COVID-19: HOW COULD A LIGHT SECOND LOCKDOWN WORK?

When I was on air this morning I avoided saying the word "lockdown" for as long as I could.  Apart from the fact that the word is poison, there are some practical matters that must be considered for another national lockdown to work:

• The need for the lightest possible lockdown
• Pre-conditions
• Experience with local lockdowns in Leicester and elsewhere
• Crucially, keeping infection rate very low thereafter
• Level of infection when lockdown started

So here's the analysis.


THE NEED FOR A LIGHT LOCKDOWN

It may surprise you that back in March I first favoured a light lockdown, similar as it turned out to Sweden's approach.  Accepting a low level of deaths, like we do for 'flu, so that we could continue with everyday life. That is because of the significant 'side-effects' of a lockdown, which were predictable and we have now experienced.

Balancing lives, livelihoods and life.

But with no vaccine or effective treatment for COVID-19, the level of deaths and serious illness requiring hospital attention was simply too high.  The same applies now, with the added issue of far higher numbers of people suffering from LongCOVID.

So just like treating any medical problem, as long as the medicine is better than what is being treated, it is worth doing.  That has proved to be the case, back in March and now.  A lockdown, as light as possible, being imperative.

In the case of COVID-19, we need to look from two perspectives:

• The six risks to individuals are such that action is needed.  
• From society's and the Government's perspective, there is also the need to avoid over-running the NHS.  That was the key reason the Swedish approach could not be adopted in the UK, and still couldn't.

TIMING OF A SECOND LOCKDOWN

Doing a lockdown back in the summer would have had three distinct advantages:

• It was more practical to do activities outdoors, which is considerably safer than indoors.  That includes all hospitality, such as pubs, cafes and restaurants
• Schools were on holiday
• Universities were on holiday

Any lockdown should do four things if at all possible:

1. Measures: Be somewhat stricter than the measures announced this week
2. Outdoor activities: Allow activities such as sports and hospitality outdoors or in very well ventilated areas (such as open-sided marquees)
3. Schools: Keep schools open if at all possible. Sweden only closed schools for over 16s
4. Universities: Keep universities open, with tuition provided without students needing to congregate

PRE-CONDITIONS

There are four pre-conditions to doing a national lockdown, only one of which I had chance to mention on air:

1. Strategy and policy: The Government must commit to keeping the infection rate very low, #NearZero
2. Financial support: This must be provided to individuals, businesses and other organisations during lockdown
3. Public Attitude: The public's voluntary commitment to keeping infections very low must be gained, through much improved communications with the public.  That must include explaining the 'whys' as much as the 'whats'.  Like any sales exercise, all the contrary "objection" viewpoints need to be tackled and overcome.  Fines very much as a last resort.
4. Immigration Arrangements: A more effective quarantine and release procedure needs to be in place to suitably control not just people, but also things coming into the country. Last I heard chilled food packaging was still suspected as being a source of New Zealand's outbreaks.

EXPERIENCE WITH LOCAL LOCKDOWNS

One of the advantages of Sweden's approach was anticipating that people would get fed up with enforced lockdowns, whilst realising that COVID-19 would be around for a considerable time.  It is a pity that we cannot follow their lead.

So how have the local lockdowns worked?  As effectively as the first national lockdown?

Here is Leicester's experience:

It was possible to get daily infections down to around a fifth of the peak, before they began increasing again.  Similar results were achieved in Oldham, Wigan and other parts of the north west.

My belief is that even better results could be achieved with improvement in communications, at least as good as the first lockdown.

KEEPING INFECTION RATES VERY LOW THEREAFTER

Keeping infection rates very low after a lockdown is absolutely critical, otherwise any lockdown is a waste of effort.  I'm not suggesting regular lockdowns as a matter of expectation or policy.

The sad thing is that as soon as an infections reduction has been achieved, it's then shot up again.  This has been seen in Leicester, Madrid and many other places.

How can the infection rate be kept very low, so further lockdowns can be avoided?

The basic anti-transmission measures (Space, Face, Hands in that priority order) must become second nature.  For all age groups.  That includes young adults, for reasons explained by the senior scientists.  That requires:

• Clear communication of the 'whys' as well as the 'whats'
• Establishing a social pressure, just as drink-driving has become socially unacceptable
• Wardens to help educate, encourage and chide.  These could be the "COVID marshals", perhaps combining their role with 'boots on the ground' contact tracing

LEVEL OF INFECTION WHEN LOCKDOWN STARTED

In the summer "confirmed new cases" were under 1000 a day.  We know these are only the tip of the iceberg, with total new cases around five times that number, at the testing levels since July.  This is because:

• Not everyone with symptoms gets tested
• Swabbing can result in 30% or more false negatives
• Asymptomatic people are not tested, who can nonetheless be carriers

A 'very low' rate of infections is under 1000 per day across the country, or 200 official new confirmed new cases.  That's 0.3 per hundred thousand a day, around 2 per hundred thousand a week in official terms.

The first lockdown took new infections down to a sixth of the peak level in three weeks, plus the time it took before the level peaked:

The higher infections are let to rise, the higher the starting point, and the higher the level achieved after 3-4 weeks.  So on a rising curve, the sooner a lockdown is started, the less time it would take to get to a specific lower level.

In the summer a rate of under 1000 a day nationally could have been reduced to 200 official "new confirmed cases" comfortably in three weeks.  Now official rates are 4500 a day, but could already be much higher as:

• This figure could be as much as two weeks out of date given that people take some time to develop symptoms and get tested.  
• Recently people have had symptoms and not been able to get tested.

There is no time to lose!  Let's get the pre-conditions in place and get into lockdown.  Before it's too late.

Update 28/9/20:  Daily infections have now risen to over 5700.  A lockdown similar to the first would not be sufficient to get infections down to very low levels.  A more robust "circuit break" in the form of a Mass Self-Isolation would be needed.  But the good news is it could be as short as 2 weeks.


AREN'T PM JOHNSON'S MEASURES ENOUGH?

The headline from Wednesday's "i" newspaper makes it clear that scientists do not believe the new measures go far enough.

Indeed the paper quotes Paul Hunter, professor of medicine at the University of East Anglia, as saying "It is doubtful that the measures currently being enacted will be sufficient to reduce the R value to below one much before this side of Christmas".  That's daily infection rates continuing to grow, albeit at a slower pace.  Not reduce, as is needed.

Over recent months the measures introduced in Scotland have tended to be stricter than England's, and this week is no exception.  Scotland's First Minister,  Nicola Sturgeon, is quoted as saying she had been advised by Scotland's Chief Medical Officer that PM Jphnson's proposals "will not be sufficient to bring the R number down".


IN CONCLUSION

There is no doubt that the infection rate cannot be left to rise.  The Government was right to introduce new national measures, but they do not appear to go anywhere near far enough.  Too little, and frankly too late.

The right balance between lives, livelihoods and life, as explained here, is at a far lower level of infection.  An investment in a tougher lockdown, whilst preferably light enough to keep schools and universities open, would be well worthwhile.  Provided it is conducted in accordance with the necessary pre-conditions.