How should we respond to local/regional COVID-19 hotspots?

Over the last few days attention has begun to focus on a few towns and places where Coronavirus cases are on the increase again. Bolton is increasingly making it into the headlines but there are other places where this is causing concern including Bedford. The other concerning factor is that these increases tend to be associated with variants, particularly the one first identified in India. It is now being reported that this could put the final stages of lockdown lifting at risk. So how should we respond.

The first thing is “Don’t panic.”  Remember that SAGE expected there to be an increase in cases as schools, hospitality and workplaces opened up.  In the last few weeks, there has been growing confidence that this will be at the low end and that even if it drives a third wave, this third wave will be later in the year and much, much smaller than expected.  Scientists will therefore first of all want to investigate and observe to see if what is happening is an uptick likely to lead to a trend of further and exponential growth in the virus or simply variation as the data bumps along the bottom of the graph. 

The other question that will hopefully be urgently under consideration is whether or not the new variants can successfully evade the vaccines currently in use. Currently the produces seem confident that it will not. There may be a level of vaccine evasion but even still the vaccines will continue to provide significant protection against serious illness and death. Remember that is the crucial point, we have been working on the assumption that COVID will remain in circulation but that we will not see pandemic level hospitalisations putting stress on the NHS or the distress of high mortality rates. So after the first response of “don’t panic” we need to focus on the second priority of observing and understanding how the virus is behaving. 

Thirdly, we need to understand how people are behaving.  There are two sides to this. First of all, remember last summer, there were a number of places especially in the Midlands, Greater Manchester and West Yorkshire that practically never really came out of lockdown. At the time I pointed out that we needed to understand why the virus had not been brought under control in those areas because there was no point in putting people back under the same harsh measures that did not seem to have worked so far. One factor we had to consider was that in some contexts due to work requirements and family circumstances it was pretty much impossible to give strict compliance to the measures. There may be a need for local restrictions to be reintroduced into places but we need to know that those restrictions will work in the context otherwise you get the worst of both worlds, a population frustrated by being subjected to restrictions and no discernible affect on the virus.

Equally important is to observe how the rest of the population is responding. As well as the need to control the virus, there is the need to get the country open and up and running again. There’s no point suffocating a virus if we suffocate everything else too.  Confidence will be a crucial factor. One of the risks ahead is that some parts of the population may become over confident and ignore all measures whilst at the same time others remain ultra-cautious and afraid to get out and participate in normal life. So there is, if you like, a huge political dynamic to how these local spikes and the presence of variants is responded to.

Fourthly, I think that the key is going to be effective contact tracing. This was missing at the start of the virus and I personally suspect that it made all the difference. In fact, if you are able to rapidly test and trace when there are outbreaks then it significantly reduces  the need for lockdowns, masks and social distancing.  Surge testing not just with variants of concern but in areas of concern becomes particularly critical. It’s also important that the contact tracing processes continue to be rigorously followed. This means, that it isn’t just those who immediately test positive who need to self-isolate but those who could have been in contact with the virus and who have not been vaccinated.

Finally, we should be willing to review the vaccination strategy. Of course, I write as a non-expert in terms of vaccines and viruses here. However, sometimes non-experts can lob in things that with a bit of work prove helpful. Further, some of us speak and write not as virologists or epidemiologists but as people with expertise and experience in systems and processes. We know how to get things moving freely without friction and delay. We also know how to control and restrict too.

At the start of the vaccination process, I argued that as soon as proven safe to do, we should look at prioritising younger people, if possible including those at the older end of schooling. We of course need to be confident that the vaccine is safe for use among adolescents. “Why vaccinate younger people?” I was asked. “They are at very low risk of serious illness and death.” I guess by the same token you could ask “Why vaccinate people in their 30s and 40s?” You see vaccination is not just about protecting the elderly and most vulnerable. There are two prongs. One prong is just that, stop elderly and vulnerable people from catching the illness or at least experiencing severe and life threatening symptoms.  The other prong is about reducing transmission

The vaccine will not be 100% effective because some people won’t be able to take it or choose not to and because even with those who do receive it, it won’t completely work with everyone.  That’s why we look at herd immunity. Herd immunity means that those most vulnerable who aren’t able to develop their own immunity are protected because there is a fire-break between them and the virus.  We also want to reduce transmission to reduce opportunities for future vaccine resistant mutations too.

I note that Andrew Burnham has asked for the vaccine to now be given to 16-25 year olds in Boltin. However, because the variant will be now transmitting beyond there I would argue it needs to be wider. Indeed, it seems reasonable to me that with over 50% of the population now having received one dose and most elderly and vulnerable people vaccinated we should now focus our attention on getting those vaccinated who are most likely to be active, mobile and in close social contact in order to substantially reduce transmission of the virus.

I have been writing generally here thinking about national policy. It is good for us to be thinking and talking about these things.  I write primarily for Christians here but Christians should be concerned with what is happening in the world around us. However, there are specific responses for us as believers. We should go back to that first recommendation, don’t panic. We don’t need to panic because we have hope beyond sickness and death in our Lord and saviour. Finally, every uptick in the virus is a reminder to us that we live in a fallen world and should jolt us into action with the imperative to share the reason for the hope that we have.

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