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Coronavirus: after the lockdown | Financial Times

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Via Financial Times

As the UK and most of Europe enjoys glorious Easter sunshine, few people can take part in traditional festivities. With travel and social gatherings banned in most countries to reduce the transmission of coronavirus, many look forward desperately to emerging from a lockdown that is not only curtailing personal lives but also destroying businesses and the global economy.

Some European countries, including Austria, Denmark and Norway, have announced tentative plans to relax the most stringent measures later this month, for example by allowing some shops and schools to reopen. But governments in the nations hit hardest by Covid-19 — Italy, Spain, France and the UK — are reluctant to talk openly about exit strategies. They do not want to distract people from observing lockdowns while death tolls are still rising.

As Rishi Sunak, UK chancellor, declared this week: “The priority right now is to stop the spread of the virus and get us to the other side of the peak.” 

Behind closed doors, however, ministers and health officials everywhere are beginning to discuss what happens next. The debates about exit strategies focus on two themes: how to manage a staged and gradual reopening of some places of work, education, culture and entertainment; and what sort of “test and trace” regime would be needed to detect and suppress new virus outbreaks once the initial wave has subsided. 

An employee holds up an Ichroma Covid-19 Ab testing kit for a photograph at the Boditech Med Inc. headquarters in Chuncheon, South Korea, on Friday, April. 3, 2020. South Korean President Moon Jae-in said on March 25 that the government will provide the necessary support for exports of coronavirus testing kits as many countries, including U.S. Photographer: SeongJoon Cho/Bloomberg
Many governments are closely watching South Korea’s ‘test and trace’ strategy © Seeong Joon Cho/Bloomberg

Across Europe there are signs that observance of stringent social distancing measures by the vast majority of the public — better compliance than many experts had expected — has led to a big decline in viral transmission.

The key figure is the “reproduction number” R measuring the average number of new cases generated by an infected individual. If R is above 1, an outbreak spreads; if it is below 1, it contracts. For Covid-19, R was between 2.5 and 3 in most places before any measures were introduced. 

According to a leading scientist in the UK’s fight against the disease, the latest evidence shows a steep fall in the R rate to around 0.6 now, which would quickly suppress the pandemic.

However, deaths are still rising fast because of the delay between infection and when serious symptoms develop. 

Patrick Vallance, UK chief scientist, said on Thursday there were clear signs of new cases levelling off. But he added: “I would expect the deaths to keep going up for two weeks.” 

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Health Secretary Matt Hancock and NHS staff stand on marks on the ground, put in place to ensure social distancing guidelines are adhered to, at the opening of the NHS of the NHS Nightingale Hospital at the ExCel centre, due to the spread of coronavirus disease (COVID-19), in London, Britain April 3, 2020. Stefan Rousseau/Pool via REUTERS
UK health secretary Matt Hancock. Ministers are beginning to explore lockdown exit strategies © Stefan Rousseau/Pool/Reuters

Mr Sunak and his officials have had to innovate at speed to minimise hardship during the lockdown. But they also know that more companies will go bankrupt the longer the lockdown continues. As a result, ministers are thinking hard about how and when to lift restrictions, even if there is no perfect testing and tracing regime available.

One minister says the focus was on three potential exit routes based on “populations, sectors and geography”. One option might be to let the young lead the way, perhaps starting by reopening schools, followed by a return to work for younger people who are less likely to become seriously ill if infected.

Some are attracted to a Warwick university paper by Andrew Oswald and Nattavudh Powdthavee, suggesting removing restrictions on 20-30-year-olds who do not live with their parents, which could release 4.2m people. One official jokes that a “youth first” policy might mean “you could even have a maximum age for drinking in pubs”. 

Alok Sharma, business secretary, this week gave an indication of the kind of sectors that could be in the vanguard of an economic reawakening, when he offered more permissive guidance on social distancing rules. He told construction, manufacturing, logistics, essential retail, waste management and outdoor industries to apply the government’s advice to stay 2m apart but they were offered advice on how to stay open if that were not possible. 

Ministers are less attracted to the idea of Britain reopening along geographical lines. Andy Burnham, mayor of Greater Manchester, says the lockdown can only work if it is “the same thing for the whole of the country.” Speaking to BBC Newsnight, he added: “It would be impossible to sustain here if there were images of people going back to pubs in other parts of the country.”

TOPSHOT - This photo taken on April 7, 2020 shows employees eating during a lunch break at an auto plant of Dongfeng Honda in Wuhan in China's central Hubei province. - Thousands of relieved citizens streamed out of China's Wuhan on April 8 after authorities lifted months of lockdown at the coronavirus epicntre, offering some hope to the world despite record deaths in Europe and the United States. (Photo by STR / AFP) / China OUT (Photo by STR/AFP via Getty Images)
Social distancing at a factory in Wuhan, China, where strict lockdown measures have started to ease © STR/AFP/Getty

Although ministers representing the country’s economic interests stress that the priority is to save lives, they are starting to open up a debate about the wider damage caused by coronavirus. 

The chancellor has been raising questions, reinforced this week by a report by the Institute for Fiscal Studies, about the longer-term health consequences of an extended lockdown and a deep recession, particularly on mental health and the wellbeing of poorer communities. 

The subtext of this argument, raised at cabinet this week, is that it is possible to call for an easing of the lockdown without simply relying on cold economic arguments. “You have to look at the health picture in the round,” says one government official. 

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The eventual easing of the lockdown in Britain and elsewhere will be accompanied by an intensive “test and trace” regime to detect and stamp out new outbreaks of the virus, once the initial surge has passed. Many governments are closely studying the experience in South Korea, which set up an extensive testing system to monitor new infections.

If the UK can achieve its target of carrying out 100,000 tests a day by the end of April and ramp up capacity further over the following months, it will be possible to test individuals in the community who report Covid-19 symptoms. In theory, this would then be followed by the tracing, testing and isolating of people who have been in contact with them if they are infected. 

This type of contact tracing, which involves questioning patients directly, took place when the first UK cases were reported but soon stopped when the pandemic swamped the country’s extremely limited testing capacity. 

TOPSHOT - A worker controls the temperature of a woman wearing a face mask as she arrives at Hankou Railway Station in Wuhan, to board one of the first trains leaving the city in China's central Hubei province early on April 8, 2020. - Chinese authorities lifted a more than two-month ban on outbound travel from the city where the global pandemic first emerged. (Photo by Hector RETAMAL / AFP) (Photo by HECTOR RETAMAL/AFP via Getty Images)
In China measures such as temperature checks by police have helped to contain the virus © Hector Retamal/AFP/Getty

“Evidence suggests that countries that are able to do very high levels of testing have many more options to allow people greater social mobility,” says Steven Riley, professor of infectious disease dynamics at Imperial College London. “Some really innovative solutions will play a part. Contact tracing based on a mobile phone app is being looked at.” 

However, apps designed to track and inform citizens when they meet people who have tested positive for coronavirus pose formidable practical and policy challenges for western democracies, from ensuring open operating standards to maintaining data security. 

In China, for instance, these health apps are not mandatory in most places, but individuals can find themselves barred from work, public transport or even the public park if they cannot show their status on a virus-tracking app, which shows their movements in the previous fortnight.

Privacy advocates aim to spot potential transgressions. “If tracking of individual movement is on the table, then that is unlikely to be in line with existing privacy laws, even in a crisis,” says Bill Wirtz, a Brussels-based analyst at the Consumer Choice Center. 

TOKYO, JAPAN - MARCH 26: People, some wearing face masks, walk through a park as they enjoy cherry blossom season on March 26, 2020 in Tokyo, Japan. Tokyo Governor Yuriko Koike held a press conference last night to request citizens to refrain from going outside this weekend for nonessential reasons after 41 cases of new Covid-19 coronavirus infections were confirmed yesterday pushing the total infections to over 1300. Koike warned that Tokyo, one of the largest and most densely populated cities on earth, could face a lockdown if there is a surge in new coronavirus cases. (Photo by Carl Court/Getty Images)
Cherry blossom season in Tokyo, Japan. Prime Minister Shinzo Abe plans to control Covid-19 without a full lockdown © Carl Court/Getty

For many scientists, the key to ending the lockdowns is mass testing for Covid-19 infection, which detects the presence of the virus. Paul Romer, the Nobel Prize-winning economist, has outlined a plan for mass testing in the US that he believes would allow for much of the economy to reopen.

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However, this requires each person being tested every 14 days — or 22m tests a day — a mammoth undertaking in terms of labs, chemicals, health workers and data analysis, even if such tests are constitutionally acceptable. In the UK, the epidemiologist Julian Peto has made a similar proposal — weekly tests, running to 10m a day.

Large-scale antibody testing, to show whether individuals have been infected in the past and still have some immunity, is a more tantalising prospect because they would only need to be conducted occasionally and could potentially be bought at a pharmacy.

But first they need to actually work. Specialised labs are carrying out studies to determine antibody levels in samples of the population but no one has yet developed an antibody kit reliable enough for widespread use in homes. Kits evaluated by the UK government have failure rates of 30 to 50 per cent. 

Eventually antibody tests could give individuals “immunity passports” to show that they are safe from infection, Prof Riley says, “but there’s some very important science to do first”. The key questions that have still to be answered are how different antibody levels relate to resistance to infection and how long any immune protection is likely to last

NORTHAMPTON, ENGLAND - MARCH 25: Residents in a Northampton street gather for a coffee morning but keep the recommended two metres apart due to the coronavirus outbreak on March 25, 2020 in Northampton, England. British Prime Minister, Boris Johnson, announced strict lockdown measures urging people to stay at home and only leave the house for basic food shopping, exercise once a day and essential travel to and from work. The Coronavirus (COVID-19) pandemic has spread to at least 182 countries, claiming over 18,000 lives and infecting hundreds of thousands more. (Photo by David Rogers/Getty Images)
A socially distant coffee morning in Northampton, England. Ministers have hinted at extending the country’s current lockdown © David Rogers/Getty

Longer-term routes out of the coronavirus crisis require safe and effective treatments and vaccines. Dozens of existing drugs are in clinical trials to find out whether they help Covid-19 patients. Some may show efficacy but pharmacologists would be astonished if any turn out to be a magic bullet. Developing new drugs and vaccines will take more than a year, even with huge resources and regulatory goodwill. 

Meanwhile governments still have a lack of knowledge about how the virus might return in a second wave and no real sense of how much immunity might build up in the population. 

As Professor Neil Ferguson, the Imperial College epidemiologist and UK government adviser, told BBC Radio 4 on Friday, working out an exit strategy “is the number one topic and priority every waking minute, both in the scientific community and in government.” 

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