now to make sure they were prepared for such an eventuality.
Mothering Sunday falls in two weeks’ time, when many people will be planning to visit their elderly mothers.
New Department of Health guidance urges every household to consider who could deliver food, in the event that they are encouraged to self-isolate.
Amanda Solloway, the new science minister, warned that elderly people could be left feeling lonely and “cut off ”, and urged friends and neighbours to stay in contact.
Prof Chris Whitty, the chief medical officer for England, said there would probably come a moment when the elderly will be urged to avoid crowded areas and stay at home, but that point had not yet been reached.
WHAT stage are we at, contain or delay? How do I self-isolate? Is it the same as social distancing? Why are things different in France and Italy? And what about my gran? Confusion is growing over the Government’s “contain, delay, research and mitigate strategy”. For some, it’s provoking anxiety and in others, complacency is setting in. The problem is fuelled by its title.
It mixes goals with actions and encourages the idea that its components must follow one another in strict sequence: containment – delay – research – mitigate.
The No10 press team may have thought the sound-bitey title would appeal to a British sense of orderliness, but it’s a poor shorthand for the real deal. Even Prof Chris Whitty, the Chief Medical Officer and a man who knows an objective from an action, is struggling: “We are now, basically, mainly in delay, but we are maintaining some elements of contain; we are mainly in the second stage at this point,” he told MPS yesterday.
The strategy we are following comes from the European Centre for Disease Prevention and Control (ECDC), the EU’S main public health body. An edited outline of the plan is given above. Its timeline is defined not by objectives, but by the likely progress of an outbreak in five scenarios (zero to four) as it moves across Europe.
At one end of the continuum is “scenario 0”, a country such as Bulgaria with no recorded cases. At the other end is “scenario 4”, a country such as Italy with widespread infection.
At each stage in the timeline, the principal objective a government should be pursuing is given – containment, delay, etc. Below are the practical measures it should be taking to achieve that – contact tracing, hand washing messages, school closures.
Laying out a response strategy like this has benefits. It drives home that a disease outbreak is not a static thing but one that develops. Questions about differing national responses start to fade, because it becomes apparent they are at different points on the epidemic curve but following common guidelines.
Crucially, it becomes obvious that things like containment, delay and research will be happening simultaneously much of the time.
The UK sits at or about scenario 2 on the ECDC document, with cases that have been imported and some local human-to-human transmission. The main goal is contain and delay and all measures recommended for this phase have been implemented.
Next stop will be scenario 3, roughly where France, Spain and Germany sit now. This is when localised outbreaks start to merge and sustained humanto-human transmission takes grip, putting pressure on the health service.
A range of “mitigation” measures including the cancellation of mass gatherings, such as sports events and
‘We are now basically mainly in delay, but we are maintaining some elements of contain; we are mainly in the second stage at this point’
concerts, will be considered. France has placed a ban on gatherings of more than 5,000 people, for example.
It is still not certain that we will move to the next phase, although it remains probable. The UK response has so far been strong and it may yet prove possible to contain the virus.
Ian Jones, a virologist at the University of Reading, said: “I think we’re doing relatively well, I think those that have been diagnosed positive seem to have been diagnosed quickly, which minimises their chances of spreading it and also maximises treatment possibility.
“Having said that, I think it is probably true that the number [of cases] will continue to grow over the next month to six weeks.”
Prof Jones said there was also a degree of luck involved. “It depends on the density of the population and frequency of travel within that population. If someone is in the middle of Cornwall in a farmhouse not going anywhere, they won’t catch it or
spread it. That’s obviously a very different scenario compared with someone in central Manchester.” Others said the key to understanding the Government’s strategy was to regard it as “flexible”. In different phases, actions may remain the same but be re-emphasised.
If a pocket of the country remained virus-free it would be sensible to put in place containment measures there, even if the disease was widespread elsewhere and mitigation measures were dominant. The need for research will be a constant throughout.
“I think it’s a strategy based on the evidence here in the UK and in my view it’s one that should be as modified as risk assessments tell,” said David Heymann, an epidemiologist and former assistant director general of the WHO.
There is also some confusion about what has become known as “self isolation” or “voluntary quarantine”. “Do you lock yourself in the loo and avoid all people, or do you remain in
the house but don’t go out? To what extent are you isolated alone or with other people? This is something that has to be judged on a case-by-case basis,” said Prof Jones.
If the outbreak progresses to stage three or four in the UK on the scale, the major pinch point will be a squeeze on NHS services. Although the UK ranks number two in the world for pandemic preparedness, our underfunded health system is a weak point. Other issues include high levels of urbanisation and the age profile of the population.
Jonathan Ball, professor of virology at the University of Nottingham, said that the success of self isolation was a necessary risk: “There’s just not the capacity in hospitals and there’s no medical or clinical reason to keep someone with something that is essentially a cold in hospital.
“But the patients really do need to adhere to not wandering around the community if we’re going to continue to slow this virus down.”
‘Someone in the middle of Cornwall in a farmhouse not going anywhere won’t catch it – a very different scenario to someone in central Manchester’