Summary: We need to make intelligent decisions about what is the right strategy when we progressively soften or remove any of the current restrictions on our behaviour in the UK. We need to accumulate a comprehensive dataset of information about the behaviour patterns of each and every person who becomes infected. With 5000 new Covid-19 cases detected each day we will be able to generate a major statistical database. This would allow us to make intelligence-led decisions about how to manage our escape from Lockdown as quickly and efficiently as possible.
The UK government appear to be allergic to the idea of even talking about how we might ease and eventually leave Lockdown. Perhaps the main strategic error in the UK apart from just doing things far too late and slowly was the decision to abandon testing in place of hoping for herd immunity. All the evidence is that probably only 15% are immune which means that the rest of us still have it to live with or die with. The dangers we are faced with from Covid-19 are in no way diminished by spending many weeks in Lockdown. We have to decide how to manage intelligently the way forward. In another piece (see: http://outsidethebubble.net/2020/04/14/escape-from-lockdown/) we have discussed how different aspects of our containment might be relaxed. The problem is we have very little information about what is happening in the UK and where those infected caught the disease. Only by understanding in detail what aspects of our behaviour is leading to those individuals being infected can we make progress.
It does seem to be agreed fairly widely that any escape from Lockdown is going to depend on a much greater and more aggressive approach to testing for people who have the disease and later for those who may have had it in the past. However there is no point in mass testing until we have a clear idea of what we hope to get out of it. In the UK we have excellent capabilities in artificial intelligence combined with data mining particularly with heterogeneous data. A good example is the work that was being done a few years ago by Cambridge Analytica. There are many other organisations working with other equally complex datasets and we need to use their skills to guide what we do next. The suggestion that the new whizzy smartphone app will sort everything out for us is probably pretty naïve unless there is some considerable investment in analysing the data produced and reacting to it as a matter of urgency. If this is all underway good and well but it is difficult to believe it will be enough.
We still have nearly 5000 new cases of Covid 19 each and every day in the UK. We need to institute as a matter of urgency a serious attempt to find out more about each new case in order to develop a much better understanding of where the problem seems to be in our society. All the evidence is that the British public appear superficially to be respecting the Lockdown pretty rigorously and respectfully. City streets are deserted. Shops are closed. Places of entertainment, restaurants, cafés and bars are all closed. So where is this infection coming from? These apparently very basic questions are ones that we simply don’t seem to know the answer to.
It is important that everyone who is tested is asked all these questions. Honestly is critical and it must be made clear that there will be no penalty for admitting going outside the present lockdown rules. The range of questions that need to be asked has to be very comprehensive and should include:
- Location and environment: Where do you live? Kind of home: house/flat/apartment? Size of home? Number of rooms? Number of people in lockdown in your own home? Any garden? Access to green spaces nearby?
- Employment: What is your job? What is your position in the organisation? Where do you work? How do you get to and from work? Private car, bicycle, walking or public transport? If public transport question is it crowded and how close do you find you are to other travellers? What is your precise job? How many people do you work with? Do you work in a relatively crowded environment where social distancing is difficult or impossible to maintain? What do your employers provide to ensure your own safety and allow you to follow social distancing rules?
- Financial: What approximately is your current income now? How long has it been at that level? What was it before the pandemic force the Lockdown? how do you feel you are managing now? What are your immediate expectations financially? Are you anxious, concerned or very apprehensive about the future? Has that been affecting your state of mind and potentially your health?
- Family: Family disease history, colds or influenza or any other recent bugs? Has the patient or other family members any other medical conditions of any significance? Diabetes, heart disease, pulmonary problems or anything else? Allergies including hay-fever and asthma?
- Close Family: Do you see or meet close family members? How careful are you to social distance yourself properly? Are they cautious and meticulous about keeping themselves safe? Do they have any potential problems with Covid-19 such as the elderly or frail? Should they be considered at risk because of your possible infection?
- Managing Lockdown: How are you managing generally? Stress levels? Behavioural problems with other members of the household? Questions designed to tease out any suggestion of domestic abuse towards partners, children, parents or anyone else living with you? How do you contact people outside your home? Telephone or video such as Zoom? Do you have adequate internet access?
- Behaviour: Facemasks. Do you use them at all? Do you wear them whenever you go out of the house? When you go out for exercise? When you visit supermarkets?
- Behaviour: Gloves. Do you use gloves at all to give you a degree of protection against contamination through touching? How meticulous and careful do you think you are about that?
- Behaviour: Handwashing and use of hand sanitisers: how often do you thoroughly wash your hands? Whenever you come back from being outside? Or only when you come back from shops? Or after taking exercise?
- Behaviour: Meeting other people: Do you ever see people you know apart from at work? Where do you meet them? Do they use facemasks? Do they social distance properly? Have any of them recently mentioned symptoms or just feeling slightly under the weather?
- Behaviour: Exercise: How much do you take? How many times a day and how long do you exercise for?
- Pets: do you have pets and if so what? do you take them out for exercise?
All these tiny pieces of information from one individual will provide a single set of instances which will not, in itself, be significant. However combined with another 5000 that we already test each day we should expect to see significant correlations that build up in importance. They would tell us very early on, for example, whether people are more or less likely to be being infected at work or in shops, in the street or other places. We would know very quickly whether facemasks should be used much more widely and how important they might be for this.
Each questionnaire should be completed within 10 or 15 minutes while the patient’s test is being processed. These questionnaire results are really important and it is essential that people are trained to carry them out effectively and reliably. Ideally questionnaire should be completed by an individual trained to do so and not necessarily a medical professional.
The results of such a survey have the potential to give us all the basic information we need about what aspects of British behaviour are likely to be more problematic. These are the areas which should not be relaxed and possibly addressed by stronger regulation. The results will also tell us what appears to be relatively harmless behaviour. This would allow some of the restrictions we have now to be dropped fairly quickly with relative confidence that that will have only a minor effect negative effect on infection.
Only by gathering this sort of information routinely can we expect to have any intelligence driving our escape from Lockdown. A good understanding of British behaviour today that is currently leading to additional infections has to be developed. In this way we might have an intelligence based route by which the UK might escape from Lockdown.