In recovery

What do you say to someone who has recovered from coronavirus, an email sent to a colleague asked this week? Probably something like ‘well done’, or ‘congratulations’. As most of us anxiously interrogate every cough and ache, some people have successfully ‘come out the other side’.
As of 22 March, 135 people had officiallyrecovered from Covid 19 (though government is looking for a new way to measure recovery). In any case, this must be a huge underestimate. Testing of people with symptoms has been abandoned for the last two weeks, unless they are ill enough for admission to critical care in hospital, so the figures for recovery must be the tip of the iceberg, just as figures for the total numbers of cases are.
Anecdotes are not data, but the fact that I know at least four people who appear to have had and recovered from the virus (three unconnected to each other) suggests there are many more cases below the waterline. What we don’t yet know is how many. A recent paper by Sunetra Gupta and others was first seized on as an indicator that the virus was much more widespread than was being revealed in official figures, then vilified as resting on some very dubious assumptions about fatality rates.  In fact, as I understand it, the paper’s main argument was that we needed much more testing to understand which of various plausible epidemiological scenarios was correct.
And it seems we will soon have the infrastructure for such testing. 3.5 million antibody tests, which test for whether subjects have been infected in the past rather than are infected currently, have been ordered by the government, and are expected to become available from next week.  There has been some confusion about how these are to be made available, with NHS staff obviously in the front line, and when. But there is surely an argument for wider distribution (ideally randomised) to establish what levels of infection have taken place across the population, what the real fatality rates are, and how near or far we might be from ‘herd immunity’.
Knowing this will help us think about our national recovery, which feels increasingly urgent. In recent weeks we have seen the impressive exercise of state power to bring trade, travel and social life to a grinding halt. Restarting may be a lot tougher. The current plan, in the UK at least, appears to be to maintain some level of restraint on mixing for a year or more, while a vaccine is developed and tested. It is possible that restrictions may be relaxed for a few months in the summer, but likely that they will have to be re-imposed as soon as new outbreaks flare up.
Seeing an economy and a nation in suspended animation for a few months is an extraordinary thing; the idea of this stretching over 12 to 18 months feels beyond belief. Even if restrictions are loosened, the crisis of contagion will be replaced by a crisis of confidence: who will buy a house, start a new business, or plan a holiday, a festival or a wedding, when a new outbreak could lead to cancellation with days’ or weeks’ notice?
Which suggests to me that we may need a more proportional and variegated approach to the disease, once this initial outbreak has been brought under control. As more and more people establish immunity, could they begin to work and socialise normally? Could they be issued with certificates that would allow them to return to normal-ish life, as is rumoured to be planned in Germany? Could those yet to be infected stay home, or would a more resilient health service enable them to re-establish minimal contact at their own risk, while the strongest protections remain in place for the most vulnerable?
There’s something that feels a bit distasteful about this, for sure. The bureaucracy of certification feels intrusive and even authoritarian, and such a policy would be divisive, undermining the sense of collective sacrifice that the government has been so keen to nurture. But the fact of the matter is that we are not ‘all in it together’ now: people with large houses, extensive gardens and savings accounts are having a very different experience from those who have none of these. And without some rekindling of the UK and global economy, the only thing we will all be in together is an ever-deepening and intransigent recession.

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