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275 ways to reduce the spread of Covid-19 once lockdown measures are eased, from University of Cambridge researchers

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Cambridge researchers have identified 275 ways of reducing the spread of Covid-19 once existing lockdown measures are eased.

Researchers have suggested a long list of ideas for reducing transmission
Researchers have suggested a long list of ideas for reducing transmission

Their ideas include the phased reopening of schools, businesses and open spaces, along with making petrol stations fully contactless, routinely taking people’s temperatures and making colourful markings on the floor to promote social distancing.

They also suggest that those with doctors’ appointments could be asked to wait in their car outside the surgery until called in, while cafe owners could initially reopen outdoor areas only, with tables spaced well apart and wiped down after each customer.

The ideas came as the government confirmed on April 16 that the UK would be on lockdown for at least three more weeks.

Professor William Sutherland, of the University of Cambridge’s Department of Zoology, who led the study, said: “There’s increasing pressure to reopen the economy and get people back to work and out of isolation. But if we return to operating as we did before the pandemic, there will be a second wave of the virus.

“All activities will need to be considered individually, and phased back in carefully, depending on the risk they pose to spreading the virus.”

Core to the research teams’ list of ideas are ensuring physical distancing, reducing the risk of contamination and enhancing cleaning and hygiene.

Physical isolation

Alternatives to handshakes could become the norm (33611992)
Alternatives to handshakes could become the norm (33611992)

With the coronavirus primarily spreading through liquid droplets formed when people coughing, keeping people further apart is at the route of social distancing measures.

The report notes: “The risk at greater distances appears much weaker but some studies have shown droplets can travel up to 8m.”

Ideas to help include:

  • Discouraging and prohibiting physical contact such as handshaking, kissing or hugging outside household members or an officially listed “bubble” of friends
  • Enforcing working from home for all jobs where this is possible
  • Creating ‘virtual schools’ to enable continued education
  • Splitting school classes into smaller groups with dedicated teachers attending one week in every three
  • Limiting the distance people can move from the house - Italy and France have limited dog walkers to 100-200 metres
  • Creating ways for people to share shopping trips through community groups or enforcing one shopper per community - a move seen in China
  • Staggering ‘working hours’ so not all workers are in from 9am-5pm
  • Offering free use of rental bicycles to reduce the demand on public transport, as seen in Prague, and widen or install cycle paths to reduce bus and train use, as seen in Germany
  • Reducing the numbers using shared spaces through booking systems, or allocate slots by verifiable groups such as the first letter of surnames, as seen in Mauritius
  • Introducing queue-in-your-car systems at supermarkets and doctor’s surgeries
  • Reducing counterflow interactions by, for example, normalising clockwise routes around shared spaces

Reducing transmission through contaminated items

Deliveries should be contactless (33612041)
Deliveries should be contactless (33612041)

Although not as prevalent as person-to-person transmission, the SARS-CoV-2 virus can be passed on by people putting their hands on contaminated surfaces then touching their nose, mouth or eyes. To reduce the risk, the study suggests:

  • Removing objects requiring physical contact, such as door handles or fingerprint scanners
  • Propping open doors and gates, or removing them where possible
  • Making contactless activity easier, by using automated doors and pedestrian crossings and avoiding the need for signatures for deliveries
  • Replacing touch screens with voice recognition
  • Increasing the use of contactless payments, making it a default option at supermarkets
  • Designing systems to reduce shared contact by, for example, removing self-packaging options on fresh bread and vegetables and introducing a mandatory ‘touch it and take it’ system in supermarkets
  • Using tools to avoid direct contact by, for example, ensuring gloves are used at petrol stations or asking individuals to bring their own tongs when shopping
  • Reducing touching with the palm and especially the fingers - finger joints can be used on keypads, and backs or elbows can be used to open doors, while water dispensers can be foot operated
  • Ensuring workers use their own desk, rather than hot-desking, and have use of their own utensils such as staplers
  • Adding copper surfaces to communal spaces, healthcare facilities and other critical locations, as it is known to inactivate viruses more quickly than common surface materials
  • Use paper instead of plastic bags

Enhancing cleaning and hygiene

The importance of good and regular hand-washing is now widely recognised, while face masks or cloths are being encouraged in many parts of the world, but there is much more than could be done to improve hygiene including, the researchers suggest:

  • Making it normal to wash hands, and arms if bare, when changing location or after possible contamination
  • Providing hand cleaning facilities at entrances and exits and areas of potential contamination
  • Introducing automatic alcohol-based hand sanitisers at the entry and exit of supermarkets and on public transport
  • Encouraging people to stop touching their face, aided by the use of tools such as vibrating wristbands or apps like https://donottouchyourface.com, which uses your webcam to train a machine learning algorithm to alert you
  • Introducing more shower facilities in workplaces and encouraging people to shower when they arrive home
  • Promote the wearing of masks when outside the home - it is mandatory in the Czech Republic, China and Slovakia - while providing consumer protection against inadequate face masks
  • Changing and washing clothing when returning home or after possible contamination - something particularly important for those such as healthcare workers, bus drivers and shop workers
  • Increasing the use of UV-C - short-wavelength ultraviolet light, which has germicidal activity - for food, post, money, phones and keys, although it cannot be used when humans or animals are present
  • Improving cleaning, by making public transport surfaces easier to wipe down, regularly disinfecting playgrounds, seats, workspaces, door handles, petrol pumps, toilets and other spaces
  • Providing free disinfectant sprays and refilling stations and guidance on creating home-made alcohol wash and sprays.
  • Leaving items to decontaminate as the viral load on surfaces reduces over time by, for example, placing non-urgent post in bags before opening
  • Introducing the principal of selecting the ‘least recently used first’ - such as hotel rooms or hire cars
  • Cleaning wastewater systems and ensuring pipework is sealed
  • Keeping properties well ventilated
  • Ensuring any air conditioning has an adequate filtration system after a study in China showed that SARS-CoV-2 virus particles were found in the ventilation systems of hospital rooms of Covid-19 patients

Reducing spread through pets

There is no evidence that animals infected by humans are playing a role in the spread of Covid-19, but a study has found the virus can be transmitted, at least experimentally and with high viral doses, to cats and ferrets, and cats have been shown to pass it on to other cats. In the US, the advice is for infected people to limit their contact with pets, while in the UK, people are advised to keep cats indoors if someone in the household has shown symptoms of Covid-19. As precautionary measures, the researchers’ ideas include:

  • Minimising touching, the sharing of food and direct contact of suspected infected persons with pet animals, such as cats, to reduce risks of disease transmission.
  • Testing pets for Covid-19 if transmission is suspected
  • Encouraging social distancing measures for both wild and pet animals.
  • Encouraging the washing of pets, where possible by an intermediary, before handing to veterinarians.

Restricting the spread of disease between areas

Regular testing can help (33612019)
Regular testing can help (33612019)

The researchers’ ideas include:

  • Imposing regional travel restrictions or closures in relation to regional indicators of infection load.
  • Prohibiting travel from urban centres to second/family homes in rural communities
  • Restricting long-distance travel to specific purposes
  • Establishing punishments for those not obeying rules on travel, as seen in China
  • Creating an expectation that people will self-isolate after travel
  • Using thermal screening at airports - although the effectiveness of this is questioned
  • Conducting testing before international flights
  • Providing those people travelling with PPE
  • Leaving a seat-width gap between passengers

The researchers used a method called Solution Scanning, which explores a wide range of sources to identify options, including experts in a variety of fields, crowdsourcing on social media and published research.

But they did not consider medical possibilities, and nor does the list offer recommendations, Instead, the authors of the report say a shortlist of the most appropriate options for a particular region and contexts should be considered against their likely effectiveness, cost, practicality and fairness.

“It’s basically about how to stop people hanging around together, and phasing in activities starting with the ones that are the safest. Making this happen will be up to the people responsible for every element of society,” said Prof Sutherland.

Adopting some of the options could enable some stricter lockdown conditions to be lifted sooner, the researchers say, and shorten the transition period back to ‘resilient normality’ - a phrase to describe a way of living that makes us less susceptible to future pandemics.

“In starting a process of decision-making or guidance-production, it’s sensible to be aware of the range of possible options. Policy makers and practitioners must decide which strategies are appropriate to phase in at different stages of the transition from lockdown,” said Sutherland.

See the full list of options online at https://covid-19.biorisc.com.

This research was funded by The David and Claudia Harding Foundation, Arcadia and MAVA.

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