Now that the first Covid-19 vaccine has been launched, with its ultimate promise of herd immunity as we have known it for the last 50 years or more, it’s time to revisit the solution mooted back in October, as the world faced a ‘second wave’ of infection.

Whatever your views on the origin and dangers of the coronavirus dubbed by scientists SARS-CoV-2; whatever your views on ‘lockdowns’, of varying degrees of severity, imposed by governments across the world, there can be no doubt that one tiny little virus has caused devastation to many nations’ economies during 2020. There are many who consider the lives lost and the broken health of many more, insufficient to justify closing down whole sectors of both national and international economies. Out of that concern was born the Great Barrington Declaration, authored by Oxford epidemiologist Dr Sunetra Gupta and American epidemiologists Dr Martin Kulldorf and Dr Jay Bhattacharya.

“As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.”, they begin.

What is “focused protection”? “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk” Ah – herd immunity rears its head again. “Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.” And the focused protection? “Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19.”

So there you have it, as British lockdown tiers and rules got more convoluted, with our hospitality industry sacrificed to keep schools open, it made a lot of sense. Yes, the declaration has been enthusiastically espoused by those who oppose lockdown on principle, who think the virus is a hoax, or no worse than flu; it is quoted by those who regard instructions to wear a mask as an assault on their freedom, it has even been lauded by minor political parties. They support it, without question, because it tells them what they want to hear.

However, it has also been signed by many scientists and physicians for whom I have the greatest respect such as Prof. Karol Sikora, the cancer specialist. Cancer diagnosis, which we all know needs to be as early as possible to save lives, and cancer treatment were put on hold during the first wave of Covid-19, with catastrophic consequences for many.

The protection for the vulnerable proposed is sound: “..nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.”  However they then go on to state that: “Those who are not vulnerable should immediately be allowed to resume life as normal.”

However attractive the Declaration sounds, it suffers from fundamental flaws. Firstly the ‘vulnerable’ are condemned to continued imprisonment and denied the hugs of their loved ones, until they have all had their vaccine, whilst watching those around them carry on uninhibited. That this is a potential problem is acknowledged, as the declaration suggests those at risk may participate if they wish. Well, thank you for that kind doctors!

The second flaw can be found in that dreaded word ‘normal’. Even with mask mandates and exhortations to observe distancing, relaxations in travel and social activities have led to increased cases. Go back to ‘normal’ and this highly contagious, airborne virus will soon be jumping from host to host with gay abandon. 

Now that we know a number of us likely have some immunity from cold coronaviruses we caught in the past, we can surmise that ‘developing herd immunity’, in the absence of a vaccine, does not have the dire implications it held back in March. Unfortunately it would still lead to an increase in hospital admissions, more needless loss of younger lives, more people left with long term health problems. Nor would the ‘protected’ be spared, even if they chose not to risk ‘normal’ life. When the hospitals fill up with Covid-19 patients and cannot carry out other treatment, it will be the elderly and underprivileged who lose out most.

Finally, the vulnerable do not live separately in isolated fortresses, they live among and with us, they are cared for by the non-vulnerable, they often need to visit clinics and hospitals more than the non-vulnerable. As the second, autumn wave showed, what starts in a young age group does spread to older people. Sorry, good idea but in reality, focused protection is a pipe dream.

Is it possible to live with Covid-19 without closing our pubs, clubs, theatres and cinemas? I believe it is but not by returning to what people still see as ‘normal’. For now, until the vaccine is rolled out and sunnier days drive away the virus, distancing and masks in indoor public spaces are still needed – it is not enough though.

We need a reset, not the one those who look at Agenda 2030 fear but one more akin to that which followed the discovery of Legionella in 1976. Once it was realised that these bacteria could get into man-made water systems and cause pneumonia, a raft of new regulations for testing and control came into being. We need the same reset for the quality of air in buildings used by the public. Air conditioning systems need to purify the air they put out with HEPA filters and internal UV lamps, airflow needs to be controlled to direct possibly contaminated air away from where people congregate. There is nothing new in this, the technology exists as do the engineers who understand airflow; sterile manufacturing has similar requirements in its clean rooms.

No, it’s not a guarantee, nothing ever is, but reducing airborne spread with sound engineering, rather than endless blanket bans for sites of airborne transmission will not only reduce Covid-19 cases, it will also improve general health by reducing transmission of other airborne diseases as well as reducing exposure to allergens. When the next pandemic arrives, if, like SARS-CoV-2, it is respiratory, we will be ready

 

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