Life after lockdown – reality check

Our objective here is to try to make sense of the emerging information.  Our intention is not to be perpetually critical but to create healthy discussion; to take a practical view and get to the facts. Our panel, our objectives and our contributors are mostly by design argumentative, constructively. If there is a better way, we are keen to hear from you. 

With that in mind, and with the false-summit of Monday’s relaxation of lock down measures still deciding whether it is fake news or just a really bad idea, we are inching towards the inevitable reality that we will have to confront some unavoidable facts and make some decisions. 

This realisation that there are some things we just can’t put off any longer or conflate with some other data to water down, has also been on your minds this week.

Here we discuss some of your questions including: whether social distancing is all a bit pointless? And who will really get sick when we inevitably all have to go back outside?

Social distancing is hard. And a bit pointless.  

Covid-19 is significantly less infectious airborne than through contact (regardless of simulations of coughs and sneezes travelling further than ever before).  These germ clouds floating through supermarkets are in fact far more dangerous settling on products than inhaled walking past someone or through their sneeze cloud. As our VE article advised, you won’t catch Covid-19 over the hedge/balcony/fence when your neighbour coughs up-wind; just decline any offers of crisps or booze (just waiting for Donald Trump to confirm Vodka is fine).

To be clear , ‘viral load’ is, for sure, ‘a thing’ but what this means in practical transmission terms is less clear.  We are not saying that Covid-19 cannot be transmitted in this way through coughs and sneezes, rather that the evidence and long-standing cross-infection studies point to contact with viral traces (loads) on door handles and supermarket trolleys etc. as being the likely higher ‘viral load’ and vector for transmission risk.

As for testing, if the virus didn’t mutate and antibody tests could confirm some resilience, if not immunity, to Covid-19 or its variants, then patients could be tested after recovering from Covid-19 and relatively safely sent with their antibodies back outside to the park, school, office or garden-centre, contributing to herd-immunity as they go.

Testing in a ‘trace’ context, however, is a practice that stems from long-standing etiological disease research but mainly where potential transmission infection sources or contacts are more easily identified, at least to a narrower candidate group e.g. syphilis.  Where this tracing approach is less helpful is where the ‘cross-infection or transmission chain’ we hear so much about may in part be made up of someone who coughed over a packet of Rich Tea biscuits in aisle 21 yesterday in Tesco.

There is no doubt that ‘testing’ is a critical tool right now and one of the only we have at our disposal. However, context is critical, as is combining corroborating or alternative data sources to avoid distorting our decisions and strategy. For instance, the false security of a test was also demonstrated in the suggestion this week that prospective dental patients could be tested and attend appointments 24 hours later if they tested negative. This plan neglects the risk of contracting Covid-19 in the ensuing gap between test and appointment.

But does any of this actually matter? – We have no herd immunity and we have to go outside sometime, right?

Who gets really sick with Covid-19 is not black and white.

The fact that Covid-19 has disproportionately impacted the Black and Minority Ethnic (BAME) communities is now widely accepted. What is less well understood is why. Worryingly, the emerging narrative and assumptions in the media this week about the reasons for this disparity is another example of confirmation bias and high-risk misinterpretation of facts.

While it is incontrovertible that these communities comprise higher proportions of front-line public services, and face more complex socio-economic challenges, attributing risk to BAME communities on this basis alone risks overlooking potentially innate ethnographic susceptibility among different populations. This has implications which limit the effectiveness of shielding and misses a trick in strategies for returning to the outside world.

It says more about our society that the rhetoric of confining the over 70s in isolation indefinitely to ‘shield’ them sits better in media messaging than applying the same measures for BAME communities, or as new emerging data shows obesity identified as a factor.

We figure that on balance the risk of inviting criticism through lack of cautious political diplomacy is outweighed by the risk of getting this wrong. Please take our sentiment as it is meant.

Everyone else can go back to work…

With no sign or imminent herd-immunity, and a vaccine, which will only last a year at a time some way off, Covid-19 is here to stay and most of us are going to get it.  One approach therefore might be to allow all under 45s to return to work who do not fall into the high-risk categories above.  The risk of cross-infection within this low risk group is only a risk if they infect the high-risk groups. We have had lots of feedback from you that the risk is bringing Covid-19 home or endangering the higher risk groups. This must be the key objective of any strategy to relax lock down measures.  Look out tomorrow for our ‘Guide to surviving the exit from lock down’.  

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