Living in West London during the lockdown imposed as a result of the coronavirus outbreak is a surreal experience. Normal existence, as we knew it less than two months ago, seems to have occurred in another life. Some of us older people lived through the nervous uncertainties of the Cold War, and we all looked with some unease at the looming challenges posed by climate change. But this is something else entirely.
As a 58-year-old man with diabetes, my vulnerability to this virus is greater. As is my son, who is asthmatic. Neither of us is among the 1.5 million most vulnerable identified by the UK government, but we are open enough to complications to have voluntarily entered more or less complete isolation, along with the rest of the family who is supporting us. Various in-laws and outlaws seem to be doing their best to tempt us into the dangerous there, but so far we have stood our ground.
Easily available data
I am not a virologist or epidemiologist. I am not even a statistician. But I have an O level in Mathematics. And while this achievement may be modest in the larger scheme of academia, it is sufficient to allow me to identify trends and draw conclusions from data that is readily available to anyone with an internet connection and a working knowledge of Google. That is why I shudder at the obvious bewilderment of many of those commentators who pass for experts.
Throughout its handling of the crisis, my administration has wanted to emphasize that it is “following the science.” Political spokespersons are invariably accompanied during briefings by medical and scientific advisers with great order and esteem. And yet what passes for the best scientific advice one day seems to fall by the wayside the next. Therefore, our initial reluctance to suspend major sporting events was based on “scientific advice” which stated that there was no evidence that large crowds of people gathered closely together presented an ideal environment in which a virus could spread, just to contrary recommendations were issued just a day or two later. Also pubs and restaurants. “Follow the science” has even been offered as an explanation for deficiencies in the provision of protective equipment to front-line workers and in testing capacity. One could be forgiven for wondering whether political politics is being informed by science, or vice versa.
Long shelf
That was then. Today we are locked up and the discussion has turned to how we will get out of it. A very nervous navel gaze inevitably ensues as the great and the good, political and scientific, are realized that a dynamic market economy cannot be held in abeyance forever. So where does it all go from here?
If one wants to know what is likely to happen in the future, the past and indeed the present often serve as useful guides. And there is enough information that can be found in the statistical data that we have collected since the initial outbreak in Wuhan, through the exponential increases prior to the lockdown in the number of infections and deaths and in the more positive signs that have started to appear more. Recently. They arise from Italy and Spain, to give us an idea of where we are going.
First, the long plateau followed by a gradual decline in numbers reflects the less drastic approach taken by European democracies than that taken by China. When a crisis hits, there may be a price to pay for enjoying the benefits of a free and open society. In southern Europe, the descent from the “peak” of the outbreak is notably slower than the original ascent. Given that the UK closure is less severe even than that of Spain or Italy, the unfortunate thing is that we can expect our recovery from this first peak, when it comes, to be even more laborious.
The reproduction number
The basic reproduction number is the mathematical term used by epidemiologists to quantify the infection rate of any virus or disease. Experts have calculated that when left unquestioned, the replication number (or R0) of Covid-19 is around 2.5. This means that each infected person, on average, will transmit the virus to 2.5 other people, causing an exponential spread.
Shutdowns, public awareness campaigns, and social distancing measures aim to lower the R0 below 1.0, thereby reducing over time and ultimately stopping the spread of the infection. To induce a decrease in infections as fast as a 2.5-fold increase, the number should be reduced to 0.4 (or 1 divided by 2.5). A preliminary study carried out by a team from the London School of Hygiene and Tropical Medicine has calculated that in the UK the current R0 of the virus is around 0.62, which, if necessary and as long as it is maintained, would mean that the virus will slow down, albeit at a slower rate than its original acceleration.
There is also more good news. Nobel Prize-winning British-American-Israeli biophysicist Michael Levitt, who runs a laboratory at Stanford University in California, notes that the R0 of a virus naturally decreases over time due to people’s tendency to move within finite social circles, thus increasingly restricting the number of new contacts you will find. Coupled with a deliberate social distancing strategy, this will further reduce the spread.
Lifting restrictions
So far all is well, if anything good can be said about a global pandemic that at the time of writing this article has already claimed the lives of more than 100,000 people. But the challenge now is how to lift the restrictions and start resuming something that is even close to normal without the infection rate rising rapidly again. Neither the needs of the economy nor human nature will allow life to stop indefinitely.
One imagines, or at least hopes, that any significant relaxation of restrictions will inevitably follow a reduction of new infections to a much more manageable number than is the case today. When it does, however, the goal should be to keep new infections below R1. Without succeeding, a second wave is inevitable.
The lesson that the initial spread of the virus taught us is sobering. Then the contagion was occurring in a city in a country far from home, and yet in just over a month it had exploded and taken over the entire planet. Now, with 240 different nations battling the virus at various stages of development, any measure any country takes to prevent it from returning within its borders would have to be extraordinary.
Learning from experience
On the other side of the coin, at least in this short space of time we have gained valuable knowledge and experience. Where Western countries, with the partial exception of Germany, were unable to test, track, and trace the pathogen rigorously enough when it first descended on us, hopefully we will be better equipped to do so the second time. Mobile applications are already being developed to assist us in this process, although it would be a denial of duty to allow our policy to be based solely on their use to the exclusion of other complementary strategies.
One imagines that the limited journeys allowed to resume between nations, at least for the time being, will be subject to testing of passengers, including returning British nationals, for the virus at the point of departure or entry, or at the implementation of a mandatory quarantine period for all travelers. Without such drastic action, it’s hard to see how a contact tracing and tracing program can have any chance of succeeding.
More than anything else, there will need to be global cooperation and coordination at all levels. A global pandemic can only be effectively addressed through joint global strategic action. Even a rogue nation that refuses to follow the rules will run the risk of jeopardizing the efforts of all nations.
Antivirals and vaccines
Ultimately, we can only contain the threat to the best of our ability until a vaccine arrives. Before this happens, antiviral drugs, whether new or repurposed, may be a game changer by allowing disease that arises from an infection to be treated before it becomes serious or even fatal. Eliminating the grim unpredictability of the Coronavirus will allow the world the luxury of enjoying something like a normal existence without too much fear.
The lifting of the blockade should be seen as the first stage of the end game, not as a poorly planned panic measure driven by the needs of the economy. Handled correctly, it offers a second chance to rectify the errors that allowed the virus to spread in the first place. Being caught taking a nap the first time was awkward, doing it again would be absolutely unforgivable.