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The Observer view: the government’s coronavirus strategy must face scrutiny

The Guardian logo The Guardian 15/03/2020 Observer editorial
a sign on a city street: Photograph: Hollie Adams/PA © Provided by The Guardian Photograph: Hollie Adams/PA

Life as we know it is about to change dramatically. And when the world eventually emerges from this pandemic, it is likely to be irrevocably altered. In the words of one public health expert, Professor Graham Medley: “This is the kind of event that is going to live on for decades.” It will either cause illness or death on a scale most of us have not experienced in our lifetimes, or it will take huge changes to the way we live our lives in order to avoid that. The social impact will be more momentous than anything Britain has experienced since the two world wars.

This weekend, ministers have warned that increasingly stringent measures will be introduced on people’s movements in the coming days and weeks, and that they are likely to be in place for months. More of us will be asked to self-isolate or to reduce the contact we have with other people for long periods of time. Many will be asked to work from home for weeks, if not months. Travelling abroad will become increasingly restricted. Major sporting and cultural events have already been cancelled, with others likely to follow. In an unprecedented move, local and mayoral elections have been delayed by a year. But by far the most devastating likely impact of this pandemic was hinted at by the prime minister last Thursday. “Many more families are going to lose loved ones,” he said at a press conference. This is the frightening truth about what the government’s top scientists believe is to come.

a sign on a city street: A sign on a gate at St Bartholomew’s Hospital, London, where two deaths of patients who had tested positive for Covid-19 were confirmed by the Barts Health NHS Trust in London. © Photograph: Hollie Adams/PA A sign on a gate at St Bartholomew’s Hospital, London, where two deaths of patients who had tested positive for Covid-19 were confirmed by the Barts Health NHS Trust in London.

Policy under scrutiny

Amid rising public anxiety, there is more scrutiny than ever of the government’s decision to move from the “contain” to the “delay” phase of its strategy. The emphasis has shifted from tracing and testing all those who have been in contact with people confirmed to have contracted Covid-19, to asking all those with symptoms to self-isolate. The government also announced some further limited measures to limit social contact: from next week, mass events with more than 500 people will be banned. But it has faced strong criticism from some public health experts for not taking more stringent action, such as larger-scale closures of places where people congregate, restrictions on public transport, closure of schools and asking more people to self-isolate.

The government says it will phase in more stringent restrictions in the coming days and weeks, and that it is not looking at this point to suppress the spread of the virus altogether. There appear to be two interrelated reasons for this. The first is that the government’s experts are concerned that asking people to observe strict social distancing measures for long periods of time, such as widespread self-isolation even for those with no symptoms, could backfire. Like all governments, it is trying to minimise the extent to which demand for critical care exceeds maximum capacity in the NHS, in order to keep death rates from the virus as low as possible and to give the NHS time to do what it can to extend that capacity, already low by European standards. There is clearly a worry that it is untenable to ask people to fundamentally alter their lifestyles for very long stretches of time and that to introduce some measures now would be to risk a significant peak in cases further down the line if people were to abandon those lifestyle changes later on, for example, because they no longer believed they were needed, or could not afford to do so.

Second, the government’s chief scientific adviser has said that its strategy is driven by the objective of developing herd immunity, which occurs when a sufficient number of people in a population are immune to a disease, to offer some level of protection to everyone. He has said that the government’s working assumption is that about 60% of the population will need to catch the disease in order to achieve that.

This implies the government is assuming that, even with social distancing measures in place, it is inevitable that a large proportion of the population will contract coronavirus before a treatment or vaccine becomes available, and the best it can do is to manage the flow of people requiring hospitalisation in order to protect those who are most vulnerable. This sits in stark contrast to the strategy deployed by a country such as South Korea – whose lead most other countries are following – which is to delay the rate at which the virus spreads as much as possible, using much more stringent social distancing measures and a more comprehensive testing and isolation regime.

Public confidence

This difference has prompted serious questions about why the government’s strategy differs from much of the rest of the world. Would 60% of the population contracting the virus be enough to offer any meaningful level of population immunity? Is it even right to assume that people contracting the virus will develop long-term immunity? On what sort of evidence is the government basing its assumption that the public will only tolerate stringent social distancing for so long? Why does it appear that there have been few measures and little guidance to protect those most vulnerable to the symptoms of Covid-19 – older people and those with underlying medical conditions – as the disease spreads? On the other hand, there are huge uncertainties and risks involved in trying to halt the spread of the disease as much as possible at this time. What would happen if people broke quarantine before a treatment or vaccine was developed? What might be the impact on the NHS of a large peak in cases as we move into next winter? What would be the impact of immediately closing schools, given that grandparents are likely to pick up the childcare slack and children are more likely to mix outside school the longer closures go on? This would significantly affect the availability of those doing critical jobs in the NHS, care homes and the food supply chain.

This is why anyone who expresses with absolute certainty that the government has got this entirely wrong should be treated with some scepticism. There is no surefire way to combat the virus: there are too many unknowns for that. It is however, absolutely right that public health experts are asking questions about why this strategy is so divergent from the overall recommendations of the World Health Organization. The government must be far more transparent about the evidence and assumptions on which it is basing its decisions, or risk undermining public confidence in its actions.

There are other problems beyond a lack of transparency. Ministers have said they will seek to legislate for sweeping emergency powers that will last for two years, including giving the police the power to detain suspected victims of the virus, and reducing standards in care homes to allow for staff shortages. Such powers should be avoided unless absolutely necessary, and should initially be introduced on a more temporary basis to avoid significant incursions on our liberty and a watering down of basic standards becoming the new norm. Moreover, after a decade of austerity that has put services like the NHS and social care under intolerable strain, and eroded tax credits for families, there are questions to be asked about whether last week’s budget went far enough in terms of channelling additional resources to public services and protecting low-income families from the forthcoming massive economic shock.

International cooperation

The contrast between the approach taken by the UK and the rest of the world has also prompted questions about the lack of coordination at an international level, both in relation to the public health or the economic response. “Our willingness to cooperate is becoming inversely related to our need to do so,” Gordon Brown wrote last week. He is right: this pandemic is exposing the extent to which the international organisations and networks that exist to promote global cooperation are fraying as a result of the spread of populism. At a moment when the US might once have provided global leadership, President Trump is flailing; having spent weeks denying the existence of a looming pandemic, he has now politicised the crisis, erratically introducing measures that seem designed to bolster his America First re-election campaign rather than protect citizens. Coronavirus may be the most pressing and immediate global challenge we face; but there are plenty more to come, from microbial resistance to the climate crisis. Effective solutions will only be found if countries rediscover a willingness to work in concert.

International cooperation may be proving elusive, but we should take hope from one comfort that might emerge from this crisis: it is heartening to see so many individuals pitching in to help neighbours, or offering to support older people who may be isolated and lonely. This pandemic may leave us a legacy of social action and civic engagement that we should seek to sustain long after its worst threat has subsided. Life may be about to change immeasurably in a way most of us would not have dreamed of just weeks ago. But by looking out for each other, by following government advice even as we question it with healthy scepticism, and by acting for the greater good, we can collectively try to minimise the pain that will undoubtedly be wrought by this pandemic.

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