After three months of lockdown are we sleepwalking into another wave of infection and if so what can be done to prevent this? – 12 July 2020

 
A Blog by Dr David J Flavell PhD FRCPath & Dr Sopsamorn (Bee) Flavell BSc PhD
Scientific Directors of Leukaemia Busters

12th July 2020

A New Slogan to Consider

The lockdown strategy to bring the coronavirus pandemic under control eventually worked well in Britain despite being put into effect weeks later than it should have been. For others such as the US, Brazil and India it has so far been less successful due in part to political disarray or an outright unwillingness of some in the general population to play by the rules.

In Britain the lockdown led to a slow but sure reduction in the number of daily cases down to a manageable level but only after more than 44,000 lives had been lost unnecessarily. The cost of this in economic and social terms has been huge and will likely be felt for a generation.

Confining people to their homes successfully broke the person to person transmission cycle but let’s not lull ourselves into a false sense of security.  It doesn’t mean that COVID-19 has gone away, it hasn’t, it’s still there lurking, waiting to re-emerge if given the opportunity and we must do everything possible to ensure that this doesn’t happen.

Arguably, we are now better prepared for a second wave having gained experience from the first but let that not be an excuse for complacency for as we all secretly know the cost of a second wave in terms of human lives and the economic consequences would be catastrophic. That and that alone is sufficient reason to attempt to do absolutely everything necessary to avoid this and this blog is about just that.

A New Trinity of Mitigation

With lockdown now being eased there is the ever present danger that person to person transmission will begin all over again. It is only through measures that reduce the person to person transmission risk to a minimum, that a second wave will be avoided. The mantra from the UK government  that we are led to believe will achieve this is through scrupulous hand washing and social distancing (now reduced to a mere one metre plus) but is this enough? We’re sorry to say that it almost certainly isn’t and we suggest the alternative mantra of Face Masks : Hand Washing : Social Distancing should be a new  trinity of mitigation measures that when used together will give maximum benefit.

Inviting Coronavirus to Join the Party!

With lockdown now eased, the current measures being as they are means that we are very likely to see the number of new daily cases and the deaths associated with them creep up over the coming weeks. The major reason for this will be transmission from airborne infection that the current measures in Britain do not adequately address. We’ve all seen the news footage in recent days of people massed on the beach or crowded onto party streets and into pubs cheek by jowl. The vast majority are not wearing any form of face covering and are essentially inviting the coronavirus to join the party.

It’s in the Air

The published evidence that COVID-19 is transmitted through airborne droplets and aerosols has been building since before the beginning of the current pandemic yet the World Health Organisation (WHO) have been reluctant to advise appropriately on using face masks to help prevent spread by this route. This is despite them announcing a few days ago that the pandemic is actually getting worse with 12 million cases and over half a million deaths and still continuing to grow out of control worldwide. You might well ask why and it’s difficult to fathom the WHO’s motives over face masks other than perhaps a fear of being overzealous or of being seen as wrong at some future date.

Numerous well controlled laboratory studies conducted since the pandemic began have now shown that tiny droplets emitted when infected people speak, sneeze or cough can carry the COVID-19 virus over distances up to 10 metres or more. Furthermore aerosolised droplets containing infectious virus may remain airborne for several minutes or even hours depending on conditions.  The danger of this is dramatically increased when indoors and particularly where there is poor ventilation.

It is true that the British government have made wearing a face covering mandatory on public transport and in hospital settings but that hasn’t gone nearly far enough to be effective at making a major impact when there are still individuals crowding together in various everyday settings. Compared with other countries our use of face coverings in public is low at 25% compared with 75% in New York and 95% in China and some European countries such as Italy and Spain. This has to change.

The failure of the WHO to advise on general face mask use in public spaces during the pandemic has given an excuse for some governments such as our own not to sanction their compulsory use in all public places, a decision that we will live to regret if, as is likely, subsequent waves of infection re-emerge in the near future. It is a fact that those countries that have done best in preventing further large scale outbreaks have been those that have mandatory face mask regulations in place.

A Sorry State of Affairs

Now in response to this sorry state of affairs, 239 scientists have just recently published an open letter appealing to the WHO and other national and international bodies around the world to recognise the potential risks from continued airborne infection and to take appropriate mitigating steps to contain the threat. It beggars belief that these discussions are still being held at this very late stage. As we have been arguing in this series of blogs since the beginning of April  (see below), face masks are the surest way of reducing airborne spread in both directions and over the past few months new evidence has arisen to support this contention with one very recent large study demonstrating that COVID-19 transmission really is reduced through the use of face coverings. Here then is a list with links to all our previous blogs on face mask use dating from the 3rd April onwards:

In our blog Facing up to Westminster (19th May) we sent an open letter to the British government stating nine good reasons for mandatory face mask use once lockdowns began to ease. We even sent each Cabinet, shadow cabinet and Health Select Committee member a high quality reusable face mask for their own personal use. The rationale for this as a valid mitigation method to avoid spread of the virus is completely sound and those who debunk or doubt it are at odds with reality.

Whilst the arguments about this between governments, the WHO and other agencies continue to rage we are wasting precious time as countries come out of lockdown and if such indecisive procrastination allows for the faintest possibility of the coronavirus finding a weakness in our armour then we must adopt the precautionary principle, that is, where there is a possibility of benefit in the absence of absolute proof then better to err on the side of caution and adopt the measure anyway. We’ve said that before so many times.

It will be beyond unfortunate if it takes a second major wave of infection to awaken those in a position to make face mask use mandatory. Prime Minister Boris Johnson has come in for criticism in the past for not setting the example of wearing a face covering when in public so we were very pleased to see that last Friday he did so when visiting his Uxbridge constituency. Now we understand that he is considering making face mask use in shops compulsory, as has been the case with many aspects of this pandemic , very late in the day but hopefully not too late already.

Set an Example and Deliver Clear Messaging

The PM and his advisers must be made to understand that this cannot just be a window dressing exercise, it must be adopted by everyone, everywhere in public life if it is to be another effective tool to help prevent the spread of COVID-19. It is entirely up to our government to make it so and carry the people along with them through example and clear messaging.

Our politicians should be setting an example of face mask use for all of us to follow, not least when they are debating in the Chamber of the House of Commons, a relatively enclosed space probably with poor ventilation and where a fair amount of spittle flies around as MP’s speak their minds on our behalf. Let’s see our politicians masked up so that we can have the confidence and the reason to follow suit without question or hesitation.

Purely as a side issue it was music to our ears when we came across this video of Tom Hanks and Matthew McConaughey avidly supporting the importance of wearing a mask during the pandemic!

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