The best ways to bring us out of the lockdown
Government faces several options of how to ease society back to normality
BRITAIN’S coronavirus epidemic is expected to peak in about three weeks before a steady decline in deaths. But will that mean an end to social distancing or could we be facing a lockdown until the end of the year? Here are the most likely scenarios:
Partial social distancing
All scenarios involve waiting until the virus has peaked and numbers of deaths have started to fall dramatically before any action is taken. If our timeline mirrors China’s, then the Government could be in a position to consider lifting restrictions by early summer.
Under the first strategy, some social distancing and lockdown measures would continue throughout much of the year but there would be breaks in which life would get back to normal.
For example, social distancing could be alternated on a regional basis to give people a rest from restrictions.
The Scientific Pandemic Influenza Group on Modelling, which feeds into the Scientific Advisory Group for Emergencies (Sage), has proposed that parts of the country could enjoy greater freedoms for six months at a time, before returning to lockdown.
Several apps have recently come online tracking symptoms throughout the country which could give public health officials an idea about where hotspots are, so they could be locked down early.
Lockdown may also be re-established as we move towards the winter months and the NHS finds itself under increased pressure again.
Paul Hunter, professor of medicine at the University of East Anglia, said: “I suspect that the disease will tail off during June and July partly because of social distancing, partly because of increased population immunity and partly because these sorts of infections tend to spread less readily during the summer.
“So I suspect there will be some relaxation at that time. But I think it may come back through less aggressively in the autumn and social isolation may need to be strengthened for a while.”
A fragmented, regional lockdown would give the NHS a series of breaks allowing it to ramp up capacity and then enjoy quieter periods. It would also give longer for a vaccine or treatment to be created and allow immunity in the population to build up slowly.
Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, said: “It’s almost certain to be a partial release. Whatever measures are relaxed, it runs the risk that the epidemic curve will start to increase again.
“Extending the lockdown buys you more time to raise the capacity in the
NHS. That wouldn’t solve the epidemic problems… but it would give us longer.”
Let immune people out
Shielding the vulnerable and allowing the healthy or immune out to carry on with their lives and get back to work could be a way to break the deadlock.
The Government has promised that antibody tests – which show whether someone has had the virus and is now immune – will be available within weeks and Britons could soon be issued immunity certificates that would allow them to leave lockdown.
In the coming weeks, public health experts are also due to start community surveillance to find out how many people have had the infection.
Prof Hunter added: “If a large proportion, around 60 per cent, of the population become immune then the lockdown will not serve that much more purpose as herd immunity will be at a level that the disease would struggle to spread. So, lockdown over.
“One thing that may happen is that people who can prove that they had the infection and are now immune may be allowed more access to work. If social distancing has worked and the NHS has survived, then we are likely to see a much smaller proportion of the population being immune. The risk of relaxing too early is that you then get a second peak.
“However, subsequent peaks will usually be less dramatic and potentially more manageable.”
Under such a scenario, the Government could bring in weekly testing for people most at risk of spreading the disease, such as doctors, nurses, supermarket workers and delivery staff.
Prof Woolhouse said: “We could change tack slightly. At the moment, the emphasis is very much on reducing transmission in the community, but if shielding the vulnerable could be enhanced including very rigorous testing with infected persons being isolated then that will save lives.
“It will reduce the burden on the
NHS and it will also allow the rest of us to be released from some of the measures.”
Prof Karol Sikora, dean of medicine at the University of Buckingham, said: “Germany has got testing spot on. They plan to test hundreds of thousands for the presence of the antibodies and issue immunity certificates to those who test positive, allowing their workers to be exempt from the lockdown.”
Seek and destroy
The third strategy involves waiting until the virus is at a very low level, lifting restrictions and combating the remaining disease through aggressive contacttracing, testing, isolation precision and quarantine zones.
The method has been adopted successfully in Singapore and South Korea, which have coped far better than most other countries, and have done so without major lockdowns.
Yesterday, Jeremy Hunt, the chairman of the health select committee, said such a strategy could save months of “anguish and economic strife”.
“If you look at what’s happening in South Korea and Singapore, they’ve
‘Whatever measures are relaxed, it runs the risk that the epidemic curve will start to increase again’
‘When we get through this and want to avoid these kinds of lockdowns, then mass testing is the way to go’
managed to keep their offices, shops and restaurants open, but they do that by having a mass programme of testing so anyone with symptoms is tested, everyone they’ve come into contact with is tested, and you can keep on top of the virus,” he said.
“So when we get through this and we want to avoid these kinds of lockdowns again, and keep the economy going, then mass testing is the way to do it,” he added.
Mr Hunt said Britain was in the enviable position of being able to look at the policies of other countries to see what was working, and said government modellers were keeping a close eye on Wuhan, to see if the virus would reemerge after restrictions are lifted.
Prof Woolhouse added: “The third strategy is essentially to extend the lockdown until numbers are very low indeed and try to implement a ‘seek and destroy mission’, where you try to track down every single case, testing very extensively and isolating those infected.
“But you can only do that if the numbers are not that high.”
Dr Marc Lipsitch, an epidemiologist at Harvard University, suggested that once testing is massively scaled up then restrictions could be lessened.
“If the case numbers are low enough, you can do a more Singapore-like strategy of following individual cases rather than just social distancing,” he said.
“Aggressive contact-tracing and quarantine could alleviate the need for stringent social distancing to maintain control of the epidemic.”
Wait for a vaccine
The final option is to wait until a vaccine or treatment is available and then build herd immunity. Many scientists think that is the only long-term solution.
“The only exit strategy from this longterm is vaccination or some other kind of innovative technology,” said Prof Neil Ferguson of Imperial College London.
Scientists predict that the first vaccines will not be available until the end of the year, and would be reserved for front-line workers and the vulnerable. Treatments could be quicker, with dozens of trials under way to see if antivirals used for other conditions such as malaria and HIV could prove effective. Plasma from the blood of recovered victims could also be injected into patients.
If a cure becomes available in the coming months then lockdown will be lifted far sooner.
Prof Hunter added: “By autumn, we may have some proven effective treatments that if taken early enough could reduce the severity of illness and need for hospitalisation, critical care beds and ventilatory support.
“That would also be a reason for relaxing social distancing.”