Coronavirus: another day, another slogan

10/05/2020

It is interesting to see Hackney Police whingeing about "fighting a losing battle in the parks" yesterday (pictured). After an interminable period of lockdown, people took advantage of the fine weather, which had the plod fulminating about "hundreds of people sitting having pizza, beers, wines".

Short of provoking a riot, there was little else they could have done other than to resort to mouthing their slogans, (Stay at Home and Save Lives; Protect Our NHS) and offer a "big thank you" to those who were observing the guidelines.

Helpfully, they were pointed in the direction of this paper - once again by a group of Chinese researchers - giving more insight into the transmission characteristics of SARS-Cov-2. The paper, headed "Indoor transmission of SARS-CoV-2", detailed the examination of 318 Covid-19 outbreaks with three or more cases. These involved 1,245 confirmed cases in 120 prefectural cities, with the locations of the outbreaks classified in six categories: homes, transport, food, entertainment, shopping, and miscellaneous.

Among the outbreaks, the researchers found that 53·8 percent involved three cases, 26·4 percent involved four, and only 1·6 percent involved ten or more. Home outbreaks were the dominant category (254 of the 318 outbreaks; 79·9 percent), followed by transport (108; 34·0 percent; although many outbreaks involved more than one location). Most home outbreaks involved three to five cases.

Crucially, the researchers identified only a single outbreak in an outdoor environment, and that involved only two cases. All outbreaks of three or more cases occurred in an indoor environment, leading to their conclusion that sharing indoor space is a major SARS-Cov-2 infection risk.

Another paper - this one using data from South Korea – looked at serial infections, the type of infection that might be seen in the family environment where one member gets sick and then passes it on to another member.

In the study, the clinical onset intervals were estimated and compared with the diagnostic intervals (the time taken for laboratory tests to demonstrate infection) and, in most cases, the infection was detected before signs of the disease became apparent. This underlines the value of rapid contact tracing and testing when cases are reported, allowing new cases to be isolated, limiting their opportunities to pass on the disease to further contacts.

Yet another paper - this one from the United States – reverts to the dreaded modelling, but the results would doubtless make Neil Ferguson proud (or weep?). The model shows that contact tracing might enable modification of current physical distancing restrictions. Specifically, with 90 percent testing and tracing as well as high isolation and quarantine efficacy, contact tracing could reduce overall transmission by >45 percent.

Furthermore, the researchers say, the benefits of contact tracing could be enhanced by testing all contacts rather than only those with symptoms and by policies to support high adherence to voluntary isolation and quarantine.

Tying together these three papers – adding to yesterday's analyses - we see more confirmation that Covid-19 transmission is primarily an indoor phenomenon. Here, an interesting article highlights the use of "open air" treatment in the 1918 flu pandemic. In one report, it is said that this therapy reduced deaths among hospital patients from 40 to about 13 percent.

In terms of this pandemic, we have already seen that much of the infection is passed between family groups (where one can also take care homes to be analogous to family groups). In this article we can see many of the points made earlier being reinforced, where we also see some emphasis on time of exposure. The fleeting contact assumes less and less importance.

And now we see how rapid contact tracing, testing and isolation can have a material effect on the progress of an epidemic, both from real-life studies and from modelling.

The contact tracing here is far beyond the weak system proposed for the UK and involves immediate testing of contacts and their isolation. That also requires family members to be removed to more suitable accommodation if isolation in their homes cannot be secured.

And all of this suggests that the simplistic policy of the UK government, telling people to "stay at home" is precisely the wrong thing to do, unless it is backed up by an aggressive policy of tracing, testing and isolation – which so far has not been in force.

As to saving lives, the Telegraph points out that the obsession with protecting the NHS has led to the seriously ill and elderly being "abandoned", leaving the care sector to bear the brunt of the Covid-19 storm, for which they were ill-equipped.

Described as a slow and botched response, the upshot of the "dump the oldies" programme was that the hospitals ended up with more space than they needed. Currently, around 40 per cent of acute beds in NHS hospitals are unoccupied, while the famous Nightingale Hospitals lie empty. Meanwhile, the front line is in the care homes who look after an estimated 400,000 residents across Britain, where the epidemic is being perpetuated.

In its entirety, the accumulation of information is telling us that the lockdown, as currently implemented, has little to sustain it. If it could be justified at the time it was imposed – simply because an incompetent government had run out of other options – now is the time for a fundamental re-appraisal.

Predictably, the Sunday Telegraph is chipping at the edges, citing a "New York study" which purportedly shows that workers are "'no more likely to be hospitalised by Covid-19 than those who stayed home". On the basis of this finding, the view is expressed that it is important to protect the elderly, sick and vulnerable, but more people could be allowed to return to normal.

This, of course, misses the point – or several points. The lockdown, as such, is not a control measure. It was sold to us as a way of slowing down the infection rate so that the blessed NHS hospitals would not be "overwhelmed". But the real objective should have been to buy time to put in place more effective (or any) control measures.

As it stands, the approach to enhancing controls has been half-hearted – pace Hancock and his magical app - and there is nothing in place which could have a significant impact on the tide of the disease. Thus, on the face of it, the lockdown is still needed. But, if the New York study has any merit, then its rationale is melting away.

That leaves the Hackney plod – and the others who have so enthusiastically nagged and nannied the population into submission – rather out on a limb. People are not stupid – or, at least, most people are not stupid all of the time – and the "wisdom of the crowd" occasionally prevails. As it increasingly lacks credibility, the government's policy is beginning to unravel.

Tonight, though, we will have to tolerate an "address" from the prime minister, when – apparently – he will deliver another vacuous slogan, previewed as: "stay alert, control the virus and save lives".

The public might be forgiven for asking whether controlling the virus wasn't primarily the job of the government and, since it's been asleep on the job, it ill behoves him to tell us to stay alert. And as for saving lives … tell that to the care homes, and the seven million people waiting for hospital treatment.

But then, this isn't any ordinary prime minister we have. This is a Boris, and for him government is all about slogans. So here we go again: another day, another slogan. Maybe they should write it on the side of a bus.