Summary: The much delayed Lockdown in the UK has been managed well by the majority of our population. The strategy of defending the NHS at all costs is substantially a consequence of years of underfunding because of austerity. There are other consequences of the Lockdown that are becoming rapidly more critical. There are substantial numbers whose income has fallen to zero and who simply cannot find the money to eat. These numbers are so great and growing so rapidly that we cannot expect the present Lockdown to be maintained for much longer. Public tolerance is finite. The most abject poverty must be managed by distributing funds as widely as possible as a matter of urgency. Responsibility for managing the pandemic needs to be passed increasingly to the individual to take responsibility for their own safety and that of their family. Businesses should be allowed to reopen provided certain essential arrangements are made for staff, customers and any casual workers involved. We all need to start using facemasks much more widely as the Lockdown is reduced over a small number of weeks.
The Lockdown has been surprisingly well-tolerated in the UK, despite the excellent weather and the Easter weekend. Unfortunately it isn’t working all that well. The number of new cases, hospitalisations and deaths continue to mount. Increasing evidence from Chinese studies suggests that social distancing at 2 m is not enough. Simply breathing the same air as infected individuals and talking with them is most likely one of the main ways the virus propagates. Recent studies suggest that only a low percentage of the UK population have already had Covid-19, probably <15%. Herd immunity is a long way from reality. Hopes that a vaccine might be available in September have been raised by efforts in Oxford but it will take some time thereafter to produce vaccine in the quantities needed to treat a major fraction of the British population. Predictions suggest widespread availability towards the end of 2020 if everything goes well.
The reality is that the UK government ignored what health experts were saying in mid-January about the outbreak in Wuhan, an outbreak that was worsened by the Chinese not wanting to stop celebration of the Chinese New Year in late January when large numbers traditionally travelled to visit their families. The UK government had been in denial about the threat to national security of a pandemic even though the Cygnus exercise in October 2016 had shown that the UK capacity to deal with a pandemic was so poor that it was “too terrifying” to be publicised. Further warnings were given regularly but ignored substantially by the Tory government still obsessed with austerity, something that compromised greatly the capacity of the NHS to deal with the health requirements of the UK anyway. The Tory government, keen to distance itself from anything the EU might do, no matter how it might help the UK, decided not to be involved in the four EU procurement schemes to order a wide range of PPE equipment. When eventually the UK got round to it, most suppliers were already committed to supply elsewhere.
Boris Johnson was happy to rely on British exceptionalism. The pathetic worries of Johnny Foreigner could be ignored. In early February Johnson made it clear that trade and commerce were of much higher priority than coronavirus. In a speech in Greenwich, he stated that the UK would emerge from the exaggerated calls for action, taking the role of a Marvel superhero leaping out to save the planet. To ignore any country that entirely shut down a city with a population greater than that of Greater London counts as one of the great examples of government negligence in modern times. Then to delay by perhaps five weeks now translates into many thousands of totally unnecessary deaths. It has also caused extraordinary damage to the UK economy and to its people more widely.
Large numbers of the UK workforce found themselves unemployed and with zero income three weeks ago. It has been known for some time that around 40% of UK non-pensioner households have savings that will barely pay for one months worth of household bills. Already the Food Foundation reports a You-Gov poll taken last week that found 1.5 million households have not eaten for a full day as they simply have no money and no access to food. In total 3 million had to skip some meals during the week. Anecdotal reports of increased hospital admissions due to malnutrition are concerning. Mechanisms for funding unemployed people with zero income have barely been established and what there is seems to move on geological timescales.
Economists such as Richard Murphy (https://www.taxresearch.org.uk/Blog/) have long advocated simply giving a modest fixed payment to everyone in the Inland Revenue’s PAYE lists with additional mechanisms to give money directly to those not currently part of the formal wage earning/tax paying community. There are a surprising number that would be missed if this was restricted to HMRC lists. It is quite possible some money will go to people who do not need it or do not deserve it. That has to be accepted as a minor detail of little consequence in the big picture as speed is of the essence here.
Widespread starvation risks leading to some civil insurrection. At present the police have a major responsibility for managing the Lockdown. However austerity has cut police numbers to the bone and it is important that the police are free to keep order more widely should the Lockdown start to crumble. Alternative approaches to keeping the epidemic under control need to be developed. Predictably, the government has barely started thinking about that and are a long way from deciding how to manage it. The absolute priority has been to manage the stress on the NHS which was already at its limits because of normal winter pressures before the Covid-19 epidemic got going. The delays in introducing the Lockdown, and the total inability of the government to engage with what had to be done (sourcing ventilators, PPE etc.) have further increased the pressures on the NHS. Even now the scandalous lack of PPE for frontline staff in hospitals and care homes is extraordinary and unforgivable.
We probably have little time to manage this critical situation. At present the Lockdown consists of the government giving highly simplified instructions to the population (wash your hands, stay-at-home, maintain social distancing, minimal journeys outside the home except for exercise, essential shopping and medical). Simply, the government is saying that if we do that then we will minimise the number of Covid-19 cases. We are all being told what to do by the government. Unfortunately this approach means that it is the young who are most unlikely to suffer from the disease and can least afford that their lives been put on hold. They are being forced into Lockdown in order to minimise the risks to the elderly and those less likely to be able to survive the virus.
A radically different approach is to turn the responsibility away from the state to the individual. Saying to everyone that each of us must take responsibility to make sure we do not catch the bug. Those most at risk need to stick rigidly to the most rigourous form of self isolation. Others must take responsibility for themselves and the people they live with. If you want to be as sure as possible you are safe while being at work then you need to wear of proper facemask (not one of those pathetic pieces of paper with two rubber bands, but a proper one that fits over your nose and mouth) and gloves. Once you are back home you need to wash your hands carefully and keep the facemask and gloves separate and secure. If you have vulnerable older people in the household you will have to be particularly careful to make sure you do not bring the bug in to them. Younger people living on their own or with other young people can be much more relaxed but they must be careful to stay at home if they show any of the symptoms, until they have recovered properly.
It is highly likely you won’t be able to buy a proper facemask anyway, but even using a scarf that wraps completely around your mouth and nose will go a long way towards giving you protection. It should be possible to design simple fabric-based masks that will give a good level of protection and can be made available quickly and cheaply.
The new self-tracking contact-tracing infection App announced by Matt Hancock on Sunday will be particularly useful and important to make this work well. He did not say when it might be ready but the phrases he used suggest that it might be three or four weeks before it is actually up and running.
It is essential that most of the British economy is restarted as soon as possible. By ensuring that everyone understands the way individuals are now responsible for doing the right thing to keep themselves and their families safe and well. This means that the present Lockdown must be substantially ended as soon as possible, and by that I mean at most a few weeks. All businesses should be able to reopen with a requirement on them that they look after the health of the employees, anybody working with them and any customers or other visitors who come into their premises. Employers must make sure that employees are provided with face masks and gloves, for example, and given enough space to feel comfortable and safe while at work. Employers would deem themselves to be unable to comply should simply be told to close until they can. All schools should reopen after the May half term in early June. Here teachers will need to ensure that they are adequately protected from infection to any of the children have the disease.
Other restrictions may be necessary. Social distancing will probably need to be maintained as much as we can tolerate. Everyone using public transport should be required to wear a face mask.
It is difficult to have much confidence in the way that this epidemic will pan out. Initially it just looked as if it was a matter of managing a rather nasty disease, significantly more fatal than the seasonal influenza we had become able to manage. Unfortunately what we also have is a substantial economic collapse that will affect individuals disproportionately at the poorest end of the scale and those that have the least resilience to manage the significant downturn in income that so many are experiencing. The government are undoubtedly culpable here to a dreadful degree and they must be held to account.