Re-opening to the virus? How the UK government’s conditions for ending the lockdown differ from the WHO.

These are the WHO’s conditions for a safe ending to lockdowns These are very clear and are aimed at eliminating the virus.

  1. Disease transmission is under control
  2. Health systems are able to “detect, test, isolate and treat every case and trace every contact”
  3. Hot spot risks are minimized in vulnerable places, such as nursing homes
  4. Schools, workplaces and other essential places have established preventive measures
  5. The risk of importing new cases “can be managed”
  6. Communities are fully educated, engaged and empowered to live under a new normal

These are very clear and are aimed at eliminating the virus. In China, the point at which disease transmission was under control was when deaths were down to single figures.

As in China, at that point the Health system has to know where any new infection takes place and have the equipment and infrastructure to rapidly intervene, test, contact trace and isolate to prevent it getting out again. This virus is very infectious and spreads very quickly.

At that point, anyone coming in from an area where the virus is still in spate will need to be tested and quarantined if need be and all schools and workplaces will have to have the appropriate preventive measures in place and be fully equipped.

The last point is as crucial as the others. Communities have to know the risks, know the procedures and recognise that this is not a blip that will “disappear like a miracle” (D.Trump) but a threat that will still be lurking at least until a vaccine is produced – which is scheduled to take 18 months if all goes well. So, even when we are out of the woods, we could still meet a wolf; and have to be on our guard.

The UK government puts different conditions. They say

  1. The government must have confidence that the NHS can still provide sufficient critical care and specialist treatment across the UK.
  2. Secondly, there is a need to see a sustained and consistent fall in the daily death rate to be confident the UK is beyond the peak of the outbreak.
  3. There also must be reliable data from SAGE that the infection rate has decreased to manageable levels.
  4. Testing capacity and PPE must be in hand to meet supply for future demand.
  5. There also must not be a risk of a second peak of infection that could overwhelm the NHS.

As the words are not the same, the differences must be deliberate. While some of them sound similar, the devil is in the detail.

  • Being “beyond the peak” can be any time from when death rates start to decline in a “sustained and consistent” way. It does not necessarily mean that the death or infection rate would be under control if the restrictions were lifted.
  • There is no specific mention of schools or workplaces, no mention of imported cases, no mention of having to minimise the risks in vulnerable hot spots.
  • There is an emphasis instead on making sure that the NHS is not overwhelmed. A laudable aim in itself, but when you consider that it is currently being achieved by pre-triage on the one hand and rapid removal of the elderly into hotspots like care homes on the other, you can see its limitations.
  • There is no mention of communities being fully educated, engaged and empowered to live under a new normal, which reflects the UK’s relatively lackadaisical lockdown.
  • Having infection rates at “manageable levels” does not mean the same as having them “under control.” “Under control” means on the path to elimination. Manageable means copeable with, not overwhelming.
  • Avoiding the “risk of a second peak” is not the same as eliminating the virus. Their bottom line is that the second peak should not be so great as to overwhelm the NHS. That could describe the current situation. The NHS is not being overwhelmed, but the UK has the second highest daily death rate in the world.
  • The phrase “testing capacity and PPE must be in hand to meet supply for future demand” implies that there is going to be a future demand. This is not the same as having a system ready and primed to “detect, test, isolate and treat every case and trace every contact”. Managing. Not eliminating.

So, we have a half way house policy here. Just as the UK “lockdown” is half a lockdown.

The danger is that there will be a return with infections at too high a level; so the rate of infection will go up again, without adequate PPE, without a testing and contact tracing system in place – with schools one of the first places to open simply to have kids taken care of during the day so the economy can “open” (in Trump’s phrase) and their mums and dads can go back to work.

This would let the genie back out of the bottle and then require restrictions to come back in to stop it running out of control. So instead of getting a grip and crushing the virus in one determined go, we end up with a reactive yo yo of restrictions going up and down; with the presumption that a vaccine will arrive like the cavalry coming over the hill. The problem with this – of course – is that it might not.

So, an apposite question for Labour (and others) to be asking is why it is that the government is not adopting the WHO guidelines without equivocation.

Lives rest on this.

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