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Those who predicted that 2021 would feel different from 2020 turned out to be correct – but not in the way anyone wanted. Despite the existence of several effective vaccines against Covid-19, the United Kingdom, many European countries, the United States and Brazil appear to be heading towards their darkest moments in the pandemic.
The number of people who test positive in the UK now regularly exceeds 50,000 per day. Infections are increasing in London, eastern England and the south-east; they are also leveling off in other regions where rates had fallen. And this despite the closure of universities and schools for seasonal vacations. A full reopening has been delayed.
The number of people hospitalized with Covid-19 is already above the April peak. Sir Jeremy Farrar, director of the Wellcome Trust and pandemic advisor, told me that we had passed the point where the NHS was in danger of collapsing; the parts are already deforming. The health workers, the same key agents called upon to deploy the vaccines, are exhausted. Many are isolated or sick. The current prioritization system does not reduce infections.
The situation is so dire that a nationwide lockdown, including school closures, seems imperative. “What we have now is two or three months of something that is going to feel and look and East worse than March and April, ”said Sir Jeremy, adding that schools may have to close in February given the prevalence of the new variant among young people, which risks turning schools into more important sources of transmission. He stressed that he was speaking in a personal capacity.
The reality is that there is a rampant spread, fueled in the UK by the combination of a new variant that is around 50-70% more transmissible, plus a lifting of restrictions in early December, as the R-number hovered around 1.
A lockdown would starve the human contact virus it feeds on and provide respite: to speed up vaccine deployment and get ahead of the virus; to set up an appropriate testing program in schools, so that they can reopen with confidence when the R number decreases; and for ministers to show honesty and humility in the face of the immense challenges that still lie ahead. The vaccine promise should not be a signal of convenience, but rather an incentive to curb transmission, so that the virus is less likely to mutate before people can be immunized.
This race between vaccination and mutation has never been more urgent – a fact recognized in the UK’s pragmatic decision to delay booster vaccines so more people can receive a first dose. A variant with higher transmissibility, although not more severe than its predecessors, is of deep concern. The arithmetic of contagion means that more infections, as with the B.1.1.7 strain that currently dominates in the UK, inevitably translates into more deaths (despite improvements in therapy and patient care). In addition to the personal tragedies that accompany an increase in infections, rampant transmission risks brewing other variants that may elude current vaccines. Brazil, India and Mexico are hot spots to watch.
An even more disturbing variant first reported in South Africa has been recorded in at least four other countries, including the UK, according to the World Health Organization. This strain, known as 501Y.V2, has already shown some resistance to monoclonal antibodies, a potentially promising treatment. A new variant can appear anywhere and spread everywhere, making the race to conquer the coronavirus global, not national.
If 2020 has taught us anything, it’s that countries can never act too soon, and delaying the inevitable leads to prolonged agony. A recent analysis from Imperial College London suggests that the lockdown a week earlier during the first spring wave would have reduced the number of UK deaths from around 37,000 to around 16,000.
Taiwan, Vietnam, and New Zealand demonstrate that early and aggressive intervention enables healthy people to participate in healthy economies. Tracing a middle course between public health and the economy, as the UK has been trying to do since March, is a half-measure that does not protect either. It’s like trying to keep a freeway open after a stack and hope that drivers can swerve to avoid debris, rather than closing the road and clearing it away so that traffic can flow normally. Other collisions simply produce more debris and casualties.
Finally, the road will still have to be closed and take more time to clear. That was the model with lockdowns in the UK in 2020. Only if we act faster will there be a chance 2021 will look different.
The writer is a science commentator
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