The coronavirus epidemic in Britain is expected to peak in just over two weeks before a steady decline in deaths. But will that mean the end of social estrangement, or could we face a deadlock until the end of the year?
Yesterday, it was reported that one of the government’s key advisers said that mass testing and contact tracing would “almost certainly” replace the current restrictions once the numbers drop significantly.
Here we explain how it could work, alongside the other most likely scenarios:
1. Intermittent social distancing
All of the scenarios involve waiting until the virus reaches its peak and the number of deaths has started to drop dramatically before taking action.
If our calendar reflects China, the government may be able to consider lifting the restrictions by early summer.
Under the first strategy, some social distancing and foreclosure measures would continue for much of the year, but there would be breaks in which life would return to normal.
For example, social distancing could be alternated on a regional basis to allow people to rest from draconian restrictions.
The Pandemic Influenza Scientific Group on Modeling, which feeds the Scientific Advisory Group on Emergencies (Sage), has proposed that parts of the country be given more freedom for six months at a time, before return to locking.
Several apps have recently gone online that track symptoms across the country, which could give public health officials an idea of where the hotspots are, so they can be locked early. The lock could also be restored as we head into the winter months and the NHS is under increased pressure.
Paul Hunter, professor of medicine at the University of East Anglia, said: “Personally, I suspect the disease will stop in June and July, partly because of social estrangement, partly because of immunity increased population (herd), and in part because these types of infections tend to spread less easily during the summer.
“So I guess there will be some relaxation at that point. But I think it could come back, albeit less aggressively, in the fall, and social isolation may need to be reinforced for a while. “
A piecemeal regional lock would give the NHS a series of breaks, allowing it to increase capacity and then take advantage of quieter periods.
And that would allow time to create a vaccine or treatment and slowly build up immunity in the population.
Mark Woolhouse, a professor of epidemiology of infectious diseases at the University of Edinburgh, said: “It is almost certain that this will be a partial release. Whatever measures are relaxed, this risks rolling back the epidemic curve.
“Extending the lockout saves you more time to increase the capacity of the NHS. It would not solve the epidemic problems, and you would need to be in another lockdown eventually – but it would give us more time. “
2. Allow healthy and immune people
Protecting the vulnerable and allowing healthy and immune people to continue living and returning to work could be a way out of the impasse and allowing large parts of society to return to normal.
The government has promised that antibody tests – which show if someone has had the virus and are now immune – will be available in a few weeks, and the British may soon be issued “certificates of immunity” that would allow them to leave isolation.
In the coming weeks, public health experts are also expected to launch community surveillance to find out how many people have had the virus, which could end the need for a lockdown.
Professor Hunter added: “If a large proportion – somewhere around 60 percent – of the population becomes immune, the lockdown will not serve much more because herd immunity will be at a level that the disease will struggle to propagate. So locking over.
“One thing that can happen is that people who can prove they have the infection and are now immune can have more access to work, etc.
“If social distancing worked and the NHS survived at that time, we will likely see a much smaller proportion of the immune population. The risk of relaxing too early is that you will then get a second peak. “
“However, subsequent peaks will generally be less dramatic and potentially easier to manage. “
In this scenario, the government could also schedule weekly tests for those most at risk from the spread of the disease, such as doctors, nurses, supermarkets, and delivery people.
Professor Woolhouse said, “We could change course slightly. Much emphasis is currently placed on reducing transmission in the community, but if the shielding of vulnerable people could be improved, including very rigorous testing with isolated infected people, it would save lives.
“It will also reduce the burden on the NHS and also allow the rest of us to be freed from some of the measures. “
Germany, which performs hundreds of thousands of tests, plans to issue certificates to citizens.
Professor Karol Sikora, Dean of Medicine at the University of Buckingham, said: “Germany has been tested on the spot.
“They plan to test hundreds of thousands of people for the presence of antibodies and issue” immunity certificates “to those who test positive, allowing their work to be exempt from the lockdown. This information will be a huge weapon against the virus. ”
3. Search and destroy
This strategy involves waiting for the virus to be at a very low level, lifting the restrictions and combating the remaining cases through aggressive contact tracing, testing, isolation and precision quarantine zones.
The method has been successfully adopted in Singapore and South Korea, which have fared better than most other countries, and have done so without major lock-in.
Jeremy Hunt, the former health secretary and chairman of the select health committee, said such a strategy could save months of “economic and economic distress”.
“If you look at what’s going on in South Korea and Singapore, they have managed to keep their offices, shops, restaurants open, but they do it by having a mass test program so that anyone with symptoms is tested , everyone came in contact with is tested, and you can keep the upper hand on the virus.
“So when we are going through this ordeal and we want to avoid this kind of lockdown again and keep the economy running, mass testing is the way to do it. “
Hunt said Britain is in the enviable position of being able to examine the policies of other countries to see what works, and said government modelers are closely monitoring Wuhan, the Chinese city where the global pandemic has started to see if the virus comes back after the restrictions on social distancing have been lifted.
Professor Woolhouse added: “The third strategy is basically to extend the lockdown until the numbers are very low and try to carry out a” search and destroy mission “where you try to track down each case, by thoroughly testing and isolating infected people. But you can only do this if the numbers are not that high. ”
Dr. Marc Lipsitch, director and professor of epidemiology at Harvard University, published an article last week suggesting that once the tests are scaled up on a larger scale, the restrictions could be reduced.
“If the number of cases is really low enough, you can adopt a strategy closer to Singapore to follow up on individual cases rather than just distancing yourself from society,” he said.
“Aggressive contact tracing and quarantine – impractical now in many places but more practical once the number of cases has been reduced and testing intensified – could reduce the need for strict social distancing to maintain the control of the epidemic. “
A new open source application from the Massachusetts Institute of Technology called Private Kit: Safe Paths alerts users if someone they have been in close contact with has been tested positive so they can self-isolate. Some countries use video surveillance to locate infected people nearby so that they can be found.
4. Wait for the vaccine or treatment
The last option is to wait until a vaccine or treatment is available, and then strengthen collective immunity. Many scientists believe that this is the only long-term solution to bring life back to normal.
Earlier this month, Professor Neil Ferguson, the government’s key epidemiologist, said, “The only way out of this long term is vaccination or some other kind of innovative technology. “
Scientists have predicted that the first vaccines will not be available before the end of the year at the earliest, and even then they will be reserved for frontline workers and the most vulnerable at first.
Treatments could be faster, with dozens of trials underway to see if antivirals already used for other conditions, such as malaria and HIV, could work. Plasma from the blood of recovered victims could also be injected into patients.
If an effective remedy becomes available in the weeks or months to come, the lock will be lifted much sooner.
Professor Hunter added, “In the fall, we may have effective drug treatments that, if taken early enough, could reduce the severity of the disease and reduce the need for hospitalization, intensive care beds and ventilatory support.
“If this is the case, it would also be a reason to relax social distance. “