UK health experts assess the wisdom of 15-weeks’ hard lockdown

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British health experts assess whether the 15-weeks of lockdown hardship was worth it and, in retrospect, what should have been done.

The coronavirus pandemic has cost Britain dear. The virus has claimed over 44,000 lives. The Daily Telegraph reports that 9m people have been furloughed and the national debt has soared. The sport, arts, travel and hospitality sectors have been decimated.

And yet, the report says, lockdown has saved many lives. In March, Imperial College London research indicated that, with no lockdown, Britain would suffer 260,000 deaths. Currently, the country’s death toll stands at just under a fifth of that projection.

What might have happened had the UK followed a different path? Has the last 15 weeks of hardship been worth it? It will take years to properly answer these questions. The pandemic is not yet over.

 

Dr Jeremy Farrar, director of Wellcome and member of Sage says in the report that the impact of COVID-19 is unprecedented, like nothing experienced in living memory.

“The scale and speed of this crisis has been overwhelming. Even for those like myself who have worked for many years in emerging infectious disease and through previous epidemics, including HIV, SARS, Avian Flu, Zika and Ebola. This virus has reached every corner of the planet, taking lives, overwhelming health systems, disrupting society, and crippled economies. All in six months.

“A pandemic like this, of a rapid-spreading novel respiratory virus, crossing from animals to humans, was a threat long warned of by the scientific community. The international health community had not, unfortunately, taken full opportunity to act on the need for pandemic preparedness.

“Since the first reported cases, scientists have worked at incredible speed to increase understanding of COVID-19. With more than 200 vaccine candidates already in development and one drug, dexamethasone, now known to save lives, we’ve achieved in months what would normally have been the work of a decade. If not longer.

“But, we are also still without vaccines, a range of effective treatments or rapid, reliable testing with robust contact tracing systems, that remain the only exit to this pandemic.

“National lockdowns have saved many lives where they have been effectively implemented, and infection numbers across Europe, are now low enough to begin very cautious easing of restrictions. It is vital to get the economy open again so people can get back to some sort of normal way of life. Schools should be the priority to fully reopen as soon as possible.

“But COVID-19 has not disappeared. Restrictions have not changed the fundamentals of the virus. It still is very infectious, transmitting between people just as easily as it ever did. As individuals, we must remain very careful. Governments must use this time to prepare for potential second waves and to learn lessons from the first six months.
By acting on mistakes of the past six months now, and by preparing our health systems now for future waves and winter pressures, there is a chance to stop local outbreaks in coming months becoming national catastrophes. The choices we make and actions we take over the next couple of months will determine whether there are second waves and the outcome of this pandemic.

“The international community must redouble efforts to support and scale up the research, development, manufacture and distribution of the tools needed globally. The International Money Fund has said the cost to the global economy could be $12trn. The cost of tools to test, treat and prevent COVID-19 has been set, by the World Health Organisation and global partners of the ACT-Accelerator, at $31.3bn. To date, $3.4bn has been raised.

“And we need to ensure any – and all – effective diagnostics, treatments or vaccines for COVID-19 are available to everybody around the world, regardless of ability to pay. Until every country is protected, we all remain at risk.

“I hope out of this crisis we this will demonstrate to the world there is no future in narrow nationalism. To protect lives and livelihoods from health threats, whether caused by pandemics, climate change, drug resistance, or mental health, we must have unequivocal trusted and effective global partnerships.”

 

“Lockdown was not a choice – better broke than dead was the thinking”, says Paul Nuki, Global Health Security editor. He says lockdown was never a political choice.

“Whitehall had not planned in advance to suppress a fast-moving virus and ill-judged talk of ‘herd immunity’ cemented that for people, rightly or wrongly. Britons looked en masse to China, Italy and Spain and said, ‘I’ll tell you what, we’ll do that instead.’ Better broke than dead was the thinking. The Prime Minister had no choice but to implement it.

“Was it worth it? If you take a very narrow view and weigh human life only in terms of economic value, then the answer is probably not. Lockdown has saved hundreds of thousands of British lives but you could argue that most are old, unwell or otherwise unproductive in economic terms. It’s also true that lockdown will, for decades to come, cause many thousands of indirect deaths as a result of the economic storm to come.

“Deaths caused by unemployment, crime, mental health issues and a withered NHS.

“But such arguments are as unworkable as they are contemptible. They are the arguments of First World War generals and nineteenth-century colonialists – people who regarded others as little more than a herdable commodity. They are not fit for a modern democracy. Today voters call the shots, politicians and Whitehall officials serve.

“When the political reckoning comes, people will ask why Britain was not prepared to suppress a fast-moving virus as others in Asia and Europe were. Why were we left with no option other than to lock down completely, while others saved lives and kept their economies ticking over?

“These are going to be tough questions to answer. They go to the heart of how we are governed and how our just-in-time economy is managed. Was it worth it? Not if you are in government or Whitehall, I don’t imagine.”

 

Dr Clare Wenham, assistant professor of global health policy at the London School of Economics said in the report that “lockdown was too late, costing numerous unnecessary deaths. Lockdown has been the only meaningful option available to governments. Yet, looking across the world we’ve seen very different lockdowns, which reveals much about how governments prioritise economic security versus people’s health.

“Some governments, such as those of Spain, New Zealand, El Salvador and South Africa have implemented strict national lockdown, requiring everyone apart from key workers to stay at home. Whilst this nuclear option can reduce transmission and limit damage to population health, it comes with significant economic and social costs – businesses go bust, vulnerable people become more marginalised, and the securitisation of health can jeopardise human rights.

“Other countries have taken a community approach, with “local” lockdowns at state level in the US and Brazil. In theory these target the hotspots of infection, although this is harder to manage with mobile populations fed up of lockdown – what’s to stop people simply going to the next town?

“The most forward-thinking governments have prioritised targeted lockdowns, through track-and-trace systems to ensure they isolate those infected or at risk, allowing the rest of the population (and economy) to continue. Here in the UK, it’s unclear whether the government is prioritising people’s health or the economy.

“We locked down too late, costing numerous unnecessary deaths, based on a hubristic argument of “British exceptionalism”. Even when the government decided to move to track and trace, this exceptionalism required a British app, rather than simply licencing one trialled already, such as South Korea’s; the UK version is still not fit for purpose. Thus, continued cycles of local lockdown seem somewhat inevitable in the UK in the absence of being able to deliver an individual targeted approach, with a second national lockdown viewed as political suicide for Boris Johnson’s government. Next time, I hope we learn that the key is to move early, be humble, and learn from each other’s experience.”

 

Anthony Costello, professor of global health, University College London, and founder member of Independent Sage said: “We forgot about public health. We forgot that infections like flu, hepatitis, dengue fever, HIV, malaria, tuberculosis and bacterial pneumonia, killed more people than all the wars of the past century. And we forgot that public health is about the ‘loving struggle’, what the philosopher Karl Jaspers calls a forum where “all kinds of power and superiority, prejudice and calculating strategic reserve against the other are eliminated.

“Imagine if a public health scientist had been invited to join Sage and had read and understood January’s research papers about the deadly nature of COVID-19. Imagine they had challenged the modellers and their flattened curves and herd immunity theories derived from a different virus. And imagine if they had disputed the myopic view that we couldn’t test, and argued that our 44 NHS molecular virology labs across the country could rise to the challenge.

“Imagine if all public health directors in every local authority across the country had been asked to draw up a local pandemic response plan, recruit paid contact tracers and volunteers, and been given extra resources.

“Then we might have mobilised like Wuhan, where, in two weeks, 9,000 community health workers in teams of five were brought to a population of 10m. England and Wales provided just 270 overworked tracers for 55m.

“Imagine if accurate, up-to-date data was shared openly with local communities, to keep them engaged and innovative, rather than concealed in contracts with accountants, call centres and apps.

“Germany, Denmark, Norway, Finland, Greece, China, South Korea, Singapore, Hong Kong, Japan, Vietnam and Thailand managed their loving struggle. If the UK had not neutered its public health service, if it had locked down two weeks earlier, had trusted primary care and local authorities, built on NHS systems, stopped boasting about “world-beating” this and that, protected the elderly as it had promised, devolved decisions, copied Ireland, and protected vulnerable health and care workers, we might have suffered far fewer deaths and been in a better position to manage the aftermath of lockdown.”

 

According to Dr Ron Daniels, consultant in intensive care, University Hospitals Birmingham NHS Foundation Trust: “We only survived because of lockdown. I’ve been an intensive care specialist, or ‘Intensivist’, for almost 20 years. In that time my colleagues and I have seen serious illnesses, unbelievable tragedies, challenging winters and seasons when we’ve been hit hard by flu. We have known for some time that a pandemic was overdue, but with threats such as SARS, MERS and Ebola not really reaching these shores perhaps we had become complacent.

“We had no idea what was to come. In a matter of weeks, our NHS and our intensive care units became stretched to levels we hadn’t imagined possible.

“We’re only just beginning to appreciate the effect on those with cancer and long-term conditions. We know there have been many thousands of deaths beyond those expected for the time of year. And it’s terrible to think that people with acute conditions may well have died at home because of fear of accessing healthcare.

“We only survived because of lockdown. All clinicians are acutely conscious of the seemingly conflicting priorities of economic stability and NHS survival, but the reality is that this very nearly broke us. Intensive care units were full, we were doubling up patients in rooms, and safe staffing was challenged by unprecedented levels of sick leave. Many staff have still not been able to return to work, and tragically we have lost far too many colleagues.

“Just as our ability to cope became saturated, lockdown began to work. Patient numbers accessing hospitals reduced, we learned more about how to manage patients with COVID-19, we were able to focus on those patients we had, and we became able to breathe a bit easier again.

“Lockdown was the right strategy. The next time a pandemic comes, we will be very much better prepared. We have to assume that it won’t be too far away. If there is one thing this virus has taught us it is that preparedness is all.”

 

“Everybody’s building the ship in a different way”, says Professor David Heymann, professor of infectious disease epidemiology at London School of Hygiene and Tropical Medicine (LSHTM) and head of the Centre on Global Health Security at Chatham House-London.

“Most countries in lockdown are really surviving day to day and nothing’s sure yet about how they will eventually be judged. One of the big questions is: had we prepared for lockdown in advance, would it have been better?

“In Asia the approach was different than in many other parts of the world. Many countries took an epidemiological approach from the start, and had planned for that after SARS and MERS outbreaks. They heeded the early warnings from WHO and prepared in mid-January. They had the testing and track and trace systems ready.

“As the virus spread they looked for where transmission was occurring in greatest intensity, and that’s where they locked down. They did not totally lockdown but rather locked down where they noted that the risk of transmission was greatest, and they opened up when that risk had decreased. In other countries, it seemed it was last minute, just locking down everything without an exit strategy.

“Now many countries are trying to develop that exit strategy. Should they go for complete suppression of the virus? Or might trying to shield the populations at greatest risk be the better strategy? These are questions we will only know the answers to afterwards, but they’re questions that policymakers are having to address now. It’s very difficult.

“Why didn’t all countries take an Asain style epidemiological approach? I think many countries planned more for an influenza-type virus which – rightly or wrongly – is seen as more difficult to contain.

“But some adjusted quickly. Germany is a good example in Europe, they continued their contact tracing having trained a large number of tracing scouts, and in many cases seem to have prevented the virus getting deep into the community.

“We are all now learning and trying different approaches. There will likely be many lessons taken from Asia. And you know, I’m not criticising anybody. Right now everybody’s building the ship in a different way – we’ll find out which are best as we sail on.”

 

“Hard lockdowns mean a shorter lockdown overall” – says Professor Devi Sridhar, professor of global public health at the University of Edinburgh.

He says the clear lesson from COVID-19 so far is early, hard lockdowns mean a shorter lockdown overall. “Trying to keep the economy going, while having the virus circulating, ends up meaning that all balls get dropped, and a halfway house where the economy can’t fully re-open while the virus is still circulating at substantial levels.

“Repeated lockdowns or whack-a-mole strategies are not sustainable and are even more destructive for small businesses and children given the uncertainty they entail. The fastest path to protect health, the economy and society is to push towards a “zero COVID” Britain, and then use border screening and checks to catch imported cases.”

Full report in The Daily Telegraph

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