Rather than tell you comforting lies and what you want to hear, I’m going to tell you some unpleasant truths. The world has fundamentally changed over the past nine months since a small pneumonia cluster was reported in Wuhan, China. The “normal” version of reality does not exist anywhere in the world, even if politicians or snake-oil pseudo-scientist salesmen try to persuade you otherwise. If you are struggling with how to cope, know that the only certainty about the year ahead is uncertainty.
As we are witnessing in the UK, restrictions can change quickly as the government grapples with how best to control the spread of the virus with minimal economic and social harm in the process. Every country across the world has some sort of restrictions in place. Yes, even Sweden. The narrative of lockdown and release is no longer helpful as we move into a future of varying degrees of restriction.
As a scientist, I’m often asked what to do and what not to do, and how to cope in this new uncertain world. Here is my advice on how best to enjoy life and get as much normality back while being a responsible citizen.
My main advice is to get outside as much as possible when seeing other people. Research has shown that 97% of “super-spreading” events occur indoors, and that outdoor transmission is minimal. If an indoor setting is poorly ventilated, crowded and no one is wearing face coverings, it is best to avoid it. The upshot is that non-essential shops, outdoor hospitality and public transport look relatively safe with the use of face coverings. Now is the time to avoid non-essential travel and to visit nearby parks, and support your local businesses.
It goes without saying that with a virus that spreads from person to person, the more contacts you have, the more likely you will have to isolate because one of them tests positive. How many people are you in close contact with each week? This means people who you are in physically close contact with for an extended period of time (more than 10 minutes) at close range. Quality of interaction over quantity of contacts is a good rule to follow.
For those who are younger, it is tempting to just want to have Covid-19 and get it over with. But Sars-Cov-2 is a nasty virus that you do not want to get. There have been a number of cases of reinfection with the second infection sometimes being asymptomatic or mild, or, in at least one case, being much more serious and requiring hospitalisation. Just because you have it once does not guarantee you immunity for life.
Worryingly, some people aged 30-59 are suffering for months, with horrible fatigue, lung damage and cardiac problems all being described as “long Covid”. The real story of Covid-19 may not be just the lives lost, but the associated disability in younger working-age populations and the burden this places on the economy and health services. Why risk potential decades of ill health instead of putting up with a few months of inconvenience?
As well as the risk Covid poses to individuals, our actions affect others including vulnerable and elderly people. Think of it as a chain of infections – if you are a part of this and it gets passed on, others may become ill and die because of your role in that chain. A wedding in Maine resulted in more than 170 people contracting the virus, and seven people dying. None of those who died attended the wedding.
The only alternative to more restrictions and modifying our own behaviour is a functioning test-and-trace system. Lockdown just presses pause on the spread of the virus. Once restrictions are lifted and governments have pressed play, it will start spreading again. The key objective of lockdown should be to carry out mass testing and tracing in order to aggressively seek out and eliminate community transmission of the virus (like China, Taiwan, Vietnam, New Zealand and South Korea have done). This also buys time for science to develop solutions (such as dexamethasone), and to build healthcare capacity. Simply to lock down for two weeks would be less effective: it is kicking the can down the road.
Nine months after South Korea and Senegal started building diagnostic capacity, it is comically depressing that the UK government, one of the richest in the world, does not have a functional testing system that returns results within 24 hours. In addition, given that we know the virus spreads easily through households, those who test positive should have the offer to isolate in external facilities (such as hotels). The “14-day isolation” measures for people entering the UK are also a box-ticking exercise where given the lack of screening or monitoring, a constant stream of infections keep coming into the country. It’s like trying to empty a bucket under a tap.
The UK government also needs a long-term economic strategy, especially for riskier sectors such as hospitality and bars. The “eat out to help out” scheme has been linked to the rise in cases: the government directly subsidised one of the riskiest settings, indoor hospitality. Instead the money could have been used for economic support packages for these businesses. What will happen to them once new restrictions are brought in? We’re taking one step forward, five steps back.
This is an incredibly hard time for most people. It is perfectly normal to grieve for our lost normality, but denial needs to be followed by acceptance. It is time for governments to plan several years ahead with an acknowledgment and honesty about the severity of this crisis. And for each of us to be patient and compassionate, and take things one day and one week at a time.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh