Back in March, during the early days of the nationwide lockdown, the government had a clear message. The greatest threat posed by the coronavirus was that it might overwhelm the NHS. By implementing a lockdown, we would not be able to eradicate the virus, but we would be able to make sure those brought down by it would be able to get the care they need. Suppressing the number of cases by reducing contact in the population would mean there would always be a bed available to those unfortunate enough to need it, or so the theory went.
Fast-forwarding to today, we see that the government was successful in achieving this goal. The NHS coped remarkably well during the first wave. Even at its peak, intensive care unit beds were readily available, and the field hospitals rapidly set up to cope with the anticipated deluge of cases proved to be unnecessary. The government’s goal to “protect the NHS” has been a considerable success by this metric.
But precious little attention was paid during that time to what would happen as lockdown restrictions ease. Our intention was never to completely eradicate the virus. Although this approach has been pursued by some nations (most notably New Zealand), Britain is too densely populated and Covid-19 too contagious to make complete eradication a realistic goal. So it was plain to all with even the faintest grasp of the principles of epidemiology that, as the nationwide lockdown eased, we would see a second wave. And it is also plain that a cycle of lockdown, followed by rising case numbers, followed by lockdown ad infinitum is completely unsustainable.
Boris Johnson has now declared that we are in the second wave. There are numerous reasons why it will be difficult to compare this wave to the previous one. The vastly increased testing capacity and demand mean we will record more cases in less sick individuals, so a high caseload does not fairly represent how quickly the virus is spreading. Had we tested as aggressively as we are currently doing back in March, we might well have seen similar numbers.
Yet despite the first lockdown buying us time (at enormous economic and social cost), there seems to have been little desire to use that time to rebuild a sustainable response to future waves. The iterative process of locking down regions as cases increase is only quantitatively different from the nationwide lockdown, and for the millions under new lockdown measures, the experience is identical. We are behaving as we did in the run-up to the first lockdown, albeit with a more ad hoc approach.
This is an ominous sign. One might have hoped that the lessons learnt during the first lockdown could be applied in such a way that our economy and society are not subject to a sustained onslaught of increasingly pedantic, illogical and destructive measures. For instance, we have known for a long time which groups of patients are at high risk of serious complications and death from Covid-19 infection, namely older individuals with multiple comorbidities.
With this in mind, there is a clear path to save lives while sustaining economic activity. The government should give clear guidance on risk stratification such that everyone understands whether an infection is likely to seriously harm them. Those at highest risk should be the government’s main focus. For these individuals, the majority of the resources available should be allocated to provide them with whatever is needed to protect themselves and their mental wellbeing.
For instance, in care homes (which suffered greatly during the first wave) we should help vulnerable adults to organise social bubbles and provide video link equipment to stay in contact with friends and family and ensure they are not socially isolated during the long haul. High-quality personal protective equipment must be given to staff and residents, as opposed to the rather feeble surgical masks which we see widely worn and which have limited protective effects. We should build infrastructure such that those shielding are able to do so in a sustained manner and with a good quality of life.
Working in a hospital, many elderly patients I encounter who isolated for months, missing contact with loved ones and many living alone, express their frustration and anger at finding their situation has hardly improved. They feel like an afterthought when they should be the primary focus of the government’s coronavirus effort.
For those at lower risk, we should return to work and rebuild our communities, acquiring that much-misunderstood “herd immunity” in a population at low risk of complications and thereby ultimately protecting the high-risk population. By stratifying our approach according to whether someone is at high or low risk, we would achieve three simultaneous goals: protecting those at high-risk, ensuring our economy continues to function and minimising government intrusion in citizens’ lives.
Instead, the government has applied the same approach it chose during the first wave: shut everything down. Where cases are rising, it doesn’t matter if you are young and fit or elderly and frail – the same rules apply to you. This is patently absurd. People should be provided with the information to judge for themselves their vulnerability and the resources necessary to act upon that knowledge. Despite the enormous cost of the first lockdown, the government seems quite determined not to learn from it.
