Science, say health chiefs, is “our exit strategy”. There are two ways that the world comes out of lockdown. The first is to let the virus sweep through the population, scything down the old and weak. The second is to find the science that will prevent that.
Ultimately, that means a vaccine. But before one arrives, there are strategies that could enable a phased lifting of some restrictions and a return to some kind of normality.
Antibody testing
They are, Boris Johnson has promised, a “game-changer”. Millions of antibody tests are on their way. A simple fingerprick that could tell you if you have been infected and, more importantly, if you are now immune. It could be that they show this has all been a fuss about nothing. Maybe, as an Oxford University study argued this week, more than half of us have been infected and not noticed. If so, that’s the end of the lockdown.
More likely, their use could confirm which people — especially key workers — can return to living almost as before. Even amid lockdown, the knowledge of their immunity will confer upon them a superpower: the ability to have a near-normal life.
Viral testing
“Test, test and test,” were the instructions of Tedros Adhanom Ghebreyesus, the World Health Organisation (WHO) director general. It was both a scold and a challenge to a UK response that has consistently failed to meet its own testing ambitions.
Viral testing is very different from antibody testing. It is about spotting the infection as it happens, while people are infectious. If we come out of lockdown then the virus will return — that is certain — but if we can spot it before it spreads, conducting surveillance to identify clusters as they appear, it is just possible we can contain it.
Ventilators
It was not the deaths that most worried the government; it was the beds.
Or, rather, it was the lack of them. When, last week, a dramatic analysis modelled the consequences of a laxer strategy on the virus, the media concentrated on the fatalities. Without strict social distancing, there would, the Imperial College paper predicted, be 260,000 deaths. That revelation was awful, but it was the second that was a clincher: intensive care capacity would be exceeded eight times over. Without a lockdown, the health service would collapse.
With more ventilators, though — and many, many more are on order — it is possible that the prime minister may think a managed second wave really is manageable. You haven’t heard the last of herd immunity.
Antivirals
One way to ensure the NHS can scrape through a second wave of the epidemic is to build more ventilators. Another is to ensure that fewer people need them. There are now dozens of global trials looking at ways to treat the virus — to attack it in the bloodstream or interfere with its life cycle. Some use artificial antibodies, some repurpose drugs we already have, such as the antimalarial chloroquine. None will be a “cure”, but they could blunt the virus’s ferocity.
Contact tracing
Late last month, a delegation from the WHO visited Wuhan. Of all the measures they saw, one impressed them the most: contact tracing. The city had 1,800 teams of epidemiologists, each with a minimum of five members, tracking down each and every person who had interacted with someone who had later been shown to be infectious.
It was, though, still not enough. If the virus is to stay quashed as the country returns to work, then we need better ways of stopping outbreaks before they begin. This is where technology may help — albeit with civil liberties trade-offs. Yesterday, the UK’s privacy watchdog sanctioned the use of mobile phone data to trace exactly who people have met in their infectious period.
Expedited vaccines
Never in human history has a vaccine been developed so fast. Less than four months after the novel coronavirus made itself known to the world, human vaccine trials have begun. That is, alas, where the speediness stops. To test a vaccine is an onerous task. Large numbers of people, typically in their thousands, have to receive either a placebo or the real thing. Then we wait for the virus to do its work.
Only when enough have been judged to be exposed — and, hopefully, stayed well — can the vaccine be declared a success. This can take six months, it can take a year. With the country in lockdown, and the virus not spreading, it could take longer still.
But what if we deliberately infected volunteers? Serious scientists are making the case that it is time to relax ethics, for the greater good. If the volunteers were young and fit, the risk would be minimal, and the trial could have results in a month. Then, the last phase of testing could begin in the autumn — done at sufficient scale that the “trial” doubles as a mass vaccination programme.
Britain would be back in business.
