End of the COVID-19 Lockdown: How to Carry On with the Coronavirus?

The virus

What are the possible symptoms?

The list of possible ailments has been growing since March. The most common symptoms are: headache, fever over 38.1°C, runny nose, cough, sore throat, shortness of breath, chest pain and dizziness. Temporary loss of taste and smell, skin lesions and abdominal pain with diarrhoea and nausea has also been observed.

In the most severe cases, the following symptoms have been noted: breathing difficulties, pneumonia and kidney failure. Confusion, encephalitis, stroke and the formation of micro clots have been seen more recently as well.

What should I do in case of symptoms?

To protect others, you must stay at home if you or someone you live with has symptoms of coronavirus and self-isolate for 7 days. After 7 days, if you do not have a high temperature you can stop self-isolating. If you your high temperature persists after seven days, keep self-isolating until it returns to normal. You do not need to keep self-isolating if you just have a cough after 7 days, as a cough can last work weeks after the infection has gone.

If you live with someone who has symptoms, self-isolate for 14 days from the day their symptoms started, as it can take 14 days for symptoms to appear.

The NHS has put in place an online tool to help determine if your symptoms are indeed COVID-19 symptoms and to tell you what to do next: NHS 111 online coronavirus service. If you feel at any point that you cannot cope with your symptoms at home or if your symptoms worsen and you're not sure what to do, use the NHS 111 online service. For assistance in other parts of the UK, visit:

• Scotland: NHS Inform Self-help guide
• Wales: NHS 111 Wales Coronavirus Symptom Checker
• Northern Ireland: Download the COVID-19 NI App to access the symptom checker

If you experience emergency symptoms (struggling to breathe, coughing up blood, blue lips or face, feeling cold and sweaty with pale or blotchy skin, have a persistent rash, collapsing or fainting, confusion or heavy drowsiness, inability to or increased urination) call 999 for an ambulance and tell the operator you may have coronavirus symptoms.

If you believe you have the coronavirus, you can apply for a coronavirus test if you are:

• an essential worker with COVID-19 symptoms
• aged 65 or older with COVID-19 symptoms
• someone who cannot work from home and has COVID-19 symptoms (construction worker, delivery driver, etc.)
• if you live with someone who falls in the above categories and you have COVID-19 symptoms
• if you have a clinical referral from NHS111 online

You need to have the test done in the first 5 days of having symptoms, and it's best to apply for it in the first 3 days as it may take 1 to 2 days to arrange. You may not receive a test if you apply as it depends on test availability. Frontline workers are given priority.

If I have been previously infected with the virus, am I now immune?

At this time, it is not yet known if the antibodies really do protect against the virus. In some individuals, infection with SARS (a close cousin of COVID-19) could, for example, encourage rather than prevent re-infection. Finally, assuming that the antibodies are competent and present in large enough quantities, it is not known how long such protection can last. It is therefore impossible to say that having had COVID-19 prevents re-infection.

Can I boost my immunity naturally? 

Yes, through sport! Physical activity boosts immunity. When we exercise, the immune cells are mobilised, and white blood cells enter the bloodstream to act as "sentinels". So if we exercise every day for 30 minutes (1 hour for children and adolescents), immunity is activated and strengthened. This reduces the risk of developing a comorbidity or susceptibility to infection. To stimulate the good bacteria of the microbiota and boost your immunity, it is also recommended to eat a large quantity of fruits and vegetables!

Going forward

How can we follow the progress of the virus transmission?

The Department of Health and Social Care has recently entered into discussions with the pharmaceutical company Roche for possible use of its newly developed and highly accurate antibody test by NHS England. Antibody tests are used to find out how many people have been infected and help to answer crucial questions about the extent and ease of the COVID-19 spread. These tests could give us insight into how many people have been infected and how we should move forward with the easing of lockdown measures.

Could summer slow the spread of the virus?

According to Professor Arnaud Fontanet, epidemiologist at the Pasteur Institute and member of the French Scientific Council, in Thailand and Cambodia, which were among the first countries to have had cases after China, there is currently not a crisis like in Europe. Progression of the virus also seems to be equally slow in Africa at present. In the laboratory, the virus is sensitive to heat, just as SARS-CoV-1 was sensitive to heat and humidity. So there may be a seasonal effect, but it may not have an impact until the summer 2021. This is because at the initial onset of a pandemic virus, as was the case in 2009 with Influenza A (H1N1), the virus often remains active during the summer. 

Should we fear a second wave? 

According to Professor Fontanet, "we have not achieved the level of herd immunity that we would need to avoid a second wave". According to GOV.CO.UK, as of May 13, just over 2 million have been tested and only 233,151 people have tested positive. Researchers at the University of Manchester, Salford Royal and Res Consortium estimate that 25% of the UK population is likely to have already had COVID-19, while generally it would take over 60% to achieve herd immunity. So if we let our guard down, there may be a second wave, as there has been for many major pandemics such as the Spanish flu.

Children

Why do children respond better to the virus than adults?

We initially thought that children were strong transmitters of the virus because we applied the flu model," explains Dr. Marie-Aliette Dommergues, a paediatric infectious diseases specialist at Versailles Hospital. But this is not the case, quite the contrary! There are several hypotheses to explain this. For example, there are fewer receptors for the virus on the surface of a child's respiratory cells. The child's immune system is built up, particularly by having been in contact with other common coronaviruses during the winter, and he or she may have cross-immunity. Finally, there are examples of several infections that are mild in children and become severe in adults, such as influenza, measles or chickenpox. Children are therefore at very low risk of serious complications. 

When can I start seeing or babysitting my grandchildren? 

Currently public gatherings of more than 2 people from different households are prohibited by law and visiting from friends and your family in your home are still prohibited. This may change as the UK enters into the different phases of the end of the lockdown. You can check the guidelines here.

Research

When will there be a vaccine?

There are about 120 research projects underway around the world, notably in the United States (33), China (27) and Canada (11). There are obviously several phases to be respected to develop a vaccine, but "we have never progressed so quickly in just a few months," explains Professor Anne-Geneviève Marcelin, a virologist at the Pitié Salpêtrière Hospital in Paris. A vaccine may be available by 2021.

What is the status of the European Discovery project?

This vast collaborative medical project, launched on 22 March between seven European countries, was designed to test 4 treatments (hydroxychloroquine, remdesivir, lopinavir and ritonavir) on 3,200 patients. Eight weeks after its launch, only France presented 750 patients for clinical trials. However, at least 600 people would be needed for each treatment tested. "If Europeans had worked as quickly as expected, we would have had results," says Professor France Mentré, epidemiologist and head of methodology at Discovery. She notes a lack of "coordination" and a counterproductive proliferation of trials around the world. This is the case of Italy and Spain, which preferred to participate in the Solidarity trial conducted by the WHO. There are no results for the time being, but we already know this from other published clinical trials around the world that involve the same molecules: there is no miracle cure. An independent data assessment committee is due to review the data again on June 3.

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Take care and stay home!