Hanover

8 Apr 2020

Britain joined the world’s creeping Covid-19 quarantine on Monday March 23 with restrictions on freedom of movement and the shut-down of entire business categories. Forecasters at Nomura have since predicted economic damage unseen for 100 years, suggesting a drop in UK GDP of 7.8 per cent for 2020 (the worst since a 13 per cent fall in 1921). And this is quite aside from fears about the human cost in terms of mental and physical harm.

Not surprisingly, after two weeks of lockdown, increasing numbers of businesses and citizens are asking when the current restrictions may be eased. The UK government’s declared position is that there will be three-weekly reviews. While in theory, this means the restrictions could end as soon as Tuesday April 14, nobody in government expects a change that fast. The first trigger for change needs to be a deceleration in Covid-19 cases and deaths, sustained over two or three weeks, signalling that the gradually-expanding intensive care capabilities of the National Health Service (NHS) will not after all be overwhelmed.

If the current restrictions are working as intended, we may see cases peak at or just after the Easter weekend. But whenever the sustained drop-off comes – what next?

The Treasury seems to have “led the charge” in forcing departments to begin looking at the numerous answers to that question. Ministers and officials there are motivated by concerns that the threat of bankruptcy could spread exponentially to otherwise profitable UK businesses if the current restrictions creep beyond the end of June.

What is already clear within Whitehall is that the easing of restrictions will be a process, rather than an event. One approach being looked at is the ending of restrictions by industrial sector, possibly by extending who is classed as a “key worker”. But there could also be adjustments to the restrictions by geography, or by viral “hotspot”, or by age, or by the health status of individuals.

Whichever path or paths are chosen, decisions link to others that will be required. How will a selective return to work be policed? How will the logistics of mass testing work? When will there be an antibody test that can reliably show who’s had the virus and developed some level of immunity, given early results internationally appear disappointing?

Possibly the most methodical study of how to handle Covid-19 and then end a national lockdown, has just been published by the American Enterprise Institute (AEI). It is authored by an epidemiologist and a health security professor at Johns Hopkins University, alongside three senior ex-post-holders at the Food and Drug Administration. Their work breaks down Covid-19 handling into four stages:

Phase 1 envisages a lockdown along the lines now being implemented in the USA and already in place across a number of the mature democracies, including the UK. The authors say this phase should end once there has been a sustained reduction in Covid-19 cases for 14 days, provided that health services have been ramped up to deal with new cases still likely to emerge – and provided there is the capability to do full testing of suspected cases, combined with tracing of their contacts.

Phase 2 is the easing of the lockdown. As outlined above, the authors suggest an end to the lockdown once Covid-19 cases slow to such an extent that health services can treat sufferers without buckling – but they also suggest only a partial return to normal life. Yes, schools and businesses reopen (the process may be phased), but home-working should continue “as much as possible”. And some physical distancing measures and limitations on gatherings will – according to the AEI – need to remain in place to prevent transmission from accelerating again. Specifically, the AEI authors suggest:

  • Continued restrictions on the movement of adults over 60 and those with certain underlying health conditions. They do not make proposals on how this might be policed.
  • A limit to gatherings, with a suggested cap of 50 congregating together. Though the authors do not spell it out, this of course implies an ongoing impact for sports, entertainment and the arts, and continued queues at supermarkets. Neither do the authors probe the implications for mass transit systems, or comment on whether to impose carriage-limits on buses and tubes. This is the kind of delicate question which will in time need to be judged by politicians.
  • Requiring people to wear fabric non-medical face masks while in the community to reduce their risk of asymptomatic spread.
  • New, tougher regimes of public hygiene, with more routine deep cleanings of shared spaces, and shared surfaces more frequently sanitised.
  • Those who are sick will be asked to stay home and seek testing for Covid-19. Testing should become more widespread and routine as point-of-care diagnostics are fully deployed.
  • Case-based interventions that more actively identify and isolate people with the disease and their contacts.
  • Use of (yet to be developed) antibody tests, to establish who has had the virus and possibly developed some level of immunity.

Phase 3 sees the restrictions suggested for Phase 2 lifted once a vaccine is available – or, failing that, public health monitoring systems have been built and are able to detect any new surge of the virus, together with anti-viral treatments to ease symptoms and improve the survival chances of those who do become infected. The authors recommend full transparency over the criterion governing who receives vaccinations first – in the UK, this is likely to be NHS and care home workers.

Phase 4 anticipates an approximate doubling in public health infrastructure to prepare for any future pandemics – specifically an increase in intensive care beds and equipment, including ventilators.

The AEI’s work has already begun to draw interest from British MPs sceptical of certain suggestions from UK government advisor Professor Neil Ferguson, of Imperial College, London. He has spoken of an ebb-and-flow approach, where today’s restrictions are lifted and re-imposed every few weeks to deal with feared secondary surges in the virus.

Ferguson thinks this may be the way forward after a lockdown of three or four months, but some politicians wonder how real-world this idea is.  As the former minister, Nick Boles, has stated bluntly: “We cannot proceed this way. Most people…. will not comply… businesses cannot be expected to stop and start productive operations whenever epidemiologists tell them.”

One question not yet being fully debated in the UK is how we – or any country – ends a lockdown if nobody finds an antibody test that works to establish who has had Covid-19; or if we find that humans develop only a limited immunity to the virus after infection.

Under those circumstances, logic points to lockdowns being ended in line with the AEI’s “Phase 2 restrictions”, with politicians explaining the risks and ensuring that anyone who does contract the virus is guaranteed the health care or intensive care they need.

Interestingly, this is pretty much what we are about to see in Austria, where Chancellor Sebastian Kurtz imposed restrictions on March 16 and announced on April 6 his plans to ease them – ahead of any reliable antibody-testing kit being available.

Kurtz described to a news conference how his government envisages “a step-by-step reopening” after a radical fall in the number of new Covid-19 cases. Non-essential stores of less than 4306 square feet (400 square meters) and DIY shops will be opened on April 14, followed by all shops, malls and hairdressers on May 1. Citizens using public transport or visiting supermarkets will be required to wear face masks.

Denmark also plans to respond to its slowing virus numbers with a gradual easing of the lockdown which began there on March 11. Day care centres and schools for children in first to fifth grade will reopen on April 15. Other restrictions including a ban on gatherings of more than 10 people, will stay in place until at least May 10, while a ban on larger gatherings will remain in place until August. The Danish prime minister, Mette Frederiksen, has cautioned that the gradual reopening will happen only if virus case-numbers remain stable.

The UK debate about how and when the current restrictions are to end will grow louder for every day that the lockdown continues. Sensitive decisions about timing, policing and how to phase any ease-up will be required by the prime minister or those deputising for him.