Living with coronavirus will not be easy even with a vaccine

THERE are two future conditions faced by the world today. One with a vaccine against coronavirus and one without a vaccine.

We pretty much know what the latter will be like. Very like right now, with just a controlled easing of restrictions for the younger, greater use of face masks and the old and vulnerable shielded.

But the hope is that at some time there will be a vaccine. There seem to be two views of when. One says it could be within months; the other that it may well be much longer than a year.

Either way it is not a magic bullet. We shall not go from lockdown to normal life overnight. No way.

If a vaccine is found and proven to be effective and safe (big Ifs) it has to be produced. And delivered. And since you clearly cannot do everyone at the same time there has to be a priority list.

Examining this is scary. The flu vaccine is administered to scores of millions of people each year. The estimate for the 2019/2020 season (this winter gone) was between 162 million and 169 million doses.

Who gets the flu vaccine in the UK? Front line health staff and the elderly. The best figure I could find was about 500,000 health workers and about 4-5 million elderly or vulnerable people. If we call it 6 million we shall not be far off.

But the industry currently produces some 190 million shots per year for the flu season. And they are in full-time, non-stop production. So that means they could produce up to 3-4 million shots a week. For a global market. The same as would be the case for coronavirus.

A month after production started there might be 16 million doses available. For the whole world.

I cannot find evidence for this but I would guess that at least one production plant is in the UK. If we could harness that to our needs and expand production might we hope for 2-3 million of our own in a month? Who knows.

But that is the minimum we need to contemplate any sort of significant relaxation of lockdown. Why?

Well the first group to be vaccinated must be the front line health workers – at least all those without immunity. That will be a good 400,000 doses and will take many days. Then come their most likely customers – the old and high risk. We know that is 1.5 million people. That will take even longer. After that comes the over 65 and other higher risk people. 3-4 million? Probably, so another few weeks.

So when could we lift the lockdown, even a little?

Well once the NHS staff and care home staff have been covered we know we can cope with some level of infection. So maybe shops and schools, factories and offices could re-open and people allowed to exercise. BUT only with face masks since it would still be possible to start a new epidemic.

Then, after a few weeks cafes, restaurants and even pubs might re-open and all forms of work be re-started. But major vanues and places of mass congregation would still be risky – no cinema, theatre, football, rugby, cricket etc.

Finally as the vaccine gets out into the wider population everything can return to what it was – a new normal.

But at the best estimate this will not be soon. If the vaccine arrives it would be at least 4-5 months before it would be really safe.

Then we would start to live with coronavirus in the environment but a bit more like influenza. If it mutates like flu then a new vaccine will be needed every year or so.

No vaccine and a real return to 'normal' is not really possible. We might risk the young and allow them, with face masks perhaps, to return to work. But without customers the shops, cafes, restaurant and pubs are unlikely to be able to function. But some activity could re-commence and begin to re-build the economy. That must happen sometime and sooner rather than later.

But to allow that we have to get the re-infection rate right down and that means ensuring the NHS can operate. That means keeping old and high risk codgers like me under lock and key for the foreseeable future. It is grim. I yearn to travel. I miss France. I need Spain in winter. But I am too much of a risk.

People like me guarantee the need for ICU, oxygen, a ventilator. At least for a while. And we infect the health workers, removing from the front line those we need most .

Sources: ONS, WHO, NHS England.

We are stuck with it for a while I fear...

THE mainstream media are not really our friends. No sooner has their clamour brought the lockdown they called for into operation than they are starting to ask when it will all end.

And when told not yet they start suggesting it should be next week, after Easter, you said a review after Easter... etc.`

For a start they only said they would review after Easter – not that there would be any changes necessarily. But MSM don't care. They just want the next story today instead of when it happens.

But where are we really? All the evidence says we are still a week, maybe more from a 'peak'. But what that will look like is anybody's guess.

• The virus, like all viruses, changes with time the science tells us.
• The epidemiology changes with time.
• It changes with response to actions.
• It changes with attitudes amongst the public.

Now I want all this over like every one does. But I would like to be still around to enjoy whatever 'all over' looks like. And premature relaxation could ensure the permanent relaxation of mine and thousands more breathing function.

Other nations have different epidemics to ours. We believe that a major vector for infection in Europe was people travelling to and mixing with others in the ski resorts. Apres ski became avant infection.

So it is perhaps that Austria has had a different experience. More like Germany. And so we read that Austria are considering relaxation in a planned and staged form. Small shops first, then cafes and restaurants, then more BUT – they require wearing of masks inside all shops etc. I say considering but if you read the MSM you may think it is already set in stone. It is not yet.

But what about the reality? There can be NO return to normal of any sort until two things have happened, and one matters more than the other:

• We have to have a vaccine.
• And we very much need an effective treatment.

Look at the facts:

This virus was entirely new and unknown until December last year.

• It has a re-infection rate above 2.0 which means more than a doubling every time someone is infected. At all. Symptoms or not.
• It is already world-wide thanks to the combination of air travel everywhere, low costs of aviation, and the dreaded 'bucket list' ensuring people do indeed go everywhere.
• And now it seems it may infect animals, even our pets.

What all this means is that UNTIL we have a vaccine we cannot return to anything close to normal.

And until we have an effective treatment not everyone can ever return to normal.

Think influenza. Think 1918. Think of 20-50 MILLION dead. New strain of virulent virus. No vaccine. Re-infection around 2.0.

Now move that up to 2020. We have turned flu into a routine but it still kills upwards of 600,000 globally every year. And until we gained the ability to tailor new vaccines to each new strain it went on killing in big numbers every year and sometime horrifically. But back then we had virtually no aviation to spread it (the Great War did the 1918 job for it).

Untl the vaccine, old people died in big numbers every year and we had little means to treat or save them. Today we do try with coronavirus but only one third make it.

We cannot sustain a world in which this coronavirus is virulent all the time – the cost would be unmanageable. Thousands of ICUs, millions of ventilators, millions of medical staff – mostly on standby, just waiting..

No way in that environment can we have unlimited concerts, race meetings, Olympics, football, cricket, golf, pubs, clubs, teeming malls and shops and schools and universities and aviation, and trains, and buses... and... it will not work.

There is a way back. But it will take courage and determination. And sacrifice.

If there was no one alive today in the at risk group, no one over 70, then we could juyst about cope until a vaccine came along.

So here is a possible plan B:

All those people like me who are the ones who will cost big time and probably die go into units like the one I live in. Independent living (of a sort for a while) but contained and served.

And the world gets back to normal to pay for it. People get ill, few need ICU, even fewer ventilation, even fewer die. Flu like?

The contract is -

• we agree to keep out of the way until the vaccine arrives and
• you all agree to keep us supplied with everything we need and
• do your best if and when we get small, containable outbreaks of covid-19.

Say 3 million people under isolated care at a cost per person of £1,000 a month. That is £3billion a month – a lot less than current ruination of our economy is costing. Worst case 12 months to a vaccine. £36 billion – still way less than current costs. Then those 3 million (plus medical staff) get the vaccine first so they can re-enter society.

And I can spend the winter in Spain again. And the spring in France, where I would have been right now.

Think about it and stop the press trying to kill me and my cohort and ruin your lives forever with their foolish bleating.

If you have been, thank you for reading.

(vale Prof Tom Stafford)