Coronavirus: Hold the line

As I stepped out onto the street for my daily walk this evening, I could hear nothing but birdsong. I live on a busy street in London, and at 6pm the road would normally be full of cars, engines whirring, horns beeping, indicators flashing. But today there was only emptiness, stillness, and birdsong. The message has got through, the world is on pause, and we are finally staying at home in anticipation of what’s to come.

And we need to hold the line.

If a week’s a long time in politics, it’s an even longer time in a pandemic. I was trying to remember how long it had been since the government ordered us all to stay at home, and did an internal double-take when I realised it was only four nights ago. It somehow seems like an age, partly because the pandemic has sped up, and partly because we as humans have slowed down — which is exactly what needed to happen if we are to get on top of this thing.

What we’re all doing right now is attempting to reduce the R0 of the virus. R0 is the term that epidemiologists use to describe the average number of people who will catch an infection from one contagious person. When R0 is above 1, an outbreak grows. When it’s below 1, it will eventually peter out. Coronavirus has an R0 of around 3 — i.e. on average, one infected person will infect three other people. It doesn’t sound very many, but think wider: those three people will each infect three other people, and those nine people will each infect three other people. By the time you’ve gone through ten iterations, that one first person has been responsible for infecting 59,000 people. That’s pretty staggering.

But coronavirus will only be able to do that if those 59,000 people are out there in the world and mixing with each other. If we all cease our social contacts, the virus has nowhere to go. R0 comes right down, and the outbreak begins to subside. This is why we have been ordered indoors, and only to socialise with our household members — because If you only see the same small group of people day in, day out, those wider contacts can’t happen and the virus can’t transmit further. Put simply: when we stop moving, the virus stops moving.

It takes a while, though. The incubation period for this coronavirus is estimated to be about 5–6 days, but can be up to 14 days. The day we started lockdown there will have been a number of people who were infected and unaware, and those people will go on to infect their household contacts. That means, for all the will in the world, we will continue to see cases rise in the next few weeks, despite our best efforts. Italy has been in lockdown for weeks, and it is only in recent days that there are indications that case numbers have finally begun to fall (we saw a spike in deaths today, but remember that the deceased would have been identified as cases a while ago).

We can expect a similar picture in the UK, with case numbers and fatalities continuing to climb in the coming weeks while we stay home and watch. And that will feel dispiriting. And we’ll miss our friends and family and want maybe to just sneak out and see them.

But we need to hold the line.

Because the moment we start that sneaking out, for a short playdate with our kid’s best friend they miss from school; for a small family barbecue on a sunny Sunday; for a quick birthday drink with a friend — we massively increase our social contacts. We are far, far more interconnected that we realise. Think of all those times that you’ve made a new friend on Facebook and realised that you both have a totally unexpected friend in common. Think of the old adage that there’s only six degrees of separation between any two of us. It only takes a small degree of social mixing for the web of contacts between us all to grow huge again — and with that, R0 will grow and the outbreak will again take off.

So: hold the line.

Because while this stillness settles all over the UK, there is a lot of movement going on behind the scenes that will be vital to guide us through this crisis as safely and as gently as possible. We are ramping up our testing capacity, both to diagnose people who are infected and to identify those who have been infected but recovered. We are increasing our ICU capacity. We are building a new hospital. We are stepping up efforts to make sure healthcare professionals have adequate supplies of PPE. We are writing reams of guidance so that the public and professionals have a clear information on what actions they need to take in the pandemic. We are studying the spread of the virus globally to give us a better idea of how we can expect it to behave in coming weeks. All these things will make us better able to limit the spread and the impact of infection.

We are also busy finding our ways to adjust to this bizarre new reality. Joe Wicks is now the nation’s favourite family PE teacher. Friends are clinking glasses on the internet at Zoom happy hours. Wholesale food suppliers who till recently served the nation’s eateries are diverting their wares to deliver fresh food straight to households. Meanwhile, the authorities are catching up with the amazing first efforts of the grassroots Mutual Aid groups, with schemes to identify the extremely vulnerable, and organised opportunities to volunteer with the NHS and charity sector. And we’re finding new ways to come together in solidarity as a community, through painted rainbows in windows to doorstep rounds of applause for the frontline staff who are quite literally putting their lives on the line for us.

There is no doubt that social distancing on this scale and for this length of time is going to be hard. But it will also be worth it. So, my advice to you now is: Follow the Five Ways to Wellbeing to keep yourself mentally healthy (if you’ve not heard of this, look it up, it’s excellent). Keep up to date with the latest developments, but don’t have the news rolling all day. Be aware of the current guidance and where to find it when you need it. And above all:

Stay home.

Save lives.

Hold the line.

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Useful links and resources

>>GUIDANCE

· https://www.gov.uk/coronavirus

· https://www.nhs.uk/conditions/coronavirus-covid-19/

· Free government WhatsApp information service — add 07860 064422 in your phone contacts and then message the word ‘hi’ in a WhatsApp message to get started

>>RESEARCH THAT YOU CAN GET INVOLVED WITH

· KCL COVID-symptom tracker app https://covid.joinzoe.com/ (Daily symptom tracker asking a couple of basic questions to help map the spread and impact of COVID across the UK)

· UCL Mental Health study www.covid19study.org (Weekly 10–15 min survey examining impacts of the outbreak on mental health)

>>VOLUNTEERING

· NHS GoodSAM app — https://www.goodsamapp.org/NHS includes volunteering roles that you can do from home

· Mutual Aid networks

· Check out ways you can donate to/support your local Food Banks, women’s refuge and VAWG services, and organisations supporting the homeless and elderly/otherwise vulnerable

>>MENTAL WELLBEING WHILE STAYING AT HOME

· Advice from Every Mind Matters https://www.nhs.uk/oneyou/every-mind-matters/coronavirus-covid-19-staying-at-home-tips/

5 Ways to Wellbeing: https://www.mind.org.uk/workplace/mental-health-at-work/taking-care-of-yourself/five-ways-to-wellbeing/

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Postscript: I’m an infectious disease epidemiologist with a special interest in new and emerging infections. You can verify my credentials on google or LinkedIn (Georgia Ladbury); note that I am writing in a personal capacity, and not linked to any organisation. I’m based in the UK and so observations and recommendations are from a British perspective, but many will apply worldwide.

I’m an infectious disease epidemiologist with special interest in zoonoses, new & emerging infectious, One Health, and interdisciplinary public health research

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