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Exiting from lockdown is a political nightmare demanding complex risk decisions. The Treasury and business leaders want to get the economy working as soon as possible so lobby for early exit; whereas the public health authorities – PHE and NHS – want to protect the public and hospitals from resurgence of the epidemic so lobby for continuation of the lockdown.  Politicians need to balance conflicting demands while mindful of public support which will deteriorate if an end is not in sight.

While countries at varying stages of the epidemic start to experiment cautiously with different exit strategies, the challenge for the UK government is simply one of risk management, and there are three distinctly different strategies: elimination, mitigation and reduction.

Elimination – This requires elimination of the threat – which is currently taken to mean the threat of catching coronavirus (it could also mean the threat of dying from Covid-19 which is not the same).  In Layman’s terms this is a vaccine or cure to enable the human immune system to recognise the virus and negate its harm. Since the virus genome was first identified in early January 2020 laboratories have been working to create an effective vaccine before the virus mutates. A fully approved and tested one for mass inoculation will probably not be available until Feb 2021. Although there is hope of one sooner, there is no guarantee a second wave will be avoided if lockdown is enacted before a campaign of vaccination.

verdict: Extending lockdown  for almost 12 months  is not politically feasible, although medically it is probably the safest strategy.  No economy in the world could suffer a ‘gap year’ so it is unlikely. Any effective vaccine will most likely suffer from supply shortages anyway, as PPE and testing kits have shown.

Mitigation – This requires preventing the virus from entering the lungs where it does most damage. Currently this would have to be through wearing a mask or respirator to block the virus.  As it travels in aerosol form the only way to avoid inhalation of the virus is through a mask rated FFP3. (this is the quality standard set by the NHS, but expect this to change under revised opinion). These masks are in short supply globally and even the NHS doesn’t have enough yet. Getting sufficient number of these to the public would take months. Note that Tuscany in Italy is experimenting with masks as part of its exit strategy, however mainly as disposable paper masks, these offer only FFP1 or FFP2 protection at best. 

verdict:  Masks could be part of an exit strategy, but at what quality and effectiveness? This would require a public health campaign as in 1939 when carrying a gas mask became mandatory in anticipation of gas attack. Who would decide on disposable or re-usable masks? Who would bear the cost, state or individual? 

Reduction – This requires reducing the risk of catching the virus through identifying those who have had it and built up some immunity.  This enables health passports or smart phone apps to define safety. This will not release the vulnerable from lockdown who will still need to follow strict social distancing until a vaccine is available.  For the economy this doesn’t matter, as neither the retired nor the ‘health impaired’ make a net contribution, however a two tier lockdown would be divisive. Note also that the UK does not have a good record on public testing:  a target of 100,000 tests a day by the end of April, looks optimistic given the daily count in mid-month was 16,000, and this only NHS workers and patients not the public.

verdict: Testing is important for understanding the behaviour and spread of the virus. A low probability of risk among the workforce can help restart the economy, but the risk among the vulnerable would still be high. Expect a two tier strategy with all the social pressures and stigma that creates.

From this analysis of three different risk handling strategies, you can see there are no easy answers. The lockdown needs to continue for public safety, but the risk of damage to life and the health service could be traded against the need to reboot the economy. It is ultimately a numbers game.