David Davis is a former Secretary of State for Exiting the European Union, and is MP for Haltemprice and Howden.
The first question that Boris Johnson will face when he addresses the House of Commons tomorrow about his lockdown plans is: “what will you do on December 2 if the R number is greater than one”?
The probability, of course, is that it will still be greater than one on that date – and that the lockdown, whilst it may have mitigated the infection, will not have stopped it. And in that circumstance, the shutdown will continue.
That is what we, and many other countries, should have learned from the last general lockdown. The disease only really stopped with the onset of summer, and has restarted with the onset of winter.
When the Prime Minister announced the first lockdown on March 23, he was hoping for it all to be done in four weeks, and in practice it turned out to be four months. This time he is announcing a lockdown at the beginning of winter, and we may well be locked down for six months, until next summer.
Unfortunately, even the scientists admit that the evidence for the effectiveness of general lockdowns is quite weak. The evidence for the economic damage that they do, however, is so strong that it is obvious.
In truth, there is only one strategy that has worked in the other countries faced with this problem. This was a very early and draconian lockdown that brought the disease under control when it still only affected a small proportion of the population – followed by an extremely focused test, track, and isolate policy. At the moment, no element of this policy is fully operational in the UK.
The complete failure of Public Health England to deliver a functional testing system early in the pandemic crippled Tthe Government’s ability to deliver such an outcome. This is compounded by the worst decision in the whole crisis – on March 12, when we gave up our attempt to test all the suspected cases.
To be fair to Matt Hancock, he has driven the system to deliver a large testing capacity today, but that is too late. It is a little like having ten fire engines outside your house after it had burnt down.
What is needed from the testing system today is immediate availability for everybody with symptoms or exposure, and very rapid response so that action can be taken quickly to suppress the outbreak.
The Government is now talking about a 15 minute test, rather belatedly. Tests that deliver a very accurate result in less than an hour have been available in the United States since March. If there is any doubt at all about delivering the rapid test in the UK, the Government should licence existing foreign technology, and set about creating the capacity to deliver that domestically as soon as possible. The South Koreans achieved more in six weeks at the beginning of the crisis than we have in six months, and we should model our delivery policy on that.
The track and trace system is currently hopeless. It will only ever be useful if it delivers results within a few days of someone testing positive. Otherwise, it is too late to check the infection. It is long past time for the Government to read the riot act to the big companies that are making profits out of failure in this area. If they cannot deliver they should be replaced, ideally by a regional structure, which, as the Germans demonstrated, is much more likely to be effective.
Most important of all, however, is the isolate policy. We currently do not have one. Telling people to stay at home if they are ill simply means that they infect their families, and possibly the supermarket assistant when they do their shopping.
And of course, not everybody who is infected obeys even those rules, and the probability is that even more will flout them after a year of Covid fatigue. So self-isolation at home will be even less effective this winter than last.
Every successful strategy to date has properly isolated the infected, and often their closest contacts as well. In Wuhan, the Chinese government created a number of Nightingale-style hospitals, and used them to immediately isolate those who tested positive, and those closest contacts thought most likely to be infected. It worked, as did similar approaches in other East Asian countries.
We need more Nightingales, and we need to use them as the anterooms to the major hospitals, not as the (empty, unused) overspills. In a Nightingale, patients can be monitored properly, and receive treatment rapidly as they need it.
We should do the same with the private hospitals that we have sequestered. We should also have an explicit strategy to separate the conventional patients from the Covid patients – ideally in different hospitals. We should remember that this is an exercise in saving lives, not in hospital capacity management. Losing track of that aim leads to more excess deaths, rather than fewer. I fear that the slogan “Save our NHS” conflates and confuses those aims. It is said that a number of NHS managers were uneasy for exactly that reason.
During the first round of this crisis, there were four categories of unnecessary excess deaths.
First, there were those who were told to stay at home, unless they were very seriously ill. Many of those turned up in hospital too late to save
Second, there were those, mostly the elderly, that were triaged out of intensive care. The NHS denies this, but the numbers show that many elderly died untreated.
Third, tthere were those who were dispatched to care homes before they had recovered, leading to new rounds of infection amongst the most vulnerable.
Fouth, there were those who were displaced from hospital, leading to excess deaths both now and in the future from untreated non-Covid diseases, most obviously cancer. Much of this was avoidable with more focused management and a little bit of foresight.
Finally, when we do get the virus under control, we should rethink our “local” strategy. The successful countries interpret this at a really micro level, in some cases locking down one street or even one block of flats. It is possible to enforce lockdowns at that micro level.
When you lock down the Greater Manchester region, it is near certain that of its millions of residents, thousands, or even hundreds of thousands of people will break the rules. Such a strategy maximises economic harm and minimises lives saved. So when we return to local lockdowns, we should make them very local indeed.
Everybody wants to save lives, and ideally at minimum economic cost. A never-ending lockdown, without an explicit infection reduction strategy, and with it a lockdown exit strategy, offers little more than a winter of misery. The Australian and New Zealand governments initially tried a strategy like our current one, and very rapidly decided that the East Asian disease eradication model was a much better option. We should do the same – or this will be a very long winter indeed.