Recently on Twitter I quipped: How many local lockdowns make a national lockdown – asking for a nation. Because, well, here we are again.
To be fair, the more accurate statement is here we are still.
As cases begin to rise again it is important we understand that Covid-19 never went away. This summer was not a remission, but an attempt to see what level of “normal” might be possible without prompting a rise in cases. As it turns out, there are very few normal activities that can resume without significantly increasing the risk of infection in our population.
However, unclear and inconsistent messaging from the government, and those businesses left to interpret them for their clientele, has led many to view the low infection numbers as a reason to relax infection control measures that are vital to controlling the virus. Over the summer, many of the simple ways to keep ourselves and others safe have been misunderstood, lost in translation or ignored by an understandably confused nation.
As a possible and necessary second national lockdown looms, it is important that the simple messages of how to control the virus are amplified, otherwise the so-called “circuit break” will fail to substantially slow the infection. Teetering on the “tipping point” (to borrow from Matt Hancock), it has become increasingly clear that the most important of all the measures is the least liked and the one with the least compliance.
Just like the pink, banana-flavoured medicine goo most toddlers loath, social distancing has been hard for Britons to swallow. The most effective medicine is the least palatable, and the nation is not following the doctor’s orders.
This is a problem.
In medicine, treatment adherence (i.e. following the doctor’s orders) is an important part of effective medicine because most illnesses require full compliance with treatment and medications so that the patient can get better. It is why the pharmacist always warns patients to take the full course of antibiotics regardless of whether they feel better – only the full course will heal the patient. The same principle applies here to social distancing – we cannot get better if we bin the treatment just as we start feeling better, because the virus is only down, but not out.
While the guidance on social distancing may seem like unwarranted hand wringing on the part of the infection control world, it is one of the most important measures we have to keep us safe. The Covid-19 virus is an aerosol producing virus, meaning that it spreads through droplets in the air around infected people, normally as they cough it out of themselves to fight the infection. However, these droplets can only travel so far. There are arguments about the true extent of the “spray zone”, but two meters keeps you more or less confined to your own droplets. By keeping a minimum of 2 metres apart from others (out of the spray zone), and avoiding crowded places (less droplets and less chance of overlapping spray zones from the people around you), it is possible to limit infection far more proactively and effectively than just washing your hands and wearing a mask.
This does not mean that hand hygiene and mask-wearing can be abandoned all together. Using just one or two of these measures exposes a weakness that the virus can exploit. To truly shop safely, for example, we need to limit the number of shoppers and enforce that they stay two metres apart while wearing a mask, which they remove only once they have left the store and washed or sanitised their hands.
The measures work as a team, each eliminating a source of infection to yourself and others that when used together create a Justice League level of protection from the virus. Even the self-isolation rules for those with symptoms is simply an extension of the importance of social distancing: if you know your spray zone is toxic, it’s best to keep it to yourself until the only risk you pose to others is potential bad breath. Which, if you are properly socially distanced, shouldn’t be a problem anyway.
Over the coming months, regardless of high or low case numbers, hospital admissions and deaths, we must not forget that the virus has been here the whole time. Just as dangerous. Just as deadly. We must remember that to fight this virus successfully, we must come together by standing very, very far apart.
Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health at Aston University, chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, and a trustee of the Institute of Medical Ethics