OVERCOMING MADNESS AND THE 2 METRE RULE

COVID-19 Alert Levels as announced 11 May

This post has been updated after the UK COVID-19  risk level has been downgraded to level 3, which still means "A COVID-19 EPIDEMIC IS IN GENERAL CIRCULATION"

This post is about how we get to Level 2 "THE NUMBER OF CASES AND TRANSMISSION IS LOW"  Only then can we safely re-open the economy, re-open schools, let people take holidays, and allow shielding people to confidently leave their homes.  Amongst many other benefits.

INTRODUCTION

This posting males the case for having a short sharp lockdown as a means to a safe reduction of social distancing rules which will fire up the economy and allow us to get back to near normality.  Save the summer, save the economy and save lives.

The proposal in this post is of benefit to everyone in the UK.  It is of especial benefit to HM Treasury which stands to gain in several ways as a result of re-opening the economy strongly, including:

• Remove need for COVID-specific support
• Reduce social security bill from people losing jobs that cold now be saved
• Start to receive VAT and other taxation again

At Wednesday’s press conference (17 June), a graph was shown which is incredibly important in terms of unlocking what the government should be doing next.

This post includes a proposal for what the government should do next, to get the UK to alert Level 2 and re-open the economy and get back to some normality.


WHY IS THIS GRAPH SO IMPORTANT?

The graph sheds light on how best to resolve a key issue discussed over the last few days.  Can the 2 metre rule be reduced?  

Change to 1 metre would make a massive positive practical and economic difference in all sorts of settings, including schools, pubs, other hospitality and places of worship. Just as PM Johnson acknowledged at Tuesday’s press conference.  But such a change would mean an increase in risk. Is it safe enough to reduce the distance? 

The government is reluctant to make that change, nor to yet commit to the easings that the public has been led to expect on 4 July.  Understandably given that the country is still at Level 3, and the government has yet to openly discuss what's shown below with the public.  But as I write (lunchtime Friday 19 June), indications on the BBC news website are that Level 3 "allows social distancing to be relaxed".  As explained below, that would be a mistake.


LEVEL OF DAILY INFECTIONS

Let's compare daily infections in the UK with  other major European countries, according to the Euronews statistics of "The number of daily new COVID-19 cases in key European countries" graphs:

• Italy - around 300 per day
• France - around 500 per day
• Germany - around 500 per day
• UK - around 1,250 per day.  Although estimates in the UK, below, are in excess of 3,600 per day at present

So we can clearly see why these European countries are able to substantially ease lockdown and re-open their economies when UK cannot do so safely.  Yet that is what so many people crave.   The proposal in this posting is the only realistic way of being able to so.  Until then the 2 metre rule should continue.

Looking at the comparison of UK and Germany, for example, even though infections started to rise significantly in both countries about the same time in early April:

The UK's level of daily cases translates directly into the number of people with COVID-19 disease.

The problem is the "Confirmed New Cases" graph shown at the press conference on Wednesday agrees with the Euronews graph, and also agrees with other studies discussed below.  All are showing that daily infections are not reducing.  They've got stuck way above the point that major relaxation of lockdown should occur.

Indeed way above the point that ANY relaxation should occur, according to this report from early May that "...ministers say they want daily infections down to the hundreds before ANY easing of the lockdown".  Yet the government is romping away with relaxations way too early.

So supported by information from other COVID studies discussed below, we are led to the conclusion that for England and the rest of the UK:

• Daily infections across the UK are no longer reducing, significantly if at all. But threaetening to rise, with an R too close to 1.0 nationally for comfort.
• The total of infections are far higher than most of Europe, and still too high to risk further easings,
• Regional R numbers are still mostly too high, with concern especially for London and the South East, threatening a second wave.  That is a switch from the South West and North West only a couple of weeks ago, showing how quickly COVID-19 can resurface if not properly under control

This means:

• We should not be planning further easings in the short term (June/July), despite the talk of changes on 4 July,. The current lockdown policies will not get us there in time
• But we should be considering re-tightening the lockdown for a short period to avoid a second wave and reduce total infections to the very low level needed to re-open the economy.  That would allow the economy to open strongly in July, let people who have been shielded to more confidently emerge from their homes, and let people take their holidays freely here and abroad.  And reduce the number of deaths and serious medical problems due to COVID-19.

But how?   And is a second lockdown really worthwhile?

The other side of the coin is we need to be aware of the ‘side-effects’ of the lockdown.  As mentioned, we should consider the economy, people’s summer holidays, and schools being closed. Yet there’s people still under virtual house arrest due to the need to be shielded.  This is because the number of infections is still “not very low” as Sir Patrick Vallance, Chief Scientific Advisor said recently.  Indeed the level of infections and new daily cases is significantly higher than most of the rest of Europe, as shown above.

But we can get daily infections down well below 1000 in as little as 3 weeks, so we can unlock virtually all the economy, and provide the right foundations for the remainder.

The proposal published in the Financial Times last week (right) , and detailed in this other posting is that we can be far better assured to make the easings planned for early July, and avoid a second wave, if we:

• Have an immediate short sharp lockdown for only 3-4 weeks, similar to that in March, but hopefully retaining some easing such as outdoor meetings. That is to get back to achieving an R around 0.4 to ensure we achieve 0.5 and avoid any risk of a second wave
• Develop a better list of anti-transmission methods that are both cheap and effective, that can be implemented shortly as a replacement for lockdown, and maintained in the medium to long term.  That removes any reliance on vaccines, and treatments.  It also puts less reliance on test/trace/isolate (which is troublesome and expensive), such that any of these can provide additional protection when available. 

The problem is that infections are either staying level, possibly rising, but in any case simply  not dropping fast enough to achieve the set of easings hoped in early July.   A different approach is needed, as in the proposal, supported by these graphs.  Firstly the reduction achieved in three weeks in the first lockdown, according to the King's College study:

The first lockdown had to first halt the growth in infections rather like throwing a ball into the air.

A second lockdown would be more like dropping the ball, hence starting the 3 and 4-week periods at the apex of the graph.  16% of the starting level of infections is achieved after 3 weeks.

Continuing on the current path of UK policies would take a lot longer to achieve that same 16% level.  The straight line would be a curve, but difficult to predict its shape as it might go up and down for any second wave.  Graphically, this would look something like

THE BENEFITS OF THE PROPOSAL FOR A SECOND LOCKDOWN

This proposal for a short lockdown would solve a number of critical problems simultaneously, primarily by achieving a far lower level of infections far more quickly than continuing with the current policies:

• Reduce the number of infectious people around the UK to such a low level that the 2 metre rule can be reduce, just like other European countries
• Thereby open up most sections of the economy in early July, including hairdressers, pubs, and hospitality.
• Let people go on their summer holidays in the UK without fear.  That is making it safe for holidaymakers and hosts.  And safe for the staycation areas that would fear being overrun by infections
• Persuade foreign countries such as Spain and France that it would be safe to welcome visitors from the UK, when UK infection levels are down to a level comparable to those countries.  That allows the set up of “travel corridors” (including air bridges, by sea and by tunnel) to many holiday destinations thereby allowing foreign holidays and business trips this summer
• Allow schools to open before the summer break, and possibly through it.  In addition to the minimal risk to children, there would also be minimal risk to staff, parents and other adult members of families at home
• Provide a foundation to re-open music and theatre venues as soon as possible hereafter.  These remain a considerable challenge, but we can learn from other countries that are beginning to open these venues on the back of having got infections down.
• Substantially reducing the need for Government subsidies.  Thereby producing a triple-win for the Treasury as VAT and other taxes start to roll in again, and fewer people lose tbheir jobs who would need social security.  Indeed the Treasury stands to benefit considerably from this proposal
• Keeping further deaths and other dreadful medical consequences to a much lower level than continuing on the current path.

Saving the Summer.  Saving the Economy. Saving lives.  Getting back to some normality.  All objectives that PM Johnson stated on Tuesday.

So let’s look at why a short lockdown is desirable and even necessary, by looking at the problem that the graph highlights.



CURRENT SITUATION

The Graph of New Confirmed Cases

The graph shown at Wednesday’s press briefing (17 June) is:

This shows:

1. The 7-day rolling average of new confirmed cases has levelled off for this last week at around 1,200 per day (though other studies below suggest in excess of 3,600)
2. That would mean that the transmission R number has been around the limit of 1.0 for transmission in the historical period 1-2 weeks ago
3. If cases are not reducing, this coronavirus cannot really be said to be “under control”.  Capped but not properly under control.  We certainly can’t be complacent.

In estimating R being around 1.0 some 1-2 weeks ago, this is having made two assumptions:

• Cases are confirmed at least a week after infection, by the time someone displays symptoms and their test result has been counted
• Any increase in testing capacity in the last fortnight doesn’t now result in a significant ‘artificial increase’ in cases confirmed, as it did in earlier weeks

But regardless of whether the second assumption is correct, looking at these test results doesn’t tell us what the transmission R has been during the last week or so.  What is R now and how it is changing?  On this evidence alone, we don’t know whether R is:

• Now over 1.0, setting off a second wave which will only become apparent in the ‘new confirmed cases’ graph in a week or two.  We can’t wait for that to happen before taking action
• Still around 1.0, in which case infections are not reducing
• Down below 1.0, perhaps in the official R range of 0.7-0.9.  The problem is that the last official updated was on 5 June, reflecting historical transmission R nearly a month ago.(Updated to 12 June only on 19 June!)  An R in that range will take many weeks to get daily infections below 1000 on the realistic count of the ONS and Kings College.

Other Evidence for R and the Level of Infections

We need to know what the transmission R number is now.  What it was weeks ago isn't especially useful.

The government SAGE team are getting information from a variety of additional sources which are potentially getting a view on what’s happening around the country based on data collected at an earlier point in people’s infection.  These include:

• The Office for National Statistics (ONS) sample-testing some 4000 households across the country, from a wide variety of social settings.  This includes people who are pre-symptomatic and asymptomatic, who wouldn’t get tested to be included in the figures in the graph above.  
• The "COVID-19 Symptom Study app"  (ZOE) project run by King’s\ College London This project is involving some 5% of the UK population, nearly 4 million people, providing daily reports of their relevant health.  Whilst it is not as representative as the ONS sampling, being limited to families with smartphones outside of hospitals and care homes, it is a far larger sample that allows better analysis of the general population by region, age, gender and pre-existing conditions such as diabetes. 
• Potentially virus tests on sewage, which can give advance warning – see the foot of this post

An ONS graph was shown at the press conference on Thursday 18 June:

This confirms that the total number of infections has levelled off.  Too high, with R around 1.0, threatening a second wave.

King’s College with ZOE offer more data to the public, including regional analysis of infections and R.  Tim Spector, professor of genetic epidemiology at King’s College London who leads the ZOE-based project says that their results are consistent with the ONS studies.  So their data is the best public data available.

Here is their latest graph of total infections, which also shows total infections remaining stubbornly high, despite the substantial reduction since the lockdown started:

By scaling up their sampling, King’s College is estimating that across the UK on 13 June there are

• Some 3,600 new daily cases becoming symptomatic 3-4 times the figure in the 17 June graph above

• Some 154,000 people across the UK are symptomatic all of whom ought to be self-isolating, though can be infecting members of their own household for some days after symptoms

• As symptoms lag infections by 3-5 days, some 15,000 people are pre-symptomatic and potentially infectious.  Plus those never showing symptoms, so a guesstimate total of some 30,000 people are going around infectious at the moment

This level of infection is far higher figure than most other places in Europe.  It means a relatively high chance of meeting one of these people, hence the need to continue the 2 meter rule.


Looking specifically at Oxford as a typical example, as shown in the screen shot above, there are some 3,700 people with symptoms.  Implying some 700 infectious people could be out and about, unaware that they are infectious. What's the chances that  you'll meet one of these people in a shop or on a bus?   Quite high.  Hopefully they are wearing a face covering.  But many won't until it is made compulsory, and in any case face coverings aren't perfect.  Won't you want to keep at least 2 metres away from them? Indeed everyone?

So this means:

• If we continue with current policies, infections will not reduce fast enough to allow the economy to re-open strongly on 4 July, and indeed there is the ever-present threat of a second wave
• If further easings are made we will make a second wave almost inevitable.  Then a second lockdown will be needed anyway.  Better to take action now to nip it in the bud.

PUTTING THIS INTO PRACTICAL AND ECONOMIC CONTEXT

The official “Alert Level” is only just now 3, meaning “Gradual relxation of restrictions and social distancing measures” as set out in the original lockdown of 23 March.  

Yet England and other parts of the UK have been easing the lockdown since early May.  There is now talk of making significant further easings on 4 July, albeit this is the earliest.

This appears madness.  Indeed it is now time to reversing easings as a much more suitable way to deal with the situation and the risk of a second wave. 

That would benefit the economy, save summer holidays, reduce deaths and get us back to some normality.


WILL THE GOVERNMENT IMPLEMENT A SECOND LOCKDOWN?

Arguably the government has no choice but to implement a second lockdown, given:
•    The consequences of continuing as we are, and
•    The benefits of a lockdown to the economy and general life.

But that is too logical.  The general reaction to the lockdown  proposal in the letter published in the FT is that the lockdown easings horse has already bolted and the government won’t do a second lockdown.

So let’s see what PM Johnson said at the press conference on Tuesday 16 June.  Does that provide any hope that this lockdown proposal could be actioned?:

PM Johnson  said in answer to a  question from Trevor from 27min05 “...as we get the numbers down and we get the rate of infection down in the country, then the statistical likelihood, Trevor, of any of us actually being next to somebody, whether two meters, one meter or whatever distance, who has coronavirus, is going down the whole time”

He hit the nail on the head.  Except numbers have stopped going down, and realistically will only do so if there is another lockdown

In his opening talk, he’d already said this from 17min41 “I know that people want us to go further with our changes to the social distancing measures, and I'm all too aware that the two-meter rule has big implications for schools and for many other sectors. I want you to know I absolutely hear those concerns and will do EVERYTHING IN MY POWER to get us back to normal as soon as possible, but we must proceed carefully [and according to our plan]. I'm still committed to that central goal to get back to life as close to normal as possible, for as many people as possible, as fast and as fairly as possible, in a way that minimizes the risk of a new epidemic, minimizes the risk to life and maximizes our chances of a strong economic and social recovery.” 
“Our plan sets out the next step for adjusting lockdown. You may remember for personal care, for the hospitality and leisure sector, for gatherings in places of worship, other public places, a lot more to come. That, as you know, will happen no earlier than July the 4th. We remain absolutely committed to that plan, and will say more about how we are going to be taking it forward.”
Except the current policies won’t achieve that plan, now infections are not falling.

Then for holidays oin France and Spain from 46min15 “Thanks very much. I should say, obviously I'll be talking to Emmanuel Macron about all sorts of ways in which we can bring our countries together, making sure that we eventually will be able to travel freely to and from each other's country. Same goes obviously for Spain, as soon as we can. The reason for having the quarantine system is very simple. It's we don't want to reimport the disease just at the moment when we've really got it under control in this country, but we're certainly looking at averages and ways to ensure that people can safely go on a holiday eventually.”

Except the problem is that infections in the UK are far higher than most foreign holiday destinations, as shown above.  Would France, Spain  and the others be willing to accept  "travel corridors" with the UK?  Unlikely, lest they import infections.


IN CONCLUSION

A short sharp lockdown could get infections down to a much better 16% of the current level in just three weeks.  That's down to about 650 new infections a day.  Still higher than other major European countries, but low enough to implement significant easings to open the economy:

• Implement a lockdown by Monday 20 June, and a re-opening could be planned for many sectors from 11 July.
• By 27 June for 18 July, around the time state schools would have broken up for the summer  

To save the summer, save the economy, reduce deaths, let shileded people out of the homes, and get back to some normality. Whilst avoiding the risk of a second wave.

This post on the lockdown proposal sets out further details of the proposal and how its success can be best assured.


Good for the economy and the Treasury.
Good for holidaymakers
Good for schools
Good for the shielded
Good for everyone
Saving lives

It's time for the PM to take action.  Lockdown, not easings.  We would only need to wait three weeks for those.