Monday, March 16, 2020


The UK is in a dilemma about the Coronavirus epidemic.

On one hand there is a theory that the virus should be allowed to infect about 80% of the population so that we get Disease Caused Herd Immunity (DCHI).
On the other hand the advice is that we should slow the spread as much as we can so that the NHS is not overwhelmed, in the expectation that a vaccine will become available to create true classic herd immunity.
The DCHI path means that somewhere between 480,000 and 960,000 will die, maybe more. [1]
That is not acceptable, and we absolutely reject the DCHI plan. Here is a professorof epidemiology at Harvard, William Hanage, making the same point. 

Therefore the UK must follow the international consensus and work on reducing the rate of spread of the disease.
To do this, we need to identify and isolate the spreaders  -  those who are walking around feeling perfectly well, but who are spreading virus to people they meet.

The problem is that we cannot identify adult spreaders, except by widespread testing, which seems to be working in South Korea.

However, there is one group of spreaders that we can identify: school children. It is well known that infectious diseases increase significantly in the week after the school term starts. 

We know that children do not often show symptoms of Covid-19 - they are only 2.1% of the cases in Wuhan. There is no reason to believe that children cannot pass the virus on to others.

Therefore, to close schools is to close down a very important method of limiting virus transmission in the community.
School closures have to be done methodically, because of issues with child care.
If closures are carried out by diktat, many parents, including those in essential services like the NHS would have to stay home from work to look after their children.

They cannot ask grandparents to look after them, because grandparents are liable to die of the virus.
The plan must be to organise Small-Group Child Care.
The principle is that if a child is in contact with only 5 other children, that child is less likely to become infected than in a group of 500 children.
First, parents who wish to keep their children home should be allowed to do so. Immediately.
Second, the school can be kept open to care for children whose parents are absolutely unable to find alternatives. In this case, children will be segregated into as small groups as possible, each group with its own teachers and its own space. Play times will be staggered. It is important to keep the children in their groups as they arrive and depart, so these times will be staggered.

If a child in a group becomes a contact, that group will have to be further isolated and observed.
Existing child care services in the community will continue, but again, will be divided into smaller groups. Each carer would have a specified group of children to look after - maybe 3, 4 or 5. The groups will be as small as possible, the same children in each group.
New groups can be organised in neighbours' houses, or with friends.
Child care must be provided - again in small groups - by workplaces, especially hospitals and healthcare generally, where a high proportion of the staff are female.
It should not be assumed that the mother must be the one to stay home. If say the mother is a nurse, and the father is an accountant, the father should stay home, even if he earns far more than the mother.

In SGCC the children can still pass the virus on, but to lower numbers of children.

So small group child care will slow the virus spread.

Yes, this is all very inconvenient. But, in the end, disease and death is even more inconvenient.

Children are resilient, and can accept the change in their life when they realise its important, and that it is only for a defined period. Importantly, screen time, which used to be a problem, will now be allowed.
In conclusion, the Green Party should oppose the Disease Caused Herd Immunity (DCHI) plan, and call for measures to limit the rate of spread while we wait for a vaccine to come up. School closures are an important part of rate limitation, but schools must be replaced by small group child care (SGCC).

1 UK population is 60 million. 80% of this is 48,000,000.
Government believes the Case Fatality rate is 1%, which means 480,000 deaths.
If the CFR is 2%, we will get 960,000 deaths.

Dr Richard Lawson MB BS, MRCPsych
Draft 1 16/3/2020

Two days after I wrote this, Government ordered schools to close. 

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