While The Sun Shines: Can We Avoid an Autumn Covid Outbreak?

Jacinda Ardern, New Zealand Prime Minister, head and shoulders in red jacket.
Jacinda Ardern, New Zealand Prime Minister (New Zealand Government, Office of the Governor-General )

Today, New Zealand declared the country to be free of the COVID-19 virus, and scrapped all COVID-related restrictions, apart from quarantine of overseas visitors.  It’s not the first country to announce that it’s COVID-free, nor is it the largest.  But it is significant in that it’s a country that’s broadly comparable to European and North American nations, and took an approach to tackling the virus that was very different from that of UK.

New Zealand’s Prime Minister, Jacinda Ardern, announced quarantine measures for overseas visitors and strict lockdown for New Zealand citizens very early in the outbreak.  She was widely criticised for that – at that point, New Zealand had only half a dozen recorded COVID cases, or around 1.2 cases per million population, and no deaths. Today, with the country COVID-free, they have recorded 1,504 cases, and 22 deaths – that’s around 300 cases, and four deaths, per million population.

Compare that to the UK.  Lockdown measures were not announced until March 23rd, by which time we’d recorded 6,650 cases and 359 deaths – around 100 cases per million.  To date, the UK has recorded 286,000 cases, or 4,300 per million, and 40,500 deaths, or around 60 per million.  And in the UK, the COVID-19 outbreak is far from over, with the number of new daily cases still tailing off disappointingly slowly. 

There seems little doubt that the UK government was too slow to react to the crisis, and was too slow to introduce a lockdown.  When it did, the population largely adhered to the rules, showing unprecedented levels of trust in the government.  However, all that was blown away by the Dominic Cummings fiasco, after which all that trust evaporated. This was not so much because of what Cummings did, but that his idiotic explanation of why he did it, and why it was within the lockdown rules, was backed by the Prime Minister and the rest of the government.  Even if Cummings hadn’t resigned, an approach that recognised that he’d done wrong would have allowed the government to retain some authority. But treating us all as fools by lying about it shredded all their trust and credibility.  Since then, we’ve seen widespread rejection of the lockdown rules, with many now assuming they no longer matter.  What’s more worrying is that the government now seems to be following the public reaction, easing lockdown with little or no scientific basis because they can no longer enforce stricter rules.

The decrease we are now seeing in the number of daily cases is welcome, but not unexpected.  In summer, people spend more time outside. That, coupled with higher UV light levels that reduce the virus survival rates in the environment, leads to lower viral transmission rates. That’s reinforced by the spread of the pandemic across different countries.  Back in March and April, infection rates were escalating in northern hemisphere countries, with fewer infections in the southern hemisphere.  Now, as southern countries enter their winter, rates are increasing more quickly there.  And across the world as a whole, the rate of COVID-19 infections is still increasing.

In New Zealand, they’ve achieved what they needed to.  They used the summer months, when the virus was less easily transmitted, to eliminate it altogether, before they got to winter when infection rates would have started to rise.  True, it was easier for them, because the disease arose in their summer, allowing them to get it under control more easily in the early stages.  But by easing the lockdown here during summer, we are taking huge risks. In autumn, with people spending more time indoors and lower UV light levels, COVID-19 (along with all respiratory viruses) will increase again, if we haven’t got it under control.

Here in Hastings, we’ve got off pretty lightly.  Only seven deaths related to COVID-19 have been recorded, and the rate of infection has consistently been in the lowest three local authority areas in the country.  But that leaves us more vulnerable to a delayed outbreak, when summer ends, or before.

There is a lot we don’t know about this virus, and viruses can behave in strange ways.  Variola virus, which causes smallpox, can survive for months in the environment (it was transmitted around the world on cotton bales) and kills around 30% of those infected.  It’s not the most infectious disease person-to-person, because victims don’t transmit the disease until they have symptoms and are too ill to move around much. Nevertheless, smallpox had been around for more than 10,000 years. By all logic, it should have wiped out humanity a long time ago.  But it didn’t, and was eventually forced into extinction in the human population thanks to a massive international vaccination programme, the first (and so far only) major viral disease where that has been achieved. Viruses do sometimes seem to self-regulate in some way – it’s not in their interests, in the sense of evolutionary advantage, to wipe out their host, or to create such levels of immunity that the virus can no longer find enough vulnerable hosts. Viruses that kill all their hosts or create high levels of permanent immunity would quickly die out, as smallpox did when those high immunity levels were created artificially.

Viruses can just disappear.  In the 1490s, a bizarre viral disease emerged each summer, which killed people shockingly quickly.  Sufferers could be perfectly healthy in the morning, and dead by the same evening. Men would return from work to find their entire family dead. This awful disease ravaged London and other cities in the UK every summer until the mid-fifteenth century, when it disappeared, never to return. 

So understanding the epidemiology of any new virus takes a few years, and a few cycles of infection. They can be unpredictable, and we really don’t know how COVID-19 behaves in the longer term yet.  The only way to be sure it won’t flare up again is to eliminate it altogether.  And that’s difficult without a huge vaccination programme.  Until then, the only thing we can do is put all our efforts into reducing the number of active cases, while the sun shines. If the infection levels in the UK keep dropping at their current rate, halving every three weeks or so, we should be able to get the disease under control, with new cases down to single figures by the autumn. But that  level of decrease is based on current lockdown restrictions – if lockdown is eased, as the government intends, that rate of decrease could change, or indeed reverse. We just don’t know what the impact of easing restrictions will be, while infection rates are still relatively high.

If we avoid a second wave of infections in the autumn, it will be through luck rather than judgement, hoping that easing lockdown restrictions won’t change the rate of decreasing infections.  But from our knowledge of the way different viruses behave differently, and our lack of any long-term data for COVID-19, we can’t be sure of that.  In taking that risk, we could enter the winter months with infection levels still high, and a government unable to reimpose restrictions because it’s lost the trust of its people.  And that could be very dangerous indeed.

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