Now that lockdown and social distancing have worked in containing the virus and limiting the number of cases and deaths, we are faced with the problems of leaving this situation and trying to return to a normal lifestyle. The difficulties that lie ahead exist both for economies, companies, individuals, and families.
Exiting lockdown depends upon the activity of the virus and is measured by its R factor – in simple terms this means the number of new cases that are caused by the transmission of the virus by an existing case. If the R factor is greater than 1.0, the epidemic will continue with increasing cases. If it is less than 0.7 or 0.6, then lockdown can be decreased. Unfortunately, the determination of the R factor depends upon case finding and extensive testing both of which do not exist in some countries.
So I am asked how can groups of people and individuals get back to normal life and work.
There are perhaps two elements to this answer. The first is to establish the disease status of any individual.
This can be done by two tests.
The first is a PCR test to make sure there is no active disease, and the second an antibody test to establish if an individual has had the disease.
The PCR test is extremely accurate, the antibody tests less so, depending on the make of the test.
However, all antibody tests can give false positives (wrongly suggesting an individual has had the disease) and false negatives (suggesting an individual has not had the disease when they have had it).
Antibody tests become more accurate as the time from the infection increases. I would suggest that anybody contemplating an antibody test should discuss the accuracy of the test with a well-informed physician.
In practical terms, a positive antibody test (from a reputable supplier and perhaps repeated after two weeks) will indicate an individual has had COVID-19 infection with a degree of accuracy of over 80%.
On the basis of such a test, an individual, families, or groups of individuals may decide to relax social distancing contact with elder parents and colleagues at work. It may also be sensible for individuals who are antibody negative to repeat their tests at intervals to check they have not had an asymptomatic infection. Schools and workplaces may also choose to perform these initial tests.
However, it is unlikely that groups of individuals will all test positive unless there has been very widespread infection. Therefore, social distancing and a degree of self-quarantine will become the social norm until a vaccine is discovered and produced. There will still be restrictions and certification for international travel and some countries will keep their borders closed while others may open them only to neighbors who have low infection rates.
Groups, workplaces, and schools may develop systems of temperature testing of individuals and of social distancing in workplaces and classrooms.
