During the summer, the lockdown measures imposed in March were dismantled piece by piece. We were even encouraged in August to ‘eat out to help out’. But in the past few weeks, more and more restrictions have been imposed across countries and regions, including the return of lockdown in Wales and Ireland. Is it time to consider alternative approaches?
Everyone accepts that these rules and restrictions will cause substantial damage to businesses, mental health and basic personal freedoms. Fears about Covid-19 and a desire to ‘protect the NHS’ have been blamed for discouraging people from seeking treatment for serious health issues. Cancer screening and referrals remain below normal levels. Funding to soften the economic blow of such restrictions is both hugely expensive and yet still insufficient to compensate for all the collateral damage.
An obvious alternative has been Sweden’s model of relatively ‘light touch’ rules. Apart from restrictions on large gatherings, asking older school pupils and workers to stay at home where they can and encouraging social distancing, life is relatively normal compared to many other countries. Even face masks are not required. Yet fatalities per million people have been lower than in the UK. On the other hand, they have been higher than in neighbouring countries. As a result, the Swedish government has been accused of causing unnecessary deaths, although current death rates from Covid-19 seem low there.
The Great Barrington Declaration is an initiative to change policy towards relative normality for most, combined with ‘focused protection’ for the most vulnerable groups. The aim is to achieve ‘herd immunity’ by allowing the least vulnerable to be infected. But the idea – essentially what was being suggested in the UK as late as early March – has been quickly dismissed as ‘unethical’ and ‘impractical’.
The other alternative most widely put forward has been an effective test, trace and isolate system to operate until a vaccine becomes available. The idea is that if everyone who catches Covid-19, plus all their contacts, were to be quarantined for 14 days, the virus would soon be suppressed. However, despite billions being spent on the system in the UK, it has not produced the desired results. Many proponents have thus argued for ‘circuit breaker’ lockdowns to bring case numbers down to manageable levels while fixing the system.
Hopes for a vaccine have also been tempered. While it is widely assumed that a vaccine would solve the problems and allow society to return to normal, this isn’t the case. The seasonal flu vaccine is about 75% effective; for Covid-19, the first generation of vaccines is likely to be significantly less effective. As David Salisbury, the former head of immunisation at the Department of Health has noted: ‘We need to communicate the clear message that although targeted vaccination may offer some protection, it will not simply deliver “life as we used to know it”.’ In any event, mass vaccination is unlikely to happen before the end of winter, which means that whatever strategy we adopt, we can’t rely on a vaccine for six months or more, during the height of any ‘second wave’.
Can we continue to live with lockdowns and restrictions, or should we find different ways to manage the risk? Indeed, how do we decide? Should we adopt a ‘consequentialist’ approach, adding up the ‘best guess’ costs and benefits of each policy and choosing the one that causes the least harm? Do we choose to emphasise rights and freedoms and live with the consequences as best we can? How should we move forward?