Anyone with flu like symptoms are now encouraged

The Bold Strategy the UK has adopted against COVID-19

The UK government had outlined its Coronavirus strategy in three distinct steps. The first stage was to contain the virus. This was implemented when spread of the virus was primarily by infected patients from abroad. Public health advice was provided, campaigns on washing hands, not touching the face, practicing safe hygiene. Potentially infected individuals were informed to self-quarantine for 14 days whilst waiting for symptoms to develop and testing to occur. Now it is evident this is not enough. The virus has spread to enough people that transmission can now occur locally, between people who have never been abroad. Containment is not the aim, mitigation of number of cases to prevent burdening the health services. The second stage aims to reduce the epidemic’s peak, flatten it out so the number of cases do not occur at once.

Anyone with flu like symptoms are now encouraged to stay home for 7 days, and testing will only occur for hospital admissions. Beyond this little appears to have changed. Schools will remain open, social gatherings have not been cut yet (but is expected over the next week) and general life will continue as normal. This is a risky measure, one that suggests the government is not taking the issue seriously. France, Spain and Italy have enacted lockdown measures, Germany has begun cutting social gatherings. So why is the UK not following in step? Are people going to die as a result of this inaction?

DELAY THE SPREAD

The answer is of course complex. PM Boris Johnson has acknowledged that as a result of his decision people may die, especially the elderly who are seen as a very vulnerable population. But this plan has been discussed with multiple scientists, doctors, public health specialists, and there is method in the madness. Currently the UK is in the early stages of the epidemic. The number of infected are expected to rise sharply in 4 weeks, with a peak in 10–14 weeks. Implementing harsh restrictions too early can lead to “self isolation fatigue”, resulting in people not following the restrictions stringently or leaving their homes at the height of the epidemic. Restrictions also come with their own problems, and implementing them may lead to more harm than good. Simple measures such as hand washing and self isolation can itself reduce the peak of cases by 20%.

Schools have not yet been closed because COVID-19 does not appear to affect children as much. Closure of schools would also mean parents having to stay at home to look after their children (after all, nurseries, creches and other forms of childcare would still result in a spread of infection). In some cases these parents are also healthcare professionals, and the UK needs every single doctor, nurse and allied health professional to be on the frontline treating patients.

So what is the strategy? The NHS is currently full of patients due to the winter burden, one that is expected to taper off in the coming months. Slowing the onset of the epidemic’s peak to Summer, spreading it across the next few months so the maximum number of people can be treated in the hospital setting without overburdening. The aim is no longer to prevent the spread of infection but to protect the most vulnerable age groups. This model allows the young and healthy to become infected, almost encourages it.

INFECT YOUR CITIZENS

Now this sentence may sound ridiculous when said out loud. Allow infection. But why? The UK has acknowledged there is no way to stop the infection. Whilst the mortality in the elderly population and those with medical conditions are high, in the young and healthy it manifests as a mild illness with almost all infected cases recovering. More importantly, recovered patients have immunity against the virus, manifesting as antibodies in their blood. Immune patients cannot infect other people, so the more immune patients there are the slower the virus will spread. This is known as herd immunity, and the process is discussed in length in our blog on vaccines. Herd immunity needs to be achieved before the onset of winter in 2020, as winter admissions alongside COVID admissions would result in a disaster.

https://medium.com/@rajneesh.dwivedi/developing-a-vaccine-for-covid-19-part-1-f7263ae9bf88

The strategy is of course risky, and one that has not been implemented before. And since the infection will not be contained people will die. But by spreading the burden of the infection across a longer time period will allow those who require treatment to receive it in a far less burdened health system. And it has received support from health professionals, even those who are fierce critics of the PM and Conservative government. But it has resulted in confusion amongst the population, a population that looks at authoritative action taking place in other countries and not understanding why their own doesn’t follow suit. The issue is these draconian measures are not sustainable, and if implemented correctly the UK strategy may result in far less lasting damage on its health service and the economy.

Dr Rajan Choudhary, London UK

Head Of Products, Second Medic Inc (www.secondmedic.com)