After 55 days of compulsory self-isolation in UK, the English government decided to start Phase 2 of the COVID19 recovery strategy, with Step 1 starting on 13th May 2020 and Step 2 will start on 1st June 2020. Therefore, in the eve of returning from self-isolation the main challenge facing the world is how to return to a normal life while facing that the virus is still contagious but the economy has to continue.
Phase 1 was implemented in steps by the government starting on 7th March. The first step was self-isolation for any person infected; by 16th March all non-essential contact between people outside your residence was ceased; by 18th March all schools were closed; by 20th March all entertainment, hospitality and indoor leisure were closed; and finally by 23rd March the UK government implemented a mandatory self-isolation program with the motto of stay home, protect the NHS and save lives.
The self-isolation was implemented in order to stop the spread of the virus by limiting the gathering of people and stopping people leaving their house only for limited purpose like basic shopping (food and medicine), exercise (alone), medical needs, and work purpose (if unable to work from home).
The UK government has taken steps to keep safe with self-isolation and to reduce the spread by creating a COVID alert level consisting of the R (reproduction number) plus the number of infections. The success containing the virus has allowed the government to proceed to the next phase while avoiding undoing what has been achieved so far. The plan is returning to life as close as before the self-isolation for many people as possible while keeping safe and protecting the NHS. However, this will be a long process with close monitory at every step of the way.
The aim of Phase 2 is to release the restrictions of self-isolation gradually while being confident that any adjustments to the current measures will not risk a second peak of infection. The dates for all next stage are dependant of reaching the R curve values before moving to the next step.
The statistics associated with Phase 1 were analysed on 9th May in order to prove that the infectious curve was declining. These said that 136,000 people in England were infected with 13,500 in hospital, which is 35% lower than the peak of 12th April, while occupying 27% of critical beds was down from the 51% on 10th April. Therefore, it was decided that England was ready to start with Phase 2 as the R curve was below 1.
Phase 2 requires smarter controls in order to make such that contact is safe in order to reduce the chance of infection per contact by reducing the infected people’s social contact while using testing, tracing and monitoring of the infection. The new motto is stay alert, control the virus and save lives.
This is aid by stopping hotspots developing, by detecting infection outbreaks at a more localised level and rapidly intervening with targeted measures, by introducing a range of adjustment to current social distancing controls, and by timing these carefully according to both the current spread of virus and the government ability to ensure safety will happen in each step.
The challenges ahead are associated with the fact that this is not a short-term crisis as the virus will still circulated within the human population. In the medium-term if nothing is done the virus will spread in an uncontrolled manner exhausting the NHS resources. Therefore, in the short term the governments cannot afford to make drastic changes in order to keep R below 1. In the meantime, SAGE (scientific advisory group for emergencies) suggest that fully opening schools or relaxing all social distancing measure now, will lead to a resurgence of the virus and a second wave that could be larger than the first.
It is important to understand that this pandemic has not quick solution and our only hope is that the vaccine can control this epidemic. In addition to developments in the vaccine, it is also important to reduce the number of cases for R to be below 1 and effectively trace new cases as the virus’ spread is difficult to detect. Therefore, the hope is to either the develop vaccines with the potential of stopping the spread of the disease or treatments that would be less likely to stop the spread but could make the virus less dangerous.
Additionally, the government needs to prepare for the challenges associated with the winter flu season as this will have a wide-ranging effect because flu-like symptoms can resemble COVID-19 symptoms and the demands of the NHS will increase. However, all this strategy is highly dependent on a wide-spread compliance in order to avoid R tipping above 1 and avoid the epidemic to increase in an uncontrolled manner.
The government’s aim is saving lives and saving livelihoods. However, if the government rushes in implementing this, a second outbreak could overwhelm the NHS. Therefore, it is important that UK government adapts a new reality, where the society returns to normal as far as possible, where children can go to school, and families protect their livelihoods while protecting against the spread of the disease.
The UK government will redesign the current social distancing measurement with new smart measures that reflect the level of risk at that point in time, and carefully wind down economic support schemes. Some of the government plans are:
With regards to health, the biggest threat to life remains the risk of a second peak that overwhelms the healthcare system in winter, when it will be under more pressure and the NHS still needs to deliver non-urgent care. This is because it is impossible to guarantee that nobody will be infected with the virus in the future.
With regards to economy, the return to work has to be achieved in a way that it is safe to do in order to go back to workplace in a safe manner. In the longer term, this could harm people by being out of jobs and by insolvencies. Additionally, sustainability of public finances so that government can pay the public services and healthcare response. The financial stability so bank and other financial institutions can continue to provide finance to the economy. The distribution effect to apply measures on different incomes, age groups, business sectors and other parts of the country.
With regards to social effect, the government needs to take into consideration: the number of days lose by children in education, the fairness of any actions the government takes especially the impact on those most affected by social distancing while maintaining the strength of the public services, and civic organisations on which the UK relies, especially those that protect or support society’s most vulnerable.
Each country within the UK will need to make their own assessments in order to lift measures as individuals in Scotland, Wales and Northern Ireland.
Phase 2 in England was implemented based on the analysis carried out by OBR (office for budget responsibility) which suggested that if the self-isolation continued until 1st June the unemployment will raise by 2 million with the most affected sectors being hospitality and retail, as they are associated with low paid, young and female. Therefore, the R will be monitor daily in order to see if the R has reached levels to see if we can go further by obeying social distancing.
Step 1 started on 13th May and consisted of: staying home whenever possible, work from home if you can, avoid public transport if possible, take unlimited exercise outside, enjoy parks and public spaces without exercising, but keep you distance in public (2 meters).
In a more detail specification this consists of allowing sports that are physically played at a distance (like golf), reopening various locations (like garden centre, state agency (viewing), removal firms, lawyers office, childminders (just children of one residence) and recycling centres), people meeting one person from outside their household, travel for work by walking and cycle as much as possible (or car), able to move house, avoid hotspots or busy areas, only use public transport for essential journeys, and no border crossing to Wales for leisure. If fail to comply the fine is £100 with repeat offence increasing up to £3,200.
Step 2 will start on 1st June (tomorrow) and consists of returning to school for early years settings, opening of non-essential retail following COVID guidelines (excluding hospitality and personal care), permitting cultural and sporting events to take place behind closed-doors for broadcast while avoiding the risk of large-scale social contact, and finally reopening more local public transport in urban areas (subject to strict measures).
In a more detail specification, the schools will reopen for very young children in nurseries and pre-schools, and primary school in reception, Year 1 and Year 6 albeit with smaller class sizes to ensure youngest children and those moving to secondary school have a maximum time with teachers. Later in June, secondary school and further education college in England should prepare to begin some face to face contact with Year 10 and 12 to aid in key exams for next year. However, it is important to note that it is not compulsory.
Step 3 will start not earlier than 4th July, if the R complies with the expected value. This will allow reopening of some of the hospitality industry, worship, leisure facilities (cinemas) and public places following COVID guidelines. Venues where social distancing is a problem will be able to partially open with pilot reopening helping impose these new regulations.
This timeframe will allow almost 2 months driven by science data and public health. All conditional of following all rules and enforcing social distancing to get the R down, however, if outbreak occurred all measures will stop as the coming down is more dangerous. Phase 2 will restore freedom that we need while being more economically dynamic to stay alert, control the virus and restore livelihoods.
Therefore, in the eve of regaining more of our freedom of movement, the government has issued a list of recommendations of how to stay safe outside your home:
Keep your distance from people outside your household, as the risk increases the closer you are to another person with virus and the amount of time you spend in close contact. Walking by but keep 2m away from people as a precaution.
Keep your hands and face as clean as possible, wash your hands often using soap and water, and dry them thoroughly; use sanitiser when outside your home.
Work from home if you can, however, if not and your workplace is open you can travel to work.
Avoid being face to face with people if they are outside your household by staying side-to-side as this will lower the risk of infection.
Avoid crowds, if you have to travel (work or school) think about how and when to travel by reducing the number of people you spend time with in at work setting where you can.
Wash your cloths regularly, changing clothes in workplace should only be considered where there is a high risk of infection like working or living with highly vulnerable people.
Keep indoor places well ventilated where different households come into contact.
Wear a face covering in an enclosed space where social distancing is not possible and where you will come into contact with people you do not normally meet.
Follow the advice given to you by your employer when at work; employers have a duty to assess and manage risks to your safety in the workplace.
In addition to the government’s recommendations, it is very important to determine your level of vulnerability as the virus continues to be deathly and there is a very high risk of infection. In order to help you identify your level of vulnerability the NHS has defined who falls in each group (source: NHS website).
High risk – are people with organ transplant, lung condition, very high risk of getting infection (either by treatment or infection), having treatment for cancer (like chemotherapy, radiotherapy, or targeted cancer treatment), blood or bone marrow cancer, stem cell transplant, serious heart condition and being pregnant.
Moderate risk – are people of 70 years old or older, pregnant, lung condition (not severe), heart disease, diabetes, chronic kidney disease, liver disease, condition affecting brain or nerves, condition of high risk of getting infections, medicine for immune system, and very obsess (with BMI of 40 or above).
The only way for the government has to measure the progress of the virus is by testing and tracing the develops of COVID-19 like symptoms. Therefore, it is important to be tested quickly, to alert people with whom you have recent close contact, and provide advice.
However, for the system to work, several new systems were built and successfully integrated in order to comply with this new system like: widespread swab testing with rapid turn-around time, local authority public health services to bring a valuable local dimension to testing, automated app-based contact tracing through the new NHS COVID-19 app (anonymously) which alerts users when they have been in close contact with someone identified as having been infected, and online or phone-based contact tracing staffed by health professional and call handlers.
Therefore, it is very important that everyone should download the NHS COVID-19 app (for smartphones), although voluntarily, will aid the NHS as a method of tracing in order to help increase the speed and effectiveness of the tracing effort, and for yourself as it will tell you if you have been in close contact with someone infected and take immediate action.
However, it is important for anyone with symptoms to isolate themselves immediately alongside their households and apply for a test. If the test is negative, then further isolation is not required. If positive, those in contact with you are considered to be at risk and required isolation either from the point of contact or after 48 hours, whichever is sooner.
Phase 3 is the final step and consists in everyone having a reliable treatment. This is because the virus is unlikely to die out spontaneously nor to be eradicated as the only infectious disease that has been eradicated is smallpox.
Therefore, the government needs a more sustainable solution, in order to lift all the restrictions mentioned above. In order for this to occur, the government must develop, trial, manufacture and distribute a reliable treatment or vaccine to deal with this disease as soon as possible.
Although, every effort has been placed in achieving Phase 3 by means of developing a vaccine, it is important to remember that to achieve this will take a very long. Therefore, it is very important to continue following the COVID-19 guidelines that apply to your level of vulnerability and find the balance between your risk of exposure and level of isolation required for you and your family to stay healthy.
My recommendation is to value your health as a premium and find a way to have a good economic balance by discussing with your boss your level of vulnerability and a way that you can follow the COVID-19 guidelines regarding this, so that you can remain healthy but employed.
Therefore, if you are in one of those levels of vulnerability and chose self-isolation until vaccination. Then, try to enjoy the self-isolation by working on all of your ‘later’ projects as you will have much free time for this, as your level of commuting will be zero. However, if you finished with all of them remember the quote from Talmul and Jose Marti “every man should plant a tree, have a child, and write a book. These all live on after us, insuring a measure of immortality.”
Therefore, do not forget the motto of stay alert, control the virus and save lives.
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