A Way out of Covid-19 Lockdown

Any path out of lockdown has to balance the interests of health against economic considerations. The ‘health’ side of the equation is clear, people are getting ill and dying from Covid-19. This is an emotional tug, but if one steps back, these numbers are not that big – nothing to compare with say the plague in the Middle Ages. The real issue on this side is to avoid the epidemic running out of control. The ‘economic’ side of the equation is usually presented in terms of various schemes to assist people and businesses as economic activity falls away and the consequent government borrowing that will be required. But it is much more than that. There are also huge human costs here, less photogenic, as people lose their incomes and frequently fall through the gaps of government programmes intended to support them[1]. There is increasing poverty and isolation, issues of mental health resulting from sustained isolation and rising abuse in the home to put into the balance here. As a result, this analysis may perhaps seem to favour the ‘economic’ side, which is not just about economics, of the equation rather than the more visible ‘health’ side.

The analysis draws on four hypotheses, each of which are plausible, but some are still somewhat controversial:

  • The virus is mostly transmitted by close or sustained contact with someone else who is infected, so for example within families, care homes, hospitals and large social events. It is rarely transmitted by casual contact with other people or with surfaces. See for example: https://today.rtl.lu/news/science-and-environment/a/1498185.html
  • Wearing a simple face covering, even homemade ones, will not stop you getting infected, but, in the event that you are infected without knowing about it, they will greatly reduce the risk of you passing the virus on to other people.
  • Children do not generally get seriously ill from Covid-19 and may not transmit the infection to any great extent.
  • People will generally abide by the rules, despite the small number of miscreants that get highlighted in the media and social media.

The data (albeit unreliable) clearly suggest that in most severely affected European countries the epidemic has now passed its peak, but the decline is slow. (In other words that famous parameter R may now be below 1, but not much below!) So, the epidemic will take time to die out. If treatments come available, and ultimately a vaccine, then the decline would begin to be more rapid. So, for the time being, countries will have to accept that a number of people will still come into hospital with the virus every day and some of them will die. Coronavirus will have to be considered, along with cancer and heart disease, as one of the major causes of death. It will be for governments to decide at what level of infection their medical systems will be able to cope with this, without excess overload, and therefore at what point they can begin to open up their economies again. They will of course then have to monitor closely the effect of ‘opening up’ on the continuing infection rate and be prepared to make changes if necessary.

A striking feature about the epidemic in Europe, but rarely commented on, is the large gap between a small group (Group A) of larger countries that have been badly affected and the much larger group of smaller countries (Group B) that have barely been touched by the virus[2][3]. In many of this latter group opening up is already taking place.

Contact tracing will be important but will only really be feasible – whether by apps of by other means – when the daily numbers of new infections have dropped to a manageable level; I would suggest to less than 0.01% of the population (less than 100 new daily infections per million people.) As it happens all the countries in the second group would already meet this criterion. Whereas contact tracing could as yet be difficult to manage in Group A countries.

The availability of tests for infection is still limited in many countries and antibody tests are still merely on the horizon. So, as tests for infection become more available, the successive priorities should be:

  • Hospital staff
  • Care home staff
  • Other ‘key’ workers – hospital ancillary staff, delivery people, transport staff, supermarket staff, rubbish collectors, postal workers, policemen, prison staff and those maintaining water, electricity etc[4]
  • People who are showing symptoms of having the virus
  • Teachers and child minders – as schools go back
  • Hospitality staff – as bars restaurants and hotels reopen.
  • People with other medical conditions that make them more vulnerable
  • Anyone responsible on an unpaid basis for the care of, young children, old people or vulnerable adults.
  • Anyone else who would like to be tested.

For the opening up, there would be five general rules to be followed indefinitely:

  1. Continue with social distancing as much as is practicable.
  2. Require everyone to wear a face-covering when in a public space with other people nearby.
  3. Those who can work from home would be expected to continue doing so as much as possible.
  4. Continue to require anyone who is shown to be infected to go into self-isolation for two weeks[5].
  5. Ban any gathering of more than, say initially, 10 people, whether in public or private. This would remain the most onerous restriction clearly showing that life had not gone back to ‘normal’.

Based on these rules there could be the following initial steps:

  • Reopen schools and day-care centres starting with the youngest children and gradually moving up the age range.
  • Reopen shops.
  • Allow people back to work, including in the hospitality sectors, though this would be subject to rule 5 above.
  • Allow people to travel domestically.

There would then need to be sustained monitoring of the numbers of new infections, as well as an attempt to learn from the experience of other countries, and a willingness to make any necessary adjustments. But assuming these numbers continue to decline, the principal subsequent relaxation would be to raise progressively the size of groups that could gather, though very large gatherings, football matches, rock concerts etc, would likely be prohibited for many months yet.

International travel remains a problem area. For international air or rail travel the approach could be:

  • Since the infection rates vary so greatly, countries of ‘arrival’ should designate from which other countries they would accept flights. (This of course is not fool proof since it would be easy to transit through an ‘acceptable’ country.)
  • For these ‘acceptable’ countries there would be compulsory temperature testing before departure and also on arrival.
  • If a passenger fails the temperature test on arrival, they would be given a normal test for the infection, and if necessary be subject to a two-week quarantine period.

In the Schengen area, or within the EU more generally, there should be an attempt to harmonise the approach across all the countries concerned – not least because road travel presents a particular problem. But since EU countries fall into two distinct groups, as explained above, harmonisation could be politically difficult. I suggest that all countries concerned adopt the 5 general rules outlined above. But within those rules each country would decide what is the maximum size of permitted gathering in that country. So, for example if Germany permitted groups of up to 50 and France up to 20, anyone travelling from Germany to France would have to abide by the French limit. In addition, there could be temperature tests for people crossing the borders.

SJMc Luxembourg

24 April 2020

[1] I am a long-standing advocate of a Universal Basic Income. That might alleviate some of the issues here, but really needs to be considered as a long-term programme of rebalancing the relations between the State and its citizens – as the NHS did in the UK three generations ago.

[2] Study for example this graph: https://ourworldindata.org/grapher/daily-covid-deaths-per-million-7-day-average?country=AUT+ITA+LUX+ESP+SWE+GBR+LTU+LVA+DNK+EST+FIN+DEU+NZL+GRC+SVK+SVN+FRA It is rather cluttered and not easy to disentangle. But it clearly shows how European countries fall into two distinct groups. (Luxembourg was initially heading to join the first group (A) but has now dropped towards the second (B)) You can add or remove countries from the graph and update it each day.

[3] What characteristics distinguish the two groups of countries? We do not know. But I would suggest, following my first hypothesis above, it is the absence at the critical time of events which drew large crowds of people. Another factor could be that the group of larger countries are more ‘international’, more open to travellers and visitors from around the world. With Greece and Scandinavian countries together in Group B it is difficult to argue for ‘cultural’ explanations. And several of these countries, such as Greece, locked down very quickly.

[4] It might even be easier to try and identify those who aren’t key workers, those doing socially useless ‘bullshit jobs’ as David Graeber calls them! This would include most of the PR, marketing and advertising industries, and many in the financial sector.

[5] For the many people living in cramped or over-crowded accommodation this might be impossible. Governments should make empty hotels available for them.