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The hard choices in lifting the coronavirus lockdown

The government should acknowledge the choice between deaths from coronavirus and other harm to society

The government should acknowledge the choice between deaths from coronavirus and other harm to society and publish its exit strategy for Parliament and the public to debate, says Bronwen Maddox

This week, three weeks from the start of the UK’s lockdown, was supposed to bring a government review. The constraints are not about to be lifted, ministers and scientific advisers have made clear, with deaths and recorded infections still rising steeply.

All the same, the pressure is growing on the government to spell out its exit strategy – and that is right. There are signs that newspapers are ahead of public opinion on this. But the full extent of the economic devastation and the implications for many of the most vulnerable in society is rapidly becoming clear. It is right that people ask at what point the cure is worse than the affliction – and how the burden of each is shared.

In choosing that exit strategy, the government cannot avoid making hard choices. These are political choices in the best sense of the word: elected politicians will take them on behalf of the country, judging both what the public wants and what the country needs. They cannot be made by officials, nor are they generated impersonally by scientific models.

So it is best that politicians acknowledge that the choices are there. In making them, they will need to show the steps of the process: their evidence, assumptions and modelling, and what remedies they propose to mitigate the effects of the decisions they make. They have done well to command a high level of public support for the moves so far, but they will retain it only if they explain where they now intend to lead the country and how they are steering a path through these hard choices.

They can be avoided through the development of a vaccine or anti-viral drugs with significant success. That is the only way life can return quickly to normal. Scientists at Oxford University, among many global efforts to find a vaccine (into which Bill Gates has thrown his resources), reported more hope this weekend that a useable one might be ready by September, a year or more ahead of many predictions; most others are more pessimistic. Without that, governments face trying to edge their societies out of lockdown with only curbs, testing and tracking as tools – and so the hard choices present themselves starkly.

Halting the spread of Covid-19 v shutting down the economy

Three weeks ago – with infections and deaths rising in the UK, limited testing capacity, the experience of other countries (particularly Italy) showing the danger of health systems being overwhelmed by the disease, and little concrete evidence on infection and death rates from Covid-19 – the government made its priority halting the spread of coronavirus and minimising deaths from it. The UK government began throwing one lever after another to shut down the economy – pubs, cafes, schools, then freedom to travel and leave the home.

It was presented as a scientific decision, following modelling from Imperial College that suggested that a quarter of a million people in the UK could die of Covid-19. But for all the drama attending the decision, there was a choice embedded within it – to put avoiding deaths from coronavirus above other forms of harm, including deaths from other causes as the NHS diverted all available capacity to treating Covid-19 cases.

As many economists have argued, the decision to shut down the economy at that point may also have been the right choice to try to minimise longer-term economic damage, particularly as it was accompanied by a pledge from chancellor Rishi Sunak to do “whatever it takes” to support businesses and people through this period. Widespread illness, loss of life (including among working age people) and overwhelmed health services would not have been good for the economy either – as a recent paper from the New York Federal Reserve, looking at experience during the Spanish flu epidemic a century ago, illustrates.

But as the government puts in place more extensive testing facilities and learns more about the disease and the health service’s ability to cope, and the limitations to the government’s support for economy and society become clear, the choice between minimising deaths from coronavirus and other forms of harm – including to the economy – becomes much harder. As the astounding economic costs and job losses become more evident, and the harm that brings to some of the most vulnerable in the country, the first choice for government remains how to weigh beating Covid-19 against economic recovery. 

As part of that, it needs to decide what “beating Covid” means. Some countries – China and New Zealand – have aimed to eliminate the virus, relaxing controls only when new cases appear close to zero and they have the ability to jump on new ones and trace contacts. Most others do not, and hope simply to contain the virus within the limits their health services can manage. Elimination implies a much longer lockdown, more curbs on travel and, for societies where the virus is already widespread, far more economic damage. If containment is the goal, though – and most likely, in Britain, it will be – then the government needs to be clear at what level it is aiming to keep the disease and what resourcing for the NHS and social care it contemplates.

Covid-19 has left the government facing hard choices in many areas

  • Old v young

Perhaps the most uncomfortable choice in weighing up when to lift the lockdown is how to weigh the harm to the elderly with that to younger people. Mortality from Covid-19 is much higher for older people, although there are exceptions where younger people with no underlying conditions have died (which the media have taken care to cover). The prime minister’s own illness shows that it can strike hard at those in full health. But younger people are suffering from the lockdown far more from loss of work and education – and in the future debt burden which the country will carry. A phalanx of 70-and-over commentators have argued that their generation’s health should not be pursued at the expense of the young.

  • Length of lockdown v civic society

Of all the gaps in the chancellor’s bailout schemes, charities are a big one despite recent moves to help them. Many are concerned that groups set up to support some of the most vulnerable in society – people among the most afflicted by the lockdown – have seen their funding collapse as they have had to cancel their usual fundraising events and as donors economic security has taken a huge hit. Some charities may not be able to resurrect themselves. The package of support for charities that Sunak has announced will be welcome to those that qualify but many will not.

  • Who pays?

If renters are let off their rent for a while, it hits landlords; if mortgage payers are let off loans, it hits banks. Maybe those are not the most popular constituencies – but there is a knock-on effect, reducing property to let or bank capital to lend. If a country suffers a big hit to GDP, the losses have to sit somewhere. Better that government decides systematically than it be determined by a popular sense of victims and villains.

So far, the government has largely avoided making an explicit decision about this. The wide-ranging economic support package has been funded by issuing more government debt and bank lending has been propped up by relaxing regulations on how much capital banks must hold to back up their loans and by an expansion of cheap loans from the Bank of England, financed by printing money. But when these interventions are unwound, the government will have to decide who should contribute and it would be better for the government to be open about these choices.

  • Covid v non-Covid patients

NHS leaders – worried about the big drop in the number of heart attack and stroke patients in A&E – have been keen to emphasise that the health system is able to cope with both Covid-19 and conventional patients. But many cancer treatments have been suspended, including diagnostics, leading cancer specialists to warn of a potential rise in deaths that would have been avoided with earlier treatment. Those patients may well be younger than those most typically suffering badly from coronavirus, something the government needs to weigh up in considering whether it is just trying to avoid Covid-19 deaths, or premature deaths from illness overall, and whether it puts a value on years of remaining life in doing so.

  • Partial lockdown: London v the rest?

The capital is not the only hotspot, as flareups in Gwent and the West Midlands show. Applying partial lockdowns to the country may be hard – but may still be preferable to the cost of treating the whole country the same. Governments are also considering whether some groups could be allowed back to normal life first – the young, or the immune. However, justifying that to a frustrated country seeing its livelihoods ripped up will take some doing.

  • How to withdraw support

“Whatever it takes”, Sunak said, and the government began to roll out its huge bailout for businesses and workers to try to mitigate the extraordinary damage of the measures necessary for public health. Reeling it back in will be harder; so will restoring the previous incentives to work and invest. The government has essentially been paying workers not to work; the hard decisions will come in considering where to cut off support, when many jobs will have been lost permanently. Equally, the government will not want to prop up indefinitely those businesses that were not going to thrive again, but it will be hard and controversial to distinguish between that category and those that could recover but will need some time to get back on their feet.

  • Civil liberties and privacy v return to normal life

In the absence of a vaccine, testing and tracking of infected people and contacts becomes one of government’s most valuable tools – but only with a degree of intrusion that pre-coronavirus would have been considered unacceptable. It might mean tracking of contacts by apps; the government is discussing with the NHS a voluntary app that would map proximity to people later diagnosed with the disease.  Immunity certificates are unlikely to be workable without an ID card. Yet civil liberties and security officials alike have warned that the terms on which data is held would have to be clear; so would the privacy and security of what might be only lightly anonymised data.

The one easy decision: coronavirus has shown the need for nationwide testing

In the many inquiries that follow about the handling of coronavirus, there will always be a lot of room for dispute – for instance, about the deaths averted or not by the strategy. It is likely to be a matter of permanent contest.

But one principle has become clear: an extensive nationwide system of testing is the only way accurately to establish the spread and true mortality of a disease. All of the hard choices for government are informed by its understanding of the risk, and it has become clear already how much the predictions of scientific models respond to small changes in assumptions or the data fed in. The choice of equipping the nation with that system of testing for future disease should be a no brainer.  

It is not too early to ask how the government is going to make these choices. It should explain the process, its assumptions and modelling, and the judgements of value that it is making. That needs public debate; only with this will the government carry the public along. Exit from lockdown is likely to prove even more contentious than going into it because the choices are harder. The government should publish its plans and let Parliament, the public and experts debate whether they think it has made the right ones.








Health Economy
Johnson government
Institute for Government

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