Rational Procedures for This and the Next Virus Pandemic

The Covid-19 pandemic has bred experts as fast as the SARS-2 virus has spread. Weak data have been subjected to intensive mathematical modelling. Precautions have been proposed and adopted that challenge normal human behaviour. Existing conventions have been stretched by decision-makers each with their own political agenda. And scientists are even now examining fragments of dead SARS-2 virus dragged up from public sewers in their search for variants. Unprecedentedly costly interventions have been based on all this. No wonder the public is confused: many have lost their nerve, many more their patience. Identify the virus and establish the natural history of its infection in humans and any other animal species, as well as any insect involved in its transmission. It can be seen to be in the interests of the virus as well as its hosts to survive, so with increasing population immunity the virus may well tend towards greater transmissibility and less virulence. SARS-2 virus may well follow this pattern. Assess the range of severity of illness associated with the virus, and the susceptibility of those humans who might be vulnerable to it through age, pre-existing illness, pregnancy, particular ethnicity or restricted access to health care. Apply to the virus genomic (e.g., polymerase chain reaction [PCR]) and immunologic laboratory tests that have been regulated and standardised with regard to their sensitivity and specificity. Commercial point-of-care SARS-2 antigen tests1 have now attained an accuracy that allows them rather than PCR to be the marker of infectiousness, at least for those with symptoms. This advance should now be transforming the UK’s and other countries’ present response to the continuing threat from the Covid-19 virus. Search for antiviral therapy that will interrupt the growth of the virus, and use it promptly while virus replication and excretion is still at its height (recognising that this may not coincide with immunopathological phases of the disease). This will both shorten the duration of the associated illness and suppress infectiousness. As far as possible, the treatment should be made available within the community, avoiding hospital admission.It may be possible to use it to prevent infection in those known to have been exposed to infection. Be fully mindful of the emotional and economic costs of measures such as masking, social distancing and self-isolation which are imposed with the intention of reducing virus transmission. For those suspected and/or known to be infected, confine isolation to the period of live virus shedding as signalled by the latest generation of rapid tests: these are now mostly ones based on lateral flow technology. For the great majority of people, this interval will be no more than a week. A negative result with these tests, as long as the sample has been properly collected, makes non-infectivity very likely. Identify vaccines shown to be safe and protective relative to the gravity of the threat to public health, and have plans already prepared for their deployment. For Covid-19, the UK government has so far been successful in this respect, and barriers to vaccine acceptance must now be overcome to the fullest extent consistent with personal autonomy. Those who decline vaccination for whatever reason must recognise some responsibility for a continuing risk to themselves and to their contacts. Be alert to persistent illness in those infected, whether or not ascribable to continuing viral replication. This phenomenon is frequent in virus outbreaks, large and small. Review progress with the interventions made to ensure their continuing value in the light of the harm they will have done, for example, by compromising other health services. The purpose of interventions should be to modify the impact rather than to expect to eliminate the virus. Only one human virus disease, smallpox, has ever been eradicated, and it was much less labile and also less transmissible than coronaviruses are. Viruses do not respect boundaries so anticipate worldwide spread. Use international funding to encourage transparent surveillance and monitoring of local outbreaks. Share international virological expertise. Monitor for variants that might escape control by antiviral drugs or vaccines. Avoid tedious recriminations based on the wisdom of hindsight, and instead show some foresight. For Covid-19, there is currently a justification for foregoing some of the existing interventions on grounds of their social and economic harm, and urgently addressing the backlog of treatable chronic physical and mental illness in the community. Never before has a virus pandemic been managed as Covid-19 has been in the developed world since it was first recognised in Wuhan, China, 18 months ago. The costs of this have been large and cumulative even if unavoidable. However, it is now time to reap the benefit of successful vaccination campaigns and rapid tests of infectiousness to allow a phased return to normality.