LONDON — The route out of lockdown is less about finding a plan and more a search for a formula.
Like many governments around the world, the U.K. is considering how — or even whether — to lift restrictions, ahead of the next legally mandated review on May 7.
Each government faces the same dilemma: how to balance the need to protect jobs and livelihoods suffocated by lockdown, with the need to prevent a resurgence of the virus that could cost thousands more lives.
The answers each country settles upon will likely be different — and there is likely to be an element of trial and error.
Gabriel Leung, chair of public health medicine at the University of Hong Kong, and one of Asia’s leading epidemiologists told POLITICO countries have “three main categories of interventions” at their disposal during this period — or “dials” they can calibrate and adjust according to their own situation.
The “very clear red line” in this decision-making process is hospital capacity, according Gabriel Leung, chair of public health medicine at the University of Hong Kong.
One, border restrictions: not to keep coronavirus out necessarily (that ship has sailed) but to “maintain the integrity of the local health system.” Two, targeted quarantine and isolation of infected people, informed by testing and contact tracing. And three, “physical distancing.”
“Under each category you’ve got a whole host of different things you may consider doing. Physical distancing can mean total lockdowns and curfews, or it can mean school closures or flexible work arrangements, or closing of bars and entertainment venues, but keeping restaurants open, or variations thereof,” Leung said, speaking earlier this month.
“Given those three dials, you need to find your combination that is contextually acceptable but also would be able to give you health protection, economic preservation and social acceptance.”
As measures start to lift, this third consideration — social acceptance — is likely to become more complicated if countries move at very different speeds. Governments will be challenged to explain why, for instance, you can go to school in one European country, but not in another, or why some borders remain open while others are closed.
The “very clear red line” in this decision-making process is hospital capacity, “that you do not exceed your carrying capacity in your ICUs or your respirator availability,” Leung said. “But beyond that there are many, many other considerations.”
What’s more, this process could be one of “suppress and lift,” as Leung put it in a piece for the New York Times. “Cycles during which restrictions are applied and relaxed, applied again and relaxed again, in ways that can keep the pandemic under control but at an acceptable economic and social cost,” he wrote.
R we nearly there yet?
In London, officials said, the decision-making process around how and whether to ease the lockdown will involve the government’s independent Scientific Advisory Group for Emergencies (SAGE) drawing up a “suite of options,” based on different “combinations” of liberalizing measures (for instance, reopening schools, reopening non-essential shops, or expanding people’s household “bubble” to include a few more people). Scientists will give ranged estimates of how each might impact on transmission of the virus — and in turn the risk that hospitals could be overwhelmed.
Alongside, experts will model the likely impact of the U.K.’s revived “trace and isolate” strategy will have on transmission.
Key to calculations is the basic reproduction number, the R0 (the average number of people one coronavirus-infected person passes the virus onto.) The weight the U.K. is giving this was emphasized at Thursday’s daily government press conference where Johnson stated that “nothing we do” when trying to unlock the economy “should lift the R … back above one.”
An R above 1, England’s Chief Medical Officer and SAGE Vice Chair Chris Whitty made clear at Monday’s press conference, leads back to “exponential growth” of the outbreak. R is currently estimated to be between 0.5 and 1 in the U.K., he said.
“Sooner or later, depending how much above 1 it is, you [would] go back to a situation where the NHS is threatened to be overwhelmed,” he said.
While the scientists can model the effects of different measures on R, the decision about what R is acceptable — and therefore which combination of measures, if any to choose — is for politicians.
Another SAGE member, epidemiological modeling expert Neil Ferguson of Imperial College, told Unherd last week: “As a scientist I feel I can give some insight into what the consequences of certain decisions would be and indeed into potentially the sort of measures which would be needed to achieve a certain outcome. But really it is for decision-makers to make those decisions.”
A U.K. official working on the coronavirus response agreed.
“That’s where the political element comes in. You can model everything but ultimately you have to make decisions along the way,” the official said.
Whitty says similar. “The decision about how the different combinations [of lockdown lifting measures] go together, that finally is one for ministers,” he said on Monday.
“There is no perfect solution where we’re going to end up being able to do all of the things people want and at the same time keep R below 1 … there are going to have to be some very difficult choices,” he added.
No one knows how the British public will react if a restriction were lifted — and then re-imposed, officials said.
Ferguson also emphasized that when thinking about hospital capacity, governments would have to consider not only whether the system can treat coronavirus patients, but also its ability to treat people with other health conditions and so avoid an increase in “indirect” deaths caused by the pandemic.
And even when (if) a decision is made to relax measures, it is possible — to return to Leung’s “suppress and lift” concept — that a particular measure — for instance, reopening schools — increases the R more than had been predicted; necessitating a rapid reimposition of controls.
This is something the U.K. government is particularly concerned about. While the level of public adherence to the initial lockdown measures has surprised some ministers who expected more resistance, no one knows how the public will react if a restriction were lifted — and then re-imposed, officials said. There are fears that adherence would be lower, leading to higher spread. Hence the strong emphasis in ministerial statements in recent days on being “sure-footed” with the next steps.
This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.