Dr Liam Fox MP - Sunday Telegraph article - We need a phased plan out of lockdown
Writing in today's Sunday Telegraph (https://www.telegraph.co.uk/news/2020/04/25/need-phased-plan-lockdown/) on 26th April 2019, Dr Fox wrote:
It is almost an inevitability that as the peak of Covid passes, and the perceived threat to human life recedes, it will be replaced about fears for the country’s economic health. While the government signals that any talk of unwinding the lockdown would send the wrong messages to the public the debate has already moved on.
The British people, the vast majority of whom have behaved with remarkable patience and restraint, know that the current situation will not be open-ended and are looking for some hope and optimism to sustain them. The big question facing the government is how to get the economy moving again with minimal threat to public health. It is a difficult ethical question but then governments are elected to take the decisions that most people would rather not have to.
In making these decisions it is worth examining what history tells us. A 2007 US study looked at how 17 American cities responded to the 1918 flu pandemic in terms of household quarantine, school closures, bans on public gathering and other measures. The clear conclusion was that those with early restrictions had reductions in the peak death rate of around 50% compared to those that did not. But significantly, their reductions in cumulative excess mortality were much less over time.
In other words, early lockdown slowed the progression of the epidemic (‘the flattened curve’) but over time outcomes were relatively similar until roughly comparable levels of population immunity had been achieved. In short, until a vaccine is available there is a limit to what we can achieve by social restrictions.
Lockdown, of course, is not without its own health and social costs. There is huge disruption to normal health services including delayed elective surgery with reduced treatment and screening of diseases such as cancer. This will have an impact further down the line, including on death rates. The mental and social costs of isolation and the tensions created by prolonged family confinement also have to be factored in. It is clear that the NHS has been able to deal with the surge in demand and that some of the projected modelling for mortality rates were enormously overestimated.
Taking all this into account it is clear that we need to get people back to work for their own sake, for the well-being of our society and to reduce pressure on the public finances. The longer the government is required to open the public coffers to support a “sleep mode” economy the bigger the price for future taxpayers will be. The costs to the domestic and global economies are still unclear but a severe contraction is highly likely (the IMF expects the UK economy to shrink by 6.5% in 2020) and the government’s rush to issue £180bn worth of government bonds in the May-to-July period is a sign of the pressure to come.
Of course, there will be risks to unwinding the lockdown, especially if it occurs too quickly. The same American research showed that those cities with low initial peak death rates had a greater risk of a large second wave and that they were likely to experience this after a shorter time interval. No cities in the study had a second wave while the restrictions were still in place, only after they were relaxed.
A second wave is something that neither government nor public health officials will want to see. No one will wish to test the public’s tolerance of a second lockdown, still less the extended economic costs or the political blame game that would inevitably ensue. This almost certainly means that any unwinding of the lockdown will occur in an incremental and phased way.
We can follow the German example of allowing small shops to open first and the restricted access to supermarkets, that we have become accustomed to, could form the model for the opening of larger stores. For larger value items, such as cars or furniture, an appointment system could be introduced to control the flow of customers. New sectors could be opened up completely. For example garden centres were not deemed to be “essential services” yet they have a hugely seasonal element to their financial viability and if hardware stores can be made to operate safely why should the same not be true for facilities that give such satisfaction in the relative safety of people’s own gardens.
Only time will tell if our global response to Covid 19 has been proportionate or not. Every human death is a unique tragedy for loved ones but the collapse of the global economy would have profound and potentially catastrophic implications for millions in the developing world in particular.
As our leaders take the difficult health, economic and ethical decisions in our name the whole country must be aware that all choices have consequences.