12 May 2020

Five scenarios to unwind the lockdown. Are there more?

Filed under: challenge, healthcare, politics, risks — Tags: , , — David Wood @ 1:55 pm

The lockdown has provided some much-needed breathing space. As a temporary measure, it has helped to prevent our health services from becoming overwhelmed. In many (though not yet in all) countries, the curves of death counts have been slowed, and then tilted downwards. Financial payments to numerous employees unable to work have been very welcome.

As such, the lockdown – adopted in part by individuals and families making their own prudent decisions, and in part due to government advice and edict – can be assessed, provisionally, as a short-term success, given the frightful circumstances in which it emerged.

But what next? The present set of restrictions seems unsustainable. Might a short-term success transition into a medium-term disaster?

The UK’s Chancellor of the Exchequor, Rishi Sunak, recently gave the following warning, referring to payments made by the government to employees whose companies have stopped paying them:

We are potentially spending as much on the furlough scheme as we do on the NHS… Clearly that is not a sustainable situation

What’s more, people who have managed to avoid meeting friends and relatives for two or three months, may become overwhelmed by the increasing strain of separation, especially as mental distress accumulates, or existing family relations rupture.

But any simple unwinding of the lockdown seems fraught with danger. Second waves of infection could shoot up, once social distancing norms are relaxed. In country after country around the world, tentative steps to allow greater physical proximity have already led to spikes in the numbers of infections, followed by reversals of the relaxation. I recently shared on my social media this example from South Korea:

South Korea: bars and nightclubs to close down for 30 more days after health officials tracked 13 new Covid cases to a single person who attended 5 nightclubs and bars in the country’s capital city of Seoul

One response on Twitter was the single word “Unsustainable”. And on Facebook my post attracted comments criticising the approach taken in South Korea:

It is clear Korea is going to be looking over its shoulder for the indefinite future with virtually no immunity in the population.

I have considerable sympathy with the critics: We need a better solution than simply “crossing fingers” and nervously “looking over the shoulder”.

So what are the scenarios for unwinding the lockdown, in a way that avoids the disasters of huge new spikes of deaths and suffering, or unprecedented damage to the global economy?

To be clear, I’m not talking here about options for restructuring society after the virus has been defeated. These are important discussions, and I favour options for a Great Reconsideration. But these are discussions for another day. First, we need to review scenarios for actually defeating the virus.

Without reaching clarity about that overall plan, what we can expect ahead is, alas, worse confusion, worse recrimination, worse health statistics, worse economic statistics, and a worse fracturing of society.

Scenario 1: Accelerate a cure

One scenario is to keep most of society in a state of social distancing until such time as a vaccine has been developed and deployed.

That was the solution in, for example, the 2011 Steven Soderbergh Hollywood film “Contagion”. After a few setbacks, plucky scientists came to the rescue. And in the real world in 2020, after all, we have Deep Learning and advanced biotech to help us out. Right?

The main problem with this scenario is that it could take up to 18 months. Or even longer. Although teams around the world are racing towards potential solutions, we won’t know for some time whether their ideas will prove fruitful. Bear in mind that Covid-19 is a coronavirus, and the number of successful vaccines that have been developed for other coronaviruses is precisely zero. Technology likely will defeat the virus in due course, but no-one can be confident about the timescales.

A variant of this scenario is that other kinds of medical advance could save the day: antivirals, plasma transfers, antimalarials, and so on. Lifespan.io has a useful page tracking progress with a range of these potential therapeutics. Again, there are some hopeful signs, but, again, the outcomes remain uncertain.

So whilst there’s a strong case for society getting more fully behind a considerable number of these medical research projects, we’ll need in parallel to consider other scenarios for unwinding the lockdown. Read on.

Scenario 2: Exterminate the virus

A second scenario is that society will become better at tracking and controlling instances of the virus. Stage by stage, regions of the planet could be declared as having, not just low rates of infectious people, but as having zero rates of infectious people.

In that case, we will be freed from the risk of contracting Covid-19, not because we have been vaccinated, but because there are no longer any infectious people with whom we can come into contact.

It would be similar to how smallpox was gradually made extinct. That virus no longer exists in the wild. One difference, however, is that the fight against smallpox was aided, since 1796, by a vaccine. The question with Covid-19 is whether it could be eradicated without the help of a vaccine. Could it be eradicated by better methods of:

  • Tracking which people are infectious
  • Isolating people who are infectious
  • Preventing travel between zones with infections and those without infections?

This process would be helped once there are reliable tests to ascertain whether someone has actually had the virus. However, things would become more complicated if the virus can recur (as has sometimes been suggested).

Is this scenario credible? Perhaps. It’s worth further investigation. But it seems a long shot, bearing in mind it would need only a single exception to spark a new flare up of infections. Bear in mind that it was only a single infectious hotspot that kick-started this whole global pandemic in the first place.

Scenario 3: Embrace economic reversal

If Scenario 1 (accelerate a cure) and Scenario 2 (exterminate the virus) will each take a long time – 18 months or more – what’s so bad about continuing in a state of lockdown throughout that period? That’s the core idea of Scenario 3. That scenario has the name “Embrace economic reversal” because of the implication of many people being unable to return to work. But would that be such a bad thing?

This scenario envisions a faster adoption of some elements of what has previously been spoken about as a possible longer term change arising from the pandemic – the so-called Great Reconsideration mentioned above:

  • Less commuting
  • Less pollution
  • Less time spent in offices
  • Less time spent in working for a living
  • Appreciation of life freed from a culture of conspicuous consumption
  • Valuing human flourishing instead of GDP
  • Adoption of a Universal Basic Income, and/or alternatives

If these things are good, why delay their adoption?

In short, if the lockdown (or something like it) were to continue in place for 18 months or longer, would that really be such a bad outcome?

The first problem with this scenario is that the lockdown isn’t just getting in the way of parts of life that, on reflection, we might do without. It’s also getting in the way of many of the most precious aspects of life:

  • Meeting people in close physical proximity as well as virtually
  • Choosing to live with a different group of people.

A second problem is that, whilst the true value of many aspects of current economic activity can be queried, other parts of that economy play vital support roles for human flourishing. For as long as a lockdown continues, these parts of the economy will suffer, with consequent knock-on effects for human flourishing.

Finally, although people who are reasonably well off can cope (for a while, at least) with the conditions of the lockdown, many others are already nearing the ends of their resources. For such people, the inability to leave their accommodation poses higher levels of stress.

Accordingly, whilst it is a good idea to reconsider which aspects of an economy really matter, it would be harsh advice to simply tell everyone that they need to take economic decline “on the chin”. For too many people, such a punch would be a knock-out blow.

Scenario 4: Accept higher death statistics

A different idea of taking the crisis “on the chin” is to accept, as a matter of practicality, that more people than usual will die, if there’s a reversal of the conditions of lockdown and social distancing.

In this scenario, what we should accept, isn’t (as in Scenario 3) a reversal of economic statistics, but a reversal (in the short-term) of health statistics.

In this scenario, a rise in death statistics is bad, but it’s not the end of society. Periodically, death statistics do rise from time to time. So long as they can still be reasonably controlled, this might be the least worst option to consider. We shouldn’t become unduly focused on what are individual tragedies. Accordingly, let people return to whatever kinds of interaction they desire (but with some limitations – to be discussed below). The economy can restart. And people can once again enjoy the warmth of each others’ presence – at music venues, at sports grounds, in family gatherings, and on long-haul travel holidays.

Supporters of this scenario sometimes remark that most of the people who die from Covid-19 probably would have died of other causes in a reasonably short period of time, regardless. The victims of the virus tend to be elderly, or to have underlying health conditions. Covid-19 might deprive an 80 year old of an additional 12 months of life. From a utilitarian perspective, is that really such a disastrous outcome?

The first problem with this scenario is that we don’t know quite how bad the surge in death statistics might be. Estimates vary of the fatality rate among people who have been infected. We don’t yet know, reliably, what proportion of the population have been infected without even knowing that fact. It’s possible that the fatality rate will actually prove to be relatively low. However, it’s also possible that the rate might rise:

  • If the virus mutates (as it might well do) into a more virulent form
  • If the health services become overwhelmed with an influx of people needing treatment.

Second, as is evident from the example of the UK’s Prime Minister, Boris Johnson, people who are far short of the age of 80, and who appear to be in general good health, can be brought to death’s door from the disease.

Third, even when people with the virus survive the infection, there may be long-term consequences for their health. They may not die straightaway, but the quality of their lives in future years could be significantly impaired.

Fourth, many people recoil from the suggestion that it’s not such a bad outcome if an 80 year old dies sooner than expected. In their view, all lives area valuable – especially in an era when an increasing number of octogenarians can be expected to live into their 100s. We are struck by distaste at any narrow utilitarian calculation which diminishes the value of individual lives.

For these reasons, few writers are quite so brash as to recommend Scenario 4 in the form presented here. Instead, they tend to advocate a variant of it, which I will now describe under a separate heading.

Scenario 5: A two-tier society

Could the lockdown be reconfigured so that we still gain many of its most important benefits – in particular, protection of those who are most vulnerable – whilst enabling the majority of society to return to life broadly similar to before the virus?

In this scenario, people are divided into two tiers:

  • Those for whom a Covid infection poses significant risks to their health – this is the “high risk” tier
  • Those who are more likely to shrug off a Covid infection – this is the “low risk” tier.

Note that the level of risk refers to how likely someone is to die from being infected.

The idea is that only the high risk tier would need to remain in a state of social distancing.

This idea is backed up by the thought that the division into two tiers would only need to be a temporary step. It would only be needed until one of three things happen:

  • A reliable vaccine becomes available (as in Scenario 1)
  • The virus is eradicated (as in Scenario 2)
  • The population as a whole gains “herd immunity”.

With herd immunity, enough people in the low risk tier will have passed through the phase of having the disease, and will no longer be infectious. Providing they can be assumed, in such a case, to be immune from re-infection, this will cut down the possibility of the virus spreading further. The reproduction number, R, will therefore fall well below 1.0. At that time, even people in the high risk tier can be readmitted into the full gamut of social and physical interactions.

Despite any initial hesitation over the idea of a two-tier society, the scenario does have its attractions. It is sensible to consider in more detail what it would involve. I list some challenges that will need to be addressed:

  • Where there are communities of people who are all in the high risk tier – for example, in care homes, and in sheltered accommodation – special measures will still be needed, to prevent any cases of infection spreading quickly in that community once they occasionally enter it (the point here is that R might be low for the population as a whole, but high in such communities)
  • Families often include people in both tiers. Measures will be needed to ensure physical distancing within such homes. For example, children who mix freely with each other at school will need to avoid hugging their grandparents
  • It will be tricky – and controversial – to determine which people belong in which tier (think, again, of the example of Boris Johnson)
  • The group of people initially viewed as being low risk may turn out to have significant subgroups that are actually at higher risk – based on factors such as workplace practice, genetics, diet, or other unsuspected underlying cases – in which case the death statistics could surge way higher than expected
  • Are two tiers of classification sufficient? Would a better system have three (or more) tiers, with special treatments for pregnant women, and for people who are somewhat elderly (or somewhat asthmatic) rather than seriously elderly (or seriously asthmatic)?
  • The whole concept of immunity may be undermined, if someone who survives an initial infection is still vulnerable to a second infection (perhaps from a new variant of the virus)

Scenario 6: Your suggestions?

Of course, combinations of the above scenarios can, and should, be investigated.

But I’ll finish by asking if there are other dimensions to this landscape of scenarios, that deserve to be included in the analysis of possibilities.

If so, we had better find out about them sooner rather than later, and discuss them openly and objectively. We need to get beyond future shock, and beyond tribal loyalty instincts.

That will reduce the chances that the outcome of the lockdown will be (as stated earlier) worse confusion, worse recrimination, worse health statistics, worse economic statistics, and a worse fracturing of society.

Image credit: Priyam Patel from Pixabay.

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