“At too many companies, the boss shoots the arrow of managerial performance
and then hastily paints the bull’s-eye around the spot where it lands.”
Stephen Powis, the Medical Director of National Health Service England commented in late March that keeping the death toll from coronavirus under 20,000 would be a “good result.”
It turned out that the government was, at the time, reporting only deaths in hospital settings, which according to the Financial Times, represent only around half of the total. And even deaths in hospitals have now exceeded his target.
As a result, we do not currently have an official target for total deaths.
And this is worrying. If Warren Buffett is right about the risks in business of not defining your targets up-front (and of course, he is), then the point is doubly important when so many lives are at stake. Without a pre-defined target, there is nothing to stop the government ‘painting the bull’s-eye’ around, say, 200,000 deaths and declaring it a success.
This article considers what might be a reasonable target for the government to set, assuming good management of the pandemic in future months. It does not consider whether all past government actions have been optimal.
We believe that lockdown has worked well enough for a figure of 80,000 for coronavirus-related deaths in all settings still to be achievable with good management of the remainder of the epidemic; but remaining below this target requires co-ordinated medical and economic action by the government.
Lockdown has been effective
Let us start by looking at the official daily deaths figures which, as explained above, are apparently precise, but far from complete. The picture looks like this:
And from this picture, it seems clear that the death toll has started to decline. What happens if we look at total deaths? Now, we do not have precise figures, but they are comprehensive. The picture now looks like this:
The numbers are far higher, but the overall message of the picture is the same: we have passed the peak of deaths (if we don’t now mismanage the pandemic). Even though we do not have accurate figures for the number infected, we can be confident that this passed its peak some weeks ago, because of the natural dynamics of the virus.
So lockdown has worked. But how well?
If we maintain effectiveness, we can keep deaths to under 80,000
Our modelling of a range of scenarios suggests that the actual data are tracking reasonably closely to our ‘hard lockdown’ scenario.
This is a very significant result. In the absence of any lockdown, in the laissez-faire scenario, we would already have seen hundreds of thousands of deaths and be well on the way to a death toll of around 400,000. Instead, we are at around 50,000 deaths and, if we were to maintain strict lockdown, on our way to a death toll of around 65,000.
What would happen to the death toll if we just declared victory and unlocked fully at the end of May (as some have called for)? Initially not much (again because of the dynamics of the virus), but soon we should see another spike and if we left it unchecked, the death toll could still rise to around 400,000. The dotted line above illustrates how the death toll would rise if we returned to pre-lockdown behaviours and rates of infection; if we did not, the rise would of course be slower. So getting it right from now on is critical.
What are the options? They include:
- (Options 1) Maintain strict lockdown (and maintain strict quarantine on international travellers to stop reintroduction) until the virus is eliminated or a vaccine becomes available – but the economic costs of this are enormous, as is the suffering imposed on the most vulnerable in society;
- (Option 2) Maintain strict lockdown until we have the capacity to Test, Trace and Isolate (TTI) the remaining cases – we have estimated that this would require lockdown until September (assuming that the government can build up industrial scale TTI capability by then)
- (Option 3) Loosen the lockdown slightly now and invest heavily in TTI, then unlock in September when TTI is in place — but the looser lockdown will both cost more lives and increase the scale of TTI needed.
There is enormous pressure on government to unlock; and much real suffering caused by the lockdown, so let us assume that option 1 is simply infeasible.
Option 2, to a lesser extent, suffers from the same problem. If we could do it, we might hold the death toll to under 70,000, but the risk of anti-lockdown riots of the kind America is facing would be significant.
So it is worth looking at option 3, as well. Instinct suggests that moving to a loose unlock would necessarily mean over 100,000 deaths as shown on the soft lockdown line. But that may not be the case: because we are so far over the peak, the impact of a slight loosening now is far less than the impact of a soft lockdown in March would have been. If we are careful (and skilful and vigilant) we can contain the additional death toll to around 2,000-3,000. Equally seriously, however, a slower decline, which would be an inevitable result of such a loosening, would mean that the caseload of infected people needing TTI in September would be around 40 times greater; and we know that building up testing capacity has been difficult.
So there is no perfect option, but there are at least two variants of lockdown followed by TTI that could contain the final death toll to below 80,000. That is our suggestion for the new target.
This requires a carefully coordinated programme and no major errors
There are many ways this could still go wrong:
- Economically, we could allow too much ‘scarring’ to take place during lockdown for a rapid bounce back afterwards – this could happen if either:
- Otherwise viable businesses go bankrupt in large numbers or reduce capacity sharply to avoid bankruptcy, creating a supply-side problem
- Households – especially vulnerable households – find their balance sheets destroyed during the lockdown, creating a demand problem (or in extreme cases causing riots and uprisings)
- Medically, we could:
- Fail to maintain adequate lockdown and either permit a second wave (disastrous) or fail to reduce the volumes of infected cases sufficiently sharply (serious)
- Fail to build adequate and reliable TTI capacity.
So this requires joined-up thinking, creativity, and openness to suggestions from outside the heart of government.
Nevertheless, the overall picture is dramatically better than it looked in mid-March: at that time, there was no lockdown and we appeared to be following the laissez-faire line which would have taken the overall death toll to around 400,000. Now, with careful management, we could aim to contain it to one fifth of that number.
And do sign-up and join the 99% Organisation.