Coronavirus exit strategies

What is the end result we are trying to achieve?

• We are told we are under lockdown now in order to “flatten the curve”, i.e. reduce the initial spike in hospitalisations so that the healthcare system can cope. But then what happens?
• The two opposing ends of the post-corona outcomes are the “genie back in the bottle” scenario, where Covid-19 is eliminated from the population completely, and the much-maligned “herd immunity” outcome, where a sufficiently large percentage of the population becomes immune to the virus, either by contracting the virus and recovering from it or through vaccination.
• I find it incredible that governments across the world have not clearly communicated to their people which outcome they are trying to achieve, given how vastly divergent these strategies are.

“Genie back in the bottle” strategy

• Most of the Asian nations that are seen by some as successful in containing the crisis (China, South Korea, Taiwan, Hong Kong, Singapore) appear to be going down this route.
  • The strategy is to try to identify each individual who carries the virus by conducting a very high number of tests, and quarantine them and their close contacts.
  • If the government is successful in tracing down every single case, then the virus can be eliminated.
  • There are very valid doubts to be voiced about the data coming out of China and about how successful China is in actually containing the virus, but we’ll leave that aside for now.
• I humbly suggest that this strategy is unlikely to work.
• By now, the virus is far too widespread globally to halt the spread.
  • There are over a million identified cases worldwide, but we know that this is actually understating the true number of cases by orders of magnitude. Modelling from Imperial College suggests that a few days ago there were already 1.8 million cases in the UK (2.7% of the population), although only 42,000 (2.3% of all cases) have been identified.
  • The true number of cases globally is realistically over 100 million and increasing.
  • Developing countries have reported relatively few cases so far, but seeing how quickly coronavirus spread all over Europe and North America in just a few weeks, there can be little doubt that the likes of India, Nigeria and Brazil are not far behind.
• It is not possible to ramp up testing capacity sufficiently across the globe.
  • The UK is struggling to carry out 10,000 tests per day at the moment and industry experts are highly sceptical about plans to ramp up to 100,000 in two months’ time.
  • The international supply chain for testing materials will likely collapse due to every country trying to ramp up capacity simultaneously. There are already ugly accusations of state-sponsored “piracy” to divert medical equipment. Protectionism and export bans will lead to even fewer tests being available globally.
• Even if one country was able to eradicate infections from its population, it would need to maintain airtight border security and test every single international arrival while the virus circulates elsewhere.
  • In the long term, this leads to economic isolation, increased xenophobia and a sharp drop in international trade. The economic damage from this could be similar to the wave of protectionism during the Great Depression.

“Herd immunity” strategy

• Herd immunity currently has terrible PR due the UK government’s bungled communication at the onset of the crisis and the resulting media backlash.
  • In popular media, herd immunity is often seen as genocidal and sensationalist articles are published about how it could lead to millions of deaths.
  • However, these narratives ignore that coronavirus is far more widespread in the population already than previously believed and also fail to propose an alternate end result.
• Herd immunity is the most realistic outcome of the crisis given that it is impossible to eradicate the virus completely at this point. Governments should find a way to re-brand herd immunity (say “mass immunisation”) and explain it better to the public.
• Experts have floated the idea of relaxing and tightening the lockdown in cycles, to let the population gradually acquire and survive the infection, while maintaining the number of active cases at a level that does not risk overwhelming hospital capacity.
  • Lockdown fatigue is a real risk, and we cannot be certain that the population will comply if they are allowed to socialise one week but not the next.
  • Many businesses cannot easily start and stop work. The economic damage from a drawn out relax/tighten cycle could be just as bad as from an extended lockdown.
• I find it impossible to understand why the government is not doing randomised testing to establish what % of the population has the virus currently. If 2.7% of the UK population have the virus currently and hospitals will cope in the coming weeks, then herd immunity could be achieved in a matter of months.
  • the 2.7% figure is based on Imperial College’s modelling and has wide confidence intervals (1.2% – 5.4%), so more testing is urgently required to establish accurately what percentage of the population have the virus already.
  • Testing a random sample of 1,000 individuals could be more helpful than any data point we have to date. It is incomprehensible why this has not been performed yet.
• We need to be clear that people in at-risk groups (which is predominantly older people) need to stay under strict lockdown for months. The data is clear that coronavirus is far more deadly for this group.
  • The public does not properly appreciate that even having sufficient ICU/ventilator capacity will not save people in at-risk groups. To put it bluntly, the medical profession can do very little to save at-risk groups besides telling them to stay quarantined for an extensive period of time. Governments need to communicate this more clearly.
  • The lockdown for at-risk groups could end once the wider population has achieved the critical threshold for herd immunity.
  • Alternatively, development of a vaccine or a cure could also bring normalcy back to at-risk groups.