How we lift the lockdown is as crucial as when we lift it
Yesterday, it was revealed that the US had surpassed China for the highest number of confirmed coronavirus cases on record.
How the US is doing relative to China in this pandemic is important and may fundamentally alter the balance of power between the two nations in the decade ahead. But the number of confirmed cases each country is currently reporting is largely meaningless, a disorienting googly, reflecting little more than the number of people tested.
Epidemiologists say the numbers of confirmed deaths are the key to estimating the true spread. The exact denominator, derived from the case fatality rate, is still unknown but if you multiply a country’s virus deaths by a factor of around 2,500 you should get a half-decent approximation of the real spread of the disease in its borders
In the UK, that maths suggests around 1.6million cases. For the US and China, it’s about 3.5million and 8million respectively. You can push these numbers up or down depending on your view of the case fatality rate and speed of the epidemic spread. A controversial study published by academics in Oxford this week (without peer review) suggested that up to half the UK population could already be infected.
It’s natural to cling to flickers of hope in a crisis, but the Oxford model does not sit well with a surge in hospital admissions being seen in the UK and around the world. For the model to be right, the virus would have had to spread unnoticed through tens of millions of young people and only now be hitting older and more vulnerable groups. Many of the old are “atomised” in Britain but even then it seems unlikely. For numbers that are both frightening and (oddly) calming, by far the best document to turn to today is a study published on Thursday by a collaboration of experts from the World Health Organisation and various divisions of Imperial College London.
On the sobering side, it reveals the pandemic to be on a par with the 1918 Spanish flu in terms of both its lethality and scale. “We estimate that in the absence of interventions, Covid-19 would have resulted in seven billion infections [almost everyone on
Earth] and 40 million deaths globally this year,” it states.
The study, based on data from China as well as high-income countries, calculates that mitigation strategies that fall short of a complete lockdown would save 20million lives but would not prevent health systems becoming overwhelmed. In low-income countries, demand on critical care beds would outstrip supply by a factor of 25. In a typical high-income nation, demand outstrips ventilators by a factor of seven. In the UK, it’s eight.
On the brighter side, the analysis finds that “if a suppression strategy is implemented early and sustained”, then the vast majority of those 40million lives, an estimated 38.7million people, would be saved. It’s a suppression or “lockdown” strategy that the UK turned to after brief hesitancy on March 16 and which most of the world is following.
Dr Patrick Walker, a co-author of the report from Imperial, said: “We estimate that the world faces an unprecedented acute public health emergency in the coming weeks and months. Our findings suggest that all countries face a choice between intensive and costly measures to suppress transmission or risk health systems becoming rapidly overwhelmed. However, our results highlight that rapid, decisive and collective action now will save millions of lives in the next year.” Donald Trump raised the prospect of lifting America’s lockdown as early as mid-april, in time to fill the churches for Easter. There are similar voices in Britain. The cure is worse than the disease, they argue, especially when you factor in the economic damage. To epidemiologists, one suspects, these voices sound a bit like children in the back of a car. You have a 12-hour drive in front of you but no sooner do you turn out of the drive than they start asking, “when are we going to get there?”. They are not just struggling to fully comprehend the time in front of them but are not thinking of how they might use it constructively.
The new study, like the others before it, makes clear that suppression strategies will need to be maintained “in some manner” until vaccines or effective treatments become available in order to avoid the risk of the virus bouncing back. Put another way perhaps, if a nation is to protect lives and revive its economy then a coherent exit strategy is urgently required. This is where Mr Trump and other world leaders need to be looking at Covid-19 tests, not in their tens of thousands but in the hundreds of millions. China and other Asian countries used their huge (preplanned) testing capacity from the outset to trace and contain the spread, and they continue to do this day in, day out. Germany is the same.
But now China has started, by increments, to lift its lockdown. It is now using testing to release vital sections of its work force back into its schools, fields and factories. It’s not a big bang for Easter, but a phased strategy that aims to balance the risk of the virus bouncing back against the need to get its vast economy burning on all cylinders again.
For those who rightly worry about the economic impact of lockdown and the many thousands of indirect deaths it is certain to cause through poverty in the years ahead, this is where the focus should be. The question is not when can we lift the lockdown, but how do we lift it. And in this, tests per million of the population is more than likely to be the lead metric.
“The lessons we can next learn from China are about which restrictions can safely be lifted, when, where, for whom, and what still needs to stay in place,” noted Prof Andrew Tatem of the University of Southampton. The West did not study the East’s preparation for a pandemic well enough. Let’s not make the same mistake with the exit.
‘Rapid, decisive and collective action now will save millions of lives in the next year’