Well we are extremely fortunate that the UK already has a fantastic infrastructure for administering vaccines. There are approximately 70 million people in the UK. We are going to need up to 90% of the population immune in order to reduce transmission of SARS CoV2. Most Covid-19 vaccine studies suggest each person is going to need at least 2 separate doses of vaccine in order to develop an adequate immune response. From known data on the many other vaccines we currently use, this kind of 2 dose strategy is usually about 95% or more effective at giving immunity. “Great, it’s been done before!” So to get 90% of the UK population immune we are gong to have to vaccinate nearly 95% of the population… that’s over 65 million people (“Gulp!”) or 130 million doses of vaccine! “Crikey! That’s huge!!”
Okay, let’s now expand this out to the rest of the World. “I hear hysterical laughter ‘cos you know the numbers are going to have many zeros”, yet with a World population of 7.8 billion, 95% of whom need to be given 2 doses of vaccines, by my calculation that’s 7.4 billion people needing a total of 14.8 billion doses of vaccine!
I think you can see where I’m going with this. Even when (if?) we do have an effective vaccine it is not going to be a quick and easy solution to Covid-19. We are not going back to the way things were any time soon and I would argue maybe we shouldn’t be going back anyway! Read on…
The new normal
There are a number of critical low-tech components to the control of SARS CoV2 for the community which have been rolled out by various Governments around the World, and these are here to stay in the new normal. These include:
- Hand hygiene
- Physical (“social”) distancing
- Limiting contacts and crowds
SARS CoV2 is spread primarily by large respiratory droplets produced by people coughing and sneezing, and also by singing and even speaking. These droplets settle out within about 2 metres of the infected individual. Yes there is potentially a small amount of infective aerosol that can stay suspended in still air (we’ve all seen the supermarket modelling graphics on the TV!) but this isn’t the major route of transmission. SARS CoV2 NEEDS something to “live in” (cats, minks or humans, etc.) to reproduce and ultimately survive. This quest to “find a host” is common to ALL viruses.
People primarily catch SARS Cov2 by touching “recently” contaminated surfaces (72 hrs approx.) or being coughed or sneezed on when within 2 metres. This is why all of the low-tech measures to control Covid-19 are based on preventing or limiting the potential for SARS CoV2 to spread in these ways, AND why they work! Boring but TRUE.
Why is it that so many people just don’t clean their hands? Don’t I sound like a grumpy old man?! I understand that in many countries clean water is such a precious resource that priority is given to drinking it rather than washing in it but in the UK, and other similar countries, we really have no excuse!
Hand hygiene is the single biggest barrier to transmission of infectious diseases. [Medical history note: first described by Ignaz Semmelweis a Hungarian Obstetrician working in Vienna in 1847 and the Father of Infection Control].
If you wash or sanitise you hands regularly you reduce the amount of infectious virus on your hands and therefore reduce the opportunity to touch your mucous membranes (mouth, nose, eyes etc.) or other surfaces with contaminated fingers. Although you cannot know who has touched a surface before you if YOU wash your hands regularly you protect yourself from whatever that person put on to the surface.
I know this sounds obvious, but people just don’t do it; but it needs to be a fundamental part of the new normal.
This is often called social distancing, and I have used the term many times, but we should really be calling it physical distancing. Social distancing is where someone is isolated from society, think leprosy, and this is a bad thing; what we are really talking about is people staying more than 2 metres away from each other and this is technically called “physical distancing”.
As SARS Cov2 is transmitted by contact with respiratory droplets, and these are generally found within 2 metres of an infected person (“I’m sure people can have coughing competitions and modelling can make droplets go further, I get it… but…”). So by staying out of that 2 metre range you will reduce your exposure to those infected droplets. Simple.
Okay, actually it’s not quite that simple. You generally know when you are outside of 2 metres when you can “see the person is there”, BUT if they have “left the area” then the 2 metres where they “had been” is still potentially contaminated. This is TRUE, but the risk is significantly reduced and we all do some risky behaviour. This needs to be kept in perspective, as “living with constant anxiety and fear” is very harmful to health! So staying 2 metres away will reduce exposure to the virus; especially if you also wash your hands regularly.
Limiting contacts and crowds
So everyone “knows” that Covid-19 started at the wet market in Wuhan, China? Correct? NO! The virus was already in humans before this moment, the market was crowded with thousands of people which “enabled easy transmission”. The virus did not enter a human from the animals at the market, it was already in a human and spread rapidly amongst other humans at the market. This is not a horror movie… it DID NOT “jump” from the live bats we’ve all seen on the TV and “face-hug” an unsuspecting market-goer! The one or two “already infected humans” came into close contact with other market-goers meaning the virus had thousands of potential new hosts to infect and spread to. The market was just the perfect opportunity for virus spread. Mass gatherings in all countries are just the same potential “Hollywood disaster zones” as that Wuhan market.
Less exposure and less contacts means less infection; it’s basically a numbers game.
Wearing a facemask all of the time is unpleasant, and even though there are lots of amazing and colourful masks out there I suspect the novelty of wearing one has worn off by now. I know it has for me. But facemasks DO serve an important purpose.
Facemasks catch respiratory droplets. Their job IS NOT to protect you by stopping you breathing in contaminated air; for that you would need a special N95 mask. Cotton and 3-ply surgical masks stop you putting droplets into the environment. Wearing one protects others.
However, in order to do their job, masks need to be worn correctly. They need to cover your mouth AND nose, and how many times have I seen “chin hammocks” and people hanging their mask off their ears to talk on their phone?! Stop it! Wear them properly!!
Also try not to fiddle with your mask. I know they’re irritating and tickle your nose and huff up your glasses, but the outside of the mask may no longer be clean. Added to this if you haven’t washed or sanitised your hands properly then you will contaminate your own masks and face (remember those mucous membranes?).
Stop fiddling with it even when it is driving you nuts! Okay I know, this is easier said than done and I have to be really careful myself as I know I also “feel the need” to fiddle with my own mask. The reason us healthcare professionals used to cope “OK” with masks is because we used to use them “as intended”; don-on to perform an infection control procedure and don-off before moving on to the next task. Now we have them for “whole shifts”, teaching sessions, in corridors etc. etc.… all day, all week. I get it, I feel the irritation too! It’s all part of the new normal.
So, there you have it…”The new normal”
Irrespective of whether we have a new vaccine in the near future we are not going to be going back to the way things were anytime soon. Whether we like-it-or-not hand hygiene, physical distancing, limiting contacts and crowds and wearing facemasks are all going to remain important. They are all here to stay for at least the medium term/year(s); these are the “new normal”.
Over time some of these (more likely facemasks and avoiding crowded places) will disappear but I for one hope that hand hygiene at least becomes firmly embedded in our behaviour from now on. This is just a fundamental part of good infection prevention and control… it should never have gone… but hopefully it’s now back for good!