If we introduce another national lockdown and bring the rate of infection under control, what next? Lockdowns are very effective in putting the brakes on the rate of infection. The central problem though is that while they treat the symptoms of Covid, they are not a cure.
Covid is still there, spreading silently and asymptomatically, waiting for the lockdown to lift. And when it does the rate of infection increases once more, moving gradually but inevitably towards exponential spread and further lockdowns.
We are now stuck in a lockdown groundhog day. However, rather than outcomes improving through each iteration, in lockdown groundhog day every cycle leads to job losses, damage to businesses and economy, reduced access to the NHS for those with other conditions, and poorer health and deaths in the future from diseases related to poverty and socioeconomic deprivation. As the public grow tired of restrictions, ever-increasing levels of compulsion are required, eroding liberties while the patient continues to suffer.
This will lead to a vicious circle of lockdown restrictions with a death toll resulting from the lockdown measures themselves that eventually outweighs those directly from Covid infections.
For the majority of people Covid is a trivial disease, but for those who are over 60 or have underlying health problems, and this includes obesity, it can be very deadly. What makes Covid a particular challenge is that it spreads easily and quickly, and the majority of our population has no immunity to it. As a result, left unchecked, infection rates can quickly become exponential, leading to huge numbers of very sick people particularly from those in the high-risk groups and overwhelm the health service.
As a doctor the thought of our NHS being overwhelmed chills my blood. We absolutely must protect the NHS and prevent a situation in which people end up dying who would otherwise survive, but for the availability of NHS Capacity to care for them. An overwhelmed health service means a collapse not just in Covid care but all other areas of health too.
After the ebola outbreak in the Democratic Republic of Congo, more people ended up dying from measles than ebola due to the impact on its health service and people afraid to go to healthcare centres. We’ve already seen people in the UK avoiding care when they need it and heard the harrowing stories of what happened in Lombardy in the start of the pandemic.
It is therefore absolutely right that the government takes measures to protect the NHS, as it did in March and again now. Preventing the NHS from being overwhelmed was the aim of the first lockdown and now regional lockdown measures. But we must also have a plan for the long term.
Without debate, our strategy has moved beyond “protect the NHS”, but to suppress while awaiting a vaccine. This presupposes that inventing a vaccine, and quickly, is inevitable. People talk about “discovering a vaccine” as if there is one in hiding, like an elemental metal, waiting to be found at the bottom of a river. The truth is we need to invent it and we have never invented a vaccine for a coronavirus before.
We have some good vaccine candidates, but these are only possibilities until they are shown they work. How many “cures” for dementia or cancer have there been announced in the tabloids, only to evaporate when robust clinical trials show otherwise? While we all hope for a positive outcome, we need a plan B in case they fail. Even the most optimistic among us do not expect a vaccine to be able to eradicate Covid and the benefits of a successful vaccine may only be modest.
Our plan B must be to manage Covid infection in our low-risk population in a way that allows the development of immunity, while protecting our high-risk groups and expanding and protecting the capacity of the NHS. There are a variety of proposals on how this could be done, but none are simple or without serious consequences.
Many people have already lost their lives as a result of this pandemic. We would of course wish to save every life. But that is simply not possible. We must debate not just the benefits but also the costs of the actions we take. In trying to minimise the number of Covid deaths now, we must consider the toll on future deaths from the effects of lockdown and restrictions, the damage to our economy and its effects on future disease, and the loss of liberty and quality of life.
We can’t simply wish Covid away with the magical promise of a vaccine. We must plan for the long-term exit strategy from the vicious cycle of Covid lockdowns. We cannot lockdown or suppress forever and if we did, the cure would end up worse than the disease.
This article was first published in The Times Red Box here on 19 October 2020.