We want to get out of this place
(with apologies to the Animals)

Well the short answer is that we can’t. We are where we are, we have virus on the loose that kills, particularly the elderly and vulnerable. I suppose the good news (from a purely biological point of view) is that it does not kill the young and fit, those of reproductive age are spared and those who have finished with that sort of thing are cleared out to make room for the next generation. Not much fun though if you come into the at-risk category.
The government finds itself in an impossible situation, whatever they do there will be deaths and recriminations. To isolate or not to isolate? There can be little doubt that the original decision was the correct one, as the immediate priority was to stop the NHS getting overwhelmed, but this has now been largely achieved at least for now.

The next thing is to get the ramped-up testing in place. They have been well behind the curve on this, probably because Public Health England (who have not had a good war so far) told them they would cope and then failed to deliver in spades. Testing is going to be part of any escape strategy (of which more later) and a it is almost impossible to have too much. The much promoted promise of being able to process 100,000 tests a day in the lab will probably be narrowly missed but the ability to take and handle all those swabs and then send out the results will be at least a week behind and probably more. It’s a massive logistical exercise and uses up a lot of trained staff who are also needed elsewhere. The NHS is not good at logistics and training takes time.

Finally there needs to be enough PPE for everyone, and this is a long way off. Shortages are always part of any war, and every Covid affected country has this problem. Like Spitfires in the last war this is only going to be solved in the long run by setting up our own national production lines and stopping relying on the Chinese for these and many other things. Till then it is bound to be a bit make do and mend. Priority, whatever promises are made by the politicians, has to go to those most at risk looking after ventilated patients on ITU’s. We know from Italy those are the most at risk, and we can’t protect all of the people all of the time.

Once we can cope better with the virus the needs of the economy require some sort of release from lockdown, and debates rage about how and when this should happen. This is a political decision as it is effectively a trade-off between direct deaths from Covid (which we can measure) and indirect deaths from missed cancers, suicides, and the depression that comes from being locked up and unemployed which is far more difficult to establish at least in the short term. I can’t tell you when, but I suspect that it will be soon as otherwise the young at least will take matters into their own hands.
As to how this will happen, I can only make informed guesses but probably have access to a bit more information than those locked up (sorry that should be locked down) at home.

The risk to the under 60’s who are otherwise fit and well is incredibly low. The politicians keep telling us that every death is a tragedy, (I disagree; we are all going to die it is just a matter of timing) but it does not make much difference if the 21 year old dies in an RTA or of Covid19 and one more or less offsets the other. It is the risk of the asymptomatic youngster visiting and infecting grandpa that lockdown has been trying to prevent. But putting people in simple age categories is far to simple and attitudes to risk vary enormously, to some a 1% risk of dying is huge to others small and people need help putting it into context. In fact the chances of my dying of non Covid related causes in the next year is about 1-2% so a 2% risk from Covid is not that different, however were I to be an obese hypertensive diabetic and I am suddenly looking at a 25% risk and that would make me think twice. So as far as letting us out and about I think that we are all going to have to make our own risk assessments. There will need tools to help you decide what your risk is and to put that risk in context, and when making the assessment we will have to consider not just ourselves but our families, both those with whom we live but also the extended family. Can we risk visiting the grandparents or mum in her residential home?

Secondly any let up has to be coupled with a massive contact tracing programme and isolating of potentially infected people to limit transmission to a manageable rate and thus prevent a second big peak. This has been highly successful in South Korea and New Zealand, but in a country as densely populated as ours requires testing on a massive scale. There has been talk about contact phone apps to help with this. To make this work they are going to have to abandon or at least modify the massive swabbing hubs that have been set up at airports and shopping centres and make swabbing available much more locally. Who want to drive for an hour or more each way feeing awful for a test? Swabbing should be available no further away than your local hospital (though probably not on the same site).

With this combination I believe a controlled safe let up is possible. No we will not be able to congregate at football matches for a long time yet, going to the pub may be difficult (especially in The Nutshell) but going to work, visiting a limited number of friends or family (at least to start with until we see how it is working), sending the kids to school and going to the gym should all start up again.
It may be that like a forest fire there will be flair ups requiring local measures for a few weeks to damp things down again, but it will, indeed must, allow the economy to get going.

In the long-term things will have to change forever unless we find a vaccine and I am not holding my breath on that. The old normal has gone forever, we will gradually learn how to live with Covid19 at home, when shopping, in the pub or in hospital, developing ways of reducing the risk to an acceptable level for most of us. Indeed I suspect we will not even know when we have reached the “New Normal” until we look back and say nothing has changed for a year or more now so this must be it, and that may be a long time coming.

Matthew 27/04/20