Then we saw how Italy's health service was so quickly overrun, and it was clear this 'novel coronavirus' would be much more difficult to handle. "Patients who cannot be treated are left to die." said the mayor of Bergamo at the time.
Not only would a disease out of control like this likely overrun any health service, it would quickly bring any country to a halt as people fell ill, died, and panic spread.
Lockdowns were the obvious 'medicine' to keep people apart and thus stop transmission of the virus. Or at least minimise its spread, given some essential functions needed to continue, such as food production and distribution.
HOW AND WHEN TO LOCKDOWN
New Zealand eliminated the virus and were able to get back to normal after a couple of months. For three months, before the latest surge in cases. Another lockdown, initially for three days, but now extended for another two weeks. Elections delayed by a month.
It's difficult to see how this on-off approach to lockdowns can be sustained.
Their strategy was to prohibit large gatherings over 50 people, but otherwise leave the public to do what they felt was right.
Schools for under 16s stayed open, businesses stayed open. Citizens otherwise did their own lockdown, for example cutting internal travel as much as neighbouring countries. The economy has shrunk, but mainly as result of lower exports.
They've taken a bigger hit in deaths short-term than their Scandinavian neighbours. But through luck, or good judgement, now look to be benefiting from cross-immunity from 'common cold' coronaviruses. Overall they've avoided the worst ravages of a lockdown, by not having one, so do not have to worry about how they ease it.
Whereas Sweden has been able to avoid their health service being overrun without an official lockdown, it quickly became apparent that the UK and other European countries had a bigger problem.
A formal lockdown was needed in England, as otherwise the consequences would have been far worse than the side-effects:
- Hospitals overrun and unable to provide services for COVID-19 or for other health conditions
- Life in general coming to a halt through absenteeism and panic
Whilst it can be argued whether the UK should have locked down earlier, the lockdown on 23 March did two things:
- Reversed an exponential rise in infections, so that within a few days infections started to reduce
- Reduced infection rates by some five sixths from the peak to three weeks later
It has been estimated that the lockdown had an R number (or an RCF rate) of 0.57. Mathematically another lockdown designed to have an RCF of 0.5-0.6 will also reduce daily infections by an equivalent proportion, down to about a sixth of the starting level (if done before it starts rising).
LOCAL LOCKDOWNS
Earlier in the pandemic the ministers and health experts at the Downing Street press briefings insisted that there would not be local lockdowns.
Since when it has become apparent that local surges that threaten to overrun the local NHS need lockdowns, such as in Leicester and the North West. But do not necessarily warrant the whole country locking down.
WHEN WOULD ANOTHER NATIONAL LOCKDOWN BE NEEDED IN ENGLAND?
Infections in an area are monitored by the number of new cases per day per hundred thousand of population.
The UK government appears to have set a local level of about 30 for England to consider and invoke a local lockdown, especially if infections are growing. Where adjacent towns are displaying a similarly large number, the areas merge into a fairly sizeable region.
But Professor Chris Whitty had suggested in early May that 1000 new cases per day across the country would be a sensible level, equivalent to about 2 per hundred thousand. That is regarded as "very low" as distinct from "low" as at present.
The hope has been that infection rates over the summer would drop to that a very low level, with people being more outdoors, where transmission is less of a risk. But rates remain stubbornly high, at ten times that level or more.
Which raises the other reason for a lockdown, which is to get infection rates down further than is possible by any other means.
As discussed here, reducing the lockdown threshold to about 2 per day per hundred thousand would mean vast areas of the country would need to merge into one for lockdown. At which point it makes far better sense to do as originally hoped and make it a national lockdown.
JUSTIFICATION FOR ANOTHER NATIONAL LOCKDOWN
Why would reducing the infection rate justify the side effects? How tough would the lockdown have to be? When should we do it?
What are the benefits of a further lockdown? There are several problems that arise from the infection rate nationally being as high as it is:
- Schools need to open and stay open. Currently there is a distinct risk that a school will have to temporarily close. Then re-open, then close, then re-open. That willy-nilly approach will not work for parents nor their employers.
- In any case many parents are still very reluctant to let their children back to school. This is especially the case for teens, where infections can spread as if for adults.
- A lot of people are still reluctant to go out to shops, restaurants and other places to spend their money. Without confidence rising, the economy cannot recover as well as might be hoped. Personally I have a simple rule. Outdoors not indoors, except to buy food
- Entertainment venues cannot open safely without infection rates being right down
- Public transport is not safe enough. Carlyle for example has stipulated that employees should only go back to work if they do not use public transport
- People who have been shielding are still extremely worried about the risks, especially parents of children at school
- With the prospect of a second wave as summer turns into autumn and onto winter, when people spend more time indoors, it makes sense to get infections as low as possible beforehand
Infection rates havn't dropped sufficiently to address these problems, nor is there any sign that they will. But they will substantially reduce if Professor Whitty's target is adopted. That's not going to happen without a lockdown. So that is the only alternative. A lockdown, despite the side-effects. Probably only 3-4 weeks to get the level of reduction required, with an RCF around 0.5.
Those side effects come at a cost, especially for the businesses affected. But that investment will pay back substantially for those businesses, and for society as a whole in the coming months by reducing our current issues:
- In extra tax and reduced costs for HM Treasury
- An improved quality of life for us all
- Less fear of death and LongCOVID
I suggested in a letter published in the Financial Times in June that a second national lockdown should take place in England, so as not to disrupt the holiday season. Then again in August, so it was complete before the schools were due to go back. As light as possible, to let people have some life, whilst avoiding the riskier activities, such as no large groups as appears to be the main issue in Germany
My sources tell me that the government has considered such a national lockdown, but has chosen not to do so. At least not yet. As we near the end of August, we have the chance to do a national lockdown in September, once most family holidays are over, but that would require delaying schools going back.
Or the government will delay the lockdown like they did the first time in March. Which will cost lives and livelihoods over the coming months.
How would the public respond to a second lockdown? It would have to be sold well to them And there needs to be a proper education programme so people understand the why and not just the what. Voluntary compliance being better and longer lasting than when it is enforced, as Spain has found with significant surges in their cities now their overly-strict lockdown has been eased.
Contact tracers could be redeployed as 'wardens' to educate, encourage and when necessary chide, perhaps alongside their contact tracing duties.
ACTION REQUIRED
Lockdowns can be justified, once infections hit a country or territory, in two circumstances:
- To halt and reverse a surge in infections
- To get a stable infection rate down, such as from 'low' to 'very low'
It is clear that the benefits of getting infection rates in England down to the very low level originally suggested by Professor Whitty would far outweigh the side-effects of a lockdown. A short national lockdown is now needed, as soon as possible.
The need to get infections down before the winter and keep schools back must take precedence. Shouldn't it?
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