Covid-19 policies likely to be in place for 18+ months: Are they considering all of the relevant outcomes? Is there any cause for optimism?
Image by Miroslava Chrienova from Pixabay
The Ferguson et al. report (published on Monday 16th March 2020), the evidence informing UK government policy on Covid-19, is sobering. We are only just beginning to feel the impact of the UK’s current policies on ‘social distancing’, but the report estimates that this is likely to be the recommended scenario until a vaccine becomes usable and available (with perhaps some intermittent relaxation between controlled peaks until that time). This is estimated to be an additional 18 months at a minimum! In other words, social distancing could be the norm for the foreseeable future…
Should we be resigned to this fate? We need to remember that the report is based on statistical modelling, inserting current data and assumptions to make an estimated ‘best guess’ at what to expect. Although I’ve no doubt that these are the very best models to go on currently, it’s important to realise that no statistical model is completely perfect. For instance: they are limited to current knowledge (ever-evolving with a novel virus pandemic); they model estimated effects of currently available/proposed interventions (not all possibly conceived ones); and they only model effects on a limited set of outcomes (i.e. not everything that we might value as important in society).
This last point might become increasingly important the longer these measures last. For example, the current models do not take account of other outcomes we might value, such as the impact on the wider economy - literally people’s ability to ‘make a living’ -, or indeed their sanity.
The economy
To make it crystal clear, my concern is not about the money/economy itself, but the fact that money (or lack of it, specifically) is linked directly to people’s jobs, with potential for job losses and poor health and suffering. We know deprivation is associated with all sorts of other infectious and chronic diseases, not least mental health conditions. There have already been some government interventions in the economy itself, but the feasibility of bridging loans, or indeed other standard economic interventions, is debatable in the long-term.
Our sanity
Arguably, the interventions chosen by the government focus on extending length of life, not its quality. They are aimed at preventing infections and deaths, and at reducing overall demand on the NHS so it can continue to deliver acute life-saving interventions. The specific focus is on protecting the most vulnerable (i.e. those closest to death) from death and suffering. This is admirable, and I obviously agree with this societal value. But, current government policies appear to mostly ignore the general panic caused by these abnormal conditions for everyone else (and, indeed, the mental impact on elderly/vulnerable who are supposed to adhere to the strictest version of isolation). My concern is that planning to effectively use whole population interventions and to use health services only to firefight for the foreseeable future, will, in the long-term, potentially create a whole host of newly vulnerable, socially isolated people.
As humans, we are social beings and, with modern technology, increasingly global beings with friends and family members across the world. A lot can happen over 18 months, the health of some of the population will naturally deteriorate (with people developing other diseases that also need management), and lives will end through other causes too (with people wanting to grieve). Whether it will continue to be socially acceptable to negatively affect everyone in the population (at least psychologically) in order to limit damage to the few, and over this sustained length of time, we’ll need to see. Of course, unprecedented in peacetime.
Any cause for optimism?
But, there might be other policy options that emerge as this situation goes on (or, other policies aimed at limiting the negative spillover outcomes discussed above, such as universal basic income which is being proposed to protect the economy). Society might well get to a point where we can’t take it anymore: we collectively decide we need to ‘rip off the band-aid’ and accept short-term pain for general relief. Stepping back at some stage and allowing the virus to run its course over a period of a few weeks would be an extreme decision, with deaths of many vulnerable/old people in a short period of time, but you could imagine a societal breaking point where this could happen (or, perhaps more likely, a point where this would happen naturally if government controls were to loosen, or people generally became fed-up and started ignoring the rules). This would be a much shorter, but more chaotic episode.
Perhaps a more optimistic, and hopefully more realistic approach, is using new technology. This would allow us to better target the social isolation policies and their negative effects to those who actually still need them. Over time, people will continue to catch the virus, no matter what. The vast majority will survive, developing some immunity to it. A so-called ‘antibodies test’, currently in development in the UK, would allow us to test whether someone has ever had (and developed immune cells to fight against) the virus, not just if they have it currently (as in tests available now). This could then allow certain members of the general population to be ‘green lit’ (as Boris put it today), allowing a steady flow of people to go back to normal life (hopefully, enough to begin to stimulate the economy and offer hope for the sanity of everyone else). Eventually, this might be combined with the option above in a more controlled way, giving time to be as prepared as possible with essential resources, such as ventilators, oxygen, NHS staff on duty, healthy volunteers, etc.
18+ months is a long-time. But, humans are adaptable and resilient to change, no matter what. And, you never know, there might be hope of shorter-term general suffering yet…