At the time of writing (14/1/21), out of 152 countries listed on the Statista COVID-19 database, the UK has the seventh highest death toll per head of population. The true death toll in the UK (and in some of the other countries listed) is higher than the confirmed total in the database: in the UK we have just passed 100,000 deaths.
And this is strange because the UK has some of the best scientists in the world, and as recently as 2019, the Global Health Security Index ranked the UK and the US as the best-prepared countries in the world.
We have previously written about the weaknesses in the government’s anti-COVID strategy and implementation. Between them, those two articles largely explain how the UK has performed so badly when it should have been expected to perform so well.
This article explores the question of whether it is now too late to make a difference to the death toll. It is too late for 100,000 people and their families. But is it too late for the rest of the UK population?
The good news is that it is not too late. If we can persuade the government to follow best practice, we can still save around 60,000 lives and simultaneously protect jobs and the economy:
- if we get it wrong, despite the existence of a vaccine, we could still see the death toll rise to around 180,000 by April 2021 – meaning that we would already have seen more deaths in 2021 than we did in the whole of 2020 – and returning to a functioning economy will still be a distant prospect;
- if we get it right, we could still contain the death toll to around 120,000 and return to a functioning economy by around April.
In making this comparison, we have made a few ‘generous’ simplifying assumptions: first that there will be no further variants of COVID-19 to complicate the picture; second that immunity both through recovery from infection and through vaccination will last many months; thirdly that death is the only major healthcare issue (‘long COVID’ is rare); and fourthly that any change in approach is implemented immediately and completely. Both scenarios would look significantly worse if these assumptions are materially wrong.
To understand how we have compared these two scenarios, you need some feel for the dynamics of the virus. This animation, or if you prefer this article, explain these dynamics in non-mathematical terms. If you have not already seen them, now is a good time.
Getting It Wrong: up to 180,000 Deaths
The key ingredients for getting it wrong are:
- loose lockdown – looser than in spring 2020, despite the new variant being at least 40% more infectious than last year’s;
- some improvement in rate of vaccination – double what has been achieved so far (from about 60,000 per day to around 120,000);
- continued weakness of test, trace, and supported isolation (TTSI);
- weak border controls so that we can continue to import new cases; and
- unclear messaging undermined by senior figures.
With those ingredients in place, as broadly speaking they are today, the future course of the virus could look something like this.
The chart summarises the progress of the virus in terms not just of deaths but an estimate of cases of varying levels of seriousness. The vertical axis in this chart uses a logarithmic scale for two reasons: first because exponential growth looks like a straight line on a logarithmic scale; and second because it shows number of cases as well as number of deaths, and they differ by a factor of at least a hundred. Using a logarithmic scale makes it possible to see both in a single chart.
You can compare the graph above (which is the result of modelling) with the actual recorded data here.
The black line represents the cumulative total deaths up to each point in time. As you can see, the line was almost flat during summer 2020. This is because the number of people dying (the red line) had fallen from over 1,000 per day into single figures.
But after schools went back, the number of cases started to rise fast and even though there was action to contain the virus during early autumn, cases continued to rise. The Christmas and New Year relaxations caused a further spike in the number of cases and inevitably given the dynamics of the virus; deaths rose sometime later.
At the end of the year 2020, total deaths stood at around 80,000. In this scenario, by the end of April 2021, they will have reached around 180,000 and still be rising.
That means that, in this scenario, by April 2021 will already have seen more deaths from COVID than 2020. And this is despite 2021 being the year that benefits from the existence of the vaccine.
Getting It Right: ~120,000 Deaths
The key ingredients for getting it right are:
- tight lockdown – tighter than in spring 2020, until the numbers are low enough for TTSI to cope with them all;
- fully functional TTSI;
- significant improvement in rate of vaccination – five times what has been achieved so far (300,000 per day);
- strong border controls so that we no longer import new cases; and
- clear messaging supported by senior figures.
With those ingredients in place, the future course of the virus could look something like this.
Of course, the picture looks the same until January 2021; we cannot change the past. But from January onwards, it is a completely different picture: the number of cases falls dramatically, and after some delay – again due to the dynamics of the virus – the number of people dying (red line) also starts to fall sharply.
The end result is that by April, deaths are again down into single figures and total cases are in the hundreds. The UK has regained control of the virus. And the total death toll is around 120,000.
Protecting the UK
The difference between the two scenarios is stark: a difference of ~60,000 deaths between now and April. And it is even more important than this:
- in the ‘getting it right’ scenario, the UK has brought the virus back under control by April: cases and deaths are minimal, and it is safe to reopen the economy – almost without restriction (but not without continued TTSI, vaccination and border controls);
- in the ‘getting it wrong’ scenario, by April, the virus is still out of control – cases are still running at almost the level that prompted the first lockdown in spring last year; the death toll is continuing to rise; it is not safe to reopen the economy.
In December, Independent SAGE set out the kind of strategy the government needs to follow to get it right. If we follow that kind of strategy, by April we will for practical purposes have beaten the virus. It will be a pyrrhic victory because of the number of lives lost, but at least we will know that that number is as small as it can be given where we are today. We will have saved ~60,000 lives. We will have reopened the economy. We will be able to live our lives almost as before (not quite, because of foreign travel). And countless livelihoods will have been preserved which are currently at risk.
If we get it wrong, by April we will be just about back to where we were at Christmas, except that a further 100,000 people will have died. We will not have saved lives, we will not have protected the economy, we will not be free to go about our daily lives as we wish. We will have achieved nothing.
There should be no need for discussion about which path to follow.
Unfortunately the so-called COVID Recovery Group (CRG) in the Conservative Party, which is to COVID recovery what the ERG was to European research, has strong views against following the science and in favour of rapid ending of lockdown to ‘protect the economy’.
Last year, we learned that there is no sense in trying to trade-off the economy against the virus. That attempt is what gave us the worst of both worlds in 2020.
This year, we should aim for the best of both worlds. To achieve that, we need MPs in all parties to understand the issues spelled-out in this article and to push for policy change.
If you would like to see that happen, please write to your MP directing them to this article; this website makes it quick and easy for you to do that. And please sign-up and join the 99% Organisation.