Voluntary exposure to exit COVID-19 lockdown

It seems that the government is struggling to agree a plan to relax the drastic lockdown that is presently in place in response to COVID-19 in the UK. Maybe a new option is worth considering. I call it voluntary exposure (or controlled infection), and have just done a simple first analysis which shows that voluntary exposure might look attractive to some people, although definitely not to others.

Here is the introduction to a new CJBS working paper that contains the analysis:

The UK-wide lockdown to cope with the COVID-19 pandemic is unprecedented. It limits all except essential workers to their homes except for brief periods, leading to a drop in their quality of life, and an economic cost as they lose part or all of their income, possibly for an extended period.
The hope is that this measure will lead to a flattening of the curve of infections, allowing the health service to cope with cases as they occur without becoming overwhelmed. But it also means that people do not know if they are infected until their symptoms show, and allows them to pass on the infection to people they encounter in shops, or on the street, while infectious.
There is another way. The government could offer the opportunity for healthy people to choose to be immediately infected with COVID-19 in a controlled way and then confined to their homes until they are no longer infectious. They would then be able to resume something closer to normal life, once sufficient numbers were immune and the government allowed it. Those at high risk or with pre-existing conditions would not be offered this, or presumably would not take up the offer if they were offered it…

The paper is, as it says, a first analysis of a new idea, using a particular method based on calculating the utility, or worth, of different actions. It’s really just a proof of concept, to show the idea shouldn’t be dismissed out of hand. It needs more verification, testing and collaboration if it’s to be used seriously, so I am keen to get comments from as many perspectives as possible.

Edited on 23 April to change the term ‘controlled infection’ to the more accurate ‘voluntary exposure’ and to expand the final paragraph with a more complete statement of the present status of the work.

6 Responses to Voluntary exposure to exit COVID-19 lockdown

  1. I was very interested in your paper as if there is no vaccine in 18 months to 2 years time, then we need to be assuming that possibility now and designing the new normal and starting it’s implementation from 7th May, not holding on in hope as damage done to 30 year olds is very different to an 80 year old. (I am 55 and can see serious issues for my two 28 year old staff members as well as my 65 year old and then my unhealthy 80 year old parents and I am not sure who is losing the most as there is the financial and emotional to balance)
    I am disappointing I haven’t seen what you are saying being debated as it doesn’t matter whether you are right or wrong, it is the lack of discussion of alternative solutions which concerns me.

  2. I saw some discussion reported in the media about voluntary exposure in relation to vaccines. One reason it takes so long to know if they work is because you have to wait until enough time has passed so that the study participants get natural exposure to the pathogen. But if the virus is suppressed and not enough people are infected in a population, then it takes even longer to be sure that they received natural exposure.

    Putting that in the model could make a big difference. If everyone who volunteers for exposure is given a vaccine candidate first, then the predicted damage from the virus would reduce based on the probability that the vaccine works. And also society would benefit greatly by bringing forwards the time when we have enough evidence of a working vaccine that can be rolled out.

  3. This is a great idea, and I’d be keen to discuss this. I’m very aware how much consideration you would have undertaken to publish such a position, so I applaud you on that front alone.

  4. There is still no evidence that you will get immunity after you have been infected, there are definite cases of reinfection.
    a lot of young, fit, healthy individuals have already died so you can’t predict who will have mild symtoms or die. This idea is like playing russian roullete and the concept is much the same as the “herd immunity” that we have abandoned a while back.

  5. ‘Herd Immunity’ (or as I might prefer, ‘societal immunity’) was the initial presumption of Sir Patrick Vallance. Subsequent to the rubbishing of the idea of absorbing the pandemic without severe social measures, the government (Hancock, I believe), stated that ‘herd immunity was not the government goal’.

    This is where the term ‘herd immunity’ became maligned in the public conscience – because that’s exactly what we get with a vaccine.

    If we’re looking to vaccines that are effectively dead versions of the virus (or parts of it), we are looking to achieve immunity by the same bodily mechanism that would enable a healthy person to recover from the virus – so if immunity is not achieved by suffering CoViD-19, how can we expect to achieve it by such a vaccine?

    The question of whether contracting the virus will likely engender immunity, is then of crucial importance. I think that while some who have CoViD-19 mildly say, may not develop sufficient antibodies to reliably prevent re-infection, infection via a controlled viral load (voluntary controlled infection) could, with the learning the process would entail, be made closer to optimal, to ensure immunity, while minimising risk to participants and thus progressively reducing risk to their communities.

    I believe that (adaptive) immunity response is normal. Do we not normally develop antibodies to viruses and to coronaviruses (such as common cold coronaviruses)? We don’t know for sure, but to completely ignore such a concept that might help save millions of lives globally, because we’re not sure that what normally happens, will happen, surely, is criminally negligent.

    Take the words of the leading scientific epidemiological government outbreak adviser, Neil Ferguson, perhaps, who, having isolated for 2 weeks following a bout of CoViD-19, told us that he then considered himself immune, immediately after relieving himself of his government responsibility.

    With as many infections as there have been globally, I find it astonishing that we hear so little regarding the immunity characteristics of this virus, given the data thus garnered.

  6. This model, being centred on the individual’s perspective, appears to disregard the impact those who participate in CI will have on broader society. It is unlikely all will be equally socially responsible and self-isolate perfectly. It may be valuable to model the societal impact of the group’s likely imperfect isolation and potential impact on the national/regional infection rate.

    In other words, some of the people who volunteer to get infected will go outside—what impact will this have?

Leave a reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.