Lockdowners v libertarians: Britain’s coronavirus divide
Britain has reached a Covid crossroads – and its leaders are being pressed to pick one of two stark options. Are they going to return to the lockdown days that brought life to a standstill six months ago, but succeeded in halting the rapid spread of the disease? Or are they going to turn their backs on “an authoritarian nightmare” that is preventing the nation from getting on with “the business of living”?
This is the basic division that has emerged over the summer in an increasingly heated debate between two unlikely groupings of scientists, columnists, campaigners and politicians.
On one side there are the lock-downers. They think the only hope of triumphing over Covid-19 is shutdowns to bring numbers of cases back under control. Pubs and restaurants may have to close and households once again may be told not to mix.
On the other are the libertarians. They say we cannot return to those days because it would trigger an economic collapse and allow thousands of untreated cases of cancer, heart ailments and other diseases to mount. Tens of thousands might die, they say.
Each side points to different nations that have had greater success than Britain in fighting Covid-19, albeit with very different policies. Each has attracted its own set of cheerleaders, politicians and journalists, as well as scientists who have also adopted strong contrasting stances. Here we take a look at the different camps and highlight those who have been their most vocal advocates. LIBERTARIANS Politicians-Backbench Tory MPs have been the most vociferous. Desmond Swayne has accused Boris Johnson of an “over-reaction to the disease that has done much more lasting economic damage, and, counterintuitively, even more damage to our health than the disease itself”. Swayne is backed by Graham Brady, chair of the Tory 1922 committee, who last week tabled an amendment to the Coronavirus Act, aimed at limiting Johnson’s powers to impose future restrictions. It is thought likely to succeed.
ScientistsCancer expert Karol Sikora has insisted a new national lockdown would be a disaster. An extra 30,000 cancer deaths will soon emerge thanks to delays in doctors picking up symptoms and in patients being referred for scans and tests, he says. Worse could follow if we have a further lockdown. Sikora has been backed by Sunetra Gupta and Carl Heneghan at Oxford, who have also urged the UK not to impose tougher restrictions in order to counter the rising number of other illnesses we are now witnessing.
MediaThe conservative Daily Telegraph, DailyMail and Sun have been consistent in recent weeks, with writers such as Allison Pearson, Julia HartleyBrewer, Steven Glover, Fraser Nelson and Sarah Vine making vociferous attacks on moves to bring back restrictions. On Wednesday, the Mail asked: “Does the PM really want Britain to oscillate interminably in and out of lockdown to try to avoid even a single casualty? Or do we accept the contagion in our midst, protect the vulnerable and get on with the business of living?” On the same day, the Telegraph urged that “this rule by decree should end forthwith”.
NationsThe poster nation for libertarians is Sweden, where bars and restaurants have been allowed to stay open throughout the pandemic, schools have carried on and gatherings of up to 50 people have been permitted – and yet its infection rates have remained low over August and September. The death rate in the Scandinavian country now hovers close to zero.
LOCKDOWN
PoliticiansSNP leader Nicola Sturgeon has earned respect for her consistent hardline policy and promises to reimpose restrictions, while London mayor Sadiq Khan is now insisting that household visits should be banned for London’s 9 million residents. Among the Conservatives, MP Tim Loughton has urged Johnson to have more “level with you” moments to ensure people are given the proper information to counter the claims of “so-called independent experts and professors of denial”.
ScientistsJohn Edmunds at the London School of Hygiene and Tropical Medicine (LSHTM) has compared the current spread of the disease to a lorry speeding down a hill. “At present the lorry’s just at walking pace but it’s starting to pick up speed. We can either hit the brakes hard now and bring it back down to less than walking pace, or leave it to gather speed. Then the same little touch of the brakes will have far less effect.” Graham Medley, also at LSHTM, warns Britain’s daily coronavirus death toll will rise from 34 to 100 a day in three to four weeks unless measures are taken now.
MediaThe Guardian, New Statesmanand British Medical Journal have all strongly backed firmer restrictions. In the Guardian, Polly Toynbee dismissed the prime minister’s latest announcement of new lockdown rules as “feeble”, while an editorial in the Observer’s sister paper last week urged that “stringent measures ought to come into force across the country, alongside a clear strategy to rebuild the test and trace system. Boris Johnson needs to move decisively to contain the risk.”
NationsFor their part, Lockdowners point to the example of New Zealand, which has had only 1,831 cases and 25 deaths linked to Covid-19 after it imposed strict controls, closed its borders to foreign travellers and required its citizens returning from abroad to go into quarantine for 14 days. Case numbers remain extremely low.
Lockdowners point to the example of New Zealand, which has had only 1,831 cases, and 25 Covid-linked deaths
hung on so far. I really fear this will be their death knell.”
Johnson also announced new £10,000 fines for people who refused to self-isolate. Advice on working from home was again turned on its head and people who could were told that they should. Businesses that were not Covidsafe would be closed. There was talk – which is gaining ground among panicked Conservative MPs – of using the army to help enforce rules and control the swelling second wave.
The restrictions would remain for six months, the PM said, through Christmas and beyond. Far from being wrestled to the ground, the virus was alive and kicking. Any optimism had drained away.
In the Commons last Wednesday, the Labour leader Sir Keir Starmer – conscious that the country was back in full crisis mode and needed some wartime togetherness – backed the strict new rules but laid the blame for the second wave at the door of the government, citing its continued failure to set up an efficient, locally responsive test and trace system. “When is the prime minister going to act?” Starmer asked as MPs from all parties demanded to know why the UK, whose health service is still admired across the world, was so helpless in the face of the coronavirus pandemic.
Lessons from abroad
Covid-19 is in many ways still a mystery enemy. Neither governments nor scientists fully understand how it spreads – authorities in the US are still debating the role of airborne transmission – and why the death toll in badly affected areas varies so widely.
In the Brazilian city of Manaus this spring, the death toll was so high that bodies piled up in the streets and were stacked three-deep in mass graves, in scenes that could have been lifted from a medieval plague diary. In war-torn Afghanistan, with a battered health system and most people unable to afford social distancing, millions of people are thought to have contracted the disease. In the capital, Kabul, nearly half of children have been infected, the government estimates. But while Afghanistan’s gravediggers, coffin-makers and others who serve the bereaved have reported an increase in burials, the country has not been overwhelmed by death as Manaus was.
There have also been countries, from India to South Africa, which have seen infections soar after they came out of lockdown but mortality rates rise much more slowly.
South Africa now has approaching 700,000 confirmed infections, but under 17,000 deaths – nearly 60% more total cases than the UK but less than half the number of deaths. Some fatalities may go uncounted in places with weak record-keeping, but it is hard to cover up catastrophe on the scale that hit Manaus.
Scientists are still arguing over the reasons some countries seem to have been spared heavy death tolls even as the infection spreads. A relatively young population may be less vulnerable than in fast-ageing western disease hotspots. People living in overcrowded conditions may have stronger immune systems, fortified by fighting off many past infections. But if it is hard to predict how Covid epidemics will develop, it is much easier to see what keeps the disease at bay.
The few countries that have managed to effectively eliminate coronavirus range from authoritarian China to liberal democracies such as Taiwan and New Zealand. The clue to their success is not in their style of government but in several key steps they have taken to control the virus. All have sealed their borders, slowing new arrivals to a trickle, and brought in strict quarantine – two weeks in sealed-off hotels – for the few who are allowed in.
They also have rapid testing and effective tracing systems that are activated on the few occasions that community spread of the virus is identified.
And there is also a second group of countries that have used similar tactics to keep the epidemic under relative control, even if the disease cannot be stamped out. Deaths are in the hundreds, or still kept to double figures. They range from Uruguay to Vietnam and Senegal.
Even Italy, one of the first places outside China where health systems were overrun by the disease, now seems to be managing far better than other western countries. Cases are rising, but only slowly: people are still enjoying restaurants, bars and beach trips; children are back at school.
The exact policies adopted by these second group of governments have differed, but they share many common factors. Those that do not enforce quarantine for arrivals in the country require negative coronavirus tests shortly before travel.
Test and trace functions effectively in all of them, so that when a new outbreak emerges, it can be halted as soon as possible. In many – though not all – mask wearing in public places has become not just routine, but expected.
In contrast – although the British government has partially accepted that without proper testing, isolation of the sick and protective equipment for healthcare staff in the early stages, the virus spreads with devastating ease – UK authorities did not prepare failsafe systems to provide these essentials.
The scale of the problem is reflected in the UK’s record in staving off Covid-19 and preventing deaths, as shown by data that is both disastrous and highly incriminating.
To date, Covid-19 death rates for the UK have reached 616 per million people. This figure is only slightly below the rates experienced in nations acknowledged to have had the worst responses to the pandemic, such as the US and Brazil, where Covid death rates were, respectively, 626 and 657 per million according to Johns Hopkins University on Saturday.
By contrast, Sweden – where shops, restaurants, schools and bars remained open and which has taken the lightest of touches in dealing with the pandemic – still has a death rate below the UK’s: 581 per million. On the other hand, Germany – which reacted rapidly and forcibly to the arrival of Covid-19 – has kept its death rate to 114 per million.
Back in the UK
And now the figures show the virus biting back in the UK and spreading at alarming rates, putting huge new pressure on the NHS. As of Friday, hospital admissions in England were at their highest level in more than three months as infections continued to rise.
As of 9am on Saturday there had been a further 6,042 lab-confirmed cases UK-wide, after Friday’s highest single-day figure. The government confirmed that new lockdown restrictions would be introduced in Wigan, Stockport, Blackpool and Leeds from midday on Saturday adding to those in place in large parts of the country. Residents in these areas were told they would no longer be allowed to mix with people outside their household or “bubble” in private.
And thousands of students are in effective lockdown, just days after starting their courses in the face of union warnings that colleges were unprepared to deal with the likely spread of Covid.
Hundreds of students in Manchester were told to self-isolate on Friday after 127 of them tested positive for Covid-19, as cases spread to more than 20 universities across the UK. And hundreds of thousands of students in Scotland have been banned from socialising and going to bars. An outbreak of more than 100 confirmed cases at the University of Glasgow led to at least 600 students being told to self-isolate on Wednesday night.
So why – in so far as we can find answers – are we back in such a mess? Many scientists believe that, having got numbers down in the summer, we failed to finish the job off and reduce them to a low enough level before easing restrictions. We moved too fast, too early. And when the restrictions were removed, there is a consensus emerging that the easing was done unsystematically, instead of individual restrictions being lifted one by one at different times.
The result was that the impact of single, specific withdrawals could not be assessed. “We didn’t keep on the pressure to maintain a reduction in [the R rate] over the summer and people have gone back to normal behaviours too quickly,” said Anne Johnson, professor of epidemiology at University College London. “We are now paying the price.”
Joshua Moon, of Sussex University’s science policy research unit, pointed to “the narrow cadre of experts” who have given advice on Covid to the UK government as a problem. “The composition of Sage [the government’s Scientific Advisory Group for Emergencies] consisted of virologists, modellers and behaviourists, rather than experts in public or global health, primary care, emergency medicine, or nursing,” he said.
In particular there was a lack of support – financial, practical and psychological – for those being asked to isolate, Moon said. “If you live alone, across the country far from family or friends, how can you gain access to food or medicine? What is needed is increased direct support for those isolating.”
The Dominic Cummings affair also had a clear impact, said psychologist Professor Dame Til Wykes of King’s College London about the antics of the prime minister’s chief adviser, leading the public to lose faith in government and authority. “He wasn’t admonished and he wasn’t sorry. That really broke the community’s trust in any government messaging.”
That messaging has become increasingly confused, Wykes believes. “You can’t go to a football match but you can go grouse shooting. That just accentuates the class divide and says we are not all in this together.”
On the ground, however, health experts, NHS workers, people working for local councils all know it is the failure to get a proper, locally responsive, testand-trace system operating that has been the key problem since the spring and summer. Prof Christina Pagel, professor of clinical operational research at University College London, explains the importance of such a programme: “If you have infected people, and lots of non-infected people, you’re trying to stop the infected people mixing. We know that quite a lot of transmission is by people who either never have symptoms, or in the two days before they get symptoms. So you have to find those people and stop them mixing. And the only way to do that is by contact tracing.”
But during the summer, England’s contact tracing system was not able to pinpoint those asymptomatic carriers. NHS Test and Trace failed to reach its target of 80% of close contacts of people who tested positive and in some areas tracers only reached half the contacts provided.
The testing programme did at least reveal Covid hotspots, Pagel said, which allowed local health teams to act. Yet demand for tests spiked four weeks ago, despite steady increases to capacity, creating a backlog of tests, and many people were unable to be tested at all.
“When testing has fallen over to the point that you actually can’t be sure where the hotspots are, because there are places you cannot get a test, then all you have left is to try and stop the whole population mixing,” Pagel added. “It’s a really blunt instrument, but that’s where we are.” So the absence of adequate test-and-tracing equals new lockdowns.
NHS trusts are also concerned. Saffron Cordery, the deputy chief executive of NHS Providers, said: “We’ve been really dismayed by the political response to the challenges and breakdown in implementation of test and trace.” Instead of chasing a target of 500,000 tests for political reasons, it would be more helpful for ministers to acknowledge the issues around capacity, she said.
“To get the NHS back up and running and restoring the whole range of services, we need a way of keeping staff safe and keeping patients safe, and one of those factors is test and trace. We are teetering on the edge of a second wave and it’s very likely that we will fall in.
“Restoring services is absolutely fundamental, because we’re coming into winter. Winter often leads to staff shortages because of illness anyway – it’s absolutely critical that teachers and healthcare and care staff are prioritised.”
As winter approaches, most scientists are now becoming increasingly worried that the colder weather will force people to spend more time indoors and so trigger rises in Covid infections, while flu and other seasonal illnesses could have further grim impacts. The UK will then have to rely on its much-criticised test-and-trace service as its main disease defence.
At the same time, MPs, including many Tories, are increasingly angry that their government is introducing new restrictions without consulting them and allowing them to vote on them in parliament first. This week, on Wednesday, Johnson faces a huge Tory revolt that may force him to ask his MPs for their backing before imposing new rules unilaterally. “He should realise that unless MPs are bound in to his decisions they will not feel they have to support them and promote them to the public,” said a senior member of the influential Conservative backbench 1922 Committee. “That has been a big problem.”
The public is losing faith in the government’s ability to manage the crisis, and in Johnson, as the Observer’s Opinium poll, which gives Labour a three-point lead, shows.
On a practical level, one suggestion to improve efficiency has been put forward by Prof Rowland Kao of Edinburgh University. “Bulk testing – where more than one sample is tested at the same time then retested separately if a positive result is obtained – has been implemented in many other countries,” he told the Observer. That would give capacity a vital boost, he added.
A looming crisis
The NHS is now facing a winter crisis like no other. It has been trying to catch up on thousands of cases of cancer, heart disease and other illnesses left untreated during lockdown. And researchers are now becoming aware that Covid’s long-term impact on patients will add further strains on the health service.
“It is now thought that 10% to 20% may suffer from ‘Long-Covid’ – a wide range of disabling and life-changing chronic symptoms that affect the young, the old, those that had mild symptoms as well as those with severe symptoms,” said the immunologist Prof Daniel Altmann of Imperial College London. “We need to get to grips with this. It may have unforeseen consequences for quality of life, employment, NHS provision for years to come.”
In addition, the threat to the nation’s mental status is now a key concern, added Wykes. “The continuing uncertainty has increased the mental health problems in those who already had problems and it has produced new cases. We need more mental health research and more research on how to gain and maintain community trust.”
On the other hand, scientists have learned a great deal about the Covid-19 virus over the past six months and that knowledge should help us over the next six, said Prof Sarah Harper, founding director of the Oxford Institute of Population Ageing.
“From surveys we now have good information on the public-health reaction of the British population,” she said. “People have taken on board health information, so long as it is clear and well communicated. Public health information should now be tailored towards individuals, and those who will need specific shielding should be informed directly from their healthcare practice. On the other hand, a blanket shutdown of care homes will lead to unnecessary suffering for older residents. They need better support.”
A short-term future of lockdowns and restrictions looks inevitable, added Jeffrey Barrett of the Wellcome Sanger Institute. “We’re all exhausted, but there are no other options for the next few months. However, at some point, maybe early next year, we will come out of this wave, and then I think we will reach a turning point. Most importantly, we may have vaccines that are proven to be effective.”
On Tuesday, Johnson ended his televised address by saying: “The fight against Covid is by no means over … There are great days ahead. But now is the time for us all to summon the discipline, and the resolve, and the spirit of togetherness that will carry us through.” It sounded a familiar refrain. But, strikingly, it was delivered by the man in charge of running the country, setting himself the task of “defeating” Covid-19 with less conviction, and confidence, than before.