The writer, a former head of the Downing Street policy unit, is a Harvard senior fellow
The Keep Calm and Carry On slogan on my coffee mug seemed quaintly amusing in better times. As the second wave of coronavirus sweeps Europe, I am clinging to its wartime message.
Nine months into this battle against a pandemic, we need to stop treating Covid-19 as an emergency, panicking over every new statistic, and start planning for the long haul.
In the early days, faced with a new and lethal disease, extreme measures made sense. The first lockdowns aimed to buy time, suppress the virus and protect hospitals until a vaccine arrived. But despite heroic progress it is clear that no vaccine will be widely available until spring at the earliest, and perhaps never. There is still no vaccine for Sars and there are reports that coronavirus is mutating. Even if there is a vaccine, the UK’s chief scientific officer Patrick Vallance said recently, it is unlikely to eliminate Covid-19 entirely. We must learn to live with this thing.
In the UK, the panic mindset of the emergency stage had some terrible consequences. Patients have been forced to choose which of their children to see before they die. Scared lonely people, forced to stay at home, have put on weight, while obesity is a significant risk factor for the virus. Curfews have displaced rowdy drinkers from pubs to car parks, while devastating takings at the till. In Wales, which has been a one-party state since devolution, the first minister has imposed a Soviet-style ban on supermarkets selling anything but “essential” goods, in case shoppers might infect someone while browsing for a T-shirt.
The challenge ahead is to look coolly at what works and explore all options. Shutting down swaths of the economy indefinitely has immense consequences for jobs, livelihoods and mental health. The UK Treasury has already spent billions to keep the economy in suspended animation. Now we are at the cliff edge: with the furlough scheme for jobs about to expire, the government must extend a more generous replacement safety net than it has fashioned so far, or ease lockdowns.
The prime minister can only feel his way through the complex trade-offs between lives, livelihoods and hospital capacity. He is constantly shown every jump in the “R” rate of infections. But there is no “R” rate for jobs, no equivalent stream showing when a business owner will lose their life’s savings and life’s work. There is no Downing Street unit scrutinising worst case health scenarios and modelling families queueing at food banks, corporations planning mass redundancies, people contemplating suicide.
Tiered local restrictions are rightly designed to target transmission more precisely, while limiting economic damage. But even Tier 2 restrictions, which limit social interactions while allowing restaurants and shops to trade under certain conditions, are not sustainable without an end date.
Barry McCormick, a health economist at Oxford university, has calculated that the national “circuit-breaker” lockdown proposed by the Scientific Advisory Group for Emergencies would not be worth the price in terms of lives saved. Squeamish as it may feel to put a price on life, the NHS has a metric for doing so, which Prof McCormick has used.
Whether he is right or wrong, this is the kind of analysis ministers should be getting. But the work relied on data from a Sage paper that hadn’t been published.
Too much modelling is being kept private, and too many assumptions go unchallenged. The debate about immunity, for example, seems strangely narrow. In a September briefing, the UK’s chief medical officer, Chris Whitty, and Sir Patrick estimated that only about 8 per cent of the population had been infected, based on antibody tests. But other research suggests as many as half the population may already have some immunity, from T- cells.
This year we have learned a great deal about coronavirus. Studies show that a majority of those infected have no symptoms and that the fatality rate is more like 0.3 per cent than the 3.4 per cent predicted in February.
We know who is most at risk: in England, more than 80 per cent of Covid-19 patients in critical care are either overweight or obese. The average age of death is 82. We have also learnt the limitations of lockdowns. Extreme social and economic restrictions can “freeze the virus in place”, said David Nabarro, World Health Organization special envoy on Covid-19, this week. But “you don’t want to use those as your primary means of containment”.
When the options are unpalatable, it is vital to consider them all. One would be rethinking how to help the most vulnerable. Manchester City Council has proposed a shielding programme for less than one-fifth of the estimated cost of business closures. The plan has been dismissed by those who fear that it wouldn’t work and that hospitals could be overwhelmed.
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They may be right. But a long-term strategy should surely consider it. How about giving everyone Vitamin D tablets, which have been shown to help against the virus, and a personal weight-loss coach? If we had done that several months ago, we might have improved the odds of resistance to Covid-19.
In 1914, the accepted wisdom was that the first world war would be over by Christmas. This pandemic has had something of the same feeling about it. Covid-19 is not going away any time soon and we need to keep our heads and grab little bits of joy wherever we can. If we lose confidence now, we lose everything.