Week 33: The need for a revised model of where we are with the pandemic

At present, the usual model in use assumes that all our problems will be resolved by using a wonderful vaccine that will be highly efficient, and that there is no real need to think about the alternatives. There is a real chance that no vaccine effective for say >85% of recipients will be developed – certainly not in the next few months, and perhaps ever.  We may possibly have to rely on more than one vaccine, but there are real doubts about our almost magical belief that somehow the problem will be solved.

 

Should we take a look at the alternative world?  The early results of the US election are proof, if proof is needed, that about half of the US population have difficulty understanding what  Dr Fauciand others have been saying to them. 

 

 

i. Are lockdowns ever desirable?

 

There are times when national leaders have no alternative but to move over to a lock-down, as otherwise their health system will be overwhelmed, and the lockdown will buy time. That important fact being recognised, the harmful and expensive aspects of this procedure, equivalent to choosing to pull the emergency chain while on a train. As the only response we have it is clearly inadequate.

The present lockdown is only partial, and is a far cry from a “circuit breaker”. It is unlikely that it will achieve much in only 30 days.

 

ii. New developments with the virus itself

 

The fatality rate for those newly infected is improving, as shown on this table, with very different values dependent upon whether there was preparation for what followed:

 

	May 6, 2020	October 31 2020.
Italy	19.9%	5.7%
Sweden	13.55	6.6%
Germany	4.3%	2.0%
South Korea	2.4%	1.8%
NZ	1.8$	1.6%

 

A  more severe form of the virus is rapidly spreading across the world (Cegolen L., BMJ Global Health, 13 May 2020). 1st Covid-19 cases with “antibody dependent enhancement”. Previous infection with type 2 SARS Covid 2 had occurred. An up-to-date adjustment to this will depend upon the extent to which the more severe virus has already occurred in a particular country, and  this can be influenced by rigorous testing linked to properly enforced quarantine and supportive services.  See how this was done in New Zealand, South Korea and Norway.  We need to consider a set of alternative procedures, less dramatic than previous procedures, that will gradually improve the situation, albeit slowly.

 

THE NEW WORLD:

 

1. Educational measures: The need for young people to modify their understanding of the present situation. Compared to older people and those with established physical disorders, they are comparatively unharmed by the virus when they encounter it, and are likely to survive, often with few signs of illness. The pressure they are under to limit social interactions is often seen by them

as pointless, that they are ‘rightly’ having to modify their social  behaviour. . This unwillingness to allow complete social freedom is understandable and correct – but they need to have a new understanding of how the system works. It may be impossible to achieve this, but we must try.

 

A revised explanation, linked to super spreader events (SSEs), and the numerous opportunities that exist across countries – recent examples would be Mr Trump’s election meetings in the USA, or young people newly arriving at universities in the UK, or young people meeting unofficially in private.  There is nothing wrong with people wishing to meet one another freely, but doing so without social distancing keeps SSEs going, and this ensures a sustained increase in new cases of the virus. We must understand the mechanisms that sustain perpetual increases in new cases. The pandemic is being largely sustained by young people who may suffer relatively little themselves, and whose basic freedoms to interact with other young people are typically greatly threatened. This unusual situation needs to be carefully explained to them, and their questions answered. 

 

2. The provision of helpful people by the  future ‘track and trace’ scheme would help to improve collaboration by young people with the basic scheme. In the UK our Health Secretary appears to have a low threshold for threatening punitive sanctions on those who do not collaborate. Much can be achieved without threats. This blog deals with the long haul: whatever we do, it’s going to take a long time. Training costs for nurses, more senior people – doctors and senior nurses should take part. A punitive system to ensure collaboration should be the task of separate people, perhaps in the police. 

 

3. New ways of organising virus testing procedures, and linking them to locally enforced quarantine procedures. In the UK dealing with what to do about unexpected new cases has been hit and miss, and poorly enforced. Only a complete revision of the test & trace system, with complete replacement of the Health Secretary and his disastrous accomplice (Ms. Dido Harding) will allow a new system to be introduced. The present organisers of the test and trace scheme leave it to the individual who has been tested to take further steps, and have not had a satisfactory response to its advice.

 

4. Cycle or walk (if possible) to work. This is often not practicable, but the provision of bespoke cycle roads may begin a revolution. Most local trips to the shops will continue to be by car. 

 

5. Gadgets to maintain social distance. Kinexon is a firm in Munich that provides technology to maintain social distance at work. A basic version sounds an audible warning if you are too close to another person, while a more sophisticated version provides details of people who are in ‘contact chains’. The next year or so should provide other equivalent new technologies.

 

6. New medical treatments for active cases.  Examples would be dexamethazone,  ramdesivir to speed up recovery, other medicines would be convalescent plasma, and vitamin D.

 

Conclusion. The path ahead is both difficult and slow. So far the case has not been made to young people, and may never will be. My personal position is that I would greatly favour an effective vaccine, but it alarms me no-one seems to have thought through the possibility that such a development may have its own downside. 

 

David Goldberg, 3rd November 2020