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Covid-19: The Exit Problem

Most of the countries in Asia, Europe and North America are now in lockdown to slow the spread of the Covid-19 virus. This is the ‘suppression’ strategy, and it should keep the death rate from going exponential for a while. The unanswered question is: what do we do next?

There is no exit strategy. “This type of intensive intervention package [‘social distancing’ of the entire population, home isolation of Covid-19 cases, and household quarantine of their family members] will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed.”

That’s from the executive summary of the key Imperial College London report that on Monday forced the British government to abandon its insane policy of letting the infections grow and hoping the population (or what was left of it) would achieve ‘herd immunity’.

The 30-strong Imperial College team estimated that an ‘unmitigated epidemic’ – no closure of schools, shops, restaurants and bars, no household quarantines of suspected coronavirus cases and their families, no ‘social distancing’ – would directly cause 510,000 deaths in the United Kingdom in the first wave of infections (now to July or August).

Infections would grow rapidly through March, and the demand for beds in intensive care units (ICUs) would exceed supply by the second week of April. At the peak of the first wave of infections in mid-May, demand for ICU beds would be thirty times greater than supply.

They did the same calculations for the United States, and concluded that 2.2 million Americans would die in the first wave of infections. (This number was instrumental in jolting the Trump administration out of its ‘deny, distract and downplay’ strategy last weekend.) Such huge case loads would inevitably crash the health-care systems in both countries, causing further ‘secondary’ losses of life.

So the team moved on to consider the ‘mitigation’ model. This concentrates on ‘flattening the curve’ of infections, which would now peak in late June. Suspected cases of infection are confined to their homes and their families are also quarantined, schools are closed, over-70s are required to self-isolate – but shops, bars, restaurants, etc. stay open, and the economy staggers on more or less intact.

The mitigation policy’s outcome is slightly better, but the peak case load is still so high that it crashes the health system. Total deaths in the first wave are reduced only by half: i.e a quarter-million die in the United Kingdom, and a million in the United States. So the Imperial College team moved on to examine the third option: ‘suppression’.

Suppression, or ‘lockdown’ if you prefer, drastically reduces human contact in order to reverse the rate at which infections are spreading. ‘Social distancing’ applies to everyone, not just the over-70s, and almost all public venues except food shops and pharmacies are closed. It does the job – after a few weeks death rates drop sharply – but the economy also goes into decline: probably 6% down or worse by the end of the year.

This is now the policy in most developed countries: mass death is no longer on the doorstep. The United States as a whole is still in ‘mitigation’, because it takes a long time to turn a supertanker like Mr Trump all the way around, but New York and some other big American cities and states have already moved on to suppression.

It has all happened very fast, and governments are just starting to realise that we will be in this mode for a long time. In fact, unless this particular coronavirus fails to cause a second wave of infections next winter – it isn’t certain – we will probably be stuck in lockdown most of the time until an effective vaccine becomes widely available, probably no sooner than eighteen months from now. August of 2021, let’s say.

In the meantime, the best we can hope for is a few breaks when new infections have fallen so low that the controls can be “relaxed temporarily in relatively short time windows” for a month or two. But the virus will still be at large in the population, and we’ll probably have to re-impose the controls as the number of infections starts to spike again.

Economically, it will be as big a hit as the Great Recession of 2008-9. Saving everything from shuttered shops, theatres and restaurants to passenger-starved airlines from bankruptcy will be a huge challenge. Keeping their laid-off employees out of poverty will be just as hard. There will have to be mortgage and rent holidays and maybe ‘helicopter money’ (dropped from above by central banks).

But here’s a silver lining, if you want one. In every country we have collectively decided, without even an argument, that we care more about the lives of our fellow-citizens than we do about the damned economy.
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To shorten to 700 words, omit paragraphs 10 and 12. (“This is…suppression”; and “In the…again”)

Gwynne Dyer’s new book is ‘Growing Pains: The Future of Democracy (and Work)’.

British Roulette

“I must level with the British public: many more families are going to lose their loved ones before their time.”
Prime Minister Boris Johnson, 11 March 2020

“Just stay calm. It will go away.”
President Donald Trump, 10 March 2020

The contrast between the two major populist leaders of the English-speaking world could not have been greater. Trump, who spent two months dismissing the Covid-19 virus as a “hoax” cooked up by his opponents to crash the market and scupper his re-election chances, finally did an about-face on 13 March and declared a “National Emergency”. But on Sunday he was still fantasizing that “we have tremendous control” over the virus.

Johnson, on the other hand, assumed a grave manner as he delivered the bad news. It’s serious, many people will die, but we do have a plan. The problem is that the plan may kill a great many Britons for nothing if he is wrong – which most experts think he is.

“When I heard about Britain’s ‘herd immunity’ coronavirus plan, I thought it was satire,” epidemiologist William Hanage of Harvard University told the Guardian on Sunday. But it is deadly serious. Boris Johnson, unlike Donald Trump, listens to scientists, but the ones he listens to most, chief scientific adviser Sir Patrick Vallance and chief medical adviser Chris Whitty, have a plan that most other experts think is crazy.

‘Herd immunity’ occurs when a large majority of the community has acquired immunity to a disease. That breaks the chain of transmission for the virus in question, and even those without immunity are fairly safe so long as their numbers stay low. So this is Boris’s cunning plan.

Let the coronavirus spread until around 60 percent of the population has acquired and survived it. Then the dreaded ‘second wave’ of the epidemic will not happen, because herd immunity will protect everybody. Alas, there are a few flaws in this plan.

Sixty percent of the British population is about 40 million people. Only 0.2% of adults under 40 who contract Covid-19 die from it (and those under 10 don’t get sick at all). The death rate goes up steeply for older age groups, but even for those in their 60s it’s only 3.6%. So for all the under-70s it’s only – hang on a minute, that’s 445,000 deaths. More than British military deaths in World War Two.

That’s assuming that Britain’s National Health Service (NHS) can give intensive care to all the severe cases of Covid-19. If the UK follows the pattern in China, around one in five coronavirus patients will need intensive care to recover. One in five of 40 million people is eight million.

The number of beds in intensive care units (ICUs) in British hospitals is 4,300. Maybe the NHS can improvise 10,000 more, but it still wouldn’t go far if up to 8 million severely ill patients need ICU beds this year, each for weeks at a time. Many more than 445,000 would die. The whole scheme is lunacy – and we still haven’t got to the plan for the over-70s.

The death rate from Covid-19 for people in their 70s is 8%. For 80 and over, it’s at least 15 %. So while everybody under 70 takes their chances with the virus, all those over 70 must self-isolate for four months. Those who venture out can be fined up to £1,000 (US$ 1,230) or even jailed.

Moreover, there may be unknown after-effects of having Covid-19, like getting shingles decades after you had chickenpox. There are reports of lung damage in many survivors. Re-infection may be possible: infected people have tested positive again after being discharged negative. Why don’t we give Covid-19 to 40 million people and see what happens?

Now, it’s possible that Boris Johnson’s advisers are right and everybody else is wrong. Maybe there is a devastating ‘second wave’ coming next winter, and this bizarre plan is the only way to stop it. But we don’t even know if Covid-19 will have a second wave. There wasn’t with SARS, a similar coronavirus. As William Hanage said, “vulnerable people should not be exposed to a virus right now in the service of a hypothetical future.”

Elsewhere, there’s a dramatic fall in the number of new infections in Asian countries that started testing, contact tracing and social distancing early on. China has had 81,000 cases, but on Monday reported only seven new cases. No official will say this aloud, but Britain is deliberately neglecting all that and letting the infections rip.

Testing, contact tracing and social distancing may turn out to be ineffective: infections may pick up again in other countries when the rules are finally relaxed. (280 million Chinese went back to work on Monday after two months of lockdown). But that strategy is certainly worth a try, whereas Johnson, in the words of Richard Horton, editor-in-chief of leading British medical journal ‘The Lancet’, is “playing roulette with the public.”

Why is he doing it? Perhaps it’s just arrogance (aka the ‘Brexit spirit’): Britain knows best, and should always steer its own course. But he probably just prefers a policy that does not cripple the economy, and doesn’t understand the implications.

So not all that much difference between the mini-Trump and the real thing after all. And the ‘herd immunity’ nonsense probably won’t last long once the British public realises what Johnson’s government is actually planning.
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THIS ARTICLE is a bit longer than usual. To shorten it to 850 words, omit paragraph 12 (“Moreover…happens”). To shorten further to 750 words, omit also paragraphs 14 and 16. (“There has…rip”; and “Why…implications”)