As we start to get this pandemic under control in England, there has been a shift in the narrative toward our lockdown exit strategy, with Boris Johnson and his government set to announce these very plans on February 22nd. However, we are already starting to see the rumblings of discontent within the ruling Conservative Party between an early exit approach and a more cautious one. On Wednesday night, the Telegraph reported that Chancellor Rishi Sunak is becoming increasingly frustrated with his government’s scientific advisors over fears that they are “moving the goalposts” on the requirement for ending lockdown. According to the report, the original target of protecting the NHS and saving lives has been replaced by a focus on getting case numbers down, which would potentially delay the lifting of restrictions. Instead, Sunak believes that England is approaching a “fat lady sings moment” where lockdown must be lifted, never to return. As this will become an ever-popular topic over the next couple weeks, setting out the main arguments on either side – as well as the evidence to back them up – is of particular importance. It shows that while we are on the right track, we still have a way to go, which calls for patience instead of action.
THE ARGUMENT FOR AN EARLY EXIT
The bulk of the argument for easing restrictions early comes off the recent publication of evidence that vaccines do reduce transmission rates, in addition to data showing that one in seven over-16s in England has already had coronavirus. People in this camp argue that case numbers become less important now as the vaccination programme ramps up because the virus no longer causes deaths or serious illnesses. They also point to the fact that the peak of the current wave has now passed, with infections, hospitalisations and deaths all in steady decline. Therefore, both of these factors undermine the logic for keeping schools closed, with the medical and educational advantages of children being back in the classroom now outweighing the cost.
THE ARGUMENT FOR A MORE CAUTIOUS APPROACH
What the early-exit advocates fail to consider, however, is the risk of mutations. High case numbers make mutations a higher possibility, which might explain the shift in the scientific position that low case numbers should be a target, alongside protecting the NHS and saving lives. A more cautious approach also highlights that while case rates, hospitalisations and deaths are coming down, they remain forbiddingly high.
ANALYSING THE DATA
This is supported when examining the latest week of data (25th-31st January). In the Telegraph piece, they state that there has been a 72% drop in reported positive cases since the January peak, while the seven-day average for reported deaths has dropped by 13% and the figure for hospital admissions by 22%. Yet the issue is the constant use of reported figures instead of by specimen date (for cases) and date of occurrence (for deaths). Reported figures are less reliable as they constantly oscillate between underreporting and overreporting, meaning they do not give us as accurate a picture as to what is really happening in the community. Policy decisions are not based on reported figures either, so any discussion about potential policy conflicts should use the more accurate data.
When using date of occurrence rather than reported, it is still relatively good news:
- Cases have fallen by 59% compared to the January peak (~354,000 to ~145,000 weekly cases / ~50,500 to ~20,700 daily cases)
- Hospital admissions have fallen by 22% compared to the January peak (25,938 to 17,663 weekly / 3,705 to 2,523 daily)
- However, hospitalisations have only fallen by 9% (33,486 on average per day to 30,357)
- And there is a similar story with deaths, though it is difficult to say with any certainty as deaths by date of occurrence can be revised up by 5% (!!) 10-11 days after
So, what the data does show is that we are on the right track; infections, hospitalisations and deaths are all in steady decline. However, instead of looking at how far we have come, we should be looking at how far we need to go. Two good periods to compare our current situation to are: (1) our lockdown 2.0 peak; and (2) our lowest totals in summer.
HOW FAR DO WE STILL NEED TO GO?
Below is a table that compares our current figures (25th-31st January) to our lockdown 2.0 peak, as well as to our lowest totals in summer.
What it shows is that we have only just successfully managed to bring cases below their lockdown 2.0 peak, meanwhile hospital figures and deaths are still significantly higher. In comparison to the lowest totals in summer, however, we are a hell of a way off. This need not be disheartening though, as projecting our progress over the next couple months based on our current trajectory (a consistent 25% weekly decline) shows how quickly we can get near these summer levels if we just remain patient.
By 5th-11th April (in two months’ time), we could be recording:
- ~8,000 weekly cases (or ~1,100 cases a day)
- ~1,000 weekly hospital admissions (or ~150 admissions a day)
- ~3,000 people in hospital per day
- ~200 people on ventilation per day
- ~350 deaths a week (or ~50 a day)
Therefore, the benefits of waiting an extra couple of weeks are enormous. For example, test and trace can begin to work effectively thanks to a more manageable load. This is crucial for maintaining surveillance on mutations and clamping down early on clusters. In addition, the coronavirus strain on the NHS will be alleviated, meaning routine services can finally resume, meanwhile the fatality rate will be minimal.
WHAT DOES THIS MEAN FOR OUR EXIT STRATEGY?
Turning back to the policy debate, the irony is that the overarching argument for an early exit from lockdown is legitimate. As the number of people vaccinated continues to increase significantly, we will see further reductions in transmission rates, hospitalisations and deaths. The more these figures decrease, the less lockdown becomes a proportional response. However, what their approach fails to consider is the risk mutations play in halting our progress. Though we can be reasonably confident that our vaccines will still offer enough protection against current mutations, we still need to be on the ball regarding what mutations are out there, what is their level of prevalence, and what effect they have on the vaccines. To do this, test and trace is crucial, alongside effective self-isolation protocols and genome sequencing. This means case numbers are incredibly important to our exit strategy (alongside hospital figures and deaths), of which they must be low enough for England to successfully manage moving forward. Therefore, to add clarity to the exit debate, we must start setting targets. Instead of using vague criteria, such as “getting case numbers lower”, we must put a number on it. An example could be “driving cases below 2,000 a day”. This then allows government and the general public to know and see what we are aiming for, providing light at the end of a very dark tunnel.