I wrote this at the start of April. On the whole it has aged well. I wouldn’t change the overall approach – the need to hedge a no vaccine scenario by managing transmission, as well as recognising that for the youngest the virus represented a risk lockdown was unwarranted for.
But I would change one element. Rather than allow natural transmission within younger age groups I should have advocated a more proactive approach where we paid young people to be infected in controlled circumstances. It would have both limited the economic cost as well as significantly reduced the overall risk to at risk groups and therefore saved lives.
It would be easy to be forgiven right now for both candidates and businesses alike to be looking ahead, as we remain under full lockdown, with a great deal of trepidation. Each day it is impossible to escape the tragic and upsetting news of those who have succumbed to this invisible killer. And for those mercifully untouched from a health perspective it is inevitable that the broader economic impact has or will affect you either directly or indirectly. The very word pandemic is to describe an event that is all encompassing to a geographic area or population. Truly, we are all in this together in some shape or form.
But I do believe there is reason to start having real hope both in economic and health outcomes as well as the speed in which some near normality will return. Even if it seems unimaginable right now. If is this hope and thoughts I want to layout for you today. Truly, I think within weeks we can start to see a significant return to ever more normal life, albeit with caveats.
I should make clear I’m not an epidemiologist. I’m a finance professional who has used their time searching for work to form a detailed understanding of this crisis. Ultimately, like crisis management and decision making in business, it requires you to understand complex data of financial and non- financial nature, piece it together and formulate risk management strategies that deliver the best outcomes for the business or in this case society. What I’ll detail is the thinking governments globally are undertaking as they decide how best to proceed and crucially why light is fast approaching. One major caveat I have to state is that I’m talking in societal terms why there is reason for optimism. Because of the nature of the virus, just like the health outcomes are unequal for numerous factors such as age and underlying conditions, so too certain industries, Cinema or restaurants, may benefit less until social distancing measures can be relaxed fully much further down the line.
First things first and the most important factor in determining our next steps is that we know more now than even a few weeks ago. A lot more. Pandemics occur precisely because a new unknown threat appears. That’s why even with best the prepared ‘action plans’ the initial response phase can seem clumsy, mistake laden or uninformed.
Covid-19 and it’s nature wasn’t known. It still fully isn’t. It appeared in late December in Wuhan and since we have had to learn and adapt our plans to accommodate it. The lack of ventilators may seem obvious now but the virus could have demanded another equally scarce resource if it behaved differently. You just don’t know until it happens.
What’s crucial in this first stage is that we establish control over the virus in terms of its spread and also our ability to have capacity to treat those requiring medical help. Across the developed world (sadly, and very much underreported, this cannot be said for less developed nations) we look to have established this control through lockdown and simple and concise social distancing advice. This control has bought us time to learn about the virus such that now we can make our own choice about the ‘exit strategy’ we pursue.
Remember, any exit strategy is a best worst option (in the ideal world we wouldn’t need it!) but they all will have one common goal, herd immunity. From smallpox to chickenpox, any highly infectious disease is managed by this method. How we achieve it is via a vaccine or managed transmission. That’s it. No other options exist to achieve herd immunity. Globally, we are about to pursue both. This is correct as it hedges our bets. A vaccine is the only exit strategy that offers a return to absolute normality. However, how long it will take, it’s potential side effects and much more is all unknown. As a result it we cannot just sit and wait for one. Thankfully managed transmission appears to be an acceptable route because of what we have now learnt.
Crucial details we have learnt about the virus to keep in mind;
- It’s highly infectious (transmitted in air, can survive on surfaces and any person can be infectious two days before symptom onset and some are asymptomatic)
Implication – almost impossible to contain transmission without the lockdowns we are seeing. It’s why this is a global pandemic and not a regional epidemic. But lockdowns carry huge direct economic and social costs as well as indirect health ones too (ordinary care for normal disease and ailments are reduced or stopped right now). To contain via testing would require a national capacity no nation on earth has and nor can quarantine be guaranteed because carriers can test negative. Truly, unless we test everyone everyday there is a risk of leaks. - The health outcomes vary dramatically with age and current health state of individuals. This pandemic is the first global one since the Spanish Flu in began 1917/18. That was estimated to have infected 1/3 of the world’s population and killed more people than all the civilian and military deaths of WW1. It’s case fatality rate was 2-3%. Predominantly these were young people under the age of 30. Covid-19 couldn’t be more starkly different. Firstly, data suggests a case fatality rate of c1% and getting lower. Far lower than early estimates as we have gathered more data. This is because more studies like some in Sweden and several US states are starting to suggest the volume of cases in populations is far higher than what is officially tracked. As a result when working out the health outcomes of deaths and hospitalisation rates our denominator is far too small. This is even more true for those of younger age groups (<40) where it seems you may be as certain as >99.5- 99.9% to be ok.
- Implication – the risk of fatality posed to certain age groups (certainly <40) is extremely low. The statistical risk doesn’t warrant lockdown in these groups. It should be noted a not insignificant risk of hospitalisation still exists of c1-4% in this age group and that capacity demand will need continued focus.
For SARS and MERS immunity for those who had the viruses lasted for c3 years. While we can’t be certain it would be sensible to assume similar for covid-19 and reassuringly research on suspected cases of people who contracted the virus twice appears to show this wasn’t the case. They had false positive tests and only had it once. Also key is that the virus is stable and not mutating. Any immunity thus has longevity as long as the virus remains in its current form. Provided this longevity of immunity exists for even a year, this should be sufficient to bridge to a vaccine.
Implication – there is a benefit to transmission in immunity. Each immune person becomes, in effect, a natural form of social distancing inbuilt automatically to society placing more distance between an infected person and someone yet to have the virus.
So. Transmission if we unlock is inevitable. But it is it sensible or logical in terms of outcome? Well, put simply, yes. Due to who this virus targets the incentives align in such a way that we are able to pursue a strategy that delivers for almost all. Restoring the economy as quickly as possible while continuing to protect those most at risk. It is an undeniable fact that those most at risk also correlate highly with the most economically inactive from a work perspective. This wasn’t the case in the Spanish flu. Then the youngest workers were most at risk. Had Covid-19 done the same then the options to lift lockdowns and protect the economy would be vastly more limited.
Also, finding a way to return or at least relax lockdown limits on the elderly as quickly as possible by reducing their risk in health terms is also vital economically as it is their spending power that plays a key part in driving our economy. For as long as we need to ‘cocoon’ them the greater the Iimitation on this critical economic engine too.
So what does managed transmission look like in practice? Once we have control (first peaks clearly past) we must then establish capacity in our health system. Once we have that we can begin unlocking by age cohort, the youngest first. This may also be done by region as for example, London may take longer to build capacity in the health system relative to areas in the rest of the UK.
By reopening schools and allowing those under 30 to move out of lockdown (while maintaining social distancing and good hygiene) we begin to build transmission and immunity. Should clusters emerge with high healthcare demands, areas or ages groups may need to return to lockdown measures. But once an age group reaches c80% immunity we can unlock the next cohort. Each time the in-built social distancing helps slow the spread in any new cohort released and thus helps better protect and manage our health capacity too.
It is by this strategic and planned opening up of lockdowns, reversing temporarily if needed, that we can quickly return our economy and society back to as near a normal state as is possible in a relatively quick period of time.
Sadly, this does demand that older age groups remain under strict lockdown until we reach herd immunity. However, this is no different to waiting for a vaccine. It is only a vaccine that offers the exit that returns us to normal. At least this route seeks to offer best outcomes for our collective health and economic outcomes and in as short a time as possible relative to any other strategy.
Hopefully, this has helped summarise that a positive way ahead, or a best worst option, does exist. One final factor unknown that will be vital in determining how long that path may be is the number of people who have had the virus to date. Given asymptomatic cases or mild flu form it is possible the level of transmission is already far higher and the path ahead even shorter as a result. Fingers crossed it’s as high as possible.
To end. This is of course a theory. The best thing anyone can do right now remains to stay at home, observe social distancing and look out for those in need until we are told otherwise.
Stay safe.