By Professor John Bryson
Department of Strategy and International Business, University of Birmingham
On 23 March 2020, I published a piece on the Birmingham Business School blog under the title Social Distancing: People are the Problem. That does seem such a long time ago. This piece was written just as the UK entered lockdown and a new socially distanced economy (SDE) emerged.
People continue to remain the problem as lockdown restrictions are relaxed; irresponsible behaviour will lead to Covid-19 outbreaks and further deaths. The question will be the extent of any intensification in the rate of transmission. Covid-19 breakouts could remain highly localised, or a localised outbreak could rapidly spread to become of national and international concern. I have major reservations with the planned relaxation in foreign holidays. My prediction is that this will lead to the rapid transmission of Covid-19 across Europe contributing to an extension of the first Covid-19 wave.
There has been a policy U-turn in the UK and elsewhere (Germany, South Korea and China) that, in part, reflects political, media and commercial concerns with the socio-economic impacts of the nationwide Covid-19 lockdown combined with a greater understanding of the virus. The nationwide approach to lockdown has been replaced with a new policy based on the imposition of localised lockdowns.
Local authorities Covid-19 action plan
All local authorities across the UK are now required to have local Covid-19 outbreak management plans in place. These plans will be published in early July. Central to these plans will be communication, enforcement, testing, tracing, and isolating combined with a focus on developing mechanisms for anticipating, preventing, and isolating incidents and outbreaks of Covid-19. Media commentators will highlight that this local approach will result in confusion, but the key will be communication combined with enforcement.
European countries have already experienced a new wave of Covid-19 cases as countries commenced easing restrictions. There is no question that the UK will experience a resurgence of Covid-19 as restrictions are reduced. This is not about a possible Covid-19 second wave as the first wave has yet to conclude. In the UK, Leicester has had to develop a solution to a local surge in Covid-19 cases including keeping pubs and restaurants closed and maintaining the 2m social distancing guideline.
The challenge is in balancing the regulation of Covid-19 interventions with political, media and citizen concerns against any return to a nationwide lockdown. Here it is important to appreciate that lived density, combined with other opportunities for Covid-19 transmission, has played an important role in the rate of transmission in a local area. Places with different characteristics have had very different Covid-19 infection rates. This suggests that the future management of Covid-19 requires local rather than nationwide solutions.
The challenge is that regulations are not yet in place in the UK that enable local authorities to impose an effective localised lockdown as strategies are still being developed. However, they will eventually become a feature of UK life, but the exact nature of these localised lockdowns will emerge via improvisation and practice. The characteristics of each local Covid-19 surge must shape the nature of the local lockdown and this could include closing schools and retail premises, intensifying testing, tracing and restricting movement. The challenge is that Local Authorities have the powers in place to close premises but not to isolate areas.
Reducing the reproduction number
The shift towards localised lockdown raises an interesting question regarding what approaches individuals, households and companies should adopt to reduce their exposure to Covid-19 related risks. There are two things to consider.
The first is to reflect on some of the processes that lie behind R0 value (R nought), or the reproduction number. It is these processes that determine the relationship between physical distance between people and the possibilities for infection. This is a complex scientific problem that lies at the interface between medicine, fluid dynamics and atmospheric science. There are at least four variables to consider:
- Place and geography matter or the environmental impacts on the spread of droplets that contain the virus. It is important to differentiate between environments with limited air movement (indoor closed spaces) versus places in which air currents will disperse and dilute droplets (outdoors). Temperature and humidity are part of this assessment in relation to the speed at which water evaporates. A suitable Covid-19 risk assessment should include environmental awareness.
- Every time we use our mouths or noses, we release respiratory droplets. This occurs when we talk, sing, breathe, cough and sneeze. Each process produces different sizes of droplets, quantities, and the speed at which droplets travel. The environmental setting is important given processes of dilution and dispersal.
- The closer you are to a droplet source then the more exposed you become. A key issue is the viral load within a droplet release or the number of copies of the virus in the release. This viral load varies depending on the illness stage that an individual has reached, but individuals without any Covid-19 systems can release virus particles.
- Exposure to a release of a virus loaded plume of respiratory droplets may not result in an infection. The key here is the viral dose required to acquire the infection. This is partly related to physical distance from a source of infection and environmental factors.
These variables are interrelated. A risk reduction strategy must be based on minimising exposure to potentially Covid-19 contaminated respiratory droplets. Strategies include face masks and an awareness that droplets may be deposited on surfaces. This might lead to the introduction of physical distance monitoring sensors in the workplace and smart security badges which enable contract tracing within the workplace
Second, the Prime Minister’s Office of Japan released a poster on 29 March that provided clear guidance on risk reduction and preventing Covid-19 outbreaks. This was based on avoiding the “Three Cs”:
- Closed spaces with poor ventilation.
- Crowded places with many people nearby.
- Close-contact settings such as close-range conversations.
Each of these “Cs” enhances individual and group risks in terms of exposure to Covid-19, but the risk of transmission is particularly high when the “Three Cs” overlap.
Avoiding the “Three Cs” reflects a risk reduction strategy that is intended to reduce individual and group exposure to Covid-19 transmission from viral loaded respiratory droplets in environments with poor ventilation. This remains the best strategy for minimising the risks of spreading or catching Covid-19 and for avoid localised lockdown from being imposed in an area. Nevertheless, people continue to remain the problem.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham.
A brief update is perhaps required. Today – Monday 19 October, I was contacted by a BBC journalist who had read this blog. I have just completed a live TV interview on this topic for BBC World News. The message within the blog has not altered. A country must balance local versus national lockdowns. The decision reflects the overall spread of COVID-19. There are some countries where a second national lockdown will be required, but for many countries localised lockdowns are the best strategy. Thus, imposing a similar lockdown on Norfolk as that which is required for Liverpool or Manchester would make no sense and I would argue would reflect an approach to policy development that would be irresponsible. The key is that citizens needs to act responsibility. This is also the case for policymakers. The average MP, or local politician, is more of generalist rather than an expert in public health. Now is not the time to play politics with COVID-19, but to appreciate that public health experts have a better understanding of what needs to be undertaken to reduce the negative impacts of COVID on a local area. The key issue is to balance health outcomes against other health outcomes including death. There is a danger that the policy narrative is too focused on the economy rather than health. The economy is important, but death is a very different issue especially when we are dealing with avoidable death defined as COVID-19 related death.