On April 23, Britain joined the US – which currently has two studies – and China, in Singapore start human trials for vaccines. However, the Prime Minister and his cabinet say they believe that a prevention jab is unlikely to appear in this calendar year.
Earlier this month, Prof. Neil Ferguson, a key epidemiologist advising the Government, said: “The only long-term exit strategy is vaccination or some other innovative technology.”
Prof. Sara Gilbert, who led the team at Oxford University in developing the vaccine said that work jabs could be available in the fall, but then need time to be improved. Even when it is widely available, it will initially be provided for frontline workers and the most vulnerable in the first instance.
But the government has confirmed that if Britain develops a vaccine first, it will be given to the British people in the first instance, which means people in the UK can be ahead of the queue.
Developing treatment can be faster, with dozens of trials underway to see if antivirals that have been used for other conditions, such as malaria and HIV, have proven to be effective. Plasma from the victim’s recovered blood can also be injected into the patient.
If a successful drug is available in the coming weeks or months, the locking will be removed faster.
Imperial College constantly warns that extensive restrictions and monitoring must remain in place until vaccines are available, to prevent a second wave.
But increasing the scale will cause problems and it is likely that only frontline workers will be given the vaccine that will initially leave
Dr Jeremy Farrar, a member of the government’s Sage group and Director of the Wellcome Trust said the disease will not disappear in the near future and is likely to surge in the future.
“My belief is that this is now an endemic human infection. It is very likely that this is here with humanity for the future. We have to find a way to deal with it.
“What’s really moving forward is we have to do a new test, we have to have a drug that treats this infection, and critically we need to have a vaccine so we can prevent what we think is the wave of the future.”
Prof Hunter added: “In the fall we might have some proven effective drug treatments which if consumed early enough can reduce the severity of the disease and the need for hospitalization, critical care and ventilatory support.
“If that is the case then that will also be a reason to calm social distance.”
Countries that have raised several locking areas, such as Germany, have begun to see reproduction rates rise again, and are worried they might have to re-impose restrictions to avoid a second wave.
Angela Merkel has warned that hospitals could be overwhelmed by the end of June if the numbers continue to increase, and said a second “closure” would be unavoidable if cases did not start to decline.
Below are questions about locking from our readers which Sarah answers on Wednesday 8 April. YYou can send your questions for our next question and answer [email protected].
‘What if the lockdown was instigated before?’
Our first question from Howard Williams asks:
“If the lockout had been instigated one or two weeks before, after we knew we were targeted by the community, would it be possible to model how much time we would need in the lockdown and how many infections would we prevent?
“The strategy for the Covid-19 battle has focused on saving the NHS from failure because demand exceeds exceeding capacity. What is the model of the impact of previous locking on the NHS?
“Does previous locking only extend the length of the epidemic by slowing down the acquisition of herd immunity?”
Here’s what Sarah said:
Hi Howard. This is an interesting question and I haven’t seen any models about this. I am sure it can be done. It seems reasonable to think that if lockdown has been achieved before, then the disease will not spread so far and the exit strategy can be done more quickly.
However, one of the reasons for delaying the locking is to flatten the projected peak instead of pressing it completely as if we did, we will see another big peak as soon as we appear because no one will have immunity. In this way, by the time we get out, a large number of people may already have the virus, and the second peak will be much lower.
“Why hasn’t the worst case scenario been communicated?”
Our next question from Roger Steer:
“It seems that part of the reason why no objective economic analysis of the costs and benefits of Coronavirus policies has been carried out is the reluctance to tell people about the worst case scenarios.
“Therefore I want to ask why the worse case scenario has not been communicated well?”
Here’s Sarah’s answer:
Hi Roger, good question. I kept asking this question to the government and I was told The Treasury was modeling it, hopefully we will soon now.
Many people in government today worry that the economic, social and health effects of locking will be far worse than the benefits. Yesterday Chris Whitty, Chief Medical Officer, spoke of the “unintended consequences” of diverting so many NHS resources to fight the corona virus. We know that many operations and treatments are being canceled and the impact can be very large. I worry that the medicine will prove worse than the disease in the long run.
“Is blood plasma the route?”
Our next question from John Doe regarding possible coronavirus treatment:
We have realized that coronaviruses were initially mutated into two types, evil and very evil. This morning on Radio 5 Live a virologist admitted that he had now mutated many times. So is the consequence of making vaccines much more difficult and immunity now swaying because of the power of variation?
Also, given the mutation, will immunity be short-lived and we might regret seeing more waves of the virus? In this case, blood plasma, with all the risks might be the route forward?
Here’s what Sarah said:
Hi John. Yes, mutations can make vaccines more difficult. That depends on where the mutation has taken place. Many vaccines in production take a ‘surge protein’ on the surface of the coronavirus – it looks like a small stem with a small crown on top, hence the name ‘corona’ – If DNA mutates to change that structure then it will inhibit vaccine development. But other vaccines use different mechanisms.
Blood plasma looks pretty good so far, and there are also ongoing trials that use healthy person T-cells to boost the immune system. It does not target certain viruses so if it mutates it doesn’t matter.
“Is it getting better?”
Our next question is from Mitch Klattle:
Is the situation getting much better now because we are locked in?
Sarah has the following to say:
Hi Mitch, it seems like it’s still early days. The number of new admissions to hospitals is declining and that means that the death rate must also start dropping immediately. We expect a peak death rate around Easter Sunday or a few days later. If we follow the development of China after that, we must start seeing a rapid decline and can think of an exit strategy around mid-May.
“Will the locking be tighter?”
Our next question from readers who want to remain anonymous:
“When the lock is in place, will the tightness of the lock remain the same as now or is it getting tougher?”
Here’s what Sarah said:
Hi. The government wishes not to impose tighter lockouts and currently seems impossible. The case figures seem to be stable and if we reach a peak when expected – within the next week or so – then there will be no need because there will be clearly a lockdown at work.
Modeling shows that we only need 75 percent compliance to be effective and we are far above that.
“How long will England be locked?”
Katrina Allen has raised a very important question:
“How long will England be locked?”
Here’s Sarah’s answer:
Hai Katrina, no one knows at this time and the government is waiting for death to peak before deciding on an exit strategy or timeline.
But if the virus reaches its peak in Britain when it is estimated – on Easter Sunday or a little afterwards – then the lockdown can be revoked in May. China began to lift restrictions about a month after their cases peaked, and they now seem to have the situation under control. Ministers and scientists watching other countries closely at this time and what is happening elsewhere will help inform our own exit strategies.
“Will London stay locked longer?”
Our next question from W FLETCHER:
“In early May or then the daily death rate fell below 150 then removed the lock for people under the age of 45 provided they didn’t live with someone over the age of 60. There might be a case for continuing to be locked up in central London for two or three weeks further than the rest of the country. “
Here’s what Sarah said:
Hi! Yes, I think the government might plan out gradually where less vulnerable members of the community are allowed to get out of the lock. Paradoxically, London may come out faster than other parts of the country because there is emerging evidence that the capital has built more immunity.
I suspect there will be a general lockdown in May and then some areas will be asked to return, if it seems like the virus is getting out of control in certain areas.
“Should older people become cocooned longer?”
Our next question from Edward Hogan:
“Maybe the time has come to move the approach to the crisis from the hospital (where they themselves will admit it is very difficult to eliminate infection) to other sectors such as manufacturing that have developed sterile and aseptic techniques for manufacturing their products that can be used to make” anti cocoons -virus “for parents and other vulnerable groups until medical science develops effective drug treatments?”
Here are Sarah’s thoughts on this issue:
Hi Edward. As long as older and vulnerable people isolate themselves, I don’t think we need to go that far, even though it’s a very interesting idea.
‘Can antimalarials be used to fight the corona virus?’
Stephen Keay asks: “What’s wrong with using chloroquine as a first-line treatment?”
Here’s what Sarah said:
Antimalarial chloroquine (CQ) and hydroxychloroquine (HCQ) have been shown to be beneficial against a number of virtual infections including Ebola and dengue and are currently undergoing clinical trials in the UK.
Anti-viruses usually need to be given at the beginning of an infection and we know that coronaviruses do not show symptoms for a while so they may not be as useful as they first appeared.
Oxford University is currently conducting trials on coronavirus patients using hydroxychloroquine, lopinavir-ritomavir – and HIV treatment – and dexamethasone – a type of steroid, and the results must be known immediately. The red tape is being removed so that once deemed safe and effective they can be launched quickly enough.
‘Do vulnerable groups still need to be careful when traveling after the lockout is complete?’
Geoff Doven asked: “When the world returns to normal holidays and holidays abroad are back on the agenda, is it safe for those who are vulnerable to be able to travel before taking anti-virus vaccinations?”
From Sarah: Hi Geoff – I would suggest watching the Foreign Office’s advice on this because it is changing rapidly. In the coming weeks I imagine that the Department of Health will also issue some guidance on what people who are vulnerable in terms of travel or just moving in general should do. It seems like vulnerable people can be isolated longer in any event, which means that when you get out of locking, the world might be a much safer place, and vaccines or treatments can be available. Maybe avoid cruises and crowded resorts for a while!
“Do we need a mask after it’s locked?”
John Crone said: “My wife and I are entering their 80s and (although not in the medically vulnerable category) are definitely at high risk until the vaccine appears.
While the lockdown is taking place in the meantime, it seems to me that people like us can emerge from isolation if provided with PPE quality masks. Plus of course pay attention to hand hygiene.
Although experts say that normal masks do not provide full protection, surely we can buy our own masks that provide 100% security? Do you have this view? “
Sarah: Hi John! There does not appear to be much evidence that masks prevent people from being infected even though it seems they are stopping infected people from spreading the disease further.
I think when the lock is removed – which can later be the most vulnerable – the virus will be greatly reduced in the community and the risk of infection will be very low.
So, as long as you maintain good hygiene practices, and maintain social distance, I don’t think a mask will be needed. It should be noted that there is no evidence that coronavirus has ever been transmitted outdoors, but there is a lot of evidence of indoor transmission.
“What about the other country behind us?”
Nigel Wheatcroft said: “We all hear about the chat about when the lockdown will be finished here in the western world, but everyone seems to forget that the virus isn’t really about the most vulnerable, namely in Africa and South America. It just started there and it gets worse, they are behind the infection curve and will be a threat to continue spreading. “
Sarah said: Hi Nigel, yes there is a lot of concern about vulnerable countries and the government has sent funds and public health experts to help with their response.
“Why do some countries, like America, struggle with testing?”
Susan Killion asks: “Why is it so difficult for the US to test all populations to isolate positives and negatives and ultimately get rid of the virus?”
From Sarah: Hi Susan, I think many countries struggle with increasing testing because of the lack of materials needed for testing. The test requires two enzymes which are usually only produced on a small scale.
Usually, demand is very stable and relatively low, so increasing global demand in large amounts takes time. In addition, quality control checks must be carried out to minimize the risk of false positives / negatives. A bad test is worse than no test at all because it allows someone to enter an infected community.
The government has also struggled to get the swabs needed for testing because a large amount is produced in Lombardy, Italy, which is currently locked.
But yes, testing is very important, and it is very important that countries get more tests.
“Will the lockdown be finished in a month?”
This is a million dollar question!
Charlotte Reilly asking: “Does it look like the lock will end in a month or will it take longer? “
Sarah: Hi Charlotte. If we follow what China has done, we can expect the restrictions to end about one month after the peak of the epidemic. The government estimates that in the next week or so, maybe six weeks from now looks like a possible exit date. But that will change if the path of the epidemic changes.
“When will the lockdown of Northern Ireland end?”
Leah Steele the word: “I live in Northern Ireland. How long do you think the lock here will last?”
Sarah: Northern Ireland seems to be on the same track as Britain and with Health Minister Robin Swann warning the public that “the worst is yet to come” so it will be several weeks after the summit before the lockdown is lifted
“Will women be allowed out before men?”
This is a fun thing but also a very interesting point (sorry gentlemen).
Laura Giuliani said: “I have read that, aside from being a protective factor for adolescents, women are less vulnerable than men from Covid-19. Do you think the age limit might be set at an older level for women, under locking relaxation?”
Sarah said: Hi Laura. Yes, you are right that the infection and death rates seem to be much higher for men than for women – about three times higher in some cases. I think that is a very interesting and reasonable suggestion, but I suspect it might be a politically unpopular move to just let a woman out. Can cause riots!
“Will people try to catch the virus if it helps them get out of the lock?”
This is very wild, but it’s still a valid point.
Mark Reeve asking: “Isn’t some kind of certificate that says you have a virus causing people to try to catch the virus, so they can get back to work / normal life faster, and therefore be counterproductive?”
Sarah: Hi Mark, yes there is always a possibility that some people might try to catch the virus to get out early, but given that it is deadly indiscriminately, I hope most people will make more sense.
‘Is it time for vulnerable groups to be isolated?’
Carpe Jugulum said: “Modelers have switched from 250,000 deaths to 7,000. Case fatality rates appear to be too high along with SARS-cov-2 Basic Reproductive Rates. Why are we listening to this model?
Wouldn’t it make more sense to isolate the elderly and vulnerable, and perhaps continue to be able to afford National Health Services? “
Sarah: Hi. The number of cases has dropped because it is locked. The original modeling was based largely on allowing the virus to sweep the population. Although this virus has a disproportionate impact on older and vulnerable people, it also kills younger people so it might be better to keep everyone inside until the number of cases is much lower.
‘Should the Government force us to download the tracking application?’
Oliver Norwell the word: “If a workable solution is an application that knows exactly where we are, and allows us to report symptoms, then tell others who are within a few meters of us for the previous five days … is it appropriate for the Government to asking us to download and run the application? (I know in China they have something similar to this).
“It will be a nightmare of epic proportions for privacy watchdogs … but, it can allow us to continue normal lives, which in itself will be worth billions for the economy, much of our sanity, and test the effectiveness of the system for future pandemics.”
Here’s Sarah’s decision:
The government has said that the application will be voluntary but hopes that a large number of people will download it. A survey today shows that 78 percent of people will provide privacy to help deal with the virus. But I think that is not necessary in this matter. All data will be anonymous and will disappear after 14 days. It is up to people to do the right thing and isolate themselves rather than being made or forced to download applications.
“Wouldn’t there be a privacy problem if we were asked to use the contact tracking application?”
Chris Wichard the word: “Hi Sarah, you may or may not have specific opinions or insights on this, but do you have a view on whether GDPR’s concerns could hinder the launch of an effective contact tracking application?”
And here’s Sarah’s answer:
Hi, Chris. The government works with civil rights groups to ensure data is anonymized. The NHS has promised not to use it to track people but to remind them if they make contact with someone who is then tested positive with coronavirus so they can do the right thing. That’s completely voluntary.
Officials are eager that other countries or companies do not have access to UK citizen data, which is why we have developed our own anonymous version in line with other countries including Norway and Germany.
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