It is a crisis many have long feared, and even grimly predicted – but, perhaps, secretly hoped or never quite believed would happen. Not here. Not to us. And yet, here we are. The coronavirus pandemic is surging towards a peak in Britain. Deaths this weekend passed 700 a day– and life has come to a standstill, with our own, and the world’s, biggest economies on a knife edge.
In the midst of this, deputy chief medical officer Jenny Harries dispatched a chilling warning – that life may not return to normal for at least six months.
For the moment, at least, there appears to be no exit strategy, no clear way out. There are no drugs proven to work; no vaccine for at least another 18 months which could protect us. World-leading experts advising the Government are clear: as soon as the lockdown is lifted, infection rates will – not could, will – begin to rise again. ‘We must not suddenly revert to our normal way of living,’ Dr Harries told the nation, in the starkest possible terms. ‘That would be quite dangerous.’
Brits have been told to stay at home as part of social distancing measures for nearly two weeks – but how much longer will it go on for?
Dangerous means more lives lost. But the prospect of a lengthy lockdown, with no end in sight, is – to put it mildly – uncomfortable to imagine.
Businesses decimated. Thousands of jobs lost. A recession that would make The Great Depression look like a dress rehearsal.
Yet there have been glimmers of hope – ‘green shoots’, as they have been described – which suggest the rate of infections is starting to slow.
It means that, although the peak of the UK’s crisis is another week or two away, the Government’s social distancing strategy is beginning to take effect.
A study by the London School of Hygiene and Tropical Medicine suggests the average number of daily contacts – how many people each of us comes into close contact with on any given day – has reduced from 2.6 to 0.62 since the lockdown. This means, in theory, the virus has nowhere left to go: if none of us are passing it on, no one new will be infected.
Not that this means the lockdown restrictions can be lifted yet – far from it.
Robert Jenrick, housing and communities secretary, has cautioned that ‘nobody’s pretending this will be over in a few weeks’. The BBC announced on Friday that it will be screening a new swathe of educational programmes for 14 weeks from 20 April – the surest sign yet that schools are not expected to return until at least after the summer holidays.
The lockdown is working, say experts – but due to the nature of the virus we won’t see the full benefit immediately. This weekend is key. One of the country’s top epidemiologists Prof Neil Ferguson, who is advising the Government on the outbreak, told yesterday’s Today programme: ‘We can [expect to] see two possible options: a very slow plateauing decay of infections over time or perhaps a rather faster one.
‘What’s critical to determine that is how well people behave outside the household and how well they restrict their contact with others. And it’s quite finely balanced at the current time.’
He said moving around in the sunshine this weekend would ‘move us to a slightly more pessimistic scenario’ which would lead to ‘high levels of infection for weeks and weeks rather than a rapid decline’.
For now, we have to wait until the death and infection rate starts to fall. The big question, however, is this: what then? At the heart of the Government’s strategy has been the need to protect the NHS from being overwhelmed – and it will be this which informs its next steps as we try to return to normal.
Deputy chief medical officer Jenny Harries, pictured, told the nation: ‘We must not suddenly revert to our normal way of living, that would be quite dangerous’
Key to every decision has been our NHS intensive care capacity: at the start of the outbreak, 5,000 beds across the country.
When those beds are full, people may start to die because those who need critical care support, such as ventilators, can’t access it.
But, initially, the Government seemed to adopt a softly, softly approach to the virus.
Any traces of the new coronavirus on raw food are destroyed when it is cooked at a temperature of 70C (158F) or above.
People with symptoms and those who had been to countries where the virus was more prevalent were tested and isolated.
Life, for the most of us, went on as normal. By early March, Italy – the first European country to be hit hard by the virus – had joined China in imposing a lockdown to contain the crisis. France, Spain, other European countries, and some US states, quickly followed suit.
South Korea, Singapore and Germany engaged in aggressive ‘test and trace’ tactics – screening those with symptoms, quarantining the infected and tracing and isolating their contacts. But the UK – alone in Europe, aside from Sweden – stood firm and did neither.
On March 12, despite protests from many in the scientific community, the Government stopped testing anyone but those who had been hospitalised with suspected Covid-19.
Regent Street, pictured, one of London’s biggest shopping attractions, has been left deserted after shops were told to close
Anyone with a cough or fever – the main symptoms of Covid-19 infection – was told to stay at home, and self-isolate for seven days. But children remained in school.
Health officials said they ‘might soon’ go further, but they were waiting until this was strictly necessary. If bans on public gatherings and events were introduced too soon, ‘fatigue’ might set in – and people would find ways around them. It would also be better economically.
Better to save such measures for when Britain was closer to the peak of the epidemic, Government advisers reasoned. But this strategy changed overnight with the publication of a report from the Imperial College Covid-19 Response Team, led by Prof Ferguson, on March 16. It suggested taking no action would lead to a demand for intensive care beds that would be 30 times above capacity, and lead to more than half a million deaths.
Crucially, the modelling also found that existing social-distancing measures put demand at eight times greater than capacity, and would cause about 250,000 deaths.
Within hours, Boris Johnson announced ‘drastic action’. All Britons should work from home and avoid travel and social contact. Days later, schools closed, pubs and restaurants were ordered to shut and the lockdown began.
The success of the initial soft approach will become apparent early this coming week, in the rate of infections and deaths.
Two small children visit their grandparents, pictured, but can only touch the glass between them due to the social distancing rules
A few days later, the first signs of the lockdown impact will start to be seen in the figures, too. But neither will give the Government any indication as to what to do next, say leading epidemiologists.
‘It’s all a bit muddy, because these changes and interventions all came in within a few days of each other,’ says Dr Michael Tildesley, an expert in the modelling of infectious disease at the University of Warwick. ‘It’s impossible to predict the effect each measure will have had individually.’
Now, there are too many unknowns to simply lift the restrictions, he says. We don’t know how many people have been infected because the Government has not been routinely testing those with symptoms.
Prof Keith Neal, an epidemiologist in infectious disease from the University of Nottingham, says the global estimate is that there are roughly 1,000 infections for every one death – which puts the UK total, to date, at 4,313,000. But we don’t know for sure whether those who have had the virus are, in fact, immune to having it again.
While experts have said they have ‘every reason’ to think they might be, there are concerns. Other coronaviruses – including the four that cause common colds – do not trigger lasting immunity. So there is no model for how to proceed. The only option is for officials to analyse carefully what happens elsewhere.
That begins with China. Travel restrictions in Hubei province – excluding Wuhan, the epicentre of the outbreak – were lifted last week. The lockdown in Wuhan, where there have been no new cases since last Monday, according to officials, is to be partially lifted on April 8.
Firefighters prepare to disinfect the Wuhan Tianhe International Airport in China, pictured, with travel restrictions soon to be lifted
We know already, though, that the lockdown alone isn’t enough to combat the virus. As experts have pointed out, we ‘need to learn to live with it’. In China, some shops, cinemas and businesses were ‘abruptly’ closed again – suggesting relaxed measures may have prompted further infections.
A second wave was also reported in Hong Kong after the two-week quarantine for travellers into the region was lifted and students returned at the end of term. Azra Ghani, Professor of Infectious Disease Epidemiology at Imperial College, says: ‘Every country is facing exactly the same challenges. We’re closely monitoring the situation in China. They have reduced transmission to very low levels, and now they are starting to open up their society again.
‘We will see what happens in the coming weeks.’
The Imperial report shows that – ironically – the more successful the attempt to contain the spread of infection, the more likely there is to be a significant second peak later in the year.
Some experts hope one way out lies in herd immunity. This is when a large enough proportion of a population have had an infection, or been vaccinated. The disease ceases to spread easily – and essentially dies out. But of course, this relies on infection leading to lasting immunity, which, as we have said, isn’t yet known.
Prof Neal said if the herd immunity theory held true, then ‘countries like Spain and Italy, which struggled to control their outbreaks, or Sweden and Singapore where shops and bars remained open, could have a lower second wave of infection.’
Despite being one of the hardest hit areas of the UK, the infection rate in London is, at the moment, estimated to be only between two and five per cent, he said.
If a second wave does come to the UK – as predicted in the late autumn – it could be even more catastrophic, coinciding with the annual flu season, which already places huge pressure on the NHS. Many experts say that aside from herd immunity the only other definitive way out is a vaccine – and neither are quick solutions.
One possible exit strategy, modelled by Prof Ferguson and backed by a Harvard study last week, involves turning the restrictions on and off intermittently for two years – or until a vaccine becomes available. The aim would be to manage demand on health services by having several smaller peaks of infection rather than one large one.
The ‘on’ switch would be triggered by the number of patients admitted to ICU who test positive for Covid-19. Prof Ferguson’s simulation suggests if that exceeded 200 – four per cent of the UK’s pre-outbreak capacity – social distancing measures and school closures could be reintroduced.
Dr Tildesley explains: ‘It will take time for interventions to have an effect, so if it is left later than this, even with suppression the peak ICU demand will exceed the capacity.’
Herd immunity would continue to build during the periods when lockdowns were relaxed, so the infection rate would slow and there would be increasingly lengthy periods between the restrictions. But many are reluctant to impose intermittent lockdown strategies simply because people would struggle to adhere to them.
Ivo Vlaev, Prof of Behavioural Science at Warwick Business School, says: ‘Intermittent lockdown is not a good idea. We are creatures of habit and ever-changing guidelines may create problems. If the Government suddenly lifts the current restrictions and we are all free to do as we choose, we will flow back into our old way of life in many respects, as our ingrained habits will resurface.’
A police officer moves a member of the public off Brighton beach on Saturday after ministers urged people to continue to stay at home in spite of the sunny weather
Dr Harries has already implied that the Government may look to relax restrictions in stages, following the Chinese model. ‘Over time, probably over the next six months, we will have a review [every three weeks],’ she said.
‘We need to keep that lid on, and then gradually we will be able to hopefully adjust some of the social distancing measures and gradually get us back to normal.’
A study modelling the effects of ending the lockdown in Wuhan, from the London School of Hygiene and Tropical Medicine, recommended this staggered approach. It found reintroducing the workforce over four weeks, and then reopening schools, could delay a second peak of infections by two months and make it easier to manage. Prof Neal says: ‘I think we’ll go through a staged relaxation of the measures. That might mean continuing to work from home if you can, and reopening pubs and restaurants but keeping tables 15ft apart, like they do in Singapore, or banning gatherings of more than 20 people so there’s still a degree of social distancing.
‘Football games could be played behind closed doors. Schools would most likely not go back until September, which could increase the spread. Universities may have to teach online.
‘Ultimately, we may find the restrictions have to be put back in place again.’
By the time we have a vaccine, we’ll probably also have achieved herd immunity – or close to it, he also suggests.
Covid-19 is spread in tiny droplets from the nose and mouth of an infected person. One cough can produce up to 3,000 droplets.
Another solution is lifting the measures in less-affected regions for up to six months at a time, as recommended by the Scientific Pandemic Influenza Group on Modelling. But ultimately, lifting restrictions relies on knowing who has been infected.
This might mean mass antibody testing, and even the issuing of ‘immunity certificates’ already used in Germany. No reliable antibody tests are yet available, however: the Government said it wants to buy 17.5million ‘subject to them working’.
But the most likely approach was outlined by Prof Ferguson yesterday. He said there was ‘a great deal of work under way’ looking at how we could substitute some social distancing measures for ‘less intensive’ measures by the end of May, which would involving swab-testing any new cases that emerge, and rigorously tracing and testing their contacts in a bid to isolate any remaining virus’
He added: ‘The critical thing first is to get case numbers down, and then I’m hopeful in a few weeks we’ll be able to move to a regime which will not be normal life – let me emphasise that – but will be somewhat more relaxed in terms of social distancing and the economy but rely more on testing.’
Swab testing – currently at 12,000 a day – should be scaled up to 50,000 a day to achieve that, and technology such as mobile phone apps could be used to track people’s contacts should they become infected.
It is not clear which approach the Government will take – Prof Ferguson says it will be ‘driven by the data’. And it remains to be seen whether any country can truly claim to have got it right.
As Anders Tegnell, Sweden’s state epidemiologist, told BBC Newsnight last week: ‘I don’t think anyone can be seriously confident of getting this right, since it’s never happened before.
‘Who will get it right? I’m not quite sure we will ever know, because it looks more and more like most countries will go through the same thing independently of the measures they are taking.’