The End Of The Affair: moving from pandemic to endemic
What is the exit strategy for Covid-19? Considering how long the pandemic has been going on, this question remains remarkably little-discussed, in the mainstream media at least. Yet it is central to the whole question of what we are trying to do now.
An early disclaimer: I’m not a scientist or doctor, so I am no more informed than any other person who has paid a keen interest in the progress of the pandemic. So all I’m going to do is sketch out possibilities. Even that, however, is going further than most of the discussions that are taking place in public and I won’t need any deep knowledge of science or medicine, or much more than some basic observations.
Options for exit
We have three conceivable exit strategies for Covid-19: eliminate it; live with it; or keep the pandemic protective measures in place indefinitely. To the average citizen, the first looks impossible, the second looks unconscionable and the third looks unendurable.
The death of zero Covid
The average citizen is right about a zero Covid strategy. It is now apparent that vaccines and herd immunity are not in the short to medium term going to eliminate Covid-19. Still more importantly to the average citizen, vaccines or herd immunity do not yet look able to eliminate the risk to that individual average citizen of a serious bout of Covid-19. Maybe in the future we will get a vaccine that is highly effective against all strains, and there are reports of such vaccines being developed, but it’s not here yet. In the meantime we face the Omicron strain of Covid-19, which is ridiculously transmissible. Even if an effective multi-variant vaccine turned up tomorrow, it would still be too late to stop Omicron spreading everywhere.
Let’s take a moment to mourn the passing of zero Covid as a strategy for now. It was a noble idea, and not stupid — we’ve eliminated smallpox and (outside Afghanistan and Pakistan) polio that way, and we’re making good progress getting rid of diseases like measles and rubella too. But right now we can’t do it for Covid-19. The virus has mutated beyond our present means to quash it.
Beyond zero Covid
Once we have eliminated the impossible then whatever remains, however unpalatable, must be the strategy. Do we keep going with extensive restrictions or do we just live with the disease?
In many ways, the whole of the battle with Covid-19 can be summed up in two facts. First, we have made the disease much less dangerous by combating it with effective vaccines. Secondly, however, the disease has become much less avoidable by mutating to become much more transmissible. Putting these two facts together, we are not going to eliminate Covid-19 but we don’t need to be as afraid of it as we used to be. We need to manage a transition from being in a pandemic to being in a world where Covid-19 is endemic (but just another manageable disease).
Unfortunately, the coalition of cod-libertarians, anti-vaxxers, nutters and the plain selfish who have been tantrumming since the outbreak of the pandemic about any restrictions at all has salted the ground for having any sensible debate about this. That coalition having spent nearly two years pumping out misinformation, motivated reasoning, nonsense about the efficacy of vaccines and ignoring any knock-on effects of removing health restrictions, the public is in no mood to give them much of a hearing now.
So let’s ignore that infantile coalition and start from first principles. What are we trying to achieve with the current health restrictions, are they working and what are the costs?
Well, first of all we need to acknowledge what we’re not trying to do. We’re not trying to prevent all deaths from Covid-19. That’s sadly not possible. Nor, with Omicron, is it really possible even to minimise Covid-19 cases, or not that much. It’s just too transmissible. You can delay the spread of Omicron with harsh social distancing measures — if you can get public compliance — but sooner or later it’s going to spread.
Let’s pause to lament that too. For over 18 months, the public has believed that social distancing was an effective strategy to reduce disease and death. Again, that was a noble strategy and it wasn’t stupid when the natural R0 rate of Covid-19 was at 3 or so. But with estimates of the natural R0 rate for Omicron being anything up to 10, that strategy now looks unworkable.
We need to get used to the idea that what we can do most effectively is defer the inevitable. Why might we do that? Two reasons: one personal, one practical. The personal reason is that we can put off the day of reckoning for each of us. The practical reason is to enable society to function more efficiently while the virus courses its way through the population (and sadly, potentially re-courses its way through the population over and over). In particular, the health service could maintain sufficient capacity to treat not just Covid-19 cases but all the other health problems that the general public need dealing with.
The practical reason is much the more important of the two for society. It pains me to admit it, but society would not be much disrupted without my continuing presence. If the health service breaks down, the disruption would be profound. (Of all the objections to lockdowns that the coalition of the infantile have put forward in the past, among the silliest is the idea that the health service needs to stop prioritising Covid-19 over other health problems. As Chris Whitty trenchantly pointed out to Dean Russell MP when questioned, keeping Covid-19 under control is essential for being able to deal with the other health problems.)
At a time when Omicron is burning through the nation like a forest fire, consuming all the human fuel in its path, government scientists are unsurprisingly extremely concerned about this possibility.
The downsides of further restrictions
If the lockdown sceptics have one valid point, it is that not enough consideration in most of the media is given to the negative aspects of lockdowns in the weighing of whether to introduce restrictions. The press and TV are willing to run stories about the problems that lockdowns cause, but not as part of the weighing process as to whether we should have one in the first place. This pales into insignificance as compared with the triviality of the anti-lockdown press, who treat the idea of a lockdown as if the government were threatening to snatch a bowl of jelly from under their noses just as they had their spoons in hand, rather than a potentially required public health measure. But the point is a valid one.
Lockdowns are bad for the economy. Of course, when Covid-19 rates are high, a lot of people will place themselves under voluntary lockdowns, as we have seen repeatedly. Still, there’s a section of the public that will take their chances even then. This avoidable economic damage should not be ignored. The country needs the economy to keep going.
The equilibrium here has shifted over time. Now we have vaccines that are reasonably effective, even if they need repeated boosters, many people will take a different view of the personal risk that they are running from Covid-19 from the view they would have taken a year ago. If Covid-19 is highly likely to be no worse for you than a bad cold even if you catch it, you might well decide to be more outgoing than you would have if you’d thought you’d got a risk of dying from it.
In any case, lockdowns are primarily for the benefit of those who can stay at home. If you’re a pensioner or if you’re in an office job, that’s all very well. If you’re a courier, a PT or a teacher, you’re just going to have to deal with the health emergency as best you can. Lockdowns are a policy instrument that protect the rich much more than the poor.
Even more overlooked, we all have a finite amount of time. My niece angrily told me that Covid-19 had stolen some of her hot years. This should not be mocked or discounted. There’s a big difference from a lockdown of a few weeks and social distancing measures that last for years. There comes a point for all of us where living a little is as important as existing. That point will be different for all of us but we shouldn’t go at the speed of the slowest boats in the convoy. Again, with Covid-19 looking a much less intimidating disease than a year ago thanks to vaccines and boosters, the balance point for that too looks quite different from a year ago.
What this all means is that the justification for stringent social distancing measures is much weaker than a year ago. So the bar for introducing them should be considerably higher.
The government has not spent much time talking with the public about any of this. Now that the public’s image of the government during lockdown is of 24 hour party people, it cannot. No one is leading the public, who reasonably enough continue to believe that stringent social distancing is the correct policy response. No one has talked with them about why that might be changing.
Where are we now?
We’re not yet at the point where we can declare the pandemic over. 750 or so people are dying each week from Covid-19 in Britain, and that figure is likely to rise in the short term. That still makes it one of the leading causes of death in the UK. We wouldn’t shrug off 40,000 people or more dying of any other cause each year and we shouldn’t do so with Covid-19 either. The risk right now of the health system being overwhelmed is substantial.
The government has decided not to introduce further restrictions in England at this time. We had better hope that they are right that the spread of Covid-19 is at the lower end of expectations and that with the widespread uptake of vaccines it is proving milder than other variants. It may work out: it may well be odds-on to do so. The government, however, is taking a big risk at a time when the public on balance would prefer them to be more cautious.
Sooner or later, however, the public is going to need to get used to the idea of living with Covid-19 in a similar way as with flu. Chris Whitty said this as long ago as the end of March, but the public has not been prepared for this properly. If the government wants us all to move on as Chris Whitty advised then, it needs a properly drawn up communications strategy — and then to implement it. Now would be a very good time to set that in motion.