Scientifically-informed, data-driven answers to your burning questions about the coronavirus pandemic

Post #4: The Exit Strategy

Welcome to Naturally Speaking’s blog series on COVID-19. This fourth episode is about the ‘exit strategy’: the lifting of lockdown measures related to the COVID-19 virus. This is a particularly challenging topic, as there are so many unknowns! That being said, if we don’t answer all your most pressing questions, please feel free to post them in the Comments section below – we’ll do our best to respond. We’ll also aim to provide any updates as advice and knowledge evolves.

As usual, this post comes in two flavours:

  1. Short and sweet – bite size summary
  2. Hungry for more? Look no further! This version includes a bit more detail and links to further resources.

Disclaimer: Some of the guidance refers specifically to the situation in the UK, although most of the content is relevant regardless of where you hail from.

Q: Will our lives go back to ‘normal’ once the lockdown measures are lifted?

A: The virus is and will still be out there, even after the full lockdown ends. Thus, it will be important not to immediately restart our ‘normal’ lives as if nothing has happened: doing that would increase the chance of being hit by a second wave of the virus. For this reason, enhanced surveillance and control will be critical over the coming months.

Q: How can we maintain control of the virus after the lockdown?

A: In order to keep virus transmission in check and to avoid a second major wave of spread, multiple types of control measures will be required. First, we should always keep in mind that hygiene and social distancing will still be the most important tools that we have in the fight against this virus. For example, always keeping our hands cleaned – using sanitizer in public spaces and washing hands when returning home – and maintaining a distance of 2 meters (6 ft) from other people, as recommended by the government. This will most likely result in a re-organisation of stores, museums, and more generally, all the places that could lead to a gathering of people. Moreover, protective equipment such as masks/face covers may help to reduce the risk of spreading the virus to others. A major emphasis will also need to be placed on testing and contact tracing.

Since the beginning of the pandemic, the World Health Organisation (WHO) has been emphasizing the importance of diagnostic testing (see Post 2 for more details). Massive, wide-scale testing has been proposed; trials of weekly testing for all members of the British public (starting with one city as a demo) have even been suggested. This would need to be combined with strict household quarantine for those who test positive, in addition to tracking and testing those with whom they have been incontact, with isolation of any of those contacts who test positive. However, testing and quarantine alone are unlikely to succeed without extensive contact tracing, as nicely discussed by Adam Kucharski, a Wellcome Trust fellow based at the London School of Hygiene and Tropical Medicine. A collaborative study between the UK Government and the University of Oxford has just been launched to help inform such actions. The Scottish government recently published its framework for decision-making as it works towards lifting restrictions.

Q: Will we have new tools to control the spread of the virus?

A: According to a recent study, manual contact tracing isn’t sufficient on its own. This is because the COVID-19 virus spreads so quickly and easily, including via asymptomatic cases. Thus, it might be necessary to find other ways to monitor the situation. Amongst the options that have been brought forward is developing an App that can build a memory of all the contacts you’ve been in touch with, to facilitate ‘real-time’ contact tracing. In fact, the App would immediately notify all the people who were in contact with an affected person, helping them to self-isolate and thus stop the spread of the virus. To this effect, a collaborative initiative by Apple and Google has already led to the development of a decentralized contact tracing tool. Thus, we’ll certainly have new tools to fight the Covid-19, but everything needs to start from surveillance and control.

For example, a methodology of this type has been proposed by the manufacturer Ferrari, who is developing a “Back on Track” plan. This company is planning to first screen their employees (on a voluntary basis) when returning to the factory, and then as a second step, to use an App which could monitor their health and safety. This could certainly be a methodology with a lot of potential, but it will be important to keep testing people on an ongoing basis, in order to be sure to isolate newly infected people before they can infect too many others. It will always be important to know the number of infected people and their distribution in order to take the best measures.

Q: Is the vaccine the best exit strategy?

A: Vaccination is likely to be the most feasible strategy to control this pandemic in the long-term. However, its development is not straight-forward, and only the first hurdle in a much longer process to ensure safety and lack of side effects (see Testing and Treatment). As we described in this earlier post, therapeutic options (anti-viral treatments) may offer an additional option in the interim.  In encouraging news, development of a vaccine against the COVID-19 virus is moving forward at unprecedented speed. The first clinical vaccine trial in the UK is already underway at the University of Oxford, and major funding has also been secured by  Imperial College London to move their vaccine towards clinical trials as well. Globally expanded scientific cooperation will certainly help to speed up the process. For instance, the European Medicines Agency is also exploring several vaccine options, with two clinical trials underway. The Vaccine Centre at the London School of Hygiene & Tropical Medicine has compiled a complete list of the many COVID-19 vaccine candidates, which will track them as they move through the development pipeline. However, for the vaccine to stem the spread of the virus, it will be necessary to vaccinate the vast majority of the population, which will certainly take time. As Ed Yong put it in The Atlantic, the most realistic scenario will be a “protracted game of whack-a-mole1 with the virus, stamping out outbreaks here and there until a vaccine can be produced,” which brings us back to the current emphasis on testing, quarantine and contact tracing.

1 whack-a-mole: popular North American arcade game ‘in which players use a mallet to hit toy moles, which appear at random, back into their holes.’ (Oxford Dictionary)

Feature image is original artwork by PhD candidate Chiara Crestani, ©2020.

2 thoughts on “COVID Q & A

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