LOCKDOWNS ARE A DISASTER?
Since their national lockdowns ended and restrictions relaxed, as people returned to work and hospitality venues re-opened, all major European countries have experienced significant rises in Covid-19(CV) infection rates. No surprise there. Also, more testing, more known cases. Many parts of the UK have experienced rising rates, so much so that UK Government (UKGOV) health advisers warn of but do not predict a possible doubling every week, reaching 50,000 cases and 200 deaths a day by November unless required behaviours are observed. The reasonableness of this warning is disputed by other experts. Hospitalisation is on the rise. Those advisers are bound to take a highly prudent view, tainted with bleakness given their burdensome responsibilities. This pandemic has proved that scientists’ predictions are very uncertain, with a variety of different models being produced with highly variable assumptions. The only certainty is uncertainty. UKGOV to date has wisely attempted to control local outbreaks with local measures and is to continue to do so: giving local communities responsibility to cure local surges may be the best way.
The weekend press was full of damaging speculation that a new national lockdown was on the cards, creating massive worry and risk for people and businesses. Only recently Boris Johnson and others have been saying that a second lockdown would be disastrous. The lesson of the first lockdown has to be learnt, that the economic and collateral damage, such as to health, education, and confidence as well as wealth, was massive. Paul Nuki, Global Health Security editor at the daily Telegraph, on 19 September wrote: “Having to do it [shutting up shop] again would put UK PLC on the slab ”(rather than just in intensive care)“ the Prime Minister knows this but can’t bring himself to say it”. Nobody is advocating national lockdown.
Should not the CV strategy take that lockdown off the table as an option, rather than, as remains the case, leaving it as the ultimate threat? What is the point of UKGOV threatening the people with national suicide?And where is the evidence that lockdowns actually work? True the NHS was not overwhelmed but it is not known what the result would have been if other measures had been adopted in the UK. Has anybody done a comprehensive survey comparing countries which locked down with those that did not? Sweden has fared better than most major European countries, but It is not just Sweden which rejected the lockdown strategy. Apparently, Belarus did so and had little CV problem. Germany’s model is decentralised, tackling CV issues region by region, which may offer an example to follow. Many developing countries for which lockdown is not really possible seem to have fared ok, as have many East Asian countries. While there is considerable uncertainty over the long-term efficacy of a lockdown strategy, there is clear certainty that it will destroy livelihoods, cause death other than by CV and leave economies on the rocks.
It is fairly certain too that locking down will not eradicate the disease but will buy time only. Recent talk of a “circuit breaker” lockdown option serves to confuse. It will damage businesses and society and may at best defer the acceleration of CV infection. Would it be necessary to lockdown every few weeks as surges re-emerge?
WHAT WORKS?
The UK’s first national lockdown can be characterised as reasonably successful – putting aside the much publicised issue about PPE, testing etc – in that it achieved a suppression of the disease and the NHS survived intact, but at a phenomenal national cost, and there is little point revisiting the decision to do it. It depended on the people adopting behaviours willingly, accepting restrictions on normal freedoms, but for many with some suffering. The public and UKGOV had a unity of purpose which the vast majority accepted. The rules and guidelines were adhered to not because otherwise police would come knocking: the UK does not have the police resources to do that enforcement job. They were adhered to because people came together and bought into the approach.
Knowledge of the disease, though incomplete, has now increased incrementally; mitigating processes and drugs, while not cures, can reduce death risk. There are plenty of ventilators and beds, The Nightingale Hospitals, unused, but ready to support people who get seriously ill. Better hygiene practices by people generally have reduced viral load.
Protecting the vulnerable evidently keeps the death rates down. In many European countries including the UK, care homes suffered high mortality. Not surprising if CV was allowed in. Care home managements, now better supported by UKGOV, should be able to reduce risk there. The weakest elderly at home can be shielded. Perhaps more resource should be focussed here on protection than on threats of more restrictions and penalties to the young and healthy. It is reported that in the period 12-19 September there were 228 CV outbreaks in care homes. Is enough being done here? There is certainly a prioritisation of testing in care homes, taking up 100,000 a day it is said.
That high testing level in care homes partly accounts for the shortage of capacity in testing, where about 225,000 tests a day are being carried out in the UK, more than in any other European country; but it is admitted that the appointment system and number of tests possible daily cannot keep up with demand. Despite some great achievements, undoubtedly there is much disappointment all round in the efficacy of the processes including the delays in getting results to those tested. Good testing and tracing seem to be an effective weapon versus CV in other countries such as South Korea and UKGOV must do all it can to get testing to the right people at the right times. Also, it is disappointing that people with no CV symptoms are seeking tests when they should not. The behaviour of the public is always relevant. If the UK can achieve the declared target of 500,000 daily tests by the end of October, assuming results are delivered promptly, that will enhance weaponry to suppress the virus.
Other countries use tests to keep their travel ports, such as airports, working. It is inexplicable that UKGOV will not approve trials of testing at airports in the UK, combined with quarantine measures, to keep the aviation industry flying. There are several quick and easy tests now available, but none yet are proven, it seems, to meet UKGOV health standards: it would be positive to see UKGOV encouraging and fast-tracking trials of these tests which could, if they work sufficiently, lead to mass testing. The more testing can enable people to move around safely, the quicker the economy will perhaps recover. Some employers, it is reported, are conducting their own CV test programmes for employees and these should perhaps be encouraged too.
Testing’s value depends on those found positive then self-isolating, which is very hard to police: it depends on voluntary acceptance. The shorter the isolation period the more real that compliance will be. Can the 14 days be shortened by testing after a few days? A new twist is UKGOV proposing large fines for those who breach self-isolation rules, having been found positive. Is there not a risk this may discourage people applying for a test even when they have symptoms: if mildly affected, why risk a fine? This is a further reason why measures need public support rather than the threat and stick approach, against which some will rebel.
NO MORE FEAR – BUILD UNIFIED CONFIDENCE?
The mere talk of new lockdowns has spooked markets. This is the strategy of fear, perhaps a big mistake. Carrots and sticks are for donkeys, not the British public. Rather than a constant flow of new or tweaked rules, which most people can no longer recite, and threats of increasing penalties. UKGOV needs perhaps to build public confidence in a strategy which is clearly and openly communicated. A good start would be a more measured and contextualised approach to the statistics, particularly those relating to deaths, which are so emotive or can be emotively used and dramatised. Saving a life at whatever the cost is unjustifiable.
It is perhaps not the task of UKGOV to protect all people from all risk of death or to maximise the lifespan of people, though it provides a health service which has to pragmatically help the sick. Better, UKGOV must account fairly the risks and damage to the various sections of society and give more weight to some, applying very limited resources in the most sensible priorities possible: risk of death is but one factor, yet it disproportionately dominates. The media has sometimes dramatised death from CV: take the interviews of those suffering bereavement from CV on television, which rarely happens where death is from another non pandemic illness. Why is a CV death to attract such publicity? Whatever the cause of death, the sadness and grief are there. There are roughly 600,000 deaths a year in the UK from all sorts of causes. Some are caused by other people, but most by the frailties which come with ageing, may be the effects of cancer or dementia, and so CV attacks especially those, mainly the old, with weakest immune systems. It is good perspective to consider some statistics in the Times of 22 September: on 21 September there were 11 CV fatalities and the normal average for daily cancer deaths is 450, and flu and heart disease are far greater regular killers than CV. During the pandemic, given the slowdown in cancer deaths, there will inevitably be more fatalities from cancer and other causes which could have been delayed or avoided. So, over emphasising death from CV to inspire fear is misplaced and deceiving. Rather, there should perhaps be more education on the reality of the relative significance of statistics.
To add a perspective, in the UK, illegal drugs and their abuse are a massive killer and destroyer of lives every year. The lives destroyed are typically children, young adults or people in their prime, who are made unproductive, commit crime, bring misery to those around them and are degraded. The cost in police and health and welfare and other public services is huge. This damage inflicted on the younger generations gets hardly any attention compared to CV.
The” fear” strategy may have given rise to over caution which needlessly harms the bulk of the population. Professor Streeck, Germany’s top virologist, is reported in the Daily Telegraph of 22 September to criticise alarmism, believing good popular behaviours are diminishing the virus. Also “It is no good looking at case numbers anymore. You have to look at what is happening in the medical wards and intensive care beds” ….” We have to realise that Covid is going to be with us for a very long time and we have to live with it. We can’t keep shutting down our daily lives and paralysing everything.”
As reported in the same newspaper, the anti-lockdown lobby is reinforced by a letter from 32 UK scientists, led by eminent professors Gupta, Heneghan and Sikora, recording that 85% of deaths occur among the over 65s and 95% among those with pre-existing medical conditions. They would have adopted targeted, not blanket, measures. “This objective (suppression) is increasingly unfeasible and is leading to significant harm across all age groups, which likely offsets any benefits”.
Taking fear of CV away will build confidence. Perhaps most of all UKGOV must pronounce a national strategy of objectives and measures for CV, not separating the economic and collateral damage risks from the discussion. Those measures must be deliverable. Maybe it could expressly exclude a national lockdown and take that speculation off the table. Application of the strategy must be consistent. Communication of strategy needs to be clear, consistent and understandable: it must make sense. Restrictions and measures which seem to make no sense either must be clearly explained or cancelled. On 22 September, this strategy was declared to be to suppress the virus and keep the economy and education running. A few wider restrictions were announced, supported across Parliament and the devolved nations. There is no talk of a national lockdown – it is a pity that rumour and speculation did its damage. Time will tell whether UKGOV can implement this effectively. Even if it does, there is a strong body of opinion that sees the blanket suppression approach as not viable long term. Living with CV and protecting the most vulnerable is maybe the only real option without a vaccine that works, and that people will take.
It is a pity that recently UK ministers have been urging Britons to spy and report on their neighbours breaking rules, particularly on self-isolation. This is divisive, and only will serve to inundate the police with calls and case work they cannot cope with. People making reports may have scores to settle, and often will get the facts wrong. It is a mistake to pretend that there will be rigid enforcement – the resources do not exist when real crime is to be dealt with. A policy of emphasising civic duty may be more practical.
An approach of “them” and “us” between people and UKGOV is fatal. But some media seem to promote it. In a recent BBC breakfast interview Jonathan Ashworth, shadow health secretary for Labour, said the British people had done their bit, now Government must do its bit. This is politics but it is divisive. The anti- Government proponents shout its ineptitude daily, quite often fake news. There remain self-declared Boris Johnson or Brexit haters who are provided airtime to display their prejudices, using the challenges posed by CV to compound their hatred. UKGOV needs to make only deliverable promises, not grand wish lists, and then deliver them competently. That may quell adverse noise. Speculative ideas about economic damage when furloughs and other support schemes run out have been unhelpful. Rishi Sunak has just announced some new and some continuing support to reduce potential unemployment which will no doubt be analysed in the coming days, but there should be no economic cliff edge at the end of October.
UKGOV proposes to reinstitute regular reporting of the state of the pandemic nation, with statistics and commentary. It needs to deploy great spokespeople who can instil trust, and who will avoid platitude answers and not dodge questions. If an answer is not known, it should perhaps be provided the day after. The UK’s economic recovery or decline should perhaps be a key part of this round of communication, which can no longer be defensive, but must pave a way of positivity, not fear of the virus. UKGOV and all people who have the interests of the UK at heart will hopefully work together to create a culture of unity of purpose.
