12 April 2020 — Dr Malcolm Kendrick
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.