A Short, Sharp Break?

You’ve probably heard by now that England (not the UK, because Scotland, Wales, and Northern Ireland have instituted different measures) has entered a second countrywide lockdown as of today, Thursday, November 5. Bonfire night, for some unknown reason. It is due to end, or be revisted, on December 2. Although Boris Johnson says he is “following the science,” the government’s scientific advisory group, or SAGE, recommended on October 15 that the break, a “circuit breaker,” take place no later than October 24. In certain situations, a two-week delay would not be that bad, but in the midst of rising numbers in the second wave of a pandemic, a two-week delay changes the entire landscape. Why did Johnson wait so long? Because he did not want to shut the economy down again. This is a valid reason, but he’s now shutting the economy down, most likely for a longer period of time, so it seems like the worst of options. How did the numbers change between the SAGE recommendation, the recommended start date, and today?

We can see the number of daily cases start their climb at the end of August, with the extremely steep part of the climb starting right around the beginning of October:

On October 3, according to Our World in Data, the UK was averaging 6272.9 cases per day. By October 15, when SAGE put out their recommendation, that number had more than doubled, to 15,767. The recommended start date of the circuit break was already on the late side, with cases at   20,248.7 per day, and by November 3, that number had risen another 2,800 a day to 23,016.3.

But we can see that just looking at cases doesn’t give us enough information. Obviously, we had far more serious cases and deaths at the height of the pandemic in April and May, yet the cases per day were far lower. This is largely due to more and better testing. I’m sure we all know someone who suspects that had COVID-19 but were not included in these numbers because they were told to stay home and take Tylenol unless it got worse. Hospitalizations and deaths, which lag cases by 2 weeks or more, are the more worrisome statistics. The two worries are that the hospitals will be overwhelmed and that a lot more people will die. So where are we with hospital numbers right now? Our World in Data doesn’t report hospitalizations, but the UK government’s COVID-19 dashboard shows UK daily admissions to hospital going from under 100 at the beginning of August to 1445.4 by October 28, with the vast majority in England, which has had a more relaxed lockdown than any of the other devolved nations. On October 15, this number was 1,028, and on October 24, it had increased to 1,232. As predicted, case numbers started their climb around the middle of August and hospitalizations started to increase around the start of September:

And deaths? They, too, started to increase right on schedule, at the end of September. On September 30, there was an average of 30.3 deaths per day. By SAGE’s recommendation on October 15, that number had tripled to 91.4. By November 3, it had almost tripled again, to 265.

We can see why scientists and the Government are worried. But what will happen with the month-long break now starting? The answer is: it depends. The countrywide R0 in England is now estimated at 1.1 to 1.3 percent. The devolved nations each have their own way of reporting and their own regulations, so we’ll stick with England. Any R0 above 1 means numbers will likely increase. Right now, nationwide, if 10 people have the infection, they will in turn infect 11 to 13 people. This increasing number means, if nothing is done, R0 will continue to rise. But the blanket response is more political than scientific, because different areas of the country have very different infection rates, R0’s, and hospital admissions. The southwest, for example, has an R0 estimated at between 1.2 and 1.5. All areas of the country, though, have a rate above 1. London right now is right in line with the nationwide average at 1.1 to 1.3, but given the population density and the reliance on public transport, that would likely change over the coming months if no steps were taken. For comparison purposes, it’s interesting to note that only 3 states currently meet or exceed an R0 of 1.3: Minnesota, Vermont, and Maine.

The efficacy of the lockdown depends largely on people’s understanding and complying with the rules. That’s part of the reason for the government’s imposing a one-size-fits-all lockdown: people in the worst-affected areas were rebelling. Andy Burnham, the mayor of Manchester, in one of the more publicized rows, refused to put the area into Tier 3 lockdown when the government decreed it. But it’s not just the fault of rowdy pub-goers and partiers. As this article, published in The Atlantic on September 30, pointed out, R0  suggests a uniformity of infection that’s just not evident. We now know that superspreading events (say, an indoor Trump rally) account for most infections. But the problem is that the event is only half the equation; the other half is a person who is extremely contagious. Most people who test positive for COVID-19, it seems, are not that highly contagious. But the ones who are can spread the virus to an awful lot of people. The White House, for example, seems to have fallen victim to a super-spreader. Of course, people with common sense would, for the time being, eschew large, poorly ventilated gatherings. But part of the problem is that without knowing exactly how and by whom the virus was spread, people are playing the odds. Back to that Trump rally. If you’ve seen the pictures, very few people wore masks. But most of those people probably didn’t find themselves next to a super-spreader, and will therefore continue to believe that it’s all politically motivated hokum. By contrast, the people sitting in a super-spreader’s section may all contract the virus, and if that spreader is not identified, he or she can go on to infect countless more people.

Since we still don’t know exactly what makes a super-spreader, the most important thing we can do is have a good, working track and trace system available. Perhaps if our tracking and tracing had been good enough, we’d have been able to identify some of the characteristics of people likely to be super-spreaders already. The article points out that we may be doing the tracing backwards, warning people who’d had contact with people who have tested positive rather than concentrating on how those people who tested positive actually contracted the virus. But we in the UK aren’t even at that level. My husband and I dutifully downloaded the NHS’s Coronavirus tracking app on the first day we were able to. We go out of our way to scan the QR code at any venue we visit. When you open the app, you’re confronted with a pulsing green circle, designed to make it look like it is tracking where you are, like a radar screen:

Note the top, where it mentions my location: SW6 is in line with national restrictions. Before the lockdown, it said “SW6 is at a moderate level of risk.” SW6 is my postcode, and it is the correct postcode for all the areas around Fulham I might frequent. But I first noticed when we were travelling to some National Trust properties that the code didn’t change as we drove out of London into Kent or Surrey. I thought perhaps it just took a while, but since it’s supposed to be scanning where I am at any given time, it would seem that it would know my postcode instantaneously. Then we went to Devon, 3½ hours away by car, in early October. We were there for five days. I scanned the QR code at, for example, Dunster Castle. My postcode never changed from SW6. I know the official answer would be that my phone will still ping if I come in contact with the phone of someone who has tested positive, and then there’d be some mumbo-jumbo about privacy, but it’s all just nonsense. The app only works if the other person has also downloaded the app and hasn’t forgotten his or her phone in the car. There is so much more data ostensibly being collected that you would think would be a lot better at determining my likelihood of contracting the virus—and, of course, determining if I am actually a super-spreader. One of the things the scientists have said about the circuit breaker is that it can be used to get the track and trace system working. Labour has made a strong push for that, as well. If you’re going to make people stop everything, at least try to ensure they won’t have to do so again. And it’s not just the phone app. It’s also the requirement that venues take your contact details. I’d assumed since the beginning, when pubs reopened after the last lockdown, that taking people’s details was a requirement. Then, when the numbers started climbing and we faced more restrictions, the government announced that the “suggestion” that pubs take contact details would now be a requirement. Luckily, most publicans seem to have been more sensible than the government. This time, we are told, the requirements will have teeth. The police are prepared to enforce the rules, and fines will be levied for non-compliance. We’ll see, but if people don’t follow the rules and our tracking and tracing don’t finally match the hype, the pain is likely to be felt for much longer than a month.

One thought on “A Short, Sharp Break?

  1. You identified the major problems. In my view these are this government’s willingness/ability to educate the population and enforce the laws. Here’s an extract of a letter I write to Boris Johnson and others last week.

    Enable – and frankly this is where I think this government has done a horrible job so far. In very simple terms, and in many languages and media explain to the British population how they need to go about their lives, this includes but is not limited to:
    How to wear a mask properly and when to wear it (essentially all the time), reduce mask wearing age requirements from 11 (or 12) to five and drastically reduce the number and complexity of exemptions.
    How to stay away from people (simple you might think, but not so in my experience)
    Walk on the left hand side of the pavement, walkway, path etc.
    Don’t walk three abreast taking up the whole path
    Actively move away from others
    Avoid crowded places
    Etc.
    Pay attention to your surroundings – maybe ban use of smartphones while walking – as many seem unable to do two things at once.

    Enforce – so far enforcement of the guidance/rules etc. has been lax at best. It’s time to start making sure that everyone follows the rule of law. We already have people on the street ensuring parking compliance – let’s have them ensure the new laws are followed – get the police from behind their desks completing paperwork and onto the streets. On the same theme – shops of all sorts must be responsible for enforcing mask wearing (hence the need for simplicity) in the same way they enforce shoplifting rules – no mask, no service – simple.

    Like

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