Covid-19 – A final rethink.

On 26 November 2020 I published this piece on Covid-19 but, as so much has happened since then, an update seems very necessary.

In late November 2020 it felt like we were surfing down the face of a “second wave” of the Covid-19 pandemic. There were one or two “good vibrations” in terms of progress with vaccine development but it was scary because, sadly, a lot of us were and are still going to experience “wipe out”. I deliberately used the surfing analogy because there had been more than a small element of wilful risk taking that had brought us to this ‘place’. As of 2nd December the latest lockdowns were replaced by a set of restrictions, dividing the home countries into ‘tiers’, in order to let the populatiuon “have a Christmas”. These tiered restrictions seemed likely to last until March 2021.

Since my piece in mid-June, much of what I then feared (even predicted) came about. The UK’s so-called “world class” track and trace system failed miserably, and for the reasons that have been obvious from day one:

It lacked the capacity to test widely

It lacked the ability to reach enough ‘contacts’

It depends on people to report symptoms and then, diligently, self-isolate

From the very earliest days of the UK’s pandemic, certainly before the initial ‘lockdown’ in mid-March 2020, it has been clear that the extent of asymptomatic disease, and transmission, was underestimated and driving community incidence. Its effects were compounded by our UK government’s flip-flopping on social distancing, on the use of face masks and, critically. It was also compromised by the overwhelming desire to “get back to normal” and to re-open the economy (see “Shop til you drop” and “Tombstoning..” elsewhere in this thread). In the summer of 2020, when Covid-19 was relatively under control, it now appears our population was used, guinea pig-like, to experiment with what happens if you let the brakes off in various ways. We were told to we could go on holiday. In the UK people streamed from areas with higher incidence rates to areas with lower incidence. People relaxed whatever adherence to anti-Covid measures they were observing, naturally enough, and largely forgot about social distancing. Young people, especially, threw themselves into party mode. At the same time we were told to “eat out to help out” and many holiday hot-spots became “super-spreader” locations. We now know that those who did venture abroad, especially to Spain, brought us back a new strain of Covid-19. Schools re-opened and, significantly for some local ‘spikes’, so did Universities. It seems nobody thought that mass movement of young people to University halls of residence across the UK might be a problem – or did they?

In the face of regional disquiet over the UK government response, and rising infections in university cities, the devolved administrations began to apply their own (some might say improved) responses. We already had confusion about what Covid-related restrictions applied, and the inevitable anomalies were (and still are) wilfully exploited by some. It just got even more confusing. Only the Welsh authorities imposed widespread travel restrictions, while in Scotland there were regional closures.

As I saw it, a significant proportion of the UK population was (and is) not disposed to following guidance, never mind instruction. Whether this is because they are incapable of understanding, or are wilfully disregarding, the importance of their part in suppressing transmission, I don’t know. With the population suffering, what was called, Lockdown Fatigue, pent up frustration, and being somewhat encouraged to anticipate a “festive season”, one had to hope that enough common sense prevailed. I thought it was highly likely we would see a third wave of infections in the new year. but actually the third wave was already under way.

Then, in short order, we got the first deliveries of two approved vaccines and the government approved plan for a 5-day family Christmas was belatedly abandoned and cut to one day. Into January and the first of the so-called “variants” was acknowledged, but we now know that one that had emerged in Kent in September began driving the third wave well before Christmas. It was this that caused the abrupt cancellation of Christmas festivities, and the imposition of another total lockdown.

Fast forward to now, late february 2021. In the UK we have a rolling programme of vaccination, with 2 vaccines available and more waiting to come ‘on stream’. 17 million + people, in the clinically most at risk groups, have had their first does of a planned 2-dose. The essential second dose is not now to be administered until 12 weeks after the first, which is not how the designers tested it. The programme is going so well that the government has now decided they have the ability to vaccinate all of the adult population by the end of July 2021 with the first dose.

The third wave has seen us pass the ghastly milestone of 100,000 dead (and as I write this update, passing 120,000). Although the third wave seems to have peaked I can see no reason why the death toll will not eventually pass 150,000. Nevertheless, hand in hand with this perceived ‘peaking’, and the available vaccine programme apparently going well, the government has decided we can plan for coming out of lockdown. It would appear that the ‘data’ supports a cautious relaxation of restrictions, with several weeks between each relaxation to monitor the effects on infections. The official view is that this is the last of the lockdowns, that this direction of travel is “irreversible”, but this is where I have fears for a fourth wave.

We know that human (at least in the UK) will not do as they are told. We know that sometimes this is because the don’t understand, sometimes because they don’t care, and sometimes because they are confused by variable and nuanced government messages. We know the economic and political imperative to reopen commercial life is powerful. We know the virus will continue to mutate. I think it reasonable to assume the government has learned epidemiological lessons which, I believe, it experimented with throughout 2020. I believe the government anticipates a fourth wave but feels it has enough data to pin its hopes on vaccines that can limit the size of that wave, and that can be ‘tweaked’ to deal with serious mutations, and in the context of coming summer weather which naturally suppresses the virus.

In the end I believe the success or failure of managing Covid-19, going forward to the winter of 2021 and beyond, will depend on whether people can remember, and apply, what they have learned over the last year to mitigate their own risks (hands / face / space), for the long term. Whether Covid-19 becomes like seasonal influenza, something we live with and manage with an annual vaccine, it certainly won’t be the last we see of it and neither will it be the last pandemic we see.