COVID-19: OPENING THE ECONOMY. OPENING THE ARTS

Three tiers

UPDATE FROM PRESS CONFERENCE 12 OCTOBER

Three key points were mentioned by PM Johnson and colleagues this evening:

• A repeat of the lockdown like we had earlier in the year is to be avoided because of the harms, such as prolonged harm to education
• Chief Medical Officer Professor Chris Whitty said we need "balance and middleway" between health and the economy
• The Chancellor Rishi Sunak said in respect to the events and nightclub industries that we need to "try and find a way to get your business back to life"
  

This blogpost does exactly that.  The suggestion is a short, sharp 'Fire Break' to re-open the hospitality and night-time industries, balancing health and the economy, without a repeat of a lockdown.

 

 

ORIGINAL FROM EARLIER 12 OCTOBER

PM Johnson has just announced a set of three-tier measures to try to suppress the SARS-COV-2 virus that causes the COVID-19 disease.

The result will be to kill the hospitality industry and kill the Arts across the country.  Affecting millions of people involved directly and indirectly in those industries.  The employed and the self-employed.  Taking the fun out of life for everyone.

At enormous cost to the Treasury in lost tax receipts and extra support costs.  With requests to extend furlough beyond the end of October.

How do you feel about all that?

Is this really the best strategy?  Let's look at the alternatives.  Especially to see what could open the Arts, and thereby open the whole economy.  Getting life re-started.

WITH A VACCINE AND MEDICINES

A key way to get life re-started is to create mass immunity through use of a vaccine.

Back in March there was hope to have a vaccine by September.  September has come and gone.  Those of us who said there won't be a safe and effective vaccine available until 2021 are looking to be more correct.  Indeed the experts have said a vaccine isn't guaranteed.  

That is because a vaccine would need to be safe and effective for a year at least to be a viable option.  Testing that in shorter time scales is very difficult.  Having worked in the biotech industry, developing drugs, I've seen so many high hopes get dashed.  But we must hope.  Fingers crossed. 

Medicines have been tested in hospitals, and Dexamethasone has come out as a good treatment.  However to my knowledge there has been no drug or treatment developed that is for home use, though this is changing fast with potential anti-virals.  Little or nothing to help keep people out of hospital, by which time any body contracting the disease will have been exposed to five risks:

• Initial long illness, often 2 weeks or more

• Second phase of illness, like PM Johnson suffered.  This can include a 'cytokine storm' where the body's immune system over-reacts, and can be one reason for hospitalisation

• Strokes, even in the young and healthy because the virus causes microclotting when it gets into the blood stream
  

• Long term lethargy, which again is disruptive and may mean being off work

• Other LongCOVID symptoms, where the virus has attacked other organs such as heart liver, kidneys, digestive system and brain, which can go on for months if not a lifetime

So in the absence of a vaccine, medicines and treatments, it is important to defeat the virus.  For health reasons, in addition to opening the economy and opening the Arts.

 

How can we do that?  Let's examine the options, in increasing order of severity of restrictions:

HERD IMMUNITY

The idea is that rather than create immunity with a vaccine, enough people have caught the virus to create natural herd immunity, which would allow normal activities to resume.  A figure of some 60% of the population would be required.

There are a number of significant problems with this approach:

• To get to 60% of the UK population of some 67 million it needs some 40 million to be infected.  34 million in England:
• At current infection rates of 14,391 per day in England (the latest 7-day average), it would take 2,362 days to reach that target. Taking into account a roughly 5-fold understatement, that would still be 473 days or 1.3 years.  After Christmas 2021.
• To reach 60% by Christmas 2020 the infection rate would need to be some 450,000 new infections per day
• Both options clearly unachievable in any reasonable timescale
  

• The health service would be overrun long before herd immunity was achieved

• Deaths arising would go through the roof, as would cases of LongCOVID

As a result, no country to my knowledge has adopted a herd immunity strategy.  Sweden did not, as covered below.

FOCUSED PROTECTION (THE GREAT BARRINGTON DECLARATION)

This recent paper is a variant on herd immunity, and therefore suffers from the same basic issues.

 

To which they add the suggestion that older and otherwise more susceptible people should self-isolate.  That in itself is unacceptable.

 

The issues this approach is trying to solve are very real.  But the solution? What tosh!  Discussed in more detail here

 

 

SWEDEN'S STRATEGY

 

Back in February and early March I was suggesting a strategy for the UK that turned out to be very similar to the one that Sweden adopted.   I am still prepared to place an each-way bet of a fiver that after one or two winters Sweden's approach will turn out to be one of the three best countries in terms of strategy.  At least as suited their specific circumstances, and considering all factors such as keeping schools open, not just deaths.

The reason being that it recognised the harms of lockdowns that underlie the Great Barrington Declaration.  But rather than go for herd immunity, Sweden adopted a 'balanced' strategy, taking a longer-term view, that involved three main aspects:

• Prohibited large gatherings over 50 people, with obvious implication for the arts and sports industries
• Retained schooling, but only for under 16s
• Made any lockdown voluntary, but with a high emphasis on social distancing

Sweden has been able to continue without a formal lockdown is that the health service there hasn't been overrun.  Though there was been a very high initial cost in deaths.

It was clear by early March that such a strategy in the UK would overrun the NHS, which is why I realised a lockdown was necessary here, and supported it.  

The risk of overrunning the NHS is still the case, and so the Swedish approach is not appropriate for the UK's situation.  Click this link for a more detailed discussion of SO WHY NOT SWAP TO SWEDEN'S STRATEGY?

EUROPEAN LOCKDOWNS AND OTHER RESTRICTIONS - 'SUPPRESSION'

With the exception of Sweden, European countries have followed a 'suppression' strategy, including a formal, legal lockdown.  There are several problems with lockdowns:

• Lockdowns have several nasty 'side-effects', that I documented back in August, many of which we have each experienced in our own lives.  These have been the background to the Great Barrington Declaration, and an increasing number of people thinking it best to let the virus 'let rip'.  As discussed, absolutely inappropriate

• The lockdowns have been long, typically more than six weeks before any relaxation.  For the UK, some parts of the economy have yet to open.

• The tougher the lockdown, the faster the resurgence of the virus, it seems.  Spain had a very tough lockdown, with people being effectively under house arrest for weeks.  They already have more than 10,000 people in hospital in this second wave.
  

Here's a summary of the latest situation (dated 12 October) in countries around Europe.

Each country is desperately trying to avoid a second national lockdown, instead relying on local restrictions.  But these restrictions are clearly not working, and the decision for no second lockdown is more a political one, but understandable given the side-effects.

ELIMINATION

Several countries have attempted to eliminate SARS-COV-2 from their country, and to a certain extent have succeeded.  The result is that they can re-open every part of society.

In New Zealand, hugs were back.  Or were until there were several outbreaks, for which their response has been another long, harsh lockdown.  Despite their relatively distant isolation from the rest of the world.  That geographical distinction and repeated lockdowns would not work here in the UK.  

The problem is that until the virus is eliminated worldwide, termed "eradication", there will always be 'leakage' of the virus into a country.   Despite the tight controls such as New Zealand have instituted on people arriving into the country.  A cold storage for imported food has still not been ruled out as the cause.  With widespread use of a vaccine, global eradication would take several years at least.  We need to learn how to live with the virus.

Countries in South East Asia have also been somewhat successful in eliminating the virus:

• Wuhan Province:  Where the virus first surfaced in the human population, they had a tough 11-week lockdown, yet cases still resurfaced
  
• Singapore has very close ties to Wuhun, so was one of the first places to record infections
• South Korea.  Here is how they control people arriving from foreign countries
  

There is much we can learn from these examples.  But we have to recognise that the culture is different in that part of the world, and the Governments can have much stricter control over their citizens.  What works there will not necessarily work here in the UK.

SO WHERE DOES THAT LEAVE US IN ENGLAND AND THE UK?

There isn't a simple proven way to get an economy fully open without significant 'costs'.  Those 'costs' can be financial, deaths, LongCOVID, or all the 'side-effects' of lockdowns.  

 

Elimination has its attractions, but only at the cost of significant lockdowns.  Best avoided.

The Swedish approach can only work if infections can be kept within the hospital capacity limitations, and then only if natural immunity will last for a significant period of time.  Not suitable for the UK.

But could there be a better way?  Balancing the conflicting objectives to minimise them all?

 

Indeed there is one other option which to date has received little publicity.  Madcap, but we must consider every idea if we are to stand any chance of getting the economy open, including hospitality, and the Arts open.  

Indeed the latest briefing on new cases and hospitalisation today 12 October has shown clearly that action is needed. 

TEARS FOR TIERS

PM Johnson has today announced the UK Government's proposals.  There are three tiers of restrictions that will be applied across England, with each area placed into one of the tiers.  In outline:

• Medium: Such as Rule of Six, possibly strengthened in England to be more similar to that in Scotland
• High: Similar to those already in place in Northern England.  Limitations on households meeting indoors
  
• Very high:  Hospitality industry closed down, but schools and retail to remain open.  Travel restrictions by advice rather than law, though that may change.
  

The Night Time Industries Association is threatening to sue the Government should hospitality businesses be further restricted, such as being closed, citing the lack of scientific evidence for the measures.

 

Indeed the continued rise of infections in Northern England suggests the measures are simply not effective.  Something stronger is needed.

Sir Keir Starmer responded to PM Johnson's statement by saying "We are at a  tipping point...the need for decisive action...question whether the restrictions can bring the country back from the brink...now deeply sceptical the Government has got a plan to get control of this virus... we need to break that cycle and finally get on top of the virus."

So what could we do?

 

WHAT DID THE ORIGINAL LOCKDOWN ACHIEVE?

The lockdown earlier in the year produced a significant reduction in infections, but went on too long, causing major problems from side-effects.  Indeed some restrictions are still in place.

What's the alternative?

 

A MASS-SIM SELF-ISOLATION - 'SUPER-SUPPRESSION'

If we want a significant reduction in infections in a shorter period, the action must obviously be more stringent.  Super-suppression.

Currently the Test/Trace/Isolate system means that any individual must be ready to self-isolate for 14 days if instructed.  People shouldn't be infectious after 14 days.

It simply follows that if we were all to do that simultaneously, after 14 or perhaps 21 days to allow for further infection within households, we would all no longer be infectious.  If we could do a total mass-simultaneous self-isolation that would mean 'elimination' of the virus.  Though with the prospect of re-occurrence as has been found in New Zealand and the others.

But this is the real world.  There are some activities that are absolutely vital, such as hospitals, care homes, prisons and domiciliary care.  There are also industries that are vital, such as water, electricity and internet, and industries that cannot be easily closed down such as steel furnaces.

Indeed the key difference between 'essential' as in the first lockdown and 'vital' is food production and distribution, including shops.  This should all close, with practical arrangements put in place for the supply chain such as milk and imports.

How can we get away with that?  As we've seen, people should be stocked up with food, medicines and other essentials for 14 days in case of a self-isolation request.  Just make sure it is 21 days.  That would allow all retail to be closed.

This "Fire Break" could be an extended Bank Holiday, with online banking taking place but all other banking activities suspended for the duration. 

Whatever the period chosen for the Fire Break, this must be finite and not extended. A guarantee that the economy can reopen as soon as that period has finished.

The result would be a significant reduction in infections.  In theory enough to reopen hospitality, the Arts and potentially every other industry.  Certainly to put England in a far stronger position than we are at present.  For at least some weeks, when we could perhaps do it again. 

Better for lives.  Better for livelihoods.  Better for the Treasury, through improved tax receipts and reduced social security costs.

A Bank Holiday 'Fire Break' wouldn't be easy.  There are a number of 'dark orange' issues that are difficult to overcome.  But if the attitude is that this strategy would be worthwhile, all such issues can be overcome.

Further details are here, and at the very least should be publicly debated.