Physical distancing for 12 months #COVID2019

The behavioural and social interventions implemented by the government over the past couple of weeks will be in place for 12 months, according to this article from the government website – Consensus view on social and behavioural and social interventions. But there may be periods during this time when some restrictions will be partially relaxed for the short-term and then implemented again.

My understanding is they want to spread the load on the NHS rather than prevent infections completely so there’ll be several peaks over the year. Each time restrictions are brought in the virus will peak and then go down until some restrictions are lifted temporarily and rates of transmission will rise again before restrictions again are brought in and we reach another peak. The goal is to match the height of the peak with NHS capacity.

I see three routes out of this cycle.

  1. Vaccine – most reports I have read say we’ll have a vaccine in 12-18 months.
  2. Treatment – we may find other ways to treat the illness using existing drugs.
  3. Antibody test – the antibody test will show us who has had the illness and is now immune. These people can go out and work and generally function normally. Over time this group of people will grow and grow and this combined with 1 will give us herd immunity at which point everything can return to normal.

Let’s imagine, hypothetically, that we don’t want to follow this strategy. Instead, we want to completely wipe out the virus. The experts say this is no longer possible but let’s pretend it is and imagine how we’d do it. Every single person would need to go into isolation for 14 days. That includes all the teachers, supermarket staff, care home staff, politicians, police, even doctors and nurses. We couldn’t put doctors and nurses into isolation because there’d be no one to treat patients in hospitals. Maybe they could all be given hazmat suits instead? But then what about all the patients? The infection would continue to spread through hospitals and care homes – they’d also all need to go into isolation for 14 days. There’d be no food for anyone for 14 days. With all the panic buying going on probably most people have sufficient supplies right now to last for 14 days but many would not and I can imagine great social unrest if people can’t buy food. They say we’re just three square meals away from anarchy. There’s also the question of whether 14 days would be long enough? If a family of 5 is in isolation and one person initially has the virus, they could transmit it to another family member after the first week of isolation. The second member of the family then transmits it to a third member at the end of the second week …. 14 days is not long enough because the daisy chain of transmission can continue and as long as it continues the virus will remain alive. Then there would be people who don’t obey the isolation restrictions. Indeed, there are people now who are not obeying the social restrictions and government models apparently include this in their calculations. For these reasons, a strategy to completely wipe out the virus seems implausible.

There is a third option. The restrictions may cause the transmission to fall to low enough levels for us to have wide-scale testing in place. This could allow us to return to the containment phase where we test everyone, isolate positive cases, then do contact searching. But we’d have to test the entire population to catch the people who are asymptomatic. That would require more than 60 million tests in the UK alone. Our goal currently is to get to 25,000 tests per day. At that rate, it would take 2,400 days to test everyone by which time this will long be over and we’ll all have had the vaccine.