14 May 2020
By Robert Kilconner
It is the old roofing problem again, the man trying to cover his shed with not quite enough roofing felt to do it properly who pulls the material up to one edge to find that he has created a gap on the other side. Never mind, snip a length off the end and use that. Oh dear, now there isn’t quite enough to cover the roof lengthways. Difficult choices have to be made.
We are used to seeing the political version of that as a shortage of money. No government ever has enough money to do everything it would like to, and so the Chancellor sits like a spider in the middle lopping bits off the departmental bids. More needed for the health service? That means less for defence but then we really do need to maintain a safe level of patrols? Perhaps we could pay for that by rationalising the benefit system but actually more money is needed to fight poverty. Put up taxes? That would conflict with our strategy for attracting businesses… It is a game of choosing between competing bids with a weather eye on what the public will or will not tolerate.
The withdrawal from lockdown involves a very similar dynamic. We all know the importance of keeping R, the reinfection rate of the Covid virus, below 1. If on average each patient infects more than one person, you have an exponential increase which would soon overwhelm any health system. If it is below one, the numbers decrease exponentially so that if, for example, it was 0.8, the second generation of patients would be 80% as large as the first generation, the third generation will be 64% et cetera.
The imperative, then, is to keep the reinfection rate down with a package which the public are willing to tolerate. Choices have to be made. If every restriction reduces R a bit, the Government has to keep sufficient of them in place to keep it well below the magic 1. Suppose that sending children back to school increases R by 0.05, but that allowing bubbles of more than one family increases it by 0.03, then it may be that you can afford one of those relaxations but not both. In choosing which restrictions to retain you have to take into account both the effect on R, by its nature rather uncertain, and the effect on public behaviour. There is, after all, no point in having restrictions which will not be observed or, worse still, which undermine public support for restrictions generally.
Of course the process is impossibly difficult, depends on guesswork as well as on science and will upset those who are affected by restrictions but see those controlling other activities, perhaps in some ways similar to theirs, being lifted. One government, seen as having handled the epidemic well, is being lobbied by those who want to liberalise the restrictions regarding funerals because people are to be allowed to go to the cinema. Of course funerals are more important to the participants but then those going to the cinema do not all meet or hug each other. I do not know what the respective effects on R might be, but one can see that the choice is not necessarily an easy one.
The fact that decisions involve a crossover between medical and behavioural science means that they will not always look, and will not always be, consistent. And the complex guidance required will be difficult to explain to the public even before you take into account the huge level of background noise, scientists who claim that the government advisers are fools and that it they who should be listened to, pundits suggesting that policy be designed around the prospect of a vaccine which may never arrive, optimists, pessimists, conspiracy theorists, waverers who are persuaded by the last thing they heard, enemies of the government, friends of the government, Old Uncle Tom Cobley and all, all posting, tweeting, demanding to be heard.
How should the government react to this? First it needs to shut out the noise when making decisions. That doesn’t mean not listening to new facts. After all, it was the new research from Imperial which impelled the overdue move to lockdown but that is different from trying to take advice from everywhere, for example from those who try to set themselves up as an informal alternative to SAGE. Yes, their theories should be among the things the government scientists consider but the Government itself must stick with one set of advisers.
Second, it needs to keep any predictions general. Every country is running experiments on how to get out of lockdown. It is important to keep matters flexible until the results of those experiments can be assessed.
Thirdly, give hope. The doomsayers talk about the non-existent vaccine as the only answer. That cannot be right. If the disease does not fade worldwide, the answer must be to stamp it out internally and maintain quarantine. That is unattractive in many ways but will become less so as states taking a similar approach formed a quarantine-free bubble of the type we are about to form with Ireland.
But fourth and most important the government must accept that it will make mistakes. It has made a number already, of course, in relation to PPE, testing and the care homes and those mistakes have cost lives. But, as Bill Gates said, no one is going to come out of this with straight As and the complexity of the decision making means that errors are inevitable. There will be more before it is over and that would be so whoever was in charge. What the Government must not do is to let the fact cloud its judgement. Feeling guilty is no aid to good decision making. Remember, when something goes wrong the best advice is on the mug:
“Keep calm and carry on.”