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Expert opinion

Throughout January and February the first clinical descriptions of the consequences of infection with the virus, SARS-CoV-2, were being published. When the epidemic in the UK started, we still only knew relatively little about the spectrum of disease that the virus could cause. We name the disease COVID-19, but what is COVID-19? We are fortunate that we have a test (the test for HIV came several years after the first disease, and we still do not have a definitive pre-mortem test for vCJD). So the sensible definition of COVID-19 is “sick and positive test”.
Many countries face the prospect of continued large-scale transmission of COVID-19 or its re-emergence as a second wave. Responses from governments and health systems have, unsurprisingly, been mixed: we’ve seen some innovative, effective measures but we got many things wrong. What matters now is that we have remarkable opportunities to learn from the first wave.
In the UK, emergency measures were taken to reduce transmission in March. Asking people to stay at home meant that the networks through which the virus moves were broken. We know that there are four main activities and settings in which people meet: home, work, school and leisure. Leisure was closed completely, and school/work contacts reduced as much as possible.
I took off my face mask when I arrived home from the health centre with my daughter, who had just received her final round of infant vaccines. The outing left me filled with gratitude that I have such ready access to medical resources to protect myself and my family during the COVID-19 pandemic. My experience is far removed from that of so many people who live with the constant threat of infectious disease and who are less insulated from the consequences of a deadly pandemic.
For my 40 birthday I got a new brother. Not a scrawny, screaming, baby brother but a corpulent, competent, pillar of the community big brother. An old friend, having drunk his fill, found himself unable to keep his secret for a single second longer and spewed it out at my party.
Whether it’s hand hygiene, physical distancing, disinfecting surfaces, wearing masks or taking actions to protect the most vulnerable, behavior change has a key role to play in tackling the COVID-19 (coronavirus) pandemic. That’s why a new brief from the World Bank, London School of Hygiene & Tropical Medicine, Harvard Kennedy School and Project Clear provides guidelines and principles to help governments develop national behavior change communications strategies.
Coronaviruses, such as the newly-discovered SARS-CoV-2, are RNA viruses that have a single short RNA strand consisting of 30,000 letters composed from either ‘A’, ‘C’, ‘G’ and ‘T’ - which provides the genetic instructions for the virus to replicate. As the virus spreads, its genetic information, or genome, randomly changes a few letters at a time (referred to as mutation). These changes can help us to track the origin, spread and transmission of SARS-CoV-2 around the world.
“Since the lockdown in Zimbabwe was mandated beginning on March 30th, I take my daily walks to get out of the confines of my house. As the weeks progress, these walks have become…busier. Cars everywhere, people everywhere. My local potato and tomato vendors started reappearing at street corners, attempting to sell their produce. At one point I asked one of the vendors if the lockdown had ended, and I had somehow missed that announcement. No, the lockdown hadn't ended but the need to feed their families and earn some income had intensified.
First we were told to work from home (16 March). Then came the school closures (18 March), followed by restaurants and pubs (20 March). And then, on 23 March - the full lockdown; no one allowed to leave his or her own home except for essential purposes. This decision changed our lives for nearly six weeks. As we consider how long these restrictions will continue was that decision worth it?
There is a wealth of statistics on COVID-19 appearing in the media. Major policy decisions and interventions are being based on statistics about COVID-19 frequency and forecasts of what that will become. These numbers are being used to create headlines and make major decisions as to which countries are 'in the lead', if we should 'lockdown' and when, what to do when the lockdown is over, whether herd immunity is an acceptable option, etc. These different policy options are supported by models which use the same data, but produce different forecasts.