It seems that it was easier than perhaps thought to put us all into a lockdown situation… but rather harder to know how to let us out. The urgency of preventing the NHS from being overcome was laudable and the public went along with it. Plus the new communication from the government was to promote fear. Anyone could die. Now fewer than one third of ICU beds are Covid cases and the Nightingale which was hardly needed has been mothballed. Doctors’ surgeries and 111 calls have been much quieter over the past week or and some hospitals in London are receiving cases in single figures. So the original reason given to us for our lockdown is no longer there. But it has been replaced with another major one – the prevention of the resurgence of the virus, itself perhaps a consequence of the government strategy to lockdown and suppress the virus. There are five tests that need to be passed before it can be lifted. No one seems to have questioned these or asked why they chose these five.
- NHS ability to cope
- Sustained fall in daily death rate
- Rate of infection
- Supply of tests and PPE
- No risk of a second peak… (track and trace policy required to be in place)
The first as said above has clearly been met as there is now excess capacity in all hospitals. The data on which the predictions were made used the former NHS critical care bed capacity. We know that the NHS acted quickly and almost tripled this by using operating theatres, private hospitals etc. as well as building the Nightingale hospitals.
The second test has also been passed as the peak of deaths is generally agreed to be on April 8th
The third test, the rate of infection is now estimated to be as low as 0.6 despite Professor Ferguson saying it would take five months to get it below 1. Germany began a relaxation of measures when their R = 0.7. The measure itself has been criticised by some with Professor Michael Levitt saying that without also knowing how long a person is infectious for, is not that much use. Should the use of a general R be the main determinant of strategy? We know that in a small infectious area like a care home it will be much higher than say in the countryside where it may be nearly O. We are not told on what data the measure R is calculated.
The last two tests are not tied into the demise of the illness but on the government’s ability to deliver testing and equipment and the introduction of a nationwide track and testing system. The economy and all our lives are further put on hold so that the government can do what arguably should/could have been done some weeks back. The mess up over PPE does not seem to have been resolved and there may be jobs to go at the end of all this, probably in procurement. But neither has the government explained its thinking behind the need or indeed the feasibility of tracking and tracing as a strategy for the ongoing suppression of the virus.
These two tests have given the government a reason to keep the lockdown longer and one wonders whether that is why they were included in the five tests to begin with. They know that by suppressing the virus rather than mitigating it, the risk of a second epidemic is higher (this warning was given in the Imperial paper, widely believed to have provided the ‘evidence’ for the sudden switch to suppression and lockdown) and they have concluded that tracking and tracing is perhaps the only effective way of stopping this from happening. Again I am just surmising here.
Surely we can demand some transparency as to the reasons why the last requirement of tracking is now so needed, that no relaxation of the lockdown can occur without it. Tracking and tracing was deemed an appropriate measure at the outset of an epidemic. The government started this well and then decided to stop.
“There comes a point in a pandemic where that is not an appropriate intervention,” Jenny Harries, the deputy chief medical officer. On March 14, officials signalled the contact-and-trace strategy for fighting the spread of the virus was ending, except for those in high-risk places like prisons or care homes. For everyone else, testing would be prioritised for those most ill in hospital.
Of course at that point the government was still following a fairly relaxed mitigation strategy of social distancing, to be followed by the closure of pubs and bars and large gatherings, to be followed by the demand that the over 70’s and vulnerable to self-isolate to a total lockdown for the entire population coming three days later.
The Imperial Paper was published on March 16th and recommended suppression not mitigation and without delay. And the government changed course. Frightening numbers were presented that no government could ignore. Even then arguably it was a bit late in the day for suppression as the virus had run rampage for a good month before this date. Other countries were doing the same, with Sweden being an outlier. The Swedish government decided to adopt measures which protected the elderly and vulnerable (and they concede that they were too late on this as well) and the impact of the illness on the healthcare system…just like our initial response of mitigation. The reason they gave for this was that it believed it to be sustainable whereas suppression by total lockdown of a population isn’t. Which our government knew at the time. And which is now proving correct. Nearly two months on and people are getting frazzled.
In the Imperial paper the downside of suppression is given “the major challenge of suppression is that this type of intensive intervention package will need to be maintained until a vaccine becomes available (potentially 18 months or more)”. This was not told to the public at the time or really has been since, for obvious reasons but it is being leaked out bit by bit in what I suppose they believe to be palatable bite sizes. However, asking us to stay in when nearly 1000 a day are dying and for a matter of three weeks is a little different from now when the numbers in hospital have fallen and the consequences of an economy on hold are being felt.
But it is easy to see the bind the government is in. As the Swedish epidemiologist Prof Johan Giesecke said in his interview with Lockdown Unherd, once a government had made a decision of total lockdown, it is hard to come out of.
They knew that lockdown had to be lifted at some stage but Ferguson et al had also warned of a high risk of a second wave after suppression. Hence the government have gone now returned to the earlier tactic of track and test, despite the virus having been in circulation for at least two and a half months, and despite the fact that the authorities have absolutely no idea of how many have actually had the illness. The paper, like Dr Harries also says that suppression strategies are best introduced at the very beginning of an epidemic, so the government needs to get the country back to a situation that resembles the beginning of the epidemic. Hence perhaps its choice of the Isle of Wight as the first trial for track and test, where the numbers of those with the virus has remained very small. The Imperial paper refers to concerns about civil liberties with this method but that so far has not been raised by many in the public eye which is surprising. MPs – where are you? Not everyone wants such an intrusive measure on their phone. How can this be a viable strategy when we have a population of nearly 70 million people and testing has barely reached the 100,000 a day level? Surely doing regular randomised surveys on parts of the population would have been a sensible way of at least getting an overall picture of the illness and how deep into the population it has spread. If this has happened I have not heard about it.
The more suppression the greater the risk of a second wave because there has been no chance for sufficient community immunity to build. So it is reasonable to ask why this was chosen as a long term strategy? The sacrifice is many people’s health, well – being, financial security, future, careers etc. This is not a temporary period of hardship for people. It has enormous repercussions for our society and economy and will do for many, many years. We will basically be a broke nation. The talk of bouncing back after a short period of difficulty has stopped.
There are clearly some questions that could be answered now such as has the Imperial Paper so far proved accurate – if not why not and what has been learned? Would 250,000 people really have died if we had followed a less stringent mitigation strategy? Are other approaches being taken into account? And fundamentally what exactly is the current goal, the logic behind it and the strategy? Is there an acceptance that the virus will remain with us at some level until a vaccine is found or herd immunity established? Is there an acceptance that some people will be ill and some people will die? By following suppression at what point can we resume normal lives without a vaccine having been found?
I cannot be the only one to bristle when I hear the “we are following the science” mantra. Mainstream media is finally beginning to give space to those questioning this ‘science’ eg. Newsnight. It is vacillating and dithering. Let us see what happens tonight. But the population deserve more transparency (and data on risk which I have written about in the another post) as to the reasons why they have been forced to sacrifice so much.