So last week we looked at the question of how we generate enough immunity in the population to reduce the reproductive rate of SARS Cov2 to less than 1 and allow us to come out of lockdown. Whoopee!!! Our conclusion was that we need a safe and effective vaccine and that this will take ages to arrive, probably the end of next year at least, booooo!
 
What!? Am I really saying we need to stay locked up in our houses until Christmas 2021?! We’ll all go mad long before then….
 
OK so we can’t stay locked in our houses until then, but how do we come out of lockdown… the answer is carefully… (that reminds me of a joke, “how do hedgehogs have sex? … Carefully!” ha ha!!)… anyway… there is no rule book for this, no one has done it before, there is no manual that says do this, or do that… it’s a case of trying and seeing what happens… and that’s a bit scary. Especially as the media is likely to pick holes in any attempts as they do like a good melodrama.

So it’s the burning question… political parties are demanding answers and the Government are saying “not yet”… but what is it all about and how do we come out of lockdown due to Covid-19.
 
On the face of it this might seem simple. All the Government has to do is say “right, that’s it, everyone back to work, school, gym, parks, beach…wherever!” But it’s really NOT as simple OR safe as that.
 
In order to safely come out of lockdown we need to be sure that there will be no rebound in the number of cases, and at the risk of sounding alarmist there is a real possibility of this happening before we realise it’s too late.
 
Remember, it takes about a week to develop symptoms after exposure to SARS Cov2, and another week before all of your contacts become unwell. Although most people are fine it still doesn’t account for those who are not and those who end up in hospital during the second week of illness. This means that it takes at least 4 weeks (1 week incubation, 1 week contacts, 2 weeks illness) before we “see” the effects of any change in policy about the lockdown. AND it will take a further 4 weeks for things to settle down again if we go back into lockdown! That’s 2 months… that’s up to end of July! We do not want to get this wrong so a careful cautious approach is what is required. I know I don’t like it either but…

One of my biggest concerns around the current Covid-19 pandemic is that all of the normal things that make people sick haven’t gone away. This concerns me because whilst Covid-19 is on the minds of healthcare staff they may inadvertently delay considering all of the other clinical problems that will continue to be going on in the background. Patients will still be coming in with appendicitis, UTIs, heart attacks and strokes; in fact ANY acute medical or surgical problem that happens in a normal day in the NHS.

There seems to be huge amount of confusion about what tests are available for Covid-19. It doesn’t help that politicians and the media keep using the wrong terms and don’t understand what the different tests tell us. The squabbles seem to surround the numbers delivered rather than correct testing!
 
There are 3 main tests that are currently being discussed:

1. Polymerase Chain Reaction (PCR) commonly referred to as a “molecular test”
2. Antigen (Ag)
3. Antibody (IgM and IgG)

 
In order to understand the value of these tests it is important to understand the basic structure of a virus.
 
The structure of a virus

Everyone I see around the hospital asks me how the Microbiology department and the Microbiologists are coping. They are concerned that WE are flooded with work… and yes we are busy… BUT we are not frontline staff dealing with acutely sick patients or GPs in primary care struggling to deal with Covid-19 whilst juggling all of their other patients!
 
I am especially in awe of how my primary care colleagues are dealing with Covid-19.
 
Primary care must be unbelievably hard right now. Not only are GPs still having to manage their normal case loads of chronic illnesses but they are also the first line of contact for many people who have been infected with SARS Coronavirus 2 (SARS Cov2). AND they are doing this remotely using telephone and videoconferencing!!! The Editor Chief in Charge (aka my wife) will tell you just how useless I would be at that… I don’t even own a smartphone; in fact I can barely use the TV remote control!