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Tue 7th Apr 2020 - Opinion Special – What’s the exit strategy? by Paul Chase

What’s the exit strategy? by Paul Chase 

If our involvement in foreign wars has taught us anything it is that it’s a lot easier to get into a war than it is to get out of one. Modern generals ask: “What’s the exit strategy?” before asking the politicians why they want to do this in the first place.

But now we’re faced with a different type of foe – covid-19. The response to the threat caused by this novel virus is more than half the world’s population is living in lock-downs of varying severity. The Spanish Flu of 1918 caused a death toll of about 228,000 people in the UK, and somewhere between 50 million and a 100 million deaths worldwide. The UK death rate was between 10% and 20% of those infected and was a consequence of a “do-nothing” response from the government of the day. The outbreak came in three waves over the course of about a year and was eventually self-limiting as population exposure led to what today we would call “herd immunity”. It wasn’t until 1933 the use of an electron microscope identified the cause of the disease as a form of influenza caused by the (H1N1 A) virus and spread by droplets passed from one person to another by sneezing and coughing.

So, the response of the UK government to covid-19 has been to take measures to curtail freedom of movement and to close businesses in a way unprecedented in peacetime. The idea of “riding this out” and letting the disease spread to create herd immunity seemed to be the early government strategy, although it’s denying it now. Then came the early modelling from Imperial College, London that suggested a laissez-fare approach leading to herd immunity would result in more than a quarter of a million deaths. Imperial College’s initial report also looked at various forms of social distancing including a “lock-down” and concluded deaths could perhaps be kept below 20,000 if these measures were implemented, but timing was crucial. The government appears to have been persuaded to take this approach. And it’s not hard to understand why. A death toll of a quarter of a million would simply be unbearable and the government would take much of the blame.

So, we’re now into the lock-down, and with no end in sight. And that is my concern and the concern of everyone in our sector and beyond. What is the exit strategy from lock-down – and is the government’s approach to suppress the disease, or, as I suspect, a carefully managed herd-immunity strategy by another name? The fact is the disease is now seeded in the population and formal tracing of infected persons’ contacts ended on 12 March. The purpose of the lock-down is to reduce the rate of infection so the NHS can cope. The government’s strategy is to keep those at very high risk quarantined, but for the rest of us lock-down is about ensuring our healthcare system doesn’t get overwhelmed until we’ve built up its resilience.

So, how and when do we exit from this? The narrative appears to be hospitalisations and deaths will peak over the next ten days and thereafter the rate of increase in both will decline. At some point – say the end of May – the government may then cautiously start lifting the restrictions and life can gradually return to normal. It seems to me this rests on several assumptions that we simply don’t know are true. Firstly, the true level of infections will be at least ten – perhaps 20 times – greater than the official number, which merely reflects the current level of testing, and therefore herd immunity starts to self-limit the spread. Secondly, people develop resistance to re-infection for a significant period of time once they’ve had initial exposure – and we don’t know this either.

I suspect there will be a second and perhaps a third wave of infections as the restrictions are lifted. This possibility has given rise to the idea we need an antigen-test that will identify those that are immune because they’ve had the disease and survived, and they can be given greater freedoms than those that haven’t developed immunity. It is suggested people will be given wristbands to identify them. With all due respect to the good intentions of those suggesting this, it is utterly impractical to think we can gradually release 62 million UK citizens in this way when we struggle to arrange 25,000 tests a day for the virus itself.

So, what is the exit strategy? I think in reality it’s a mixture of muddling through and copying what other countries do. And hope and pray a vaccine can be found quickly. It is vital the government puts in place a national vaccination programme now – ready to go when a vaccine is identified. The idea we can lift restrictions and then reimpose them if there’s a second or third wave of infections, or we can divide citizens into two groups – those that have the mark of Cain and those that don’t – and treat each differently is simply nonsense.

The truth is once we’ve ramped up NHS resilience – emergency hospitals, extra ICU beds, extra ventilators, personal protective equipment – the government will be faced with a very real and very difficult trade-off – the one between saving lives and saving businesses and jobs. “Saving lives must take priority” is what most MSM commentators say. And in the short term they’re right. But we can’t afford to do this twice – the economic cost is simply too high. The government will take cover in modelling and the mantra “we’re following the best scientific advice”, but the truth is the decision to relax restrictions will be a highly political one – based on a calculation about how many deaths the public will accept as the price we have to pay to get back to work and repair the economy.

This is Darwinian selection at its most brutal.
Paul Chase is director of Chase Consultancy and a leading industry commentator on alcohol and health

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