Let’s be clear on policy trade-offs over a second wave of Covid


The writer is a science commentator

The UK government is, if nothing else, sloganeering its way through the Covid-19 pandemic. “Hands, face, space” has been the back-to-front recent advice: space, or distancing, is the most effective way to cut transmission, with masks and handwashing sensible added precautions. Perhaps it is time for a new catchphrase: “As restrictions ease, expect disease.” That is the reality of living with a highly transmissible novel virus to which few have natural immunity, in the absence of either a vaccine or a fast, effective testing regime.

After months of telling workers to get back to offices and subsidising meals out, Prime Minister Boris Johnson last week imposed new curbs in England in the face of rising infection rates, now exceeding 6,000 new cases a day. The UK, along with other countries including France and Spain, appears to be heading for a second wave. September feels like a rerun of March, but with less public goodwill and colder weather. Hospitality venues in England will now close at 10pm; sports stadium plans to welcome fans back are postponed; fines for breaching regulations can reach £10,000. Some think the measures an intolerable infringement on liberty; others, including scientists on the government advisory group Sage, that they are too little too late.

Once again, debate is raging over whether to sacrifice public health for the economy, or vice versa. That makes it more vital than ever to think clearly about what a lockdown is meant to achieve, and to disentangle the science and politics of infection control. The modus operandi of the virus is reasonably well known: it spreads through droplets expelled by coughs and sneezes, virus particles left on surfaces and aerosols. Indoors is riskier than outdoors. Without intervention, an infected person will on average spread it to two or three others.

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The primary objective of a lockdown is to break chains of transmission by keeping people apart. And they clearly work as emergency measures to keep infection rates down: countries that introduced them in the spring shrank their epidemics. 

But any restrictions on normal life are not consequence free. Long shutdowns bring social isolation, joblessness, poverty, child hunger and educational damage. The trade-offs involved are set out in two recent opposing letters from academics to politicians and ministerial advisers. One group urges suppression — on-off rolling restrictions and lockdowns — to get the R number down. This group, mostly experts in public health, contends that this protects, not imperils, the economy. 

The other, whose signatories include economists, argues that since Covid deaths and sickness are skewed heavily towards the elderly and those with medical conditions, high-risk groups should shield while everyone else carries on as usual. The dispute is not over the science but the politics of managing risks and trade-offs.

Policy decisions today are constrained by those of the past: if a world-beating test, track and trace system had been delivered in the summer, less drastic action might have sufficed now. Even so, does shielding trump shutdown?

Infections in the young are likely to spread to vulnerable groups. Some think a Swedish-style stampede towards herd immunity, a touted advantage of shielding, is the way to go. But immunological evidence suggests otherwise: less than 8 per cent of Britons have Covid-19 antibodies.

The young do not escape unscathed. As many as 300,000 people in the UK, including previously healthy adults, might be struggling with “long Covid”, a lingering post-infection fatigue. Given the long-term clinical unknowns of a virus that attacks multiple organs including the brain, it seems callous to see hospitalisations and deaths as the only metrics of tragedy. 

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Still, the letters usefully set out decision makers’ unenviable choices in a pandemic that could have years to run. One offers a collectivist view: a risk to anyone is a risk to all. The other is geared to the individual: my risk is not your risk, a reckless assumption with this virus. The latter policy direction offers a strange, segregated future: the elderly and risk-averse navigating a Covid-stricken world, while the young and incautious inhabit a parallel pandemic-free paradise.

A vaccine, incidentally, might not absolve us from having to find a new mode of living. Many current candidates will be deemed successful if they lessen disease, not necessarily stop transmission. There is only one certainty: the road ahead is long, unpredictable and paved with tough choices.



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