Pandemic decision-making

As the death toll in the COVID-19 pandemic increases, governments in wealthy countries are trying to slow the spread of infection by shutting down large parts of their economies in partial ‘lockdowns’ – hoping to avoid overwhelming their health services until a vaccine is available.  People are losing their jobs; the quality of life for many will be permanently diminished; many will die earlier as a consequence of this year’s government decisions; and, above all, the policy isn’t working even on its own terms – large numbers of excess deaths are being reported in the countries which have imposed partial lockdowns, despite the restrictions.

There is a need to re-examine the policy, at least for future pandemics – which will undoubtedly occur.  The partial lockdown policy should be challenged on ethical, legal, and practical grounds.

Partial lockdowns can be challenged on ethical grounds:

• An individualist might argue that governments have no right to infringe people’s liberty and that people should be allowed to take their own decisions about the risks they are taking. They might not be harming anyone else in most situations, although it can be argued that they should wear masks in crowded public spaces.
• Collectivists might argue that it is wrong to harm the many for the sake of the few: old rich people (a fair description of many politicians) have decided to enforce restrictions to protect people like themselves, at the expense of the wider population of working age and the poor. As reported in the UK for example, Pandemic leaves poorer families £170 a month worse off.
• The economic damage inflicted by lockdowns cannot easily be evaluated. The immediate drop in GDP can be reported, but the resulting increase in the national debt would have to be paid back under later governments.  This amounts to theft from later generations.
• The long-term damage caused by job losses is hard to assess. People’s quality of life is seriously affected.  Some will be permanently unemployed and require benefit payments, and poverty has health consequences.

The legality of the partial lockdowns is also questionable.  “It has been the most significant interference with personal freedom in the history of our country”, according to a former British Supreme Court judge, Jonathan Sumption, in an article This is how freedom dies; he highlighted the lack of Parliamentary scrutiny over such an all-embracing set of restrictions.

The impracticality of the policy can be shown by the fact that it isn’t working, for many reasons:

• Healthcare resources cannot be expanded quickly. Shifting them onto COVID-19 is increasing the number of deaths from other diseases – as can be seen from the fact that Britain had suffered more than 70,000 excess deaths since the start of the pandemic, at a time when deaths associated with COVID-19 were reported at 52,147.  There is no way of knowing whether this result is better or worse than other possible policies, especially when the later deaths from consequential health issues are taken into account.
• Many people disagree with the policy of partial lockdowns and don’t comply with the restrictions. There is widespread public discontent on both sides of the Atlantic, arising partly from unease about how decisions are taken, partly from lockdown fatigue and partly from ideological opposition to restrictions on freedom.  As reported in Europe, for example: Protests break out in Berlin as France and Germany plunge back into lockdown.  There have also been protests in Italy and Spain as people tire of having their lives disrupted.  In Britain, a political party has been formed to oppose further restrictions: Nigel Farage: Brexit Party to focus on fighting lockdown.
• Partial lockdowns depend upon being able to identify infected people and isolating them, but it has proved impractical to expand the capacity of test and trace quickly enough. Many of those who are told to isolate refuse to do so, either because they cannot afford to or because they don’t have suitable accommodation.  Some people refuse to identify those who have been in contact with them, for fear of social embarrassment.
• At the end of October, in common with many other European countries, the British government imposed a new lockdown – which is certain to inflict more economic damage. Although this lockdown was projected to last four weeks, it might last longer: The long winter – why Covid restrictions could last until April.
• COVID-19 will not be the last global pandemic. The astronomical cost of the current response to it cannot be matched for every new disease.

There are at least two alternative policies.  China, New Zealand and Taiwan stand out as having performed much better than Britain, Europe and America – by closing borders, enforcing quarantines and imposing total lockdowns immediately in affected areas; their populations were prepared to comply.  Another approach is Focused Protection, as recommended by the Great Barrington Declaration, which has been signed by distinguished scientists; its argument is based on protecting the vulnerable whilst letting others live normally:

“As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e.  the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.

The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”

The declaration has, though, been challenged – by Dr Stephen Griffin for example: The problem with the Great Barrington Declaration.  He acknowledged the value of shielding the most vulnerable, whilst noting that it becomes more difficult if the virus has spread widely through the population, but he criticised the aim of achieving herd immunity.  He pointed out that it would be difficult to identify all those who needed protection and argued that it is uncertain how long immunity would last in those who have had the disease – as described in a Telegraph article: Why is Boris Johnson having to self-isolate given he has already had Covid?

No policy totally eliminates the risk of dying from COVID-19, and Dr Stephen Griffin doesn’t offer any alternative to repeated damaging lockdowns.  Herd immunity may eventually require regular vaccinations, as is the case with flu.  Until that becomes possible, Focused Protection could command the support of many people who would otherwise suffer from lockdowns.

It is very important to note that Focused Protection requires effective political leadership.  The population must be fully informed about who needs to be protected and how to do so.  It is grossly irresponsible to pretend that COVID-19 isn’t a serious problem (as was argued by Donald Trump, Jair Bolsonaro and, initially, by Boris Johnson).

Politicians in Europe and many American States have found it politically easier to do something dramatic – implementing a lockdown – instead of explaining how to protect vulnerable people.  It may not be too late, though, to change course.  A policy of Focused Protection would allow freedom to people who are prepared to risk catching the virus, subject to them complying with regulations that explicitly protect the vulnerable.  A group of young people could decide to have a party, for example.  Focused Protection could also grant freedom to those who have been vaccinated, or who have had the disease; such people are now very unlikely (though not certain) to either catch it again or infect others.