COVID-19: A Way out of the Maze?

May 19, 2020

Tom Jefferson, Carl Heneghan

The events in those countries most hit by COVID-19 are quite clear. There was a headlong rush to close down social contacts, transport and confine people to their homes. The results have seen the worst economic recession in 300 hundred years, probably eclipsing that following the War of Spanish Succession and the great frost of 1709.

The newly dispossessed and all who have borne the brunt of what is happening will seek someone to blame. As Coronaviridae cannot be brought to the dock, politicians and decision-makers offer the next obvious target. Some of the finger-pointing and mudslinging has already begun. There also signs that scientific advisors may be in the line of sight of a vengeful public opinion once the immediate threat is thought to be over.

As the future is uncertain, and it is possible that transmission of either COVID 19 or some other unknown agents might pick up, we need to think carefully about our next moves.

Lockdown must be lifted in short order, simply because there is no alternative. To run essential services, we need taxes to be paid into state coffers. That is not possible if the economy is halted. The education of a generation of school children will be blighted. We have the impression that politicians boxed in a corner are reluctant to let go of the strings and the media are incapable of seeing a bigger picture, grounded on what we know of previous pandemics and the little we know of this one.

Given that we must start the engine of society again and that mudslinging, inquests and finger-pointing after the event are of limited value, we propose a different way to break the deadlock.

All those who made decisions (right or wrong) on the basis of ignorance and good faith should not be subject to an inquest or criticism, which is not constructive. Any questioning and examination of events should take place very soon, not to castigate or score points but to learn the lessons and implement those changes that could see us more ready for any future similar challenges, be they six months or 100 years ahead.

We urge all parties to: reinforce existing infectious disease surveillance and laboratory systems. Test the best combination of PPE and other preventive measures and stockpile or arrange instant access for the ones found to be the most appropriate. Carry out an in-depth review of hospital construction and urban architecture to minimise future risk of transmission. Start an emergency building programme of infectious disease hospitals which are entirely separate from non-infectious disease and are built according to the lessons of the past and the current epidemic. Carry out regulatory mobilisation exercises using different transmission scenarios from mild to very quick and gravity of the threat. Sign up to an international protocol to share epidemiological data without any limit or censorship. Finally, prioritise the next generation of learners, who may help us mitigate the mistakes of the past.

Microbial agents do not care much about party politics and scientific divisions. When this is done we should move forward with renewed confidence and a spirit of collaboration which has been lacking at present.

Tom Jefferson is an Epidemiologist. Disclosure statement is here

Carl Heneghan is Professor of Evidence-Based Medicine and and Director of Studies for the Evidence-Based Health Care Programme. Disclosure statement is here

Disclaimer:  the article has not been peer-reviewed and the sources cited should be checked. The views expressed in this commentary represent the views of the authors and not necessarily those of the host institution, the NHS, the NIHR, or the Department of Health. The views are not a substitute for professional medical advice.