Coronavirus: The 'what ifs' that could have prevented the UK COVID-19 crisis

September 24, 2020

What could we have done, practically, to have controlled COVID-19 better in the UK - if we had no restraints?

Dr Julian Tang, a professor of respiratory sciences at Leicester University, explains what he would have done regarding lockdowns, restrictions and fines if he did not have the political and economic constraints our government has.

Scenario 1: Immediate border lockdown with track/trace and isolation/quarantine (similar to New Zealand)

After the identification of a British businessman "superspreader" towards the end of January 2020, we could have locked down borders and quarantined all returning travellers from Europe and Asia - similar to New Zealand's approach to completely eliminate the risk of the coronavirus entering the UK.

Although this was theoretically possible it may have been practically very difficult, with so many Brits on overseas skiing or other extended New Year holidays, and there were no customised isolation/quarantine arrangements to accommodate all such returning travellers at that time - even if they all agreed to this.

If this could have been done, we could have prevented the bulk of COVID-19 cases entering the UK unnoticed - as most of those infected appeared to have entered the UK with the virus from around mid-February onwards, according to a UK-wide SARS-CoV-2 sequence analysis.

The problem with this is that the border lockdown cannot continue forever - and if cargo freight is still imported (even if people are not), there may still be a risk of importing virus-laden packages.

Scenario 2: Living with the virus - not Swedish-style, but Taiwan/Hong Kong-style - with early/universal masking and other measures

Hong Kong and Taiwan reacted quickly, early and at a population level to reduce the transmission of the virus.

Largely helped by their experience of the SARS 2003 outbreaks, they practised universal masking and applied what they learnt from SARS 2003 in terms of temperature monitoring, rapid testing, contact tracing and isolation/quarantine across their populations.

Having very compliant populations meant there was no need for any prolonged, major, nationwide lockdowns.

This type of approach is unlikely to work as a complete package in the larger UK, European, North American countries/populations, mainly because of the cultural differences, as many of these measures are seen as an infringement of civil liberties/personal freedoms.

But the flip-side of this (as these same countries have experienced, unfortunately) is that if these measures are not practised early, comprehensively and universally, the virus will spread very quickly - ultimately resulting in high infection/death rates, and local/national lockdowns, with all the socio-economic fallout that we have seen in the UK.

Conclusions

Ultimately, you cannot control the spread of the virus without sacrificing personal freedoms and business profitability.

Even if we can reach where we are with seasonal influenza with COVID-19, there is still a significant degree of influenza mortality every year - even with well-established vaccines and antivirals.

In fact, we have essentially already decided to sacrifice the control of influenza each winter to maintain our way of life.

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There has been no masking, social distancing or curfews or lockdowns for flu, even in particularly bad years.

Hospital ICUs do admit influenza patients and thousands of people die from it each year but we have just learned to live with this.

Influenza also disappears during spring and summer each year, so we get a regular welcome and expected reprieve.

Eventually, our attitudes and approaches to COVID-19 may become the same.

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