Past the peak. Moving to a ‘new normal’

Dr Steve O’Brien, Visiting Professor, has been following the developments relating to the coronavirus pandemic with keen interest over the past few weeks.

Here, he provides an update about what’s happened, where we are now and gives clarity about the Government’s new, ‘Stay Alert’ guidance and what this means.

A little background

I think it’s fair to say that we are living in very strange days. The last few months have been, to coin an overstated phrase, “unprecedented”.

The Coronavirus pandemic is the greatest Public Health crisis that I can recall since the HIV outbreak in the 1980s. We know that the outbreak started in Wuhan, Hubei province, China, as early as November 2019. The World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern on 30 January 2020 and recognized it as a pandemic on 11 March 2020.

Interestingly, there are many similarities between HIV and Coronavirus. Both posed a global threat, both were new, and both had no treatment and no vaccine. The routes of transmission however differ. Coronavirus is an airborne droplet infection which science tells us is always the most difficult to manage in terms of spread.

To manage the current pandemic, with no treatment or vaccine we have had to turn to the old and trusted methods to reduce the spread; social distancing and good hand hygiene. Nevertheless, the pandemic has progressed relentlessly across the world and within the UK with currently over 223,000 people having tested positive and of those over 32,000 people have died.

In the face of the challenge of rising cases and a fear for the NHS being overwhelmed the UK went into ‘lockdown’ on March 23rd, 2020 and until last Sunday the message was very clear. It was ‘Stay Home, Protect the NHS and save lives’.

The impact of lockdown has been enormous on the economy, the world of work, our families, our social lives and the nation’s children with schools closing and home schooling being introduced to fill the gap. These changes have been felt by all and have been enormously challenging as the virus and the lockdown altered our “normal” way of living.

In addition, there have been well documented challenges to our mental well-being and relationships. For example, we know that the incidence of domestic violence has increased significantly because of the lockdown. Not being able to meet as a family has been difficult with the technological alternatives useful but never the same. On the other hand, there have been positives; greater exercise, a focus on alternative forms of social connection, reductions in air pollution and a re-evaluation of what we all believe to be important as we head towards the so called ‘new normal’.

Where we are now

Whilst lockdown has been challenging and many have experienced fatigue, it does appear to have worked. The evidence on new cases and the power of the transmission (the so-called R number) are such that we have now moved to a phased and conditional recovery strategy; the so-called road map that will allow us to control the virus and open the economy (HM Government 2020).

On Sunday we saw sight of this road map for the first time during the Prime Minister’s address to the nation. A more detailed 60-page document was published on Monday providing greater detail on the overall aim, strategy and stepped approach.

So, what does all this mean? Over the past 48 hours there has been significant criticism about the “clarity” of the new message. Is ‘Stay Alert, Control the Virus and Save Lives’ clear enough? What are we now allowed to do in England as the recovery plan becomes operational? I say England because the message has not changed in Scotland, Wales and Northern Ireland. Something I’ll pick up on later. In an attempt to provide some clarity, I have set out below the key elements of the three-step approach.

Some clarity

Step One covers a return to work from Wednesday for those in non-essential industry where you cannot work from home if the work environment is Covid-19 secure. However, people travelling to work should avoid public transport where possible as it’s more difficult to keep your social distance.

It also allows for greater trips outside of the home for exercise, play certain sports and we can now meet in parks with one other person from a different household and drive to take exercise. In addition, where we are in enclosed spaces we are asked to wear a face covering to protect others.

At this stage there is no return to school for children and those most vulnerable are asked to continue to ‘shield’.

All of this will be subject to enforcement.

Finally, the government have indicated that people arriving in the UK will be subject to self-isolation for 14 days.

Step Two outlines the ambition for a return to school for some primary school children (reception, year 1 and 6), the opening of non-essential retail, resumption of professional sport behind closed doors and the potential for greater mixing of households. All of this will happen no earlier than June 1st 2020.

Step Three would cover the opening of pubs, restaurants, leisure facilities and hairdressers no earlier than July 4th 2020.

However, what is very clear is that every step is conditional on the control of the virus and to do this a new Covid Alert System will be introduced with a RAG rating from 1-5. The rating will reflect the rate of infection (R) in the community and the number of new cases. It’s hoped that this will show where there are hotspots and that if the R increases then restrictions could be employed again. In tandem the Test, Trace and Isolate strategy will help identify where the interventions are required. This could allow us to see how the regions and the other countries in the UK are doing so we can co-ordinate actions.

The clarification document also provides detail on the 14 associated programmes of work to support the strategy.

In conclusion, it’s important to stress that during the pandemic to date and in the future the NHS is still open for business. There has been some concern that attendance at A&E has dramatically reduced and we run the risk of people with serious non-Covid health issues not going to hospital to seek treatment. The unintended consequence of this could be many indirect deaths.

What is abundantly clear is that we are only partly through this pandemic and there is a huge amount of work still be done to control the virus, save lives, protect and re-build the NHS, research for better tests, treatments and of course a vaccine. The next few months will continue to be a challenge to us all so its equally important to hold on to all that is positive in our lives and look forward to the better times ahead.

You can also listen again to Steve talking to BBC Radio Northampton’s Annabel Amos about this. He appears at 1:11:50; 1:44:00; 2:12:00; 2:12:00 and 2:55:30 in the programme.

#StayAlert #coronavirus #covid19