SUPPRESSING THE CURVE

Let’s start with the epidemiological science around brining this virus under control. On Monday 16th, March, researchers at Imperial College London published a paper outlining the projected path of the epidemic in the UK and the US following the application of a number of non-drug interventions.

In the uncontrolled, do-nothing scenario of the epidemic the modelling suggest that there would be 510,000 deaths in the UK and around 2.2 million deaths in the US, with a higher peak in the UK compared to the US due it a relatively older population.

The researchers suggest two fundamental strategies for brining the virus under control in these populations: suppression and mitigation.

With suppression the aim is to reduce the basic reproductive number to below 1, while mitigation seeks to reduce the basic reproductive number but not below 1.

The basic reproductive number (R0) measures the transmission potential of an infective agent and is the average number of secondary cases each COVID-19 case generates. In the case of the SARS-CoV-2 the Ro ranges between 1.5 and 3.5.

SUPPRESSION AND MITIGATION

So what are the differences between these two strategies?

Let’s take suppression to begin with this strategy was used quite successfully in China and South Korea to reduce the number of cases. But given what we already know about this new Coronavirus this approach would have to sustained for a long period of time to avoid a resurgence once the controls were lifted.  Which would obviously have extensive social and economic costs.

In the case of mitigation the aim is to reduce the impact of the epidemic by flattening the epidemic curve, allowing the population to build up immunity to the virus across throughout the duration of the epidemic. This would lead to a rapid decline in cases and a reduction in transmission. However it would be necessary for social distancing measures to be in place for as much of the epidemic as possible and for interventions not to be introduced too early before sufficient herd immunity develops within the population.

It’s important to note that following this strategy will not fully protect those at risk of severe disease or death. In addition it is unlikely to be feasible without emergency healthcare surge capacity being exceeded many times over.

NON-PHARMACEUTICAL INTERVENTIONS

In order to achieve suppression or mitigation the researchers looked at four specific non-drug interventions these were: case isolation, population-level social distancing, household quarantine and school and university closures.

They go on to say that all four interventions combined, which could be referred to as a partial lockdown, will provide have the largest predicted effect on reducing transmission. This will help reduce critical care requirements for as long as the interventions remained in place, ensuring that healthcare services are not overwhelmed.

But how long should these interventions remain in place when the health of the population is so inextricably linked to its wealth?

The modelling suggests that once interventions were relaxed in the autumn infections will begin to rise causing a secondary peak later in the year. To avoid this rebound transmission the researchers go on to say that interventions will need to be maintained until large supplies of vaccines are available – which could well be 18 months away.

The researchers  go on to conclude that “epidemic suppression is the only viable strategy at the current time.” They also acknowledge that the social and economic effects of the measures needed will be profound and that the scale of what’s required has never been previously attempted for such an extended period of time.

MANAGING STRESS

Stress is ubiquitous in modern life and with the uncertainty, worry and lack of control that you may feel from living through this pandemic may add to an already stressful life and pull you further away from what your focus should be on; keeping yourself and your family as healthy and well.

Chronic stress and anxiety can actually make you more prone to catching a cold or become ill. It also affects you both the physically and psychologically. Causing an increase heartbeat, sweating, higher blood pressure, digestive issues and even increasing inflammation. During stressful events your body is triggered to produce stress hormones that send signals throughout the nervous system. This then reallocates resources and energy to the threat and in the short term there can be immune benefits but chronic stress will reduce immune function and will reduce your body’s natural ability to fight off infections.

TIPS & STRATEGIES

Avoid information overload – For most people there is a point at which having too much negative information coming in can increase stress and anxiety, you need to know what that is for you. If you feeling overwhelmed with all the information and daily press briefing then you need to take a step back from it. Remember this virus is new and no one  has all the answers.

Tip: Limit the amount of Covid-19 screen time

You have choices – Remember you have a choice in how you receive this information. You can dwell on the negativity or you can accept the cards you been dealt and think about ways to make the best of the situation.

Five Ways to Wellbeing  – The New Economics foundation reduced a long list of actions to five key messages: connect, be active, keep learning, taker notice and give. The children’s society replaced the give with be creative and play. These actions are designed to produce their own positive feedback loop reinforcing frequent and similar positive actions to support wellbeing.

Practice gratitude – Be grateful for the time that you now get to spend with family and loved ones that you may not have had had you been at work or the amount of money you’ve saved by not being on public transport and possibly being able to work from home.

Try something new – think about all the things you can learn or try your hand at or projects that you started that never quite completed, this is a great opportunity for  you to try something new

Mindfulness Meditation – this can have a huge positive impact on mental wellbeing and physical health. There are plenty of free videos and apps for meditation. Try a few to figure out what works best for you.