What are the potential exit strategies from Covid lockdown?

Sarah Knapton
·7 min read
Potential exit strategies from lockdown
Potential exit strategies from lockdown

When the Government published its roadmap out of the pandemic in the summer, it was hoped that social distancing could be eased by November and local lockdowns would needed only as a last resort.

Fast forward three months and the position is altogether bleaker. Local restrictions seem to be doing little to curb the spread of infections, Test and Trace is failing to pick up tens of thousands of cases each day and deaths are on the rise.

It is clear now that normality cannot resume without an increase in the virus, and that cases will come back as soon as restrictions are lifted.

So how do we get out of the ongoing "lockdown and lift" cycle? Here are five strategies scientists think could work:

Whack-a-mole and wait

The current strategy being deployed by the Government is to suppress the virus in hotspots while allowing areas with low infection rates to have more freedom.

Keeping the virus at manageable levels prevents the NHS from being overwhelmed while buying time for vaccine trials to be completed and new drugs to be tested. If Britain can get through the winter managing the virus, by the spring it will be in a better position to get the pandemic to an end.

A poster in Middlesbrough warns people to stay at home after tougher new restrictions were introduced to suppress the virus in the area - Ian Forsyth/Getty Images Europe
A poster in Middlesbrough warns people to stay at home after tougher new restrictions were introduced to suppress the virus in the area - Ian Forsyth/Getty Images Europe

A source close to the Government's science team told The Telegraph that, under such an approach, life could be returning to normal by the end of spring and early next summer.

"It's going to be difficult for the next two to three months, but as we move into spring we would expect to see some scientific advances helping out, much more rapid testing, we will see something happening on the vaccine front," said the source.

"Medical care will continue to improve and we will see new drugs and so, come springtime, it starts to look like we'll have a long-term sustainable way out of this."

Elimination

Although many scientists now believe coronavirus will become endemic, like flu, others think we should be trying to eliminate it completely.

If a vaccine becomes available, some countries are now considering "ring vaccination" which involves rapidly identifying those infected and then inoculating their contacts to avoid the virus spreading further. That strategy has ended Ebola outbreaks in Africa and was used in the eradication of smallpox, the only human disease that has ever been successfully wiped out. 

Such an approach would require strict border controls and quarantines from all countries to avoid new infections once cases were low in Britain. It would also need a highly responsive test, trace and vaccinate system. 

Passengers returning to Heathrow Airport from Greece in September. Strict border controls and quarantines from all countries would be needed for virus elimination - Yui Mok/PA
Passengers returning to Heathrow Airport from Greece in September. Strict border controls and quarantines from all countries would be needed for virus elimination - Yui Mok/PA

Devi Sridhar, professor of Global Public Health at the University of Edinburgh, said it was vital to drive numbers down and then stop reinfections from elsewhere.

"Either we live with daily restrictions and lockdown cycles, but we have open borders, or we close the borders and we largely get back to normal," she said. "People have to make a choice. Do you want your summer holiday or do you want to go to the pub? Next summer will be the chance to clear it. 

"A vaccine isn't going to be a silver bullet and we don't have a pan-European strategy, so if we keep the borders open countries keep going down like dominoes. The Government is trying to protect business, but uncontrolled transmission is far worse for the economy. Early intervention and strong measures gives people more confidence."

However, Sir Patrick Vallance, the Government's chief scientific adviser, has warned that such an approach is not feasible, saying: "The notion of eliminating Covid from anywhere is just not right, because it will come back. Elimination strategies... I think that's very unlikely."

Full lockdown and wait 

Many scientists believe Britain is now seeing a deadly second Covid wave because restrictions were imposed too late and lifted too early.

A full lockdown that lasts until the virus is very low, or drugs and a vaccine are available, may be the only way of getting out of the cycle.

Dr Stephen Griffin, associate professor at the University of Leeds school of medicine, said: "The simple fact is that measures were relaxed too soon and too much, the tone of messaging was that the worst was over and much of the support that allowed those least well off or most clinically vulnerable to take appropriate precautions was removed.

"How to avoid lockdown cycles? Simple – make them count and face the short-term hardship for the greater long-term good."

A sign by the side of a road in Flint, north Wales, urges people to stay at home during the country's new 'fire break' lockdown - Oli Scarff/AFP
A sign by the side of a road in Flint, north Wales, urges people to stay at home during the country's new 'fire break' lockdown - Oli Scarff/AFP

Doctors and scientists are also hopeful that, as well as a vaccine, drugs will be available which can lower the death rate to something closer to flu. If that happens, the virus would become endemic and the country could return to normality.

The Recovery trial, led by Oxford University, has found that the common steroid dexamethasone can lower death rates by one third, potentially saving hundreds of thousands of lives across the globe.

Profesor Martin Landray, the co-lead of the trial, which is testing several more treatments, said: "I think drugs are a major part of the solution, and I am quite optimistic about new treatments. 

"For most people this is a relatively mild illness – not trivial, but most people get better on their own. However, of those who end up in hospital the chance of survival is not good. If we could fix that problem it obviously benefits the patient and their family but also the health system and society more broadly.

"If we can find two or three drugs to turn this disease from something that kills one in three in intensive care to one in 10, then this turns it into something resembling seasonal influenza. Then it ends the cycle of lockdown and the burden on the NHS."

Herd immunity

Thousands of clinicians and scientists throughout the world now believe that protecting the elderly and vulnerable while allowing herd immunity to build in the population is the best way out of the pandemic.

Older people and those with underlying illnesses are hugely more likely to suffer severe Covid-19, while for most people the disease is very mild and many do not show symptoms at all.

David Livermore, professor of medical microbiology at the University of East Anglia, was one scientist who signed the Great Barrington Declaration, which called on governments to adopt herd immunity globally

"I think we have to learn to live with this virus, and we would be foolish to bet on a good vaccine," he said. "That involves trying to shield the vulnerable as much as we can and as much as they want to be shielded and accept the virus is going to circulate in the healthy population.

"The problem of lockdowns is they kick the can down the road and do huge damage. This virus is behaving seasonally – you look at other countries and despite having different measures they are seeing similar trajectories."

A change of tack 

A complete volte-face on how Britain is responding to Covid is the way to end the pandemic, according to some experts.

Ashlely Woodcock, professor of respiratory medicine at the University of Manchester, does not believe the virus is airborne but is largely being transferred by touch on surfaces.

Shifting the focus to cleaning homes and coating public amenities such as cashpoints with long-lasting disinfectants could rapidly stop the spread, he believes.

Most airborne viruses, such as measles, have very high reproduction numbers, with one person typically infecting more than a dozen others. Yet even on aeroplanes, where the air is circulated for many hours, only small numbers of people have picked up the virus.

Social distancing, combined with keeping surfaces disinfected, could be a key weapon against the virus - Oli Scarff/AFP
Social distancing, combined with keeping surfaces disinfected, could be a key weapon against the virus - Oli Scarff/AFP

"People have been looking for coronavirus in the air for about six months and there is one paper so far where they generated an aerosol of the virus artificially where they have shown persistence in the air," Prof Woodcock said. "Nobody has identified coronavirus in the air in Sainsbury's or a school or a pub. What they have done is found it everywhere on surfaces, on cashpoints, on phones, on supermarket tills.

"I think social distancing is important, but just so you don't touch anybody. We need to have a 'Let's Clean Britain' campaign."