Until the Imperial College Covid-19 Group published their report last Monday, the strategy of the government was laissez-faire. The government’s Chief Scientific Adviser explained that this was in order to build-up herd immunity in the UK population.
The Imperial College Report made clear to journalists and to the public something that should have been clear all along, which was that infecting 60% of the UK population with a virus that kills ~1% of those it infects would lead to hundreds of thousands of deaths. (And we do not know for sure that being infected and then recovering will confer valuable immunity, so there may be no compensation for the loss of life).
As a result of the public and media outcry caused by the analysis in the Imperial College report, the government has made significant changes in the way it talks about the challenge of the coronavirus.
The Chancellor, Rishi Sunak, introduced a raft of measures aimed at protecting businesses and employees from the inevitable economic slowdown.
And on 23 March 2020, the Prime Minister, Boris Johnson, gave a speech to the nation which formally introduced the concept of a lockdown and gave far clearer instructions to the British public than had previously been the case.
We have been arguing strenuously both that a lockdown was essential, as soon as possible, and that without a comprehensive support package (a key element of Stage I of our Three-Point Plan) the containment strategy would fail because, faced with the risk of starvation or eviction, people would continue leaving their homes in order to work.
So the obvious question is: has the government done what we believe needs to be done?
Our conclusion is that they have taken a significant step, but have not yet done enough to implement a successful lockdown policy:
- from the point of view of virus containment, it is critical to reduce sharply the rate at which individuals can infect each other – and it is far from clear that enough is being done to achieve this;
- to achieve such a reduction in infection rate, there must be very few holes in the support provided to businesses and government, and they must not remain there long – and it looks as though significant gaps still remain;
- the government urgently needs to commit completely to achieving lockdown and elimination of the virus.
Words matter but the infection rate matters more
Boris Johnson’s speech was far punchier than anything he had said before. He moved from advising and urging to instructing; and the extent of the lockdown that he talked about was far greater than he had previously suggested. And this is unequivocally good news.
So, let’s take a moment to see what lockdown should mean in practice, in terms of numbers. Based on the latest (24/3/2020) figures, our analysis of the final death toll in the UK, depending on the number of people that each carrier of the coronavirus can infect each day, is shown below.
Currently coronavirus cases are growing at over 25% per day, which means that each person with a virus is infecting at least 0.25 other people each day. With no reduction in that rate, as we explained last week, the death toll in the UK will be more than half a million lives lost.
This is an extraordinary number: if unchecked, the virus will kill more people in the UK than did the Second World War.
Other countries have done similar analysis, as has the World Health Organisation, and the virtually unanimous conclusion is that the only acceptable strategy involves a dramatic reduction in the number of people who will be infected by each individual who carries the virus. Almost every country has gone for lockdown, and they have done it very thoroughly.
In the UK, we need to reduce the rate of infectivity to below 0.1 – a reduction of at least 60% in interpersonal contact.
60% sounds like a big reduction, but in reality, it is even bigger than it sounds. It is relatively easy to stop purely social contact, but it is much harder to reduce work-related contact. And since some jobs are part of the critical national infrastructure, we don’t want people to stop doing them. We still want doctors and nurses to be practising; we still want food (and toilet paper!) in the shops; we still want gas, water and electricity – and nowadays an Internet connection – to reach our houses, et cetera.
So if those people are going to work, and probably will not reduce their personal rate of infectiveness very much, what about the rest of us? To get the average rate of infectiveness down to 0.1, the rest of us will need a greater than 60% reduction in interpersonal contact.
On 24/3/2020, the government sent out these guidelines to its citizens. Are they enough? No, not really. They begin well, listing only four reasons for leaving home. But at the bottom of the first page, they quite explicitly state, “if you are not a critical worker, you may still travel to work provided you cannot work from home.”
Of course, some of us can work from home – and if there is any possibility of doing that, we should take it. But some non-essential jobs cannot be done from home. And in these circumstances, that means they should not be done at all. But that is explicitly not what the government is saying. Similarly, while the government claims to be closing non-essential shops, the guidelines state:
“With the exception of the organisations covered above the section on closing non-essential shops and public spaces, the government has not required any other business to close – indeed it is important for business to carry on.”
Of course, it is too early to say with certainty whether we are on track to achieve the necessary reduction in infection rate, but there are grounds for concern. Reports suggest that public transport in London, which now has a reduced service, remains as crowded as ever. Construction sites are still busy with workers in close proximity. Supermarkets are crowded, and some have not yet implemented distancing or rationing measures. Many employers are still insisting that their employees come in to work; and others have severed their workforce without compensation.
Without comprehensive support the containment strategy will fail
And this brings us to the second point, that even if the government had given clear and comprehensive lockdown guidance and most people were committed to the lockdown strategy, if they risk starving, losing their jobs or being evicted from their houses, they will not obey the rules.
For lockdown to work, we need the entire population to be able to commit to it. Specifically, most of the self-employed need to be able to cease work; workers in non-essential occupations who cannot work from home need to be able to cease work; the homeless need to be able to survive without close physical proximity to others, et cetera.
There is no easy way to support these people if they are not working, but a way must be found. We and others have argued that a temporary universal basic income might be the simplest way of supporting compliance with the lockdown strategy.
But if the government does not wish to do this, it must nevertheless commit with great urgency to a comprehensive support package. Approximately 15% of the population are self-employed and/or work in the gig economy. Roughly 2% do not have a bank account. It is more difficult to support these people, but if 15%-17% of the population cannot afford to comply, the lockdown strategy will fail.
The government needs to commit 100%
So if the government is serious about moving from the laissez-faire strategy to lockdown, it needs to commit 100% both to much firmer and clearer lockdown guidance to individuals and businesses and to a much more comprehensive support package.
It also needs to commit to large scale testing, tracking, tracing and isolation as other governments have done. Without that, lockdown can never safely be removed. And as a matter of urgency, it needs to address the shortage of personal protective equipment on the front-line, without regard for political allegiances or loss of face. It is not an insurmountable logistical challenge, if the government is open to all sources of supply.
In summary, the government has taken some very welcome steps, but still needs to take several more.
The good news is that governments which have done that, for example China, have seen a rapid and dramatic falloff in the number of coronavirus cases – to the extent that their challenge now is not Stage I but Stage II of our suggested three-point plan. This is a remarkable achievement which our government should emulate.
If this matters to you, please do sign-up and join the 99% Organisation.