Will the current cycle – lockdown; open up; eat out; restrictions; lockdown – go on forever? In their handling of coronavirus, Boris Johnson and his colleagues have become increasingly media-responsive, fear-bound, model-sensitive, sound-byte producing, u-turn prone and, quite frankly, embarrassing to all who believed the UK to be a beacon of rational thought. Has the Government lost the plot? We are not sure if it ever had one.
This week at its annual meeting, the British Medical Association lamented the Government's lack of grip on the public health during the current pandemic and proposed a ‘near-elimination’ strategy. Put simply, this involves what the BMA called ‘sacrifice in the short-term to ensure that we can avoid a large-scale prolonged lockdown that would be ultimately much more detrimental to the health of our society.’
To achieve this, the BMA proposed a number of measures. These included better messaging, targets for the daily and weekly number of new cases, hunting out cases rather than waiting for symptomatic outbreaks, and trigger points for the implementation of specific additional measures both locally and nationally.
All of them have been tried in one form or another as part of the PM’s whack-a-mole strategy, and yet cases are increasing. So is ‘near-elimination’ really a viable strategy if it involves doing many of the things the government is doing already?
It’s worth remembering that our options in the fight against Covid-19 are limited; one alternative – eradicating the disease entirely – is impossible. The WHO has declared only two diseases officially eradicated: one in humans (smallpox) and one in cattle (rinderpest). Trying to eliminate Covid-19 any time soon is not a viable option.
If it proves impossible to rid our planet altogether of Covid-19, could it still be eliminated from specific countries or regions? This would require what we are lacking in Britain at the moment: a coherent governmental response. Yet if one is forthcoming, there is hope: viral disease such as polio has been eliminated in many countries across the world (it is not eradicated as it is still endemic in some countries such as Nigeria). The elimination of polio also required an effective vaccine and was possible because humans are the single hosts for the virus. There is bad news here: coronaviruses are zoonotic and, therefore, spread between animals and people, which makes it harder to tackle.
We also know comparatively little about coronaviruses compared to other viruses. There are hundreds of different viral respiratory agents, some known and some unknown like SARS CoV-2 was. The important thing to bear in mind about all these respiratory viruses is that they do not have clinically distinctive features so that you cannot distinguish one from the other. This would be a pointless exercise for two reasons.
First, there are no licensed specific treatments (antivirals) or preventive measures (vaccines) for any of them with the exception of influenza.
Second, the respiratory viruses cause respiratory problems with a wide spectrum of severity from mild (sniffles, common cold) to severe (respiratory failure and death). Thankfully apart from the severe cases, the vast majority are self limiting and by the time you get to see your GP you are probably on the mend.
For decades, most of these agents have been either ignored or tolerated. Only occasionally have people taken notice of their impact. Coronoviridae have been systematically understudied and names like 'parainfluenza' and 'respiratory syncytial virus' are unknown to most. We still know next to nothing about their ecology and modes of transmission.
Covid-19 may have inadvertently given us a hand, however. We can turn this crisis to our advantage with a little organisation and clarity of purpose. Although we have not had an open and far-ranging debate on the issue of acute respiratory infections, there is clear appetite for one. We now see all too clearly how acute respiratory infections have the potential to disrupt our lives, inflict damage in just about any field we can think of and take our elderly loved ones away.
We cannot eradicate or eliminate them because we do not know enough about them. And our ignorance about these viruses could exacerbate the problem: our uninformed actions may actually accelerate their spread.
So if we cannot beat them we have to learn to live with them in the hope that one day humanity will be free of their scourge.
In the meantime, we must do our best to follow the evidence and plug the well-known enormous gaps in our knowledge. We can then put in place interim measures based on a minimum of credible scientific evidence to protect the vulnerable this coming winter and every future winter. We can also invest in sensible community surveillance and better tests. Here is the bonus: these measures may protect us against Covid-19 and all the other pathogens you have never heard of in future winters.
But what is clear is that the current approach isn't working and isn't sustainable. If we want to try and defeat Covid-19, we urgently need to accept our ignorance, learn more about this virus and use this evidence on what works when, how and in whom to control the viral impact for what happens next.