Several politicians, including Keir Starmer, the opposition Labour Party leader, have been demanding to know the exit strategy for the lockdown. "We should know what that exit strategy is, when the restrictions might be lifted and what the plan is for economic recovery to protect those who have
been hardest hit," he said last week.
This is an entirely valid question, but the Government cannot have an exit
strategy unless they have an overall strategy. One follows directly from
the other.
And there are only four possible strategies:
To eradicate the virus from the entire population by enforcing lockdown. Or
to enforce lockdown until there is an effective treatment. Or to enforce
lockdown until there is a vaccine. Or to enforce lockdown to slow the
spread of the virus, so as to prevent the NHS from being overwhelmed.
Eradication is virtually impossible with such a highly infectious disease.
Even if the UK was successful, if other countries were not, keeping
Covid-19 out would require border closures for years, maybe decades.
Endless checks on planes, boats, lorries, cars. Constant testing and
restrictions. It is almost certain that the virus would still slip through.
This does not seem a viable option.
What about finding an effective treatment? The chances are vanishingly
small. Influenza, a very similar virus, has been around for decades, and no
game changing medications have yet been found.
As for a vaccine? This solution is so distant that it does not really
exist. It will be a minimum of eighteen months before an effective vaccine
can be developed, then tested, then produced in sufficient quantities to be
of any use. Waiting for eighteen months before releasing lockdown would be
socially and economically impossible. We would be committing national
suicide.
Ergo, there is only one overall strategy that can be followed. Control the
spread to avoid overwhelming the NHS. This has never been made explicit,
but the Government has, albeit indirectly, told us that this is exactly
what they are doing.
In the last few days, a letter was sent to all households, signed by Prime
Minister Boris Johnson, before he too succumbed to the disease. It was
entitled "Coronavirus – stay at home; protect the NHS, save lives." It
contained this key passage:
"If too many people become seriously unwell at one time, the NHS will be
unable to cope. This will cost lives. We must slow the spread of the
disease, and reduce the number of people needing hospital treatment in
order to save as many lives as possible."
The key sentence is the first. If too many people become seriously unwell
at one time.
This fits with the initial UK strategy. Contain, delay, research, mitigate.
The UK has passed through "contain" and is now in "delay and mitigate".
Research sits in the background and may, or may not, provide a solution.
However, delay and mitigate doesn't mean that people will not become
infected and die. It just means that the NHS will not be overwhelmed by a
massive wave of people getting ill at the same time. We are simply, it
should be made clear, trying to control the "peak", which now may likely be
a series of "peaks".
At present, ministers are not admitting this. They are presenting lock-down
as a way of "beating this virus." In order to enforce lockdown, they are
haranguing and scaring the population into compliance.
Covid-19 is being presented as a deadly killer that does not discriminate.
Young, old, we are all at risk of contracting this dreadful disease. Every
night, the television news has story after story of young people who have
been infected, and who have died. In fact, very, very few people under 20
have died so far. I believe it was five, at the end of last week.
There is hardly anything said about the fact that the average age of death
is around eighty, that the vast, vast, majority of those dying are old (92%
are aged over sixty) The great majority of them have several other serious
medical conditions.
The reality is that for anyone younger than about sixty, Covid-19 is only
slightly more dangerous than suffering from influenza. The infection
fatality rate (IFR) currently stands at around 0.2% in those countries
doing the most testing. This figure will inevitably fall, once we can
identify those who were infected but had no symptoms.
By avoiding this more reassuring message, by frightening everyone into
compliance, the Government has painted itself into a corner. How can they
say to people that, last week you couldn't drive two miles to walk in the
countryside, or go to the beach, or go to a restaurant, or lie in a park
sunbathing, in order to prevent the spread of this deadly killer disease
…but this week you can?
Worse than that, when cases begin to rise again, about a month after
lockdown is relaxed, we will all have to lock down again, to prevent the
next surge? How will the public respond to this? I don't know, but I expect
that it is going to be extremely difficult, if not impossible, to force
everyone back into lockdown again.
By this point, millions will have been financially crippled and will be
desperate to work, if their jobs still exist. Thousands of businesses will
have fallen over, bankrupt. Hundreds of thousands of operations, and cancer
treatments, will have been postponed and cancelled. I have already warned
that it's possible, perhaps even likely, that many more people could as a
result of the lockdown than will die from coronavirus.
That great harm is being done by it was made clear in an article last week
in the Health Service Journal:
"NHS England analysts have been tasked with the challenging task of
identifying patients who may not have the virus but may be at risk of
significant harm or death because they are missing vital appointments or
not attending emergency departments, with both the service and public so
focused on covid-19.
"A senior NHS source familiar with the programme told HSJ: "There could be
some very serious unintended consequences [to all the resources going into
fighting coronavirus]. While there will be a lot of covid-19 fatalities, we
could end up losing more 'years of life' because of fatalities relating to
non-covid-19 health complications."
It may well seem that all this suffering was…well, for what, exactly? To
simply prevent a surge of cases. This government, all governments, must be
honest about this and admit that in the longer term we cannot prevent
almost everybody getting infected and acknowledge that a proportion of
those infected will die.
When lockdown restrictions are lifted this does not mean that the virus has
gone. It does not mean that people cannot infect each other. It does not
mean we can simply carry on as before. It means that we have kept the first
surge under control.
So, what is the exit strategy? The answer is that we don't have one. We
have a strategy of delay and mitigation which will continue until… when?
Until everyone has been infected? Until we have an effective treatment?
Until we have an effective vaccine? Until enough people have been infected
that we have achieved herd immunity?
The Government must tell us the truth and be clear about what end point
they are seeking to achieve. Only then can we have an exit strategy. One
thing for sure is that this lockdown is not a way to defeat the virus.
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