Richard North, 21/04/2020  
 


We are now seeing a number of media reports suggesting that the rate of new Covid-19 infections is slackening off. And, by reference to NHS England figures for deaths, we can see that the number peaked on 8 April (currently at 803) and has been on the decline ever since.

One would, of course, expect a decline in the death rate as countermeasures bite, not least with the imposition the "lockdown", now entering its fifth week, but so degraded are the figures that nothing can be taken for granted.

However, even if we do allow that the epidemic has peaked (for the moment), with the recorded deaths standing at 16,509 – as of yesterday – there is no expectation that this is the end of it, and we have seen the last of the SARS-Cov-2 virus. The best that we can hope for is that – at great cost in blood and treasure – we have bought a short-lived pause.

The reason why there are no grounds for greater optimism is simple: none of the conditions required for ending this epidemic have been satisfied. And despite the almost overwhelming torrent of verbiage from "leading experts", politicians and commentators, the actual conditions are relatively simply defined, amounting to a mere two in number.

In essence, these boil down to satisfaction of one of these propositions: either you take the infection out of the people, or you take the people out of the infection. In principle, it really is as simple as that.

Looking at the second proposition first, this is what the government has been hoping to achieve with the lockdown. The infective virus is abroad, carried by an unknown number of people, with hotspot reservoirs in hospitals, care homes, prisons and other institutions. Thus, we are kept out of harm's way by keeping us locked up in our homes, minimising our contacts with virus carriers.

There is, as we well know, an alternative way of achieving this, by vaccinating the population. This makes humans unavailable to the virus, which means that it can no longer spread from individual to individual. In time the epidemic will die down, just as assuredly as if we all stay isolated in our own homes.

Sadly, a vaccine is not available and, despite the hyperventilation of some media organs, we are unlikely to secure a vaccinated population in the UK for at least a year, if not longer – assuming that a working vaccine can be found and that enough doses of vaccine can be manufactured in the time.

As to the lockdown, it is impossible for this to be complete so all we can hope for is one of sufficient rigour to achieve the desired object, before it becomes economically and socially unsustainable.

Just starting week five of what is a six-week period, the government may have difficulty in extending it further. And each extension, should the government take this path, will be harder and harder to enforce, especially if the reported case and death figures are on the decline.

The problem with that, though, is the virus is still out there and, as controls are relaxed, we can expect a second surge in the number of cases and deaths. And given that the indications are that only a very small proportion of the population has been infected, and/or carries antibodies, there is nothing to stop the virus ripping through the population once again. The diggers will be back to work, creating the mass graves as crematoriums run out of capacity.

Thus, if the government is to avoid a second peak, it really has no option but to address the issue that it should have confronted right at the start: it must take the infection out of the people.

This is done in the first instance by isolating suspect cases and keeping them isolated until they have been tested clear and can be allowed to resume social contact with the rest of the population.

For this to have maximum effect, we probably need more than voluntary self-isolation that is currently required. Helpfully (apart from the paywall), the Telegraph spells out the Wuhan experience, where suspect cases were removed from their homes and held in central quarantining facilities.

As a result, family members no longer infected each other. Families with sick members stopped passing on the virus to others during their inevitable shopping trips. In a later stage, we are told, teams of epidemiologists went house to house looking for individuals with potential illness, isolating them as well, reducing the rate of transmission even further.

But this is only part of the picture. In lockstep with this procedure, the authorities mounted a programme of aggressive contact tracing, with the same isolation and testing protocol, with those who either tested positive or showed signs of illness referred to the quarantine centres.

Whether it likes it or not, the government will certainly have to re-introduce the abandoned programme of contact tracing. And while secretary of state Hancock is putting his faith in a mobile app, it is extremely unlikely that the system proposed will work. And, to reinforce that, we see a warning that, if public health bodies build centralised contact tracing apps that transmit superfluous data, they will struggle to win the trust of enough citizens to ensure the activity is a success.

The warning comes by way of a letter signed by academics from 26 countries worldwide. It highlights the potential that digital contact tracing has in helping prevent a resurgence of Covid-19, but cautions that the effectiveness is no excuse for riding roughshod over privacy protections – and is, in fact, closely entwined with them.

As cited by the Guardian, "Such apps can otherwise be repurposed to enable unwarranted discrimination and surveillance", the letter states. "It is crucial that citizens trust the applications in order to produce sufficient uptake to make a difference in tackling the crisis. It is vital that, in coming out of the current crisis, we do not create a tool that enables large-scale data collection on the population, either now or at a later time".

It is possible, we are told, to carry out such tracing without needing to build a centralised database of every meeting between individuals. One proposal, backed by Apple and Google, sees every smartphone build a decentralised record of only the other phones it has interacted with, and waiting to hear from the state if any of those phones have been marked as infectious.

In my view, I would have no objection to such a scheme, if the data were accessible only to the phone owner, then to be used to create a framework for a face-to-face interview with a trained contact tracer. Without a direct human interface, I do not see any system working effectively.

However, this is not what Hancock is currently considering and if he is rash enough to go ahead with a centralised scheme – one without a direct human interface - he could find himself with an expensive failure on his hands. If relaxation of the lockdown is built on the expectations of success, the nation could find itself facing a second, more rigorous bout of confinement, as the infection surges once more.

Whether or not to release the nation from lockdown, therefore, is apparently splitting the cabinet as different factions ponder over its advisability. And yet, there hardly seems to be the emphasis on contact tracing and isolation that will be required before relaxation can be allowed.

One clear voice on this, though, is Jeremy Hunt, the former health secretary, now chairman of the health select committee. He is warning that contact tracing "needs to be our next national mission", and is suggesting that a national figure outside of politics is needed to spearhead a programme.

A national figure, however, may not be enough, or even desirable – adding more complexity to an already confused chain of command. It would be best handled by a cabinet office committee, headed by a secretary of state working directly with the prime minister – if we ever get to have one again.

In one small glimmer of light, the need for effective contact tracing has been emphasised by a major report by the Organisation for Economic Co-operation and Development (OECD). It says that testing and contact tracing in the community is the "most promising approach" in the short term to help lift the lockdown.

Bluntly, short of that, there is a third option: to revert to the Foot and Mouth strategy and hire an airfield to dig new mass graves. It is as serious as that, and it is about time the government woke up to the reality of what is needed – and the consequences of failing to do so.






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