Coronavirus Exit Strategy: GOVI

Before reading the following content, I would suggest you read the precursor article I posted to my blog site on 26th March 2020, entitled Coronavirus Exit Strategy.

Reading that blog post will help to set the following information in context and make all the information easier to understand as a whole.

I am writing from a UK perspective throughout, with data at time of publishing – 26th March 2020. However, the ideas would be the same for any country with Covid (COVID-19, Coronavirus). Furthermore, if all countries do not act in unison, we may have to remain in Moat Phase indefinitely or until a viable vaccine is available and has been given to 7.7 billion people.

—————————

The Key Questions: What will our lives be like in the 1-2 years after the 12 weeks of Lockdown in the UK? How will we exit the Suppression Phase, while 

1. Saving lives (controlling the virus’ mortality rate),
2. Protecting the NHS, and 
3. Without destroying the economy along with millions of livelihoods?

We must consider and discuss all options, from different perspectives, to come up with the clearest and most effective plans. 

My concern is that many people are glossing over the 2-3 year period between the current Suppression Phase and the moment we will have successfully made it through our battle with Covid. In the UK and elsewhere, what comes after Contain and Delay?

This note attempts to highlight the options, explore some alternatives and progress the discussion around planning for our future with Covid. 

After the Suppression Phase, we will have three main options:

1. Go back to normal – to how things were pre-Covid. 
   1. This option might save jobs, industries and livelihoods, but it is predicted to have a significantly higher death toll and would beg the question, “Why did we bother to do the other steps?”, unless
   2. We shut everything down again immediately upon finding a new case in our country. However, a second, or third round of turmoil and global stimulus might be too much for the economic system and mental health of everyone.
2. Build immunity or protection.
   1. Protection can be done with a vaccine at some point, but it is 18 months or more away, or 
   2. We can build immunity through a Government Organised Voluntary Infection programme (GOVI) ✅
3. Remain in semi-permanent lockdown for years.
   1. We could shift between lockdown and ‘normal’ life as cases rise and fall within bounds deemed acceptable by the government, scientific and medical communities. The frequent jolts from the changing rules could be severely testing on the population.
   2. Remain in Moat Phase. This is where a virus-free country puts up a figurative moat to ensure the infection does not return to the country (explored further below). ✅

————-

Follow your government’s policies:

To be clear, I agree with the current strategy of a Suppression Phase, which is to use social distancing and lockdowns to reduce the spread of the virus. I believe we must follow the strategies prescribed by our government, health and scientific authorities and we, as a family, do strictly adhere to them. We do this, not because we are high risk or are knowingly in contact with anyone who is, but we know how important it is to comply, in order to help protect other families with ageing members or that have underlying conditions.

This strategy of Suppression has been well documented around the world by scientists and medical experts and outlined in popular posts like The Hammer and the Dance and described by the UK government as Push Down the Peak or Flatten the Curve.

What’s next?:

What is missing is an effective exit strategy, with a known timeframe, after we successfully emerge from the Suppression Phase. The financial markets and global citizens are becoming anxious and want to know what comes next so they can see a future with a return to a working economy.

Without a clear, credible and time-bound exit strategy from this situation, our citizens will continue to be anxious or fearful and our markets will continue to drift lower with the lack of confidence and the lack of certainty which have decimated fundamental economic drivers like supply and demand.

Where we are and current efforts:

This pandemic, with its dire health, economic and social consequences, cannot be solved with a monetary or fiscal response. We have seen this tried and fail over the last few weeks as governments around the world have added many trillions of dollars of support to the global economy. Regardless, the financial markets are continuing to fall further and people’s lives are being thrown into chaos through layoffs and sound businesses are going bust.

This is a unique situation and it requires different thinking. It requires real demand from real consumers and real production from real people. Pumping trillions of dollars into an economic system that is shut down, with many people in fear of leaving their home, is not going to work. People need hope, a higher level of certainty and a clear path to a specific outcome before they will return to the (closed) shops and start consuming again.

While the Suppression Phase can protect a population indefinitely, it is not very practical over a long period of many months or years. This is especially true when considering all the factors in the global mix, such as people’s livelihoods, and the exceptional toll this strategy is taking on everyone’s financial, social and personal lives. 

Possible parallel strategic options:

We must absolutely follow our governments current policies. However, governments have not spoken about an initiative to develop targeted herd immunity (GOVI) in parallel with the current social distancing, searching for a vaccine and testing.

The three main phases currently being run in parallel in the UK are:

1. Suppression Phase (Reduces spread. 12 weeks to run in the UK. It may be longer if policies not followed) 
2. Vaccine Discovery Phase (Ideal solution. Unknown timeframe. 1.5 years considered minimum realistic timeframe. Success is akin to winning the lottery)
3. Test Phase (Test and quarantine infected people. Test for immunity. Does not increase rate of immunity)

It is here that I would like to briefly explore the idea of a fourth phase, The Moat Phase, as outlined below. With a viable vaccine 18 months away, or more, The Moat Phase would be a more desirable option than going back to how things were in December with its subsequent higher death toll and possible intermittent shut downs. I also think people would prefer the certainty and ‘normalcy’ of the Moat more-so than having to live in semi-permanent lockdown for years.

The Moat Phase defined:

The Moat Phase follows on from the Suppression Phase once we have no new confirmed cases and those outstanding are coming down to zero. I am assuming effective eradication of the virus, in the country, at this point. In this phase, three things would need to happen:

1. We continue to keep the 70+ population and those with Underlying Conditions (UCs) in self-isolation for the entire, unknown period to safeguard them
2. We allow citizens to roam freely in the community/country (though still away from the 70+ and UCs). 
3. We only allow visitors, returning citizens and goods from other countries to cross our ‘Moat’ and enter our country after a strict, government enforced quarantine period of 14 days. This is to minimise the chance that the virus is brought back into the country and an outbreak flares up again.

The Moat Phase benefits:

The Moat Phase would allow most people in the country to get back to a normal, everyday way of life. We could relax social distancing rules but keep up the hand washing (its simply good hygiene). Knowing that the virus was eradicated from this country would allow people to go about their business, confident of remaining virus free. 

Depending on the scientific and medical view on eradication, this virus-free period may mean that the 70+s and UCs could emerge from their self-isolation. I’m sure this would be a welcome development for all concerned after nearly 4 months in self-isolation.

The Moat Phase challenges:

The key challenges in this phase is keeping the virus out of the country. To do this effectively, we need to block or quarantine any external or returning people or products. We could do this with the following two combined policies, which together would be known as The Shield. 

The Moat Phase would mean a severe disruption to travel, tourism and trade, bordering on non-existence. If people wanting to visit our country had to wait 14 days to get into our country, and 14 days to get back into their own country, thus spending 28 days in quarantine for every trip, it would be unlikely that more than a few people would travel anywhere. This may be a small price to pay for near-normalcy in all other aspects of our lives.

The same infection challenge with international trade occurs if all goods require 14 days quarantine at the port of entry. It would need to remain on the vessel bringing it, with its crew, until it is safe to bring it into the country without fear of contamination. This is based on varying views of how long the virus survives on surfaces (9 days say some experts, to a reportedly 17 days on the Diamond Princess cruise ship).

Like millennia ago, each country would need to become virtually self-sufficient. Our near future would be considerable de-globalisation with all of its inherent pros and cons.

The Moat Phase duration:

Under the current plan, which requires a vaccine to return things to normal, the Moat Phase could last 12 months, 2 years, 5 years or more. The current plan timeline is unknown, uncertain and not accurately measurable. As long as there is not a viable vaccine, and there are still a few cases of Covid anywhere on the planet, we would seem to need to remain in this Moat phase indefinitely.

This uncertain future and unknown timeframe is creating significant economic and market issues as we have been noticing in the markets, in reports and in discussions between family, friends and colleagues. This unprecedented situation is likely to create additional social issues as the unintended consequences of this crisis really start to have a significant impact over the coming few weeks.

It is for these reasons we should be considering another parallel phase, a fifth phase, called The Advance Phase. In addition, The Shield policies, as outlined above, would continue to be in place.

The Shield and The Advance:

In battle terms, think of how you would use a shield to protect yourself, and others, while advancing on the enemy. 

The Shield:

While the post-Suppression activity has been called various things, including The Dance, I would call it The Shield, particularly if we are in The Moat Phase. The Dance assumes that we keep the virus circulating within the country but at an infection rate that is controlled through semi-permanent lockdown. That way, we can keep hospitalisation and ICU treatment below resource capacity (NHS in the UK). However, if we have eradicated the infection in the Suppression Phase, we could then use The Shield policies to protect our citizens from further infection, through significant changes to international movement.

The Advance Phase: 

The Advance Phase is an exit strategy for the pandemic. The purpose of this phase is to carefully spread the virus throughout the country, by the government, in a controlled way, so that a herd immunity is developed over a set period of time (GOVI).

By developing this Immune Army, in parallel with the other phases, it may greatly increase the probability of an earlier, successful recovery from this pandemic. It would only begin once the effects of the Suppression Phase are clear and the pressure on our healthcare workers, and its infrastructure, has been relieved and is trending toward normal. 

Health, economic and social benefits of the Advance Phase and GOVI:

The growing Immune Army could be relieving or assisting critical workers temporarily, knowing they would not catch or pass on the virus. Critical workers could then go through the GOVI programme (or self-isolate if they were higher risk) and then return to their roles in 10 days. At that point, the original GOVI cohort could move on to help in other areas of the economy.

This continuing process would take about 2.25 years to get immunity in every healthy, age-appropriate person in the UK. However, we would have a continually growing, immune population across that timeframe until reaching a generally immune society in case a suitable vaccine was not discovered, tested and distributed globally in that time. The certainty of ever-increasing employment and life normality would steady the markets and give hope to the population. 

Summary:

When starting down a road, it is good to consider the bends and speed bumps ahead, before we get to them. “Begin with the end in mind”, as Steven Covey said. 

So, how do we exit the Suppression Phase, while controlling the virus’ mortality rate, protecting the NHS, and without destroying the global economy along with millions of livelihoods?

I believe we need to have scientists, medical professionals, statisticians and economists work with our governments and assess all the factors at play. I would hope they would consider the GOVI concept, The Advance Phase and The Moat Phase within that. 

For the next couple of years, we could lurch from laissez-faire to lockdown, live in a semi-permanent lockdown, hope to win the vaccine lottery in time, or we can dig a moat, put up the shield and advance toward a better, more certain future.

Afterward: Antibodies potential:
Bill Gates noted in the video that there were challenges in being able to scale a weekly antibody transfusion programme. However, it could change dramatically if there were 700,000 people, in the UK, joining an Immune Army every ten days. The group able to donate antibodies each week would quickly grow ever larger. If they were able to donate weekly for transfusions, the overall immune group could grow almost exponentially.

Appendix:

We could allow several phases to run in parallel:

Some rough calculations:

1. Testing at 25,000 per day in UK takes 4 days to test 100,000, 40 days to test 1 million and 2,680 days (or 7.34 years) to test all of society. Even if we could eventually ramp up testing to 100,000 per day it would take about 2.5 years to test everyone once. 
2. GOVI Hotel program. 700,000 GOVI participants gain immunity every 10 days. At the end of the UK’s 12 week suppression phase we could have about 5 million people in the Immune Army. We would need to roll this program out 10 more times (during Moat Phase) to reach a further 50 million UK citizens. This would mean c.55 million people would have immunity in about 2.3 years. The remaining 12 million people may not be young and healthy enough to participate in this program so we would hopefully have a vaccine by then. Although, with the depth of immunity in the population, perhaps they wouldn’t need a vaccine by then.
3. Antibodies transfused and Immune Army. 700,000 go through the GOVI programme and join the Immune Army in 10 days. In the following 10 days, those 700,000 donate antibodies to 700,000 more people. While this is happening, a second cohort of 700,000 are going through the GOVI programme. In the third period of 10 days, could we then have the first (700k) and second (700k) cohorts of GOVI, combined with the first antibody transfused cohort (700k), altogether providing antibodies to a further 2,100,000 people? If we could continue to scale the antibody programme at this rate, we could have the entire UK population (67.7 million) in the Immune Army in 90 days (the first three sets of 10 days plus 6 more sets of 10 days: 30 + 60 = 90). We may not be able to move that fast due to equipment and personnel. But what if we could do it in 300 days? Less than a year and before we found a vaccine. That would be a game changer. Please send this to scientists you know to test the theory.