Sometimes I find it hard to believe, but one day soon the UK is going to have to figure out how we should leave our current state of lockdown, and with the government reluctant to have a public conversation about how this should be done it’s time put some thought into this ourselves.
The key planks of any strategy to exit lockdown safely are largely technical: we need to be able to implement efficient personal protection, testing, contact tracing and treatment procedures, all points on which this government has, so far, failed to cover itself in glory. However, there will also be important social choices to be made about how we go about extending people’s rights and freedoms once again in a safe and responsible manner.
To kickstart policy discussions on this key issue, a group of us at the University of Cambridge and elsewhere to build up a ‘solution scan’ of all the non-medical interventions that can be put in place to allow people to go about their lives as safely and responsibly as possible, and it turns out to be a remarkably long list – 275 suggestions and growing.
Many of these are common sense ideas to improving personal hygiene and social distancing in ways that interfere less in our day to day lives. However, taken together they suggest that we have some tough choices to make.
For instance, there have been some suggestions that the government’s preferred method for exiting this present lockdown will involve extending freedoms to selected groups (e.g. communities where the virus is less prevalent and age groups that are less vulnerable to it). In theory, this could allow some to regain a large number of freedoms relatively quickly, but at the cost of being highly unequal in how people are treated for a long time to come.
On the other hand, Italy, Austria, and other countries that are actually starting to experiment with leaving lockdown, seem to be taking a different approach, allowing a little more freedom for almost everyone, with the focus on rebuilding their economies. Construction work is resuming, more shops are opening, but people must still observe very strict regulations when accessing them. This approach has the potential to be somewhat fairer, and also to be most helpful in terms of short term national recovery. However, it privileges economic activity over social, cultural and political considerations that may be equally, if not more, important.
Finally, there is a model suggested by New Zealand, where transition comes in the form of being permitted to expand their personal ‘bubble’ of people they interact with. At present we can do many more things with members of our own households than with outsiders. If we could manage to join households together, for instance, to include additional family members, local communities or the households of close colleagues for frontline workers, this could create spaces in which both economic and social activities could resume without significantly increasing the likelihood of widespread uncontrollable transmission.
These strategies do not need to be exclusive, and they can all be phased in gradually over time. Indeed a key point of our study was to emphasise the important of individual communities, companies, institutions and authorities to take responsibility for planning their own version of a responsible transition out of lockdown. However, they do show the huge scope of choices we face as a nation when we finally make the decision to try and live more openly once again. How might we go about making these choices?
This is especially important as the costs of restrictions will not be borne equally by all members of a society. For instance, some people love exercise while others hate it, and for some the closure of places of worship is highly distressing while for others it may be practically welcomed. In justifying these unequal burdens, the government needs to transparent about the process used to evaluate the trade-offs in determining which kinds of activities are restricted more than others.
As a liberal, I hope that we leave this present lockdown in a way that honours everyone’s basic rights, such as freedom of movement, association, expression and belief and prioritizes the rule of law, democratic accountability and collective organization over simple economic expediency. However, that is just my view, and far more important than what I think is that people own up to the difficult decisions that will need to be taken in the coming months and start talking about how we should respond to them, in private and in public.
* Simon Beard is Academic Programmes Manager at the Centre for the Study of Existential Risk and a two time PPC for Dartford. He lives in Cambridgeshire.
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It is a difficult problem. For example, nothing short of vaccination is going to be good enough to allow people at high risk from returning to a normal way of life. That could take 18 months unless acceptable ways of cutting corners in providing vaccine availability can be found.
That simple fact suggests that differentiation by age and/or precondition is an obvious filter. That simple fact of life (or likely death, in this case) is borne out by the data. It is unfair but how many at risk people are going to argue? Self preservation is voluntary in a free society.
The problem, as always, concerns the interface between the two groups. The young and healthy must not mix with the old and infirm when the former have abandoned large elements of lockdown restrictions.
Other dimensions pose further questions. Lockdown restricts social freedom but it also causes enormous damage to the economy. Categories of employment may be easier to regulate than social interaction and may be more beneficial to the nation. Mixing of the two groups is still a potential problem but that exists already where a family member is on the NHS front line.
The decisions will not be trivial and mistakes will be made. I hesitate to fully support the writer’s view that liberal ideology should be a consideration, though sensitivity, compassion and awareness of human needs are important elements.
In order to know what is going on we need to measure what the disease is doing. This means large scale testing. To describe a process which does not allow for the basis of decision making – measuring – as scientific is bizarre. The Met Office puts huge resources into mathematical modelling, but in their case with world wide constant measurement. The accuracy of weather forecasts allows us to form our own opinions abut the limitations of this methodology.
The next issue is how to strengthen the immune system for us all. These include as well as a balanced diet, things like breathing clean air, but also reducing stress. A lot of people are under enormous stress. Examples are people who might not have a job in future. Oh and doctors who are working 12 hour shifts in highly stressful situations.
I wonder where these factors are in the mathematical models?
Testing, tracing and isolating, as carried out at the start when we had very few cases, will be essential since relaxation of the rules will lead to more infections.
I suspect that the main problem will be uncertainty. Models simply number crunch the data to calculate trends. Estimating the effect of, for example, opening garden centres or churches on a national scale will involve mainly guessing since the behavior of people is difficult to predict.
A recent study in the USA (not yet validated or peer reviewed) suggests that many more people (up to 75 times) have covid-19 antibodies than were thought to have been infected. This just underlines the point that we lack reliable facts about this pandemic and today’s best assumptions may prove to be badly wrong.
Peter 17th Apr ’20 – 10:12pm………..Testing, tracing and isolating, as carried out at the start when we had very few cases, will be essential since relaxation of the rules will lead to more infections………….
How do you equate this with your tirade against Starmer for having the temerity to even ask for the government’s thinking on any relaxation?
What is increasingly obvious is that this government had no plan for tackling it’s spread, for dealing with the ongoing pandemic and for a future when the peak has passed. What we are seeing is a haphazard lurching from shortage to shortage, with testing lagging well behind even the minimum promised (or, to listen to Hancock) not promised. Infection and fatality rates at care homes and at home are uncounted or unknown’ in short a shambles.
Labour and the media have largely been keeping to the ‘National Solidarity’ line and not politicising the situation’ I doubt that, had there been a Labour administration, either would’ve happened.
However, now is the time to plan for the future; there have been umpteen calls on here about the consequences of an open ended lockdown. No-one is asking for a detailed timetable but the criteria needed to gradually reduce its severity need to be spelled out.
As for the future…This is not the ‘Black Death’ but that plague had the effect of giving power to the peasants in wages and working conditions. If left to Capitalism and the Tories conditions will return to ‘normal’. It is up to this party and Labour to ensure that the appreciation of the sacrifice and worth of the ‘low valued’, who kept this country going, does not end with the pandemic..
“This is not the ‘Black Death’ but that plague had the effect of giving power to the peasants in wages and working conditions.”
OK but that was because there were many fewer peasants left afterwards. We don’t want workers to have more bargaining power on the same basis.
“What is increasingly obvious is that this government had no plan …….”
This is true for all nearly all Western governments and political parties. At the last election all the parties would have had some policy on ‘defence’, its not even necessary to say military defence, even though the chances of an outbreak of war are small. Not one had anything to say about defence against a new virus. This is a human failing. Even though we have the mental capacity to calculate risks quite accurately we won’t act until we’ve seen something go wrong. In order words we don’t act but we do react.
“However, now is the time to plan for the future……”
As we scramble to fix this problem this is starting to happen. Well be much better prepared for the next pandemic.
I know we need long term forward planning; but for me at least, it’s ‘short termism’ that counts at the moment, namely STAYING ALIVE! Let’s keep concentrating on that first and why they can’t make PPE equipment like gowns, for example, that you can wash and reuse? Surely there must be chemicals that kill the little blighters?
Let’s be honest. None of us will be 100% safe from this or any other new virus for that matter until an effective vaccine is produced, thoroughly tested and administered to most of the world’s population. Even then, there will be those, who seize on any adverse side effects that such a vaccine might produce, as was the case with MMR.
Until then, here’s one human being, who will be even more careful about his personal hygiene, where he goes and how near he stands to people. If wearing a mask will help, always assuming you can get hold of one, then so be it. I’m not that pretty anyway!
Oh, and as for who should shoulder the blame for all of this, WE ALL SHOULD. After all, many of us insist on the lowest prices, especially for food and most items of clothing, except, of course, for luxury goods, (or hoping that our house keeps going up in value), being able to fly away for our ‘dream’ holidays in exotic places, being pampered on cruise ships, having what used to be seasonal produce all the year round etc. etc. Many of us baby boomers worked hard for our index linked pensions and, by George, we’re going to enjoy ourselves whatever the cost!
We in the West continue to turn a blind eye to many of the injustices still perpetrated around the world and to do nothing to stop the rich elites cornering even more dosh. We elect governments that still promise us the earth. So, yes, talk about easing the lockdown if you must, but, if we ever do get back to some semblance of normality, LEARN THE LESSONS!!!
Yes, agree with John. As a transplant recipient I fully expect to be housebound for the next year to eighteen months because, as John says, its about STAYING ALIVE…. in order to see the grandkids grow up, to finish various projects I can do at my desk and to enjoy the company of the long suffering her indoors. I’ve also developed a relationship with a cock robin who follows me round in the garden…. so I’m much luckier than most.
I can’t honestly get worked up about any supposed ‘infringement’ of my civil rights because staying alive is paramount..,., it’s the biggest civil right there is… for me and everybody else. My situation is as nothing to that endured for six years by my parents between 1939-45……so what’s the point of moaning. As my miner’s daughter Mum used to say when I moaned about having Algebra or Latin homework , ‘just get on with it’.
An incidental thought about the black death…. we’re talking about a fairly static rural society with minimal travel.
Peter Martin 18th Apr ’20 – 9:02am……………..“This is not the ‘Black Death’ but that plague had the effect of giving power to the peasants in wages and working conditions.”……OK but that was because there were many fewer peasants left afterwards. We don’t want workers to have more bargaining power on the same basis…………
Nit picking..The reason is immaterial the fact was that their work was worth more and rights, once gained, are difficult to remove,,When the population recovered ‘Feudalism’ didn’t return (an attempt to return to widespread serfdom was a major cause of the Peasants Revolt)..
The fact that some other governments were less prepared than ours ignores the fact that others were far better prepared.
As for “better prepared for the next pandemic” ? After the 2008 financial crisis the sector has largely returned to pre-2008 behavior (a 2018 FT report stated “So what happened after the global financial crisis? Have politicians and policymakers tried to get us back to the past or go into a different future? The answer is clear: it is the former).
Obama spoke about a probable pandemic years ago; the timing of Operation Cygnus wasn’t a random guess..Both were ignored…
Will money be spent year after year in planning for a possible more serious pandemic; I doubt it..Like harsh winters the lessons are rarely learned ‘long time’..
Say for argument’s sake that only 10% of the population have got or had the virus, that means that 90% are still at risk and even that assumes that it cannot affect someone twice. The lockdown has caused the number of new cases to stabilise but currently at a very high level. How much relaxation of the lockdown can be permitted without the infection numbers soaring once more? Clearly, we need to continue with the lockdown until the number of infections in the community are substantially reduced, in turn lowering the risk of further spread.
All of this means that we are on a long journey. Yet we have voices from the back constantly asking, “Are we there, yet?”
What precisely is the function of any residual measures, once we start releasing the present lock down? We must continue to isolate the at risk unless they are shown to be immune. Given that some with no risk factors get serious disease we should continue social distancing. I can’t see any reason for further restrictions so social gatherings will depend on whether distancing rules can be applied.
There are some good articles at The Conversation which you haven’t referenced:
https://theconversation.com/coronavirus-when-should-we-lift-the-lockdown-136473
https://theconversation.com/green-zones-a-mathematical-proposal-for-how-to-exit-from-the-covid-19-lockdown-136002
https://theconversation.com/lockdown-uk-four-experts-explain-how-to-end-it-136436
I don’t understand how the Government or the advisors can possibly say that the rate of infection is flattening off. If we are only testing those that become really sick and end up in the hospital then how on earth can they possibly know what the rate of infection is in the community?
Going on the Governments own analysis that said 20% of those that become infected becoming unwell enough to need hospital treatment and going on the basis that we are seeing around 5k positive tests a day, surely that means the true figure is around 25k infections a day?
Over the last couple of days, there has been twice as much capacity to actual tests carried out? Why then has the Government not started rolling out tests to the community? Instead, they seem to be moving the criteria for testing, we have moved on from NHS staff and carers to Police, Firefighters and DWP workers. I am not saying that these people do not need tests, but it does appear that the Government are appearing to resist community testing.
Why the reluctance?
@ expats,
It’s not clear that any government has been better prepared. Superficially, this may look to be case in that some have had a slower rate of infection than others. However, it could well turn out to be that they should have aimed for a faster rate to build up the general level of immunity in the population but not so fast that their health systems are unable to cope. We’ll know the answer to that in a year or so.
I don’t think we can compare an economic crisis with a health crisis. There’s something about economics which causes many people to think irrationally. There are a myriad of different opinions about the causes of the GFC. Economists are totally incapable of ever reaching a consensus. The differences in scientific opinion in the areas of epidemiology and virology are quite minor by comparison. It’s the same in engineering too. If someone had said Boeing’s 737 Max was unsafe before the two well known crashes they would have been ignored. But, we have a couple of crashes and the plane is grounded. Engineers and all scientists aren’t like economists. We do learn lessons.
Peter Martin – ‘I don’t think we can compare an economic crisis with a health crisis.’
I take your point, but surely here they are entwined? If you don’t have an economy then you don’t have public health. There was a very interesting article in a European newspaper (and sadly I can’t find the link right now) that talked about the grisly possibility of a ‘twin track pandemic.’ On track one we have the vulnerable trapped in a miserable and isolated existence as society and medical endeavour fashion unhappily around them.
On the other track are the ‘less vulnerable’ who will see quasi-permanent house arrest, a smashed civil society, have declining health results and live in poverty, their retirement savings eroded to nil and their children’s lives blighted. Basically sitting around waiting for the breakdown over a virus that likely (STRESS LIKELY) would not require their hospitalisation.
That twin track might fly for lockdown one and (maybe) two. At some point though we’ll be enforcing this ‘new health and economic normal’ through the barrel of a gun. Looking at the news just now they might already be nearing this point in some countries. That thought worries me greatly. Pessimistic? Well there’s zero guarantee of a vaccine, still less one that could be given to the vulnerable. There’s a likelihood I suspect that we’ll improve treatments and preparedness but that’s probably not going to be a lot of use to those who are very vulnerable. We can ‘deglobalise’ the supply chains – that might help a bit with resilience, but it wouldn’t solve any of the fundamental problems here. We can not possibly keep going like this, even with the best will in the world.
On top of all this is the possibility that a large number of the 10m+ unemployed will be in penury not because of any moral hazard or because there were in some unsustainable job, just simply by the nature of their work.
My guess at a best outcome would be some sort of personalised testing device for use 2-3 times a day, but we’re nowhere near even that.
@Little Jackie Paper
“Well there’s zero guarantee of a vaccine, still less one that could be given to the vulnerable. ”
I am unsure why you keep insinuating that a vaccine would not be available to the vulnerable, that is going on the assumption that only a live vaccine could be found and I have seen no evidence of anyone saying that.
“If you don’t have an economy then you don’t have public health”
And the reverse is also true, if there is no public health there is no economy.
It’s more likely that this virus is so engrained in us worldwide now that there is no way out until a vaccine is found. There is no evidence that immunity is gained by exposure to the virus, in fact, if this is like other coronaviruses (common cold) you can get repeat infections in the same year.
The scenes and conditions that our front line care staff are working in, in hospitals is not sustainable, staff cannot be working in a “war zone” conditions 7 days a week, months on end with no end in sight, it is not a question of capacity it is a matter of staff sustainability, they would be dropping like flies from exhaustion and stress, then there is the matter of safety if they feel that the danger to themselves and their families becomes too great, then many would certainly question the service.
If the Public see’s large infection rates continued with high death rates and fear that the NHS was not able to treat them if they were to fall seriously ill as part of the unfortunate 20% who for them this disease is serious, then confidence would never be restored and no matter what the governments’ advice was, they would refuse to go out and they certainly will not spend in the economy to get things moving again.
Peoples attitudes which swiftly change and they would readdress what is important to them, and for many, I suggest that would be living as safely as possible and spending time with their family and living with “limited means” rather than earning money and being so obsessed about acquiring that latest fads and gadgets.
There are no easy answers in any of this, but the answer is most definitely not the economy above all else, because without a functioning health service with sustainable staffing conditions, there is no economy
@Matt – There is no evidence that immunity is gained by exposure to the virus, in fact, if this is like other coronaviruses (common cold) you can get repeat infections in the same year.
I think there is evidence that people do get immunity; however, as yet SARS-CoV-2 isn’t mutating like the common cold. The really big concern is as you imply if SARS-CoV-2 does take on the attributes of the common cold/flu we will have really big problems – vaccine or no vaccine…
@Roland
According to the World Health Organisation https://news.sky.com/story/coronavirus-no-evidence-that-covid-19-survivors-have-immunity-who-warns-11975011
Speaking at a news conference in Geneva, Dr Maria van Kerkhove said: “There are a lot of countries that are suggesting using rapid diagnostic serological tests to be able to capture what they think will be a measure of immunity.
“Right now, we have no evidence that the use of a serological test can show that an individual has immunity or is protected from reinfection.”
She added: “These antibody tests will be able to measure that level of seroprevalence – that level of antibodies – but that does not mean that somebody with antibodies means that they are immune.”
That’s why we should not be in any haste to end lock-down until more is known, any lock-down has to be done in a controlled manner and as in a safe as way as possible.
@Matt – I don’t disagree – see my other posts. But thanks for another reference source.
There is no mystery. Some people are never going to feel safe no matter what action is taken. Lockdowns are not curing or really stopping anything. If we can’t ensure that care homes with a few residents in an enclosed environment are virus free , why on earth does anyone seriously think it has worked in the wider community? The premise of the lockdown was faulty in the first place. The result is not saved lives but social and economic problems for decades.
Matt:
I have rebutted this before. There is no evidence of immunologically distinct strains of CoVid-19. It has been suggested that there might be strains of different virulence, but this is not confirmed. In fact, if there were an immunologically distinct strain it would be given a different name, so this would be obvious to us.
There is no fundamental reason why a vaccine cannot be developed, however this does not mean a vaccine can be made available very soon. Nevertheless enough is known about corona viruses for putative vaccines to be trialled. Early on, China released the virus’ genome and in Germany, sections of the viral RNA have been artificially synthesised and made available.
Matt, do you have any understanding of the body’s specific immune response? How do you think people recover, if they are not developing immunity? Reports of repeat infections have been anecdotal, it is most likely that either the patients did not recover from the initial infection or the initial infection was not CoVid-19. There is no suggestion that CoVid-19 compromises the immune system as is the case with HIV, but again if this were the case recovery would not be possible.
The report you cite muddles immunity of those who have recovered with antibody testing. Although the headline is alarmist, the article in fact refers to WHO concerns about the reliability of serological antibody tests. These tests are known to be liable to produce false negatives and false positives. Anyone who understands the nature of immunoglobulins will realise that this is inevitable. Nonetheless, so long as their limitations are understood these tests can have a value in helping us minimise the infection rate. They can be used in a controlled easing of the lockdown once it is known that infection rates have been lowered. There is currently no prospect for this in the UK because of the lack of testing. The UK has almost no reliable statistics. Germany meanwhile, is better informed and can consider the next phase. We can also learn from other countries such as Taiwan (where the vice president is an epidemiologist), Hong Kong and South Korea.
Hey, what’s happening? Sensible, constructive ideas from that almost forgotten political party, the Lib Dems, reaching number 9 in the BBC’s “most read” hit parade? Not before time!
https://www.bbc.co.uk/news/uk-52342511
@Martin
If the truth is known there has never been a successful vaccine found for any coronavirus. Admittedly the ones for Sars and Mers was abandoned because it no longer became financially viable to pursue because they managed to suppress the infection through quarantining people early on, still, it does not fill one with optimism.
There are reports from some that the treatment with Ventilators is not necessarily the right way to be treating this disease as the effects of this virus is more like altitude sickness and shortness of Oxygen rather than Pneumonia. There are so many conflicting reports it is impossible to know what to believe. But when you have members of Who saying that not enough is know about this virus to have any real confidence on whether someone develops immunity then that has to be taken seriously.
There is no denying that being exposed to a virus does not guarantee immunity as is the case with the common cold, flu, dengue fever to name just three.
The point I am making is that we are only a couple of months into a brand new virus with little known about it, and yet people are rushing into pressuring governments into ending lockdowns and getting back to normal which is irresponsible and could cause far more damage to the country, its citizens and the economy in the long-term if this is not done properly in a controlled and cautious approach.
Re David Allen’s posting at 19th Apr ’20 – 11:04am
Perhaps ‘danger money’ payments to NHS staff and other front-line risk takers could be started with all government ministers forfeiting a large chunk (50%?) of their ministerial salaries as a contribution. After all – if they weren’t government ministers they’d have to manage on the hardship of their MP salaries or lords’ allowances.. so they shouldn’t really need the money..
No – I’m not holding my breath..
@matt “There are reports from some that the treatment with Ventilators is not necessarily the right way to be treating this disease as the effects of this virus is more like altitude sickness and shortness of Oxygen rather than Pneumonia.”
This is why the CPAP masks now being manufactured by Mercedes are a potential game changer, they allow for more people to receive oxygen treatment at an earlier stage, ie. before the disease enters the lower lungs.
@ Martin @ matt,
It is to be hoped Martin is right when he says:
” How do you think people recover, if they are not developing immunity? Reports of repeat infections have been anecdotal, it is most likely that either the patients did not recover from the initial infection or the initial infection was not CoVid-19.”
My guess is that he is and that we can develop a vaccine. But who knows? We can’t assume anything. Dr Maria Van Kerkhove, an American infectious diseases expert who is the WHO’s technical lead on Covid-19, has said:
“Right now, we have no evidence that the use of a serological test can show that an individual has immunity or is protected from reinfection.”
If the study referred to in the same article is correct we can expect that no more than 3% of the UK population has been exposed to the virus. It which case the numbers will likely start ramping up quickly when restrictions are lifted. We’ll probably need at least 30% ‘herd immunity’ to end the epidemic so that means we’re only a tenth of the way there. We can expect a total of about 200,000 deaths.
https://www.theguardian.com/society/2020/apr/20/studies-suggest-very-few-have-had-covid-19-without-symptoms