SAVING THE SUMMER. SAVING THE ECONOMY (More detailed)

The letter in the FT - see below for text

This posting provides more detail than in the subsequent posting titled "SAVING THE SUMMER.  SAVING THE ECONOMY.  THE PROPOSAL" which is best read first.

The Financial Times published a letter on 11 June titled “A lockdown plan to save what’s left of summer” (right).  The letter went on to explain that the proposal was to open up the economy by July 2020.  Indeed save the economy.

The proposal was to prompt a debate.  There wasn’t space in the letter to explain the proposal thoroughly nor to address the likely objections.  Some have suggested this proposal is impossible, due to political hurdles  But these are not insurmountable, and the benefits of the proposal are too important to write it off without serious consideration.

So this blog post provides extra details around the proposal and how to overcome objections. Especially how to overcome the political objections. 

THE FUNDAMENTAL ISSUES AND THE PROPOSAL’S BENEFITS

The national R number was announced today (Friday 12 June) as being in the range 0.7-0.9, unchanged from a week ago.  This means the fundamental issue is that the level of infections is reducing, but only slowly.  Too slowly for infections to be low enough by early July to safely re-open the economy, nor for popular holiday destinations such as Spain to welcome British tourists.

At the regional level, R figures are available which suggest R is around 1.0 and maybe even above it in some regions.  This provides the extra issue of the risk of a second wave and all the extra costs, troubles and lost lives that would result.

The lockdown proposal in the letter would substantially reduce the level of COVID-19 infections by early July, to a much lower level than possible under current policies.  This would do several things:

• Help to ensure that the economy can substantially reopen in July, including pubs and restaurants.  This is otherwise in doubt, with the opening date already postponed a fortnight.
• Let people more easily take holidays in UK and abroad, and thereby Save the Summer
• Make it far safer for people who are shielding to leave their homes
• Make it far easier to re-open schools in September and optionally in July.
• Substantially reduce the risk of a painful second wave pf infections, and so remove that cloud over our lives
• Reduce the total number of infections, and therefore reduce the number of deaths and other serious consequences
• A very low level of infections that would provide the foundation for keeping infections low in the medium and longer term, with or without new vaccines or treatments

There are therefore substantial benefits to be achieved by a second lockdown, which would only need to be around three weeks.  Whether or not another lockdown would have otherwise have proved to be essential.

These benefits should be sufficient justification for this proposal, but it is worth looking at the situation in more detail.  Especially the political hurdles.


OBJECTIVES

Firstly it’s worth looking at the fundamental objectives.  The UK went into lockdown on 23 March 2020.  Since then there have been a number of key objectives that include:

1. Deaths. Keep the number of deaths from COVID-19 to a minimum
2. Financials. Open up the economy as soon as possible, to avoid business failures, restore people’s livelihoods, and avoid redundancies.  Then from the Treasury’s perspective, restore tax income and reduce support costs
3. Social.  Let life get back to as near normal as possible, as soon as possible.  This includes getting children back to school and letting those people who have had to shield themselves out of their homes safely
4. Safety: Avoid a second wave of infection, whether or not that threatens to overrun the NHS

Save lives, save livelihoods and live again.

It has since become apparent that COVID-19 is not just a respiratory disease.  It can leave survivors with major ongoing medical problems all around the body.  Even more reason to only ease lockdown restrictions and open up the economy carefully and safely.

In the UK the objectives have appeared to be mutually exclusive.  Open up too fast and there’s a risk of a second wave of infections, with many more lives lost or ruined.

This is because the level of infections in the UK has remained stubbornly too high.  Weston General Hospital was overrun on 25 May, and other hospitals have been close to that position, especially in North West England.  That is because R has remained around 1.0 in some regions, and so the level of infection has not reduced.  Indeed there remains the risk of a second wave of infections wherever R rises above 1.0, when infections would increase exponentially again.

Regional R numbers are now being published.  The latest regional R numbers from one of the modelling groups, as announced yesterday, are as follows.  The "Effective Reproduction No." in the table.  Note these would have been as R effectively was around 31 May, with some R numbers up and some down on the previous week.  This situation is likely to have been repeated in the days since:

There is also another problem.  Spain has said that Britons will not be welcome this summer given the current high infection rates in the UK.  The Spaniards prefer to turn away British business than import COVID-19 to their hospitals and local population.   Similar sentiments have been expressed by the major staycation regions in the UK.  If we want holidays home or abroad this summer, infections must drop substantially.

Hence the title of the letter.  But the real issue is to open up the whole economy quickly and safely:
.

THE SOLUTION

There is actually one solution to all these objectives.  That is to reduce COVID-19 infections to a very low, manageable level.  Or even to zero. 

We look on enviously as New Zealand removes all lockdown restrictions amid pictures of people there hugging each other again.  That’s not to say that NZ’s COVID-19 problems are over.  Far from it. There have been reports of localised ‘flare-ups’.  New Zealand needs to continue with precautions for the foreseeable future, especially at the country’s air and sea borders.  As will we all throughout the world.

In the UK, the target for opening pubs and restaurants has been put back a fortnight from 22 June to 4 July.  There remains no certainty that will be possible.  Not unless infections have been brought right down by then.  That is unlikely under the current policies.  R remains far too high.  Reductions in R and infections are far too slow, with too many setbacks, such as Weston General Hospital being overrun.  Hence the letter and its proposal.


THE PROPOSAL

There are two parts to the proposal in the letter:
1.    A second lockdown should be instituted now. 
2.    A suite of anti-transmission measures should be constructed to replace lockdown. A stronger set than currently  

The letter reads as follows:

Why a Second Lockdown?

As explained below, an R number under 0.5 would reduce new cases of infection to near zero in as little as 20 days.  Lockdown now and cases will be right down in time to open pubs as hoped on 4 July. Indeed it would become possible to open up nearly all of the economy during July, with the option of getting schools back.   With the right anti-transmission techniques, the 2 metre rule could become irrelevant except for dance clubs, concert halls, theatres and places of worship where people are close together for long periods. These remain major challenges, which require a separate discussion.

The restrictions of the lockdown should be such as to achieve a R number less than 0.5.  That will require:

• Most non-essential businesses to close again, with schools not opening any further in June  But given that transmission is far less outside than inside, it may be possible to retain outdoor businesses such as garden centres, theme parks and even possibly allow outside cafes and pub gardens to open
• Back to the simple “Stay at home” message, though preferably retaining the relaxed outside rules and the ‘bubbles’ concept of merging two households

The modelling teams will be able to assess how tight the rules would have to be to get R rapidly below 0.5 and keep it there.  SAGE can then determine an approach that reflects the various modelling proposals.

Anti-Transmission Measures

The ongoing anti-transmission measures would preferably be a self-sufficient set that in aggregate would be as effective as lockdown.  The problematic “Test Track and Isolate” (TTI), whilst important in both the short and long-term, would then only be needed in a support role. 

TTI’s role in the success of South East Asian countries getting the infection under control was only part of the solution.  Face coverings have been important, with reports that they have had a bigger effect than TTI.

The suite of techniques and measures needs further work, but the approach in Thailand would act as the starting point.  Note face coverings come first:

Furthermore the anti-transmission methods adopted by the general public must be seen as long term measures, which become a matter of habit.  The best way to do that is to make them voluntary.  Make it clear that to do otherwise is anti-social and let communities self-police them   The restrictions on businesses would nonetheless need to be legally enforceable, as would face coverings on public transport.

This balance would also put less pressure on the police, who have had a devil’s own job trying to enforce public restrictions.

That means that the second lockdown would need to be ‘sold’ to the public. The carrot of fast easings in July and the various other benefits should see to that.  Plus that other infections such as colds and flus would reduce.  But only if the government’s PR is far superior to what it has been so far.  The benefits of a second lockdown need to be explained clearly.


THE MATHEMATICS OF THE ‘R’ NUMBER

Taking no precautions to restrain transmission of the virus, the natural R number for COVID-19 is around 3.  As shown in the government’s own slides:

With an R of 3, every infected person would naturally infect another three people on average.  For an R of 1.0, this means that if someone showing symptoms self-isolates, they must have only have infected one other person, be they a member of their own household or someone else they infected pre-symptoms.  Think about that for a moment, and you’ll realise the 1.0 target is difficult unless there are good anti-transmission techniques used by pre-symptomatic people.   Hence face coverings, for example.

This graph shows the effect of different R numbers on the cumulative number of infections. The daily change in the graph is the number of new infections.  People get over the disease, or sadly die, but unfortunately the graph doesn’t show the number of people currently infected.  Nonetheless we can deduce that:

• An R around 1.0 means the daily addition to infections stay constant, resulting in the total number of current infections maintaining a high steady level
• An R only just over 1.0 results in exponential growth, and sets off a second wave
• An R of the current 0.7-0.9 range produces infections significantly above an R of 0.5.
• An R of 0.5 produces a cumulative total of infections that levels out with no new infections after about 20 days.  That results in current infections dropping to near zero

The graph reflects a number of assumptions, such as how long after infection somehow becomes infectious, and then for how long they remain infectious before symptoms if any.  An update is probably needed to reflect current understanding.  Nonetheless the overall picture is likely to bevery similar, An R under 0.5 will rapidly reduce the number of new and total current infections.

The 0.5 target is even tougher than 1.0, especially as asymptomatic people who never display symptoms can be infectious.   But R went down to 0.4-0.7 as a result of the first lockdown, so it is achievable.


THE PRINCIPAL OBJECTIONS

So why isn’t the Government doing this?  And why are some people saying this proposal is impossible?  There are a number of objections, including:

• The Government won’t shift from their roadmap of continued easings, even though they have consistently said they will reverse easings if need be.
• It is possible that this proposed option has never been proposed to Government by SAGE and/or never discussed.  Anyone with better knowledge of what’s been going on behind the scenes may be able to comment
• The risk of a second wave is perhaps perceived as low. Nonetheless the current approach is just too slow at reducing infections to the very low levels needed
• This is a radical proposal which nobody else has suggested.  In which case just re-read it and judge it on its merits.  An R target of under 0.5 is tough, but is achievable.  If we don’t try it we’ll never know.
• The British public would not accept another lockdown.  It would certainly need to be carefully sold to them.

Which whittles the list down to two key objections.  The political issues, and public compliance.

The Treasury and the Conservative party’s financial backers have been putting pressure on PM Johnson to ease lockdown more quickly for financial reasons.  However, the proposal would actually achieve their objective not only as quickly but more thoroughly.  Everyone would be a winner.

But the proposal is heavily reliant on public compliance, which as suggested should be voluntary.

The Cummings episode has completely undermined public trust in the government and the need for restrictions.  But then the same can be said about current restrictions.  Unless Cummings goes, any government plan will be undermined by the public’s lack of confidence and adherence to the rules.


THE POLITICAL SOLUTION

In addition to dismissing Cummings, the proposal cannot be achieved unless there is either:

1. A massive change of attitude from the Government.  That includes a realisation that it would be less embarrassing to have a second lockdown than continue to be at the bottom of the European league table on deaths and economy
2. A change of government, by appointment of an Interim PM.  In other words replace Johnson with a new Conservative leader pending a full leadership election at some more appropriate later date

In both cases, Cummings needs to go for public confidence to be in any way restored.  This has nothing to do with politics nor Brexit, unless that is seen as more important than beating COVID-19.  Most people would agree defeating COVID-19 is actually more important than Brexit, and indeed arguably a pre-condition, whatever Michael Gove is saying to the EU.

There is a list of over 40 Conservative MPs  who have spoken out against Cummings.  They include both Leavers and Remainers, and former Cabinet Ministers.  The Interim PM should be chosen from a short list of interested people on this list.

Cummings should be immediately dismissed. The new Cabinet may need to exclude any of the existing cabinet who backed Cummings, but that is a decision for the new PM.  Whilst losing continuity is not desirable, it is the lesser of two evils in terms of defeating COVID-19.

How the Conservative party’s rules would allow them to do this quickly is an interesting question.  Given the substantial deterioration of the party and PM Johnson in recent polls, a quiet word with him may suffice to let Johnson go.  Then an emergency appointment somehow.  At least we can hope.

Indeed probably the only hope that the proposal could work.  Unless PM Johnson has a massive change of heart about Cummings and adopting this proposal for a different strategy.


IN CONCLUSION

This lockdown proposal in the letter will:

1. Allow the economy to substantially re-open in early July.  Save the Economy.
2. Let everyone go on their holidays this summer at home or abroad.  Save the Summer..  

This is provided:

• A second lockdown of non-essential businesses is done with a set of rules for the public that rapidly provides an R number less than 0.5.  That means adjusting the easings about businesses due to come into effect on Monday 15 June
• A suite of anti-transmission techniques is determined for use by the public from July onwards, and indeed straight away
• The idea is sold well to the British public, with communication far better than we’ve seen so far about anti-transmission measures, preferably advisory so they become a long term habit
• Cummings must be dismissed to avoid undermining the initiative
• PM Johnson is replaced or has a massive change of heart about reversing most if not all easings

This is a proposal for debate.  Your feedback and thoughts would be appreciated, be they in agreement or otherwise.