What we are doing simply isn’t working. There have been countless individual sacrifices; relatives not seen since Christmas and restaurants shuttered forever. As cases spiral alarmingly again, we are moving back towards economically devastating restrictions or, worse, thousands more patients struggling to breathe in intensive care units.
Can we take hope from the new strategy of ‘circuit breaker’ lockdown? Yes – but only if done correctly.
From our vantage points by the bedside on COVID wards, and as part of the COVID-19 Statistics, Policy Modelling, and Epidemiology Collective, we saw firsthand how we failed before. We argue that a coordinated circuit breaker followed by intermittent and contingent ‘reset’ periods could avoid a longer lockdown, help the economy, keep a handle on COVID, and save lives.
This would mean imminent strict regulations for two or more weeks to reduce the disease reproduction rate, R, below 1. Then in the subsequent months, intermittent repeated resets would allow increased activity overall whilst remaining below this safe threshold.
A failed approach
It is pivotal we understand how we arrived back at this precipice. The current ‘moderate distancing’ approach walks a dangerous tightrope, aiming for social and economic activity up to just before the point where disease rates would explode. It then resorts to disordered de-facto lockdowns, like we are currently seeing, but only as a reaction to a situation that is already out of control. It is doomed to fail for multiple reasons.
First, moderate regulations are prone to behavioural slippage. Early on, people largely followed the rules. However, when one or two friends push the boundaries and squeeze seven onto a table, or a high profile figure is compelled to explore Barnard Castle, others relax their internal standards in unravelling policy chaos. If we don’t change course we thus face an interminable loop of moderate restrictions punctuated by kneejerk lockdowns that fail to effectively suppress the disease.
Second, it requires excellent testing to stay on the tightrope, and constant policy tinkering as disease rates evolve. If recent weeks have revealed anything, it is the inability of current Test and Trace to cope with higher rates of disease.
Third, it leads to disparities in infection rates, which make sacrifice inefficient. Many towns and subpopulations have already sacrificed more than enough to eliminate internal spread, but a constant threat of outside reinfection prevents them from relaxing and enjoying their triumph.
Finally, this approach still requires months of major adjustments to everyday life, and rather than minimising cases, it simply spreads them out. Even with all this sacrifice, there is no clear point of ‘success’ or increased freedom until a vaccine is found.
Breaking the doom loop
In recent weeks, discussion of ‘circuit breakers’ lockdowns have made the headlines, with everyone from Keir Starmer to SAGE calling for a snap policy to regain control. Yet there is little discussion about what a good circuit breaker would look like and even less about what must happen afterwards.
In a recent paper, we considered exactly this question. Suppose a town wishes to allow 1,000 small but risky activities like essential workplace meetings, haircuts, and small social gatherings over the course of a month. Is it better to put all the activities in the same fortnight or space them out evenly? The mathematical answer is clear: we should take the former strategy. Temporally concentrated sacrifice beats temporally spread out sacrifice.
The exact optimal way to cluster these activities in time then becomes a policy question, not just a mathematical one. In practice, business and social activities could be permitted during the second fortnight of each month from November to January, but curtailed during the first fortnight. This would immediately lead to better disease control and more economic activity than the present approach. The resets might mimic what we had in early June: multiple households only meeting outdoors, with financial support for businesses that suspend trading. We emphasise that some economic activity could continue even during these periods: thanks to contactless supply chains, PPE, and other innovations, many businesses could safely remain open. But safety would be paramount. The goal is to drive the as low as possible over two strict weeks; the lower the disease rate, the less costly and more feasible a Track and Trace system becomes.
Print
Anne Williamson Scott Sheffield Anna York | Radio Free (2020-10-16T10:03:46+00:00) How to break the COVID doom loop. Retrieved from https://www.radiofree.org/2020/10/16/how-to-break-the-covid-doom-loop/
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