Published: 16 April 2020
Author: Ben Richardson

If our timeline mirrors China, the Government could be in a position to consider lifting social-distancing restrictions by early summer - we need an Exit Strategy.

 

The UK's coronavirus epidemic is expected to peak towards the end of April before a steady decline in deaths. But will that mean an end to social distancing, or could we be facing a lockdown until the end of the year?  This past week calls for a coronavirus exit strategy have been heard. The virus is highly contagious - r0 of 2.7+ which means that when isolation is relaxed, the virus will only continue to spread.  The only thing that can stop the further spread of COVID19 is immunity which can be achieved through vaccination or herd immunity.

There are five elements to address in the exit strategy:

Delivering ICU capacity

Ensure capacity is sufficient to meet demand. As demand peaks, we will see the shift to focus from ICU beds to community and social care and in particular the staff to support this.

Pervasive testing.

The population will need testing, hence the race for antibody tests. For now, testing needs to focus on front-line staff and patients. For 1m staff current volume would take two months— 100k tests a day means that every 10 days the NHS staff could be tested. To test the population in a 2 week period would take 4m tests a day.  The optimal practical route out may be a policy of testing everyone within the UK, but even if the government hits its target of 100,000 tests a day by the end of April, at that rate, it would take the best part of two years to test us all.

Contact tracing

Contact tracing will be critical to prevent creating “transmission vectors".  Contact tracing coupled with technology that allows easy 'contact tracing' of anyone who has met an infected person in the previous few days, like the Singapore one that monitors and records everyone we come within a few metres of. This needs to be done in a way that is appropriate for liberal democracy and hence the news about Google and Apple collaborating in this is so promising.

Easing of restrictions

Countries can begin easing restrictions in areas that show a lower incidence of cases. With a controlled, strategic approach, the system can divert resources where they are needed.  Easing restrictions with risk-based approaches include the return of children to school and the young to work whilst continue to protect high-risk groups.  The WHO is developing new strategic advice for countries considering lifting restrictions. 

Clear the backlog

Address backlog of elective care and cancer cases and chronic conditions built up from weeks of patients staying away.