Since my last post about why you should self-isolate now, France has moved into full quarantine along with my home country NZ yesterday (23.03.20).
Like NZ, France elected to quarantine early, quickly adopting the suppression method of containment.
Which means we can only leave our house to:
- Travel to your place of work when remote working is not possible, and only when accompanied by a signed Justificatif de replacement professional
- Go to a Dr or hospital appointment
- Exercise alone, with your family unit or with your dog for a short period of time, close to your home.
The latter two require an attestation de déplacent dérogatoire and all 3 risk fines of €135, increasing to €1,500 for failure to comply. Or €3,500 and 6 months in prison for repeat offenders.
Here is the full speech from Président Emmanuel Macron from March 13th, when he announced the new measures of protection.
Suppression vs mitigation: war against an invisible enemy.
Watching the numbers ebb and flow as countries employ different strategies in their battle against an invisible opponent, I can’t help but wonder which strategy is going to pay off.
France, Italy, Spain and NZ have chosen the suppression route, coming down like a hammer on the spread of the virus, closing borders and quarantining entire populations as confirmed cases increase.
The ethos behind this approach is to drastically reduce the speed in which the virus spreads, giving the healthcare system time to prepare for the onslaught of ICU cases.
It also provides an opportunity for a ‘hard reset’ by getting the speed of spread under control and providing the ability to reset social distancing strategies following a period of quarantine.
The UK, Canada, Australia, and the USA have opted for the mitigation approach, closing schools, bars, restaurants, and public spaces but leaving it up to individuals to employ social-distancing.
Edit: 24/03/20 Boris Johnson announced quarantine for the UK.
The ethos behind this approach is that you protect the vulnerable through isolation and expose the remaining population to the virus to create herd immunity.
Once the number infected and recovered is equal to or higher than 60%, the spread of the disease becomes slower and easier to manage.
This relies on current information that only the elderly and immunocompromised are at risk and you can only catch it once.
With this approach, numbers also increase exponentially putting healthcare systems under immense pressure.
Suppression quickly protects the population, providing a point of containment of the virus, leaving the Government to subsidize the economy.
While mitigation temporarily increases the risk to the population aiming to protect them in the long term from reoccurrence and relies on individuals adhering to social distancing.
For in-depth information on the strategy and success of these two approaches, read this article which explains it in detail.
The Washington Post also produced these interesting simulations showing the effect of the various strategies.
As a trained biological scientist, I tend to make sense of the world through data and statistics.
Here is a simplified timeline of events in China:
- December 31st: First case of Covid-19 confirmed
- January 23rd: Wuhan into full quarantine
- March 2nd: Confirmed cases reach peak
- March 11th: Essential services return to work
- April 8th: travel ban expected to lift
The time it took from the first confirmed case of the virus to the end of quarantine is 11 weeks. In-country travel ban expected to lift after 16 weeks.
It’s important to note that China took extreme measures early on by quarantining their entire population after 3 weeks.
Italy and France confirmed its first case in the last week of January and after 6 weeks moved to quarantine.
Spain, 1-week later following its first case on February 1st, moving to full quarantine on March 14th.
The UK announced full quarantine on March 24th, 8 weeks after the first case.
Germany and the USA are now approaching 8 and 9 weeks respectively, with no enforced quarantine, only closed borders.
As seen above, the first outbreaks of Covid-19 in the UK, EU and USA, all occurred within 1 week at the end of January.
With Italy, France and Spain moving to quarantine after 6 weeks, the UK, 8.
The difference in the trajectories is the amount of time it took for the Government to effectively inform the public and for the public to take action.
Although UK Primeminister, Boris Johnson was slow to enforce quarantine measures, data indicates that many Brits were already reducing their movement and working from home.
The benefit of an enforced quarantine is that it provides a definitive point to estimate the peak of confirmed cases and recovery time. Based on China’s data.
While a delay to quarantine protects social liberties and keeps the economy moving, it risks exponential growth in the number of cases.
More on when we can expect to return to normal life below.
Mitigation: Social distancing.
The theory behind social distancing is that by limiting our contact with other people we can slow the spread of the virus.
This gives Governments time to prepare: purchase protective equipment, develop an economic plan and protect the healthcare system.
However, it relies on us, The Humans, to do the right thing.
France tried the social-distancing and within 48hrs people gathered in large groups at parks and markets, forcing Macron to quarantine the country.
Similarly, as Boris announced the closure of schools, public spaces, restaurants and bars on Friday, people flocked to beaches, parks, and mountains in their thousands over the weekend.
For social distancing to be successful it requires a complete reduction of time spent within 2m of 5 or more people.
In case you are still on the fence.
Like the rest of the World, 2-3 weeks ago my attitude towards Covid-19 was cavalier.
It’s just like the flu, I’m young(ish) and healthy, it can’t be that bad, it won’t affect me.
I jokingly posted on my winter project, Chamonix Snow Report that everyone should escape the media hype and come hang out in the Chamonix bubble.
The engagement on my page went up 800% in 4 hours with a 9:1 ratio reaction of laughter compared to anger or shock.
As pleading warnings came in from Italy, I realised, this is not a drill.
And the data is now impossible to ignore.
While its true, 80% of us are unlikely to suffer any longterm affects of Covid-19, we must think of the 20% – our parents, grandparents, and those with compromised immune systems.
Most of all, we need to think of healthcare workers. The true soldiers in this war.
Return to normal life.
The question on everyone’s minds is when can we return to normal life?
Using China as a benchmark for estimation; the time it took from enforced quarantine for confirmed cases to peak was 6 weeks.
After this time, the number of cases started to level out and deaths decrease.
So for Italy and France, we can expect to see Covid-19 peak during the week of April 20th, Spain April 27th and the UK May 5th.
And after this, a slow return to normal life within 2 weeks and travel restrictions lifted 10-12 weeks after the start of quarantine.
I say hopefully because this is still an evolving situation.
China is not yet in full recovery and since the end of quarantine on March 11th has recorded 860 new cases of Covid-19.
I am yet to find concrete evidence of the percentage of imported cases vs local transmission.
The final battle.
The final battle against Covid-19 requires a combined response of suppression (quarantine), mitigation (social distancing) and containment.
And a return to normal life through the control of Covid-19, a succinct and coordinated effort in 3 stages.
Stage 1: Suppression – the battlefield. Current stage for the EU, UK, NZ, and parts of the USA. The goal is to stop the spread of the virus and deal with evolving cases.
Stage 2: Mitigation – negotiating our future. Current stage for China. A slow but gradual return to normal life employing social-distancing and good hygiene methods to reduce the accelerated spread of Covid-19.
Stage 3: Containment – return to normal life. Testing, tracking and isolating every case of Covid-19 to stop human transmission. Testing allows people to know they are infected and take the required precautions to protect others.
Presently, there is not enough testing to accurately measure of the spread of this pandemic.
And testing is not accurate enough to be reliable.
Within the next 2 weeks, every westernised county outside of China will move to Stage 1.
By the end of 6 weeks, thanks to China’s efforts, we will know the success of social distancing and have a measurement of success thanks to accurate testing.
If you are experiencing or concerned about symptoms of Covid-19, please register on these sites. This helps with track and trace.
Accepting a new reality.
By understanding the trajectory of Covid-19 we have an opportunity to let go of fear and take action for our future.
So far, we know that suppression, mitigation and containment of Covid-19 is the only solution.
At least until a vaccine is developed in 8-12 months.
The next 6-10 weeks, undoubtedly, will be very different from anything we have ever experienced.
We have all lost control of important elements in our lives: from our personal freedom and our ability to earn an income to having to work from home while caring for children and feeling concern for our loved ones.
It is emotionally and physically overwhelming.
To overcome this fear, we must let go of the things we can’t control, and grab hold of the things we can.
A hard reset for humanity.
Covid-19 and this enforced quarantine give us an unprecedented opportunity to press reset in many aspects of our lives.
Businesses, restaurants, bars and public spaces are all closed.
Our global movement severely restricted.
From this day forward, we have an opportunity for change.
And a chance to reduce our environmental impact on the world.
Covid-19 was able to evolve to infect humans because we are continuously expanding into and exploiting the environment.
This isn’t the first time a zoonotic disease has moved from animals to humans.
Although SARS, MERS and Ebola were unable to spread as expeditiously as Covid-19 (thankfully), this is unlikely to be the last pandemic of our lifetimes.
And while it’s easy to blame China with its wildlife (or wet) markets and the illegal trade in animals for food and medicine.
Every single one of us has contributed to this pandemic.
Our contribution comes through the way we consume the earth’s resources and treat the world around us.
If we want to reduce the occurrence of pandemics like Covid-19, we need to dig deep now into the elements of our lives that affect the environment and learn to be better.
From the way we care for ourselves, to how we travel and the effect our actions have on the planet.
Don’t worry – there’s no judgment here.
For the first time in our history, we have an unprecedented opportunity to change.
Stick with me and I’ll provide you with the science and data behind many of the topics affecting our world along with easy, positive ideas for change.
Let’s do it together!
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- Sustainable Living: Coronavirus, why you should self-isolate now
- Sustainable Self-Care: Reset Challenge: week 1
- Sustainable Adventures: Treasure Hunt Challenge
- The start – what this project is all about and why
I think vaccination will be the main goal to create herd immunity – but with the risk of pandemics on the rise this isn’t going to be the last time we face a global crisis like this. Herd immunity is also difficult to establish via virus contraction of Covid-19 as it has already evolved into 2 known different strains – possibly more. For sure the loosening of restrictions will result in a resurgence of the disease but the thinking is to a less fatal degree with the implementation of social distancing.
Testing is also not accurate enough yet and requires strict protocols to get the best results (i.e tests processed within 12 hours and too many tests atm).
Italy – very likely. They are going to surpass China in the next few days. 🙁 USA looks on a much worse trajectory too and will be harder hit due to high numbers of obesity.
“Herd immunity through contraction of disease has never successfully been tested…”
I would say that there is probably strong evidence that the “virgin soil effect” can have a strong influence on the morbidity and mortality of previously unseen diseases. Even though this is now a somewhat anachronistic concept given the relative connectedness of most of the globe.
In this respect, it will probably be necessary at some point to develop some kind of immunity across large sections of the population, since if it is not achieved there will be difficulty in crafting an “exit strategy” from the current socially and economically restrictive conditions. That is to say, in lieu of vaccine or widespread immunity, the loosening of conditions will result in a resurgence of disease.
I agree that revealing the true number who have/have had CoVid is very tricky… there is no antibody test currently, and most viral tests are performed on those exposed or hospitalised. It is probable that only a large and random same of the population would yield any useful statistics.
On the Italian trajectory, if the infection rate remains at around 10%/day, they are set to hit 130k cases by the end of the month.
Hi Jeff, unfortunately without accurate testing its impossible to know exactly what the current rate of infection is and how much of the population is infected. Quarantine really just gives Governments time to deal with the issues they are now facing – overwhelmed healthcare system, not enough protective equipment, lack of accurate testing. Of course, quarantine does slow down the rate of infection because it spreads through close contact between humans and if we are not connecting with each other, we are slowing down spread.
China only started to see a significant reduction in the number new cases after Feb 20th – 4 weeks after the start of quarantine. Italy is only just at the end of week 2 so it will be at least another 2 weeks until the peak and then reduction – truly scary times for Italy. They are likely to surpass China very soon. The difference in rates of transmission comes down to how quickly governments acted to warn the public and how quickly the public reacted to take it seriously.
Herd immunity through contraction of disease has never successfully been tested – usually, herd immunity is established through vaccination i.e. in the case of measles and smallpox. In the case of Covid-19 there is not enough information yet about recurrence and affect to each age group including a-symptomatic carriers so its an incredibly risky strategy. Had the UK continued with herd immunity alone they would have been a risk of 1.5M deaths before reaching a high enough level of immunity (it needs to be at least 75%).
“France, Italy, Spain and NZ have chosen the suppression route, coming down like a hammer on the spread of the virus, closing borders and quarantining entire populations as confirmed cases increase.”
Given the measures that many European countries have chosen to adopt, to what level can they hope to reduce their rates of infection? Are the figures from Italy, after 2 weeks of quarantine, encouraging?
Will the development of widespread immunity, through infection, be a necessary by-product in lieu of a human developed vaccine becoming available?
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