Compared to 2020, we have new tools (vaccines) and we have new challenges (mutation). We also have a year’s worth of international experience to look at. So, what is the best way out?

First published in February 2021.

The field of exit strategies appears to be:

  1. Vaccinate the elderly, open up in February (“focussed protection”)
  2. Vaccinate all at risk, open up after Easter, allow COVID to be endemic in the young (“endemic”)
  3. Maximal suppression, vaccinate all, and eliminate COVID

From the top then:

Option 1 is nonsense.

  • Around 1/3 of the population is at risk of severe COVID.
  • We need two doses for sustained and high quality immunity – at 12 weeks, that’s by March.
  • This does nothing to relieve hospital and ICU pressure, where the average age is 60.

Option 2 is subtler:

  • If we fully vaccinate the elderly, we can reduce direct COVID deaths in that group.
  • However, this does nothing to relieve hospital pressures either, and deaths rise anyway in younger patients, as well as non-COVID.
  • No healthcare is not sustainable.
  • Endemic COVID, at high levels, will result in tens of thousands of deaths in young people, as well as a huge burden of Long COVID.
  • Up to 1/5 of patients, including children, have long-term health problems after COVID.
  • after discharge 1 in 8 COVID patients DIE within 4 months.
  • The other major issue with this is mutation.
  • The current vaccines appear to be effective against the current U.K. variant.
  • But there are already escapes here and around the world where that might not be the case.
  • Mutation is a literal genetic lottery.
  • To “win” means a mutation needs to change something, and that change needs to make the virus more competitive.
  • Like the lottery, the more tickets you buy, the better your chances. So, the more virus, the more chances a mutation arises.
  • Endemic COVID with partial vaccination engineers a lottery where there are millions of chances to “win”. And “winning” means escaping immunity from a vaccine.
  • In this scenario, eventually a new mutation of COVID is inevitable, and we are back to square one.
  • Remember also COVID is around 1% mortality, while a very close genetic neighbour coronavirus, SARS, had mortality of 10% (The same SARS we nearly eliminated globally with only 8,000 cases).
  • So, we really DO NOT WANT uncontrolled mutation.
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So what’s the alternative?

  • We need to do BOTH.
  • As we vaccinate lockdown measures become MORE effective.
  • The virus can’t exist for longer than 2-3 weeks without a new host.
  • No susceptible hosts, no more virus.

So, we should SUPPRESS to as small a number of cases as we can, VACCINATE as fast as we can, and close the borders until we ELIMINATE COVID locally.

At the current fantastic rates, we can give 120,000,000 doses by August. That’s the WHOLE POPULATION vaccinated.

But we will reach herd immunity long before that point, and newer vaccines like Johnson & Johnson are single dose, so we could open up much faster.

This lockdown needs to be the harshest, longest lockdown yet but it must also be our LAST.

In order to do that

  • We keep schools closed till Easter.
  • We keep borders closed. Lorry drivers crossing the Channel every day: change the drivers at the border and quarantine of goods can occur in transit.
  • We move to N95 masks for all.
  • We make isolation a 5-star paid experience.
  • We mandate employers to allow staff to work from home.
  • We support, by all means necessary, businesses and the self-employed.
  • And we keep vaccinating, as fast as we can, as many as we can.
The exit strategy. | Shutterstock/MBLifestyle

The R will fall further with the same measures as we do, and we can move from physical limitations to keep it reduced to true herd immunity.

This is the only feasible way out.

We must not waste our chance at it.  

Dr Dominic Pimenta, Doctor. Writer. Researcher. Chairman of Active NHS campaigner.

[This piece was first published as a Twitter thread and turned into the above article on 7 February 2021 with the purpose of reaching a larger audience. It has been minorly edited and corrected, and published with the author’s consent. | The author of the tweets writes in a personal capacity.]

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