ON PAIN OF DEATH - HOW BEST TO REDUCE THE TWO METRE RULE?

On Pain of Death

As an Oxbridge science grad and qualified financial professional myself, I solve knotty business problems.  Working with the CEO and CFO of FTSE, AIM and private businesses.

Imagine I’ve been asked to consider the issue of the 2 metre rule.  Can the distance be reduced?  How best to do so?

So in classic Findings / Conclusions / Recommendation format, here goes.

INTRODUCTION AND OBJECTIVE

The social distancing restriction of 2 metres between people is making it very difficult to re-open the economy, re-open schools and get back to anything like normality in other settings.  In particular, the hospitality industry would not be economically viable at 2 metres, putting millions of jobs at risk and undermining our summer holidays.

It is therefore important to reduce this limit as soon as possible. The existing target is 4 July. Certainly reduce the distance by the start of the normal summer holidays.  State schools typically break up around 17 July this year, and private schools around 10 July.  People don’t want to lose their holiday bookings, here or abroad.


FINDINGS

We know that transmission is lower outdoors, so we need to consider the 2m limit in at least two settings, indoors and outdoors.

Ministers were warned back in April to relax lockdown measures only when daily infections had fallen to below 1,000 a day.  That seems a sensible target.

Though other European countries such as France and Spain have got daily infections down to around 500 before easing lockdown restrictions to the extent the UK hopes on 4 July.

As we discovered yesterday estimates for the UK are currently averaging around 4,000 per day:
•    4,500 per Office of National Statistics per Matt Hancock [link]
•    3,612 per the King’s College ZOE-based study, involving nearly 4 million smartphone users
•   Compared to 1,346 new confirmed cases per NHS testing, which looks unreliable

In each case we saw that the daily figure had levelled out, implying a transmission R number of 1.0.

Though yesterday, Monday 22 June, there was a sign of a slight reduction in the New Confirmed Cases graph to 982 a day

That would imply an R of 0.9-1.0, not the 0.7-0.9 level that has been the official estimate for the last few weeks.

We know from the first lockdown that it is possible to reduce daily infections by 84% if R is 0.4-0.5, consistent with what we’d expect.  That would get 4,000  cases a day comfortably below the 1,000 target.

We also know that if R were to rise only slightly above 1.0, exponential growth would re-start and we’d have a second wave of infection.  Undoing all the hard work that people had put in during lockdown.  Having R around 1.0 is asking for trouble.

Indeed the COVID-19 outbreak at the abattoir in Germany, in Beijing  and now in South Korea shows that the virus is only too willing to surge back if it is given the chance.


CONCLUSIONS

Although the “New Confirmed Cases” figure from NHS testing has just dropped below the 1,000 target, a more realistic estimate is around 4,000 per day.

R appears to be around 0.9-1.0, which is too close to starting a second wave for comfort.

So it is too early to reduce the 2 metre social distancing rule.  This is also the conclusion reached by the Independent SAGE group, composed of former members  Definitely not indoors, and debatable whether the limit can even be reduced outdoors.

The daily infection rate is now static, though may have reduced slightly.  But as symptoms take a few days to develop, and the figures are already a few days old, we don’t; know what the current infection rate is.  It could be rising.  We just don’t know.

We can ignore this uncertainty given it is possible to get the 4,000 figure s down to around 640 per day in just 3 weeks.  That;s down to 16% as shown on the graph below.  640 cases per day would be comfortably below the 1,000 target and more comparable to other European countries.  That would allow significant easing of restrictions, including reducing or even removing the 2 metre rule.

The First Lockdown, showig reductions in 3 and 4 weeks

That would require an R of 0.4-0.5, which therefore has to be the target.

The only realistic, reliable way to do that is a second lockdown, which other countries are also now considering.


But to avoid a resurgence in the virus after that 3-week period,, we need a suite of anti-transmission measures that would keep R well below 1. A target aroun 0.5-0.7 would be sensible, to give some slack to avoid rising over 1.0.



RECOMMENDATIONS

Core Recommendations

Letter published in FT 11 June

The letter published in the Financial Times nearly two weeks ago, right, made a pair of recommendations .  These are still valid:

1. A short sharp lockdown of 3 weeks, and.
2. Development of a stronger set of anti-transmission measures to help keep infections down afterwards

That is to adopt a target R of 0.4-0.5, and keep it well below 1.0 on an ongoing basis.

A lockdown would be based on the UK lockdown of 23 March, modified to allow any subsequent easings that would still keep R below 0.5:

• This is essential retail only, with other businesses closing temporarily.  
• But with the carrot to non-essential retail and the public of a far stronger recovery in just three weeks, with people far more confident to go out shopping once infection rates are down, and cafes and loos are open. 
• Perhaps retaining some of the easings such as small outdoor meetings and the new dual-household bubbles. 
• Maybe even allow pub gardens and outside cafes to open.  
• The modellers can help decide what can be done whilst keeping R down to 0.4-0.5.

Anti-transmission measures need to be cheap, effective and equivalent to at least 80% of a lockdown in aggregate.  Measures also need to be fundamentally voluntary, so that the public will continue using them well into the future. That is until vaccines and effective treatments become available, maybe in 2021, unikely 2020.  Measures would probably include extending advice on using simple masks to a wider range of situations, such as being in any shop or other public space, where it needs to be compulsory until it becomes a habit.   Just as is happening in other countries.  Again let the scientists and modellers recommend.

'Test/Trace/Isolate'  (TTI) is a useful technique in theory, but is not a magic bullet.  We’ve found ts very difficult in practice.  It is also expensive at national scale.  Whilst TTI can be a useful technique, it is best to develop a measures set that achieves the 80% target without TTI.  Then TTI can be a bonus, especially useful in response to local outbreaks.


Timescales

When the letter was published, the plan could have been implemented in time to substantially relax lockdown on 4 July, as targeted.

Now there needs to be time for modelling, and a little notice to businesses that would need to temporarily close, or indeed be allowed to open.

So if the lockdown was to start formally on Monday 29 June, then 17-20 July would be the target to re-open the economy and much of daily life.  Coincident with the start of the state school summer holidays.  For the hospitality industry, just in time.  Our holidays assured, here and abroad.

That is a week after private schools break up.  So it may be possible to relax restrictions on overnight accommodation a week earlier, to avoid losing those bookings.

Many of the anti-transmission measures can be done now, making achievement of the 17-20 July target more assured. No point delaying.

Other Practical Considerations

One issue is that the public are fed up with restrictions, and are increasingly ignoring them.  Not least since the flagrant disregard shown by Cummings in his trips to Durham and Barnard Castle.

Whilst we can’t expect everyone to voluntarily adhere to lockdown guidelines again, many will.  It will need a programme of education of a much higher calibre than we’ve had hitherto, which frankly won’t be difficult.

There are also political considerations. 

The government has repeatedly said that 4 July is “at the earliest” and lockdown restrictions can be re-imposed if necessary.

This second lockdown option may be embarrassing for them, but not as embarrassing as a second wave of infections, and falling further behind our European neighbours.  Let alone allowing an unnecessary rise in deaths and other medical problems if we stay on the current path.  That would be unforgiveable.

There’s also the point in the FT letter that a second lockdown may become necessary anyway, so better to do it now.

At the press conference last Tuesday 16 June. PM Johnson said, from 17m42s  “I absolutely hear those concerns and will do EVERYTHING IN MY POWER to get us back to normal as soon as possible, but we must proceed carefully..”

Time to take action on that basis.  Run with these recommendations.


BENEFITS OF THE SECOND LOCKDOWN OPTION

Let’s remind ourselves of the numerous benefits that would arise from reducing the 2 metres limit.  These benefits would be the carrot for the public to comply with the restrictions of a second lockdown:

1. A far stronger economic recovery, yet still starting by mid-July
2. Relief for the Treasury, as VAT and other taxes start rolling in again, and the need for financial support to be substantially reduced
3. Relief for many fearing for their jobs and self-employed livelihoods
4. Letting those who have been shielding to more safely leave their homes
5. Let schools go back fully in September, with the possibility of schooling over the summer.  Universities too.
6. Let hospitality venues re-open to save jobs and let people take their summer holidays
7. A lower level of transmisison means a lower level of deaths and other medical problems
8. And much more besides

Everybody wins.

Save the economy.  Save the summer.  Save lives and save livelihoods.


CONCLUSION

It is too early to relax the 2 metre rule now, at least not indoors.  This should be deferred to July..

The government effectively has two options when they meet today, each with minor variations:

1.  Keep to the current plan:

• Tentatively re-open the economy in July with the spectre of a second wave.  
• That might still be too early to safely relax the 2 m rule indoors

2. Change the plan

• Hold a second lockdown for 3 weeks followed by a better suite of cheap anti-transmission measures.  
• Open the economy strongly in July with a reduction of the 2 m rule indoors.
• Virtually no risk of a second wave

Which option would you prefer?  Which would you ask the Government to adopt today?