As we wrote on March 15, although there are many variants, there are only four basic strategies for handling the coronavirus.
The four generic strategies are:
- the laissez-faire strategy – let the virus take its course without interrupting normal economic activity in the hope of building herd immunity quickly and doing minimum damage to the economy;
- the isolate the vulnerable strategy – as above but find a way to protect those most at risk: the elderly, BAME, economically disadvantaged and those with underlying conditions;
- the retard the progress of the virus strategy – pursue the herd immunity strategy, but slowly so as to prevent the NHS from being overwhelmed;
- the lockdown and eliminate strategy – maintain a tight lockdown to reduce cases to a number where other means of elimination (most likely Test, Trace and Supported Isolation) become feasible.
The UK government has never explicitly stated which of these strategies it is following: even at the point of lockdown, it was not clear whether the strategy was lockdown and eliminate or lockdown in order to retard. And therefore it is hard to know for sure whether they have been following the best strategy.
But a look at public statements and documents suggests that they have vacillated between three of the strategies, are not now committed to the optimal strategy, which means the UK risks both needless loss of life and great damage to its economy:
- The Government has repeatedly changed its strategy, initially in a positive direction, but more recently in a dangerous one;
- The recent changes give the government unpalatable choices; but
- It could still revert to lockdown and eliminate, and save both lives and businesses.
The Government has repeatedly changed its strategy
Because the government has never stated its strategy explicitly, it is impossible to say with absolute certainty what it has been at any given time, but of course the government and its advisers have made public statements throughout the year which give an indication.
The diagram below summarises both the course of the virus in terms of the Financial Times’s estimates of the death toll and a series of statements guidelines from the government.
These events are described in more detail below.
The first important event took place at the end of January when the first case of the virus was identified in the UK.
A few days later, in early February, Boris Johnson made a speech which strongly suggested his preference for the laissez-faire strategy. Here are a couple of relevant paragraphs:
“And in that context, we are starting to hear some bizarre autarkic rhetoric, when barriers are going up, and when there is a risk that new diseases such as coronavirus will trigger a panic and a desire for market segregation that go beyond what is medically rational to the point of doing real and unnecessary economic damage, then at that moment humanity needs some government somewhere that is willing at least to make the case powerfully for freedom of exchange, some country ready to take off its Clark Kent spectacles and leap into the phone booth and emerge with its cloak flowing as the supercharged champion, of the right of the populations of the earth to buy and sell freely among each other.
And here in Greenwich in the first week of February 2020, I can tell you in all humility that the UK is ready for that role.”
Other countries might cower in the face of the virus, Johnson suggested, but the UK would be like Superman, championing humanity by continuing to do business undaunted.
But sometime between early February, and mid-March, it seems likely that the government had shifted from full laissez-faire towards the retard strategy. According to The Independent, SAGE (the scientific advisory group on epidemics) had already told the government of the risks of the laissez-faire approach:
“Professor Medley also confirmed reports that the government was told in late February – long before the Imperial College study – that half a million people could die in the UK without a lockdown.”
And on 5 March, Boris Johnson made his famous “take it on the chin” speech, which suggested that the risk of overwhelming the NHS had started to become a consideration with him.
Later in March, both Johnson and Hancock are recorded as having discussed with their Italian counterparts – who had had an earlier exposure to virus, and at that time had what was considered a high death toll – the idea of herd immunity.
As The Independent reports:
“Boris Johnson told Italy’s president he was aiming for ‘herd immunity’ to defeat coronavirus, an explosive TV documentary has revealed, despite No 10 denying that was ever the policy. The Italian health minister has undermined the government’s repeated denials by recounting a conversation between the two leaders on 13 March, as the pandemic neared its peak.
‘I spoke with [Giuseppe] Conte to tell President Conte that I’d tested positive [for coronavirus].’ Pierpaolo Sileri told Channel 4’s Dispatches. ‘And he told me that he’d spoken with Boris Johnson and that they’d also talked about the situation in Italy. I remember he said, ‘He told me that he wants herd immunity’.”
And the UK’s chief scientific advisor suggested around 13 March that we should follow a different path: hoping for 60% of the UK population to get the virus to build herd immunity.
And Bloomberg confirms that this was the government’s policy at the time:
“The health secretary [Hancock] dialled into a conference call for Group of Seven countries as governments across the world sought to coordinate their responses and share their experiences. Hancock asked the Italian representative if Italy was also working on a herd immunity plan.
The Italian representative was blunt: Allowing the virus to run riot would result in thousands of excess deaths and there was way too much uncertainty about the nature of the virus to be sure that such a gamble would even work. Hancock was shocked. The damage was done.”
But as Bloomberg explains, everything changed on 16 March:
“On Monday, March 16, a secretive group of Britain’s top scientists, health experts and government officials gathered to discuss the unfolding coronavirus pandemic. They knew they had a problem.
For days, Prime Minister Boris Johnson had brushed aside a crescendo of calls from politicians and academics to close the country’s more than 30,000 schools. He had repeatedly refused, insisting that the scientific advice he was so publicly heeding showed such disruption wasn’t necessary.
But shocking new data modelling presented to those gathered in the grey government offices on London’s Victoria Street suggested the policy needed to change—and fast.”
One key aspect of the Imperial College modelling was that it became public on 16 March – suddenly, everybody knew the numbers. The idea of sacrificing up to 1% of the UK population to protect the economy was something that could not be kept quiet.
And the policy changed dramatically. On 23 March, Boris Johnson announced serious lockdown measures:
“From this evening I must give the British people a very simple instruction – you must stay at home. Because the critical thing we must do is stop the disease spreading between households.
That is why people will only be allowed to leave their home for the following very limited purposes:
- shopping for basic necessities, as infrequently as possible
- one form of exercise a day – for example a run, walk, or cycle – alone or with members of your household;
- any medical need, to provide care or to help a vulnerable person; and
- travelling to and from work, but only where this is absolutely necessary and cannot be done from home.
That’s all – these are the only reasons you should leave your home.”
As we wrote on 24 April, the lockdown measures were extremely effective.
But naturally, they also had a paralysing impact on the economy and on government finances. There have been repeated calls almost since the lockdown began – e.g. in the Telegraph – for a rapid unlock, and it is likely that pressure on Johnson was becoming unbearable. And in late April, the government’s fifth test for unlocking – that the government must have “Confidence that any relaxation of restrictions would not risk a second wave” was replaced by the weaker requirement that the government must be “confident that any adjustment to the current measures will not risk a second peak infection that overwhelms the NHS.” Which sounds very much like a return to retard.
Some claimed that the government’s messaging on lockdown had been too effective and had caused too great a curtailment of economic activity. So just before VE day, Government sources let it be known that a relaxation was coming. And it duly came with the clear messaging about staying at home replaced by ambiguous messages about alertness and common sense, and with many of the restrictions now accompanied by phrases like “where possible.”
And on 1 June, in the wake of the public controversy over Dominic Cummings’s breach of the lockdown rules, the first stage of unlock was announced.
The recent changes give the government unpalatable choices
If we assume that the government policy – though not its declared policy – has reverted to herd immunity, there are three obvious ways that it could seek to meet this objective:
- the government could, in principle, revert to the laissez-faire strategy and decide to let the virus do its worst – we could call this the ‘Superman’ option;
- it could aim to retard the progress of the virus just enough to protect the NHS and keep the death toll below, say, 1000 per day;
- it could aim to retard the virus so as to keep R just below one, so that there is no second peak, but there is also no rapid decline in the prevalence of the virus.
It’s worth looking at each of these in turn, but first this chart indicates how these options compare with the alternative of continuing with lockdown. Note that the scale on this chart is logarithmic.
In this chart, the faint line represents the original laissez-faire strategy – what would have happened had we never locked down: by now the virus would have ripped through the bulk of the population, and we would have seen over 400,000 deaths.
The red line indicates what will happen if the government reverts to the laissez-faire strategy, ‘Superman,’ assuming that the population agreed to revert to their previous patterns of social contact. We would see almost the same death toll as under the laissez-faire strategy; this scenario is not likely to be tolerated by the population of the UK.
The amber line represents what would happen if the government adopted retard merely to protect the NHS and to keep the death toll below 1000 per day: the death toll would still be rising in April next year and would already have reached almost 250,000.
The Orange line shows what will happen if the government adopts retard to contain R to just below 1: the death toll continues to rise, but much more slowly, and is still rising by April next year.
The Green line represents a reversion to lockdown until the government has an effective system for testing, tracing and effective isolation. In this case, the virus would be dealt with before Christmas and with a death toll of under 100,000.
Finally the thick Black line represents actual deaths as estimated by the Financial Times on the basis of Office for National Statistics data.
On the assumption that the first of these three strategies is unacceptable, let us take a slightly more detailed look at the second and third.
Ideally, when we do this more detailed examination, we would look not only at the death toll but also at the impact on the economy. But precise economic modelling at a time like this is extremely difficult: it is hard under any circumstances, but now, when there are enormous uncertainties over what the government’s economic policies will be, it is effectively impossible.
Nevertheless, it is reasonable to assume:
- that the lockdown has a profound negative effect;
- that the longer it persists, the greater this effect will be; and that
- the stricter it is, the greater negative effect will be.
Furthermore, we do have two data points: we know how the economy was performing before and after lockdown; and we also know something about how the lockdown has reduced interpersonal contact and therefore the infection rate, so we can use this to calculate a degree of lockdown figure representing the percentage by which interpersonal contact is reduced.
The picture looks like this:
There was of course no lockdown in 2019, but the lockdown began at the end of Quarter One 2020 and already had some effect. In Quarter Two (which is not yet finished) lockdown has been present, and will be present throughout in some form.
So if, when we look at each strategic option, we consider the degree of lockdown and its duration, we can at least form some reasonable ideas about the degree of economic damage.
Retard the progress of the virus to keep the death toll below 1,000 per day
In this scenario, the government sequentially unlocks with the principal aim of preventing the NHS from being overwhelmed. They keep the number of serious cases below 40,000, and the daily death toll below 1,000.
To achieve this result requires a series of partial unlocks, the first of which has already happened; a second would be possible at the end of October, and a third (but not final) unlock at the end of the year. The average degree of lockdown during 2020 would be 48%, but we would still be roughly 50% locked down at the end of the year and the final death would occur after the end of the modelling period, sometime in 2021. By the end of that modelling period, the death toll would have reached almost 250,000 and it would still be rising.
Keep R just below one
In this scenario, the government sequentially unlocks with the principal aim of preventing a second spike. They keep the value of R below one at all times, so the virus is in constant but slow retreat.
Achieving this result also requires a series of unlocks. The average degree of lockdown during 2020 would be 54%, and we would still be roughly 66% locked down at the end of the year. Again, the final death would occur after the end of the modelling period, sometime in 2021. By the end of that modelling period, the death toll would have reached almost 110,000 and, again, it would still be rising.
On the face of it, neither of these scenarios looks appealing. And it is therefore worth asking whether the government has any other option.
And of course, the answer is ‘yes.’
Revert to lockdown and eliminate
The obvious option to consider is reverting to strict lockdown with the aim of eliminating the virus by a combination of reducing the numbers until we are ready to make a transition to a proven test, trace and isolate (TTI) containment system.
Of course, it is hard to be sure when that test, trace, isolate system will be sufficient in terms of capacity and reliability, so for the purposes of this exercise, we have assumed that the lockdown remains in place until there are no more cases in the UK. This is of course a pessimistic view, but even so this option looks good in comparison with the others.
Achieving this result requires an immediate reversion to tight lockdown. The average degree of lockdown during 2020 would be 60%, but we would have completely unlocked before the end of the year. The last death would occur before the middle of November. And the final death toll would be under 80,000.
It is not 100% clear – and never has been – what strategy the government is following, but all the evidence indicates that we are again following some form of retard strategy. Neither of the two version of this strategy we explored above is attractive. But the government, and we as a country, still have the option of reverting to lockdown and eliminating the virus.
Here is how the strategies compare, on two dimensions: 1) how long it takes to ‘resolve’ (well or badly) the problem the virus poses as measured by the date of the last death; and 2) how many people will die.
In terms of loss of life, it is clear that lockdown followed by TTI is by far the best strategy. But what about the economic impact?
On the basis of the estimates above of degree of lockdown and duration, the options compare like this:
If we were a society with no morality, we might pick laissez-faire or ‘Superman’ because of the speed with which the issue would be ‘resolved’ and the lower average degree of lockdown – and hence economic impact. But we are not, and the idea of choosing to incur more deaths than were caused by the Spanish ‘Flu and almost as many as by the Second World War is repugnant to most people.
And it would be a choice: the argument that the UK cannot afford to handle the crisis well because of the state of government finances is nothing more than debt hysteria.
Which leaves us with the two versions of retard and with reversion to hard lockdown followed by TTI.
We have already seen that the two versions of retard are neither good for containing the death toll nor for rapid resolution and resumption of full economic activities.
By contrast, reversion to hard lockdown followed by TTI could contain the death toll to well below 100,000 and also resolve the issue relatively quickly. A full resumption of economic activities by November would be possible. But only if we act fast.