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I know. I know. No one wants to hear this. But with all the current talk of coming up with an ‘exit strategy‘ for the Covid-19 lockdown, people are trying to buoy up the idea that the end will be in sight in a matter of weeks. I believe that is utterly unrealistic, and in this post I’m going to lay out why.
Why are you being such a pessimistic grumpy-guts?
I’m attempting to be pragmatic. I think this is one of those times where we should hope for the best but plan for the worst. Crucially, I think that a terrifying number of people are in denial about the timescales of disruption that Covid-19 will cause, and this is causing them to make horrible personal and professional decisions. I believe that we have a responsibility to consider any reasonably likely worst case scenario, and take appropriate steps to mitigate it. But to do that we have to be honest about the worst case.
I am not an epidemiologist. This is not about forecasting, or statistical analysis. I do not have privileged access to any relevant information. This is simply about interpreting fairly straightforward information that is in the public domain.
Why can’t we come out of lockdown right now?
The following are all currently true:
A1) If we end lockdown now, a large number of people will get severely ill
A2) If a large number of people get severely ill, the NHS will be overwhelmed
A3) If the NHS is overwhelmed, lots of people will die unnecessarily
A4) It’s not ok for lots of people to die unnecessarily
∴ It’s not ok to end lockdown now.
Furthermore, it will only be ok to end lockdown when one of the above changes. So how could this change?
Possible get-outs, and why I don’t think they will be helpful.
No one sensible is predicting it will take less than 12-18 months to deliver a vaccine, if one can be found. Factor in the time required to manufacture it in sufficient quantities and distribute it, and best case scenario you’re looking at 2 years before the vaccine has been administered to a large enough proportion of the population to invalidate A1.
There’s an idea that if we can simply wait it out until 60-80% of the population have had it, we can all then get on with our lives because we’ll have herd immunity. But that relies on everyone who has recovered from it being immune. And we’re seeing 30% of recoverers not having the necessary antibodies for immunity in their bloodstreams, and some people are already testing positive for the virus having previously recovered.
Everyone who dismissed coronavirus as “just like flu”, may be right in the worst possible way – it may be something that you can keep getting, which really stuffs up the herd immunity solution.
What if we could track everyone who has been in contact with someone infected using some smart technology? Could that work? I’m doubtful, because this approach relies on people being sensible and responsible. And not just some people. All the people. In South Korea, basically one 61-year-old woman managed to spread the disease widely enough that it became uncontainable. In the UK we have people attacking 5G masts because they think they’re spreading the disease. The level of panic-induced idiocy at large is enormous. There is no way the entire country is going to adhere to a contact tracing regime properly, and that’s what it would take for it to work.
So far, there is only one drug, remdesivir, that even looks like it could be effective, and the data for how effective it is is very limited so far. Other treatments, such as blood plasma transfusions, are pretty pie-in-the-sky at this stage. It’s really hard to be optimistic about treatments when we’ve got so little to work with at the moment.
Maybe we could end lock-down for everyone except people at high risk. I doubt this would work well for two reasons. First, we still don’t know what the risk factors are (other than age), and even the ones we are aware of are dubious. It seems like, probably due to socio-economic factors, BAME people are at higher risk, but no one is going to say “only rich white people can end lockdown”, are they? And second, sticking to lockdown is hard, and if one group is kept in lockdown while another is allowed out, that makes it way harder psychologically for the locked down group to stay locked down.
What if we made everyone who exits lockdown sign a disclaimer saying they agree not to be treated by the NHS in the event they get a serious case of coronavirus? That would have a go at reducing A2, but it seems like it would be very hard to enforce. The hippocratic oath, for example, stands in the way.
The lesser of two evils
In the end, I suspect the only way out of lockdown in anything like the short or medium term is if we can assert something new:
A5) The social and economic damage caused by lockdown is going to cause more unnecessary deaths than those caused by ending it.
If lockdown ends in those circumstances then we definitely, definitely shouldn’t be celebrating. But furthermore, lockdown will only stay ended for as long as the economic evil is greater than the public health evil. And the longer we stay out of lockdown the more likely we are to see the scales shift. In which case we should expect for a long period of being sporadically in lock-down. It won’t end, it will simply periodically pause.
So why plan for 5 years?
I am advocating planning a 5-year timeline because I believe that the most likely scenario is that we wobble between more and less severe forms of lockdown until a vaccine is widely available. I believe over time the lockdown will get less severe as better treatments are discovered, but it will only properly end with a vaccine. The vaccine could be available within 2 years, and it could be available never. Let’s not forget that AIDS was first reported in 1981 and the HIV/AIDS pandemic is ongoing.
The thing about a 5 year timeline, as well as being conveniently situated between 2 years and never, is that it’s about as far ahead as most humans can ever try to look and plan. There’s a reason why businesses tend not to forecast further ahead. 5 years is enough time to get a degree, to start a family, to change jobs a few times. 5 years is manageable.
So I would advise everyone to think how they could cope, psychologically, physically and financially, with a lockdown that lasts, on and off for 5 years. Make a plan for what that looks like. Then go back to hoping for the best.