This Is How Life Will Be

Time has been cut into two eras: before and after Coronavirus.

Our loved ones suffocate to death in near-total loneliness in the new future. Everything has come to a stop except our hospitals.

We find ourselves stuck at home. Jobs are lost. Businesses shut down. On the verge of a crisis, the global economy is teetering. Intensive care units in Spain and Italy collapse under the number of deaths. That is the magnitude of suffering; doctors are urged to choose who should live or die with the military mobilised to cope with the enormous amount of dead bodies. Soon, there will be even more nations getting their versions of such tales.

It took just three months for the new Coronavirus to bring the whole world to a halt, to change our lives and our societies and force us on lockdown. More than 40,000 have died. But this is just the start of the coronavirus crisis. Without a vaccine or proven treatments, it is likely COVID-19 is here to stay for at least a year. While the worst of the outbreak is just ahead of us, it will be a long time before life goes back to normal.

For the British government, it came like a punch to the gut.

From its confusing messages during the first half of March, it seemed like officials hoped that COVID-19 would be a short and sharp shock, racing through the population till herd immunity was built against the virus. If any traces of this approach continued, they were marked out by March 16 when a report by Imperial College London clearly states the cost of inaction over Coronavirus. Without a switch to much more extensive social distancing rules, the capacity of intensive care units would be reached eight-fold, and 250,000 would die – in a best-case scenario.

The same day Imperial College published their report, the UK prime minister, Boris Johnson, advised everyone in the country to stay at home. Only a week later this became a proper lockdown with police given the power to issue fines for anything other than exercise, food shopping, going to work or assisting a vulnerable person. Overnight, the social fabric in Britain had contracted like never before.

How long will it all last?

This is the question asked at politicians and healthcare officials during the government's daily briefings. Johnson's first register was optimistic hubris, telling the public on March 19 that in twelve weeks we could get it done with the new Coronavirus. The following week, the deputy chief medical officer Jenny Harries uncovered a sober tone, warning that social distancing actions might be in place for six months, and even longer.

Either of these scenarios, twelve weeks or six, nine months, will only be the start of our fight against COVID-19. While there is hope that transmission could fade away during the warmer months, it is much more possible that the threat of this disease – its devastating consequence on health and sabotaging of our societies, is here to stay until we produce a vaccine. Things are unlikely to be as they were for a long, long time.

COVID-19 is a perfect storm of disease. Infectious enough that it jumps from person to person until healthcare systems are overwhelmed, but slow enough that extreme lockdown measures, like those we saw in China, seem to stop its spread. If it were any more infectious, it would have swept through the world's population before we had any chance to react.

It is still too soon to know the exact CFR of COVID-19, but by some estimates, it is already out-stripping any fictional figure. A research has placed it at between 0.25 and 3.0 per cent. In my country, Italy, it is currently at ten per cent. At the same time, in the UK the figure hangs at just over six per cent – although the exact values are expected to be much lower as we just don't know how many infections are currently moving undetected.

Approximately four per cent of all cases in Europe need intensive care or respiratory support, while 30% of cases need hospital admission. It's this sickening cocktail of infection severity and infectiousness that has put so much pressure on intensive care units in Italy, where fatalities passed 11,500.

Yet a significant number of COVID-19-infected people experience only mild or no symptoms at all. An examination of people repatriated from China at the end of January discovered that between 40 and 50 per cent of people going back to their countries had undetected virus infections. Tests from the quarantined Diamond Princess ship saw that almost half of those who had the virus showed no symptoms at the time. This adds up to a vast pool of healthy – or just moderately unwell – people living their normal lives who may spread the virus to more vulnerable people unintentionally. By the time the first cases show up in hospitals with severe respiratory failure, it's already too late – the infection has spread well beyond what we can trace. The aim has shifted from containment to merely surviving the coming surge of the tide.'

And this is a battle which we are going into entirely blindfolded.  

Although the British government has lagged behind others in detecting COVID-19 – South Korea had done 317,000 tests as of March 20 versus the 65,000 of the UK tests – only testing can give us an idea of the spread. Although most countries are ramping up their testing – the UK has only recently set the target of 100,000 COVID-19 tests per day by the end of April.

Another important way to look is at the fatality rate. Since most of those who end up dying from COVID-19 are going to be admitted in hospital and test positive for the virus, we can be confident that there are not large numbers of unrecorded deaths. Fatalities give us a better and more accurate picture of the epidemic.

But here we are hamstrung again. It takes roughly 18 days for, someone, to die from COVID-19, from the first symptoms to their last breath. There is also a gap between someone first being exposed to the illness and presenting symptoms, the disease's incubation stage. For COVID-19 this varies from one to 14 days, with most estimates placing it at five days. By the point a person dies, more than three weeks may have passed since they were exposed to the virus.

Using death rate to estimate our progress facing COVID-19 is like peering into the past through a pinhole. In the UK, the number of new fatalities from COVID-19 has been rising from one day to the next. Every day brings a new record, but this is to be expected. In Italy, where the entire nation went into complete lockdown on March 10, it is still not yet clear whether the amount of daily deaths is in steady decline.

While the rest of us are glued to scrolling news coverage, the real fight will take place in the NHS intensive care units. There, at least, there is a bit of hope. According to the recent modelling by Imperial College London, it doesn't look like intensive care unit capacity, across Britain as a whole, will be breached.

According to scientists, intensive care units will reach their peak demand in the next two weeks. If the UK's social distancing efforts have been useful, we should notice demand begin to ease after that limit as the number of new infections in the UK decreases. On March 30, Patrick Vallance, the UK's chief scientific advisor, hinted that there was evidence that the COVID-19's reproduction number, a measure of how many new infections are sparked by each infected person, was already in decline. If that gets under one, the number of new cases will start to decrease. This will be the first indication that the UK's approach is working. Then the actual task to defeat COVID-19 can start.

The world is in a scary real-time experiment.

In Japan, schools are set to reopen in April following a shutdown of over a month. Although the nation experienced one of the earliest notable outbreaks outside of China, its total number of cases has stayed moderately low. In Hubei, which once was the epicentre of the global pandemic and a region with more than 3,100 COVID-19 fatalities, the lockdown is gently being lifted.

More than 56 million people, both in Wuhan and the neighbouring areas lived in total lockdown, At its peak, with people restricted to their homes and all travels barred.

Neither of these countries managed to stop the spread of COVID-19.

The number of new cases, in Japan, has been rising and now is at 1,866. China saw over 5,000 new cases per day at the peak of its outbreak in February. As of March 30, it was still recording more than 100 new infections daily – most of them imported from overseas. Yet the risk is that if social distancing rules are peeled back, the number of infected people will begin to grow again: the so-called 'second wave' that governments are desperate to avoid.

A second wave can be even more devastating than the first.

Although the Spanish Flu began in March 1918, it was the second outbreak in the summer and the third the following winter that saw for the majority of its total deaths. The problem for countries now in lockdown is that it's hard to predict when a second peak will happen, how severe it will be, or if it will occur at all. In one Harvard study, virologists modelling the shape of a second outbreak found that any one-time social distancing actions now would shift the pandemic peak into the fall, where intensive care units are likely even further stretched than at the moment.

Social distancing is a double-edged sword. While it delivers the vital task of decreasing the spread of the virus and preventing it from reaching the most vulnerable, it also leaves the majority of a population with no likelihood of getting the infection and gaining potentially significant immunity.

In the UK, the Imperial College report illustrates similar outcomes to the Harvard study. Its models hint that even with five months of social distancing, the UK will experience a second peak in mid-November. Both reports say that only intermittent and continued social distancing will avoid a second wave, but the measures may need to be in place for over a year for that to be successfully avoided. The Harvard study says the rules may be required until 2022, whereas the Imperial research shows that before a vaccine we have to wait at least 18 months and once ready we won't know how effective it will be. Germany is planning to reduce the shift from current lockdown by issuing so-called "immunity documents" that would let people leave lockdown early if they tested positive for antibodies to the Coronavirus. The UK has requested 3.5 million of its own antibody tests, but it's not yet very clear how the government plans to use them.

We don't have a tried-and-tested vaccine against this new Coronavirus. Even for the most promising candidate vaccines – those that are in human trials already – it is expected to be at least twelve to eighteen months before they are announced safe to use, manufactured, shipped and ready.

What will happen in the meantime?

It shouldn't surprise that those countries that had previous coronaviruses outbreaks are among those countries that are managing to contain infections most successfully. South Korea, hit by an outbreak of Middle East Respiratory Syndrome (MERS) in 2015, has led to flatten the curve of its own epidemic, going from a peak of over 800 daily cases to its current rate of about 100 per day. Just 162 people have died out of the country's 9,786 confirmed cases, a case fatality rate below that of Italy, UK, Spain, France and China.

In the early stages of its epidemic, South Korea reacted aggressively, checking extensively and retracing anyone's footsteps with a confirmed positive result. According to a report published by the New York Times, the country's contact tracers behaved like detectives, using security cameras, credit card data and mobile apps to track contacts. Mild cases of infection were sent to specialist centres to maintain hospitals clear for the seriously ill and avoid possible transmission in hospitals. People put into self-quarantine were closely tracked by an app, and officials were alerted if they broke isolation, with fines as high as £2,000.

Widespread testing is vital for stamping out the sparks of new outbreaks, virologist Ilaria Capua says.

The BBC has reported, the NHS is considering the use of a contact tracing app for people that would warn those who have been in contact with anyone who tested positive for the virus.

But until a vaccine brings a definite end to the outbreak, governments will have to stay open to the possibility of re-implementing lockdowns.

Even with adequate testing, isolation and contact tracing, the situation can get out of control devastatingly quickly.

The next eighteen months are going to pass in a mist of transitionary terror.

In October 2021, after we've all had our jabs and the threat of the virus has faded out, we should finally begin to count the damage the Coronavirus has wrought on people lives. Ferguson, during his evidence session to the select committee, said: "We will pay for this year for decades in terms of the economic impact". The United Kingdom's economic performance is expected to fall by 15 per cent in the second half of 2020 and unemployment will double. We are now certainly faced with the worst recession since the financial crisis in 2008.

But there are also those impacts that are more difficult to quantify. Parents who could not say goodbye to dying children; those who worked for years for exams they had not to take; the careers crashed and the mental health impact of bright spring days that we spent in worry and isolation. All of these will leave their signature on a whole generation. And then, once all our debts are counted, and wounds healed, we must get everyone ready for the next one.