The UK government, in its capacity as the English government, has been easing the Coronavirus lockdown steadily over the last couple of weeks. Generally the public has been one step ahead. The picture shows the scene yesterday at one our nearby beaches yesterday; you would be pushed to find any difference from a normal day half-term week in May. The public toilets were open (big queues, no social distancing), and you could hire a windbreaker, buy ice creams and no doubt many other things too. Is this all happening too quickly?
Meanwhile, the scientific advisers seem to be behaving more and more like economists, and not always in a good way. They are very attached to their models predicting how the out break will develop. Abstract aggregated measures, especially the Reproduction or R-rate, are treated as if the are real, tangible things, rather than statistical abstractions. In one way they don’t behave like economists, though. They accuse our leaders of taking political decisions because they go against their advice. On probing them, it turns out that what the scientists mean by this is that the politicians are weighing up factors like the economy and mental health. Stuff that is somebody else’s problem for the scientists. Economists need no excuse to barge into somebody else’s field.
But even taking a broader view, the scientists have a point. The prevalence of Covid-19 is greatly reduced, though it is very hard to get a decent fix on this, given the weaknesses in the testing regime. This means that the risk of catching the disease is now quite small, depending on where in the country you are (though apparently the regional variations aren’t that great). But this low risk is precisely what led to complacency at the start of the epidemic. The countries that locked down early (i.e. before they had a visible problem) are the ones that have suffered least; Britain has one of the worst Covid-19 death rates on any country in the world.
The problem is this: living with the virus is very hard if it means maintaining 2m social distancing. So many activities become impossible: restaurants and bars for example, unless customers can stay outside. Reducing this distance to 1m, as I heard former Chancellor Norman Lamont suggest, is a bit of a nonsense. If you are indoors and with somebody for more than 15 minutes, then the risks escalate. This is what bars and restaurants are for, and you can’t mitigate them by getting everybody to wear a mask, as you can on a bus or aeroplane. 2m is probably not enough in this environment. Which is very bad news not just for those us dying to eat out again, but for the huge numbers of people employed in hospitality. At the same time shops, factories and the businesses can’t maintain their previous productivity.
The aim has to be to not have social distancing rules at all. How do you achieve this? The first step is to get infections down to a very low level. Much lower than is prevalent in any part of the UK at the moment. Then you implement a rigorous track and trace system, to identify and isolate anybody who has the disease. Extra regulations are required where people congregate in an enclosed space period of time, so that everybody can be rapidly identified if one of them turns out to be infected. People coming into the country need to be tested on arrival, with results coming back in 24 hours while they wait somewhere safe. This is all well-trodden territory for countries like South Korea, for example. This is not life returning to normal by any means, but it is much better than trying keep everybody 2m apart.
The loosening of the lockdown being implemented in England (and at a slower pace in other parts of the UK) may well not lead to a rapid escalation, as many fear. There seems to be a lot less danger associated with being outdoors, especially if it is sunny (and also, for different reasons, I suspect, if it is wet). 2m social distancing may be impossible all the time on beaches like the one in my picture (the family groups sitting and sunbathing are OK – but the problems are when you are moving around), but the risk is probably very low. Shops and schools, now opening up, are probably not very risky either, with the mitigation measures in place – though we need to be careful about people that work there. But if there is no major escalation, it seems unlikely that the opposite will happen either: that we can get infections down to the level where social distancing can be dropped. The danger is that Britain will be stuck in a no-man’s land between emergency levels of the disease and being on top of it.
Alas Britain’s problems don’t end there. The government has still not mastered the logistics of mass testing, and of large-scale track and trace operations. The press is full of things going wrong, and especially of test results taking a very long time to come through, as well as difficulties in getting the tests to people that need them. To me it smells very strongly of an over-obsession with economies of scale – which lead to problems in linking the bits together. Much can be learned from the decentralised organisation of Germany, for example. Getting this infrastructure working properly is critical to moving beyond the world of social distancing. The bad news is that the people in charge don’t show any real grasp of what is causing the problems, and assume they can be solved by working a broken system harder.
Which means that the UK’s dismal record on tackling the Coronavirus is likely to continue. Well at least we aren’t Brazil.
The solution, short of a vaccine, has to be testing, testing and more testing. If necessary we’ll need to compulsorily isolate anyone who is shown to be a carrier until they are shown to be free of it, even if they are asymptomatic.
And it is about the R value. It isn’t just a statistical abstraction. Isolating known carriers at an early stage stops them passing it on to anyone else which is just another way of saying their personal ‘r’ value is then zero. If they had passed it to three people it would be 3. The R value is just the average of lots of ‘r’ values for everyone who is infected, and the lower they are, the lower is R too. The goal is to get R to be less than one. It doesn’t have to be zero for the infection to die out. 0.5 will do nicely.
The testing, therefore, doesn’t have to be perfect and the testers can afford to miss a few infections. It should have been expanded and improved, rather than stopped, in March. It shouldn’t have been an either/or choice between lock-down and testing. Even a reduction from R from, say, 2 to 1.8 due to testing and a further reduction to 0.7 due to lock-down would have been useful.
So I’m not sure what the scientists were thinking about at the time.
I take your point. The R value has some value, but I think it often gets in the way of clear language. “Slow down the spread of the virus” is clearer than “reduce the R-number”. A bigger issue is that the use of averages might conceal particular problems, for example in care homes. Still, you are dead right about testing. I don’t think testing was stopped in March – it was overwhelmed by demand from hospitals, so they stopped track and trace. My big beef is that the whole expansion of testing looks wrong-headed. It is critical that the time between the test being requested and the result being fed back is minimised. But the government system has so many but-in delays, and they focus on a quantitative target. Something similar seems to be going on with the new track and trace. It’s a bad signal if Serco are running it.