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DR ELLIE CANNON: Why aren’t we shutting schools and what do they mean by social distancing?

Over the past few days, I’ve heard time and again that ‘we are not doing enough’ to protect the nation from the threat of Covid-19. I want to say, hand on heart, that this isn’t true. Quite the opposite, in fact.

As a GP who cares passionately about the health of my patients, but also as someone with my own family and friends, I understand why people are so concerned. The virus is well and truly out there and among us.

Experts estimate that 10,000 people are now likely to have Covid-19, and we know that it passes rapidly from person to person.

As the Prime Minister himself said on Thursday, many families will lose loved ones. And this is the painful truth behind so much of the worry.

Boris Johnson washes his hands during a visit to the Mologic Laboratory in the Bedford technology Park, north of London on Friday, March 6

But UK health chiefs have issued a clear set of guidelines based on the best scientific evidence available.

From now on, anyone who develops a persistent cough or temperature over 37.8C should stay at home and self-isolate for seven days.

After this time, if things have not improved, patients should seek medical help – for more details, see below.

Although other countries are closing their borders, we have no blanket ban on foreign travel and schools are still open, although school trips are prohibited and people over the age of 75 have been told not to go on cruises.

From next week, mass gatherings and sports evens will be banned – meaning key summer events like the Wimbledon tennis championships, Glastonbury Festival and Royal Ascot might not happen.

Many, including some in the medical community, feel this isn’t enough, and our ‘keep calm and carry on’ approach won’t be adequate. Some have gone as far as to say we are the subjects of an ‘uncontrolled experiment’, and that no one knows whether the pandemic planning will work.

Having studied the evidence, I disagree. And here, I will try to explain why – as well as answer the questions you have been asking.

Why banning foreigners won’t work 

Why aren’t all visitors arriving from Europe being temperature-tested for Covid-19 before being allowed in? Shouldn’t we close our borders?

We know, after the SARS outbreak in 2003, that airport testing is not helpful – in fact, it was proven to be pointless.

People who are infected may not show symptoms right away, or at all, so it is unlikely that this kind of screening will catch every case of Covid-19.

If someone who has Covid-19 doesn’t have a high temperature, it won’t work.

With up to 10,000 Britons estimated to be infected already, the vast majority of cases will be contracted within the community from now on.

Other countries are shutting schools, banning travel and telling everyone to stay indoors. Why aren’t we doing the same?

Our Government is following the advice of teams of medical and science experts who have spent decades studying the way diseases like this spread.

And they do not yet feel that closing schools and introducing a blanket travel ban are necessary.

Likewise, they are not enforcing a ‘lockdown’, where large swathes of the population are told not to go out.

We are, it has been said, at the start of what could be a 12-week outbreak. These measures may be needed: health chiefs have already indicated that it’s likely the elderly and vulnerable, due to existing health problems, will be advised to stay at home in the coming weeks.

And whole households could be ordered to self-isolate if a single person has symptoms – this could happen in areas where there are spikes in the number of cases.

But should such measures be introduced too early, they are less likely to work when they are needed. For any medical intervention to work, it must be tolerable and not cause too much disruption to life.

A lockdown would be extreme, and the longer such measures go on, the less likely people are to actually stick to the rules.

We have to take this measured response so that we can all cope with what is going to be a long and difficult few months.

So what is the Government waiting for before taking these more drastic measures?

They will, undoubtedly, be watching closely to see how rapidly the virus spreads – testing some 10,000 people every day, those with the most severe, and clear Covid-19 symptoms. Depending on how things develop, further measures will be introduced.

We are currently seeing a much more gradual increase in numbers and these are distributed throughout the UK – unlike the situation in Italy, for instance, where most cases were concentrated in a single region. That’s what led to the lockdown there. This may not happen in Britain, so we may never see similar action taken here.

Prime Minister Boris Johnson speaks during a news conference inside 10 Downing Street in London last week

Prime Minister Boris Johnson speaks during a news conference inside 10 Downing Street in London last week

What is social distancing, and how does it differ from self-isolating?

Social distancing involves taking steps to reduce our chances of catching Covid-19, and of it spreading quickly in communities. It means reducing your general contact with other people.

The important word here is reducing, not stopping completely. It may mean stopping shaking hands, keeping meetings small (some companies are advising against five or more people getting together), or avoiding non-essential public transport journeys, or not going to the gym, theatre or cinema, where lots of people are packed in close proximity.

The Government banning large gatherings, such as sports events and concerts is another form of enforced social distancing.

The coronavirus that causes Covid-19 can spread if a person who has the infection is in close, sustained contact with someone who is not infected. According to Public Health England, this could mean being within a couple of yards of an infected person for 15 minutes – easy to do in the course of a face-to-face conversation.

Reducing the numbers of contacts we have in a day slows down the spread of the virus.

Self-isolating is what people must do when they have symptoms or test positive. This means completely stopping any – or as much as possible – contact by staying at home, away from those you live with. For more detailed information, both nhs.uk and Public Health England (gov.uk) have really detailed, medically sound advice.

Is bumping elbows any safer than handshakes?

People say we should bump elbows instead of shaking hands or kissing people to greet them. Is that enough? How far away do I need to keep from people in order to avoid getting Covid-19?

The advice to avoid shaking hands is aimed at preventing the possibility of spreading the infection. If you touch a contaminated surface and then touch your face, your eyes or your nose, you can become infected. Shaking hands runs the risk of spreading the infection between people.

Dutch Prime Minister Mark Rutte (R) gives Dutch Minister for Medical Care Bruno Bruins an elbow greeting in order to prevent the spread of the novel coronavirus during the weekly Question Time in the Lower House in The Hague last week

Dutch Prime Minister Mark Rutte (R) gives Dutch Minister for Medical Care Bruno Bruins an elbow greeting in order to prevent the spread of the novel coronavirus during the weekly Question Time in the Lower House in The Hague last week

Some experts suggest bumping elbows might not be that much safer. Officially, ‘close contact’ means being within 6ft of another person for 15 minutes or more.

Remember, this is about reducing your risks.

There are some people such as your children, your partner and your family you will be in close contact with, and that is fine if you are all well.

The idea is to limit other contacts to reduce the spread.

Along with hand-washing and cleaning surfaces, this is our best defence in slowing down the spread of the pandemic as well as our own chances of developing symptoms.

What are the ‘hotspots’ I should avoid if I want to start social distancing for myself?

The coronavirus that causes Covid-19 – called SARS-CoV-2 – is thought to be transmitted by droplets emitted in coughs, sneezes and possibly breath.

But close contact isn’t the only route to infection.

Surfaces can be contaminated by falling droplets – for example, if someone sneezes in a crowded train carriage, or coughs into their hand then touches a pole or handrail. The virus can survive for days on surfaces.

This is why it’s so important to cover your mouth and nose with a tissue when you cough or sneeze, then throw away the tissue.

If you don’t have a tissue, cough or sneeze into the crook of your elbow rather than into your hand.

This is why handwashing is key.

Wash your hands after using the loo and before eating, of course, and also after blowing your nose or sneezing. Do it after passing through a public space and after caring for a sick person.

Wash the hands for 20 seconds with soap and water, or use a hand sanitiser containing 60 per cent or more alcohol.

How long should I social distance for? When will it be safe to stop?

We don’t yet know. It isn’t clear at this stage how long the measures will need to be in place to be effective – or indeed how to judge if they are working.

Social distancing will probably have a short-term impact. But all the indications are that this will be a long outbreak.

The UK’s chief medical adviser, Professor Chris Whitty, has warned that the epidemic is likely to be ‘a marathon not a sprint’.

Will the Government’s plan mean fewer people will die?

It is too soon to be able to say for certain. But social distancing was used with success during the recent ebola outbreak in West Africa, for example.

You might have heard the term ‘flatten the curve’. The actions we are advising now should, if people stick to them, help to avoid a sharp peak of cases in a very short space of time.

Instead, there will be a steadier rise in cases spread over months – this will allow the healthcare system to cope better, and not get overwhelmed with severe cases.

We have seen the tragic consequences of a sharp rise in cases in Italy, and the plan put in place here is designed to avoid an outcome like this.

This is why it is so crucial that we all play our part, and follow current government guidance.

I have read some horrible stories on Facebook about people very sick with Covid-19, and that the Government isn’t telling us everything. Should I take my children out of school just to be on the safe side?

I know it’s hard not to get swept up by panic and anxiety. But the fact is it will not help the situation.

NHS guidance is based on the best information and expert advice, which can’t be said for conspiracy theories on social media.

The current NHS guidance says schools should remain open. Children are the least likely group to have the infection and certainly the least likely to get seriously ill from it.

The current NHS guidance says schools should remain open (file image). Children are the least likely group to have the infection

The current NHS guidance says schools should remain open (file image). Children are the least likely group to have the infection

The decision to keep schools running is sound: studies of previous pandemics show that school closures slow rates of infection down for a few weeks, but then there is a significant increase – higher than expected.

Parents start having to go back to work. Groups of children end up being looked after by one parent, who won’t be able to properly supervise hygiene.

And infection rates rocket, which is what officials were trying to avoid in the first place.

Should I self-isolate if I just get a cold?

Official guidance is that anyone with a temperature or persistent cough should stay at home for seven days.

But some patients with Covid-19 do seem to suffer a standard cold-like illness with a runny, or blocked nose, and sneezing.

So if you do feel unwell, with any of these symptoms, you should stay at home for seven days to see how things develop.

Try to self-isolate. Please do not go to a GP, pharmacy or hospital.

You do not need to call NHS 111 or your GP. You will be able to manage at home, just as if you had flu – and you will not be tested. After seven days, if your symptoms persist, then log on to 111.nhs.uk.

Only call NHS 111 if you cannot access the internet. At this stage, you may receive medical help and be tested for Covid-19.

If  I’m self-isolating with a cold, does everyone I live with also have to? If they don’t, is it pointless for me to?

It is true that there is a high risk of the virus spreading among people who live together.

Soon, whole households may be advised to self-quarantine if just one family member becomes ill.

But the current advice is that if someone is staying at home with a fever and cough, they should limit contact with the rest of the household as much as possible.

This may be enough to slow the spread of Covid-19.

It means the person who is unwell needs to stay in a separate, well-ventilated room, not share utensils, crockery or towels, and use a separate bathroom if possible, or have a bathroom rota.

If you’re self-isolating and you share a bathroom with others, make sure you use it last and clean the bathroom thoroughly afterwards.

I am avoiding shaking hands, I’ve quit the gym and sold all my upcoming theatre tickets. I’m washing my hands endlessly. But I still have to get public transport every day. Are my attempts to socially distance pointless?

No, it’s not pointless. This is about risk-reduction. None of us can reduce our risk to zero – but everything you do will help bring it down a bit.

With self-isolation, do I have to be perfect? What if I need to go to the shops to get some loo roll? Is it all or nothing?

Self-isolating is about reducing the chances of you passing the virus on to someone else.

So yes, it means not even popping to the shops to get toilet roll.

The virus can live on surfaces for several days, so even if you don’t come into contact with someone, things you touch – and leave the virus on – might.

If we have to self-isolate. it must be done as perfectly as possible if it is to be effective in protecting those around us and wider society.

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