What's the exit strategy?
What is the exit strategy for all of this?
Some things have been obvious for some time:
We are in economic free fall – I don’t believe the exact numbers from the economists. Their track record is poor – very poor. Do people not remember the great financial meltdown Despite figures in the media, we cannot begin to estimate the size of economic hit. Even if we could, would it even be relevant to individual circumstances such as the loss of a job or business?
We have already missed the boat on testing - Tests can currently only identify the virus while a person is actively infected – not after the fact. The failure to mass test has denied ourselves the opportunity to identify those who have previously been infected. We also assume people cannot be reinfected – an assumption we should perhaps return to in the future.
The cavalry is not coming (anytime soon) – Tests to identify that a person has developed an immune reaction to the coronavirus do not yet exist. After the initial hype, all seems to have gone quiet as the reality of how difficult it is to provide a test really hits home. Vaccines also take at least 12-24 months, absolute minimum. To create something new it helps to have a starting point – the spoiler is that we didn’t really have a starting point on which to base a vaccine.
We have to decide how much economic pain we can endure and how we balance that against the inevitable additional deaths that will occur due to stopping the lockdown. Eventually, the infection will die out or at least dramatically decrease as herd immunity builds – remember how the government assured us that herd immunity was not their strategy… hmmm.
For my money, I think we are about to witness just how little value is placed on life. This may shock the general population but is a well established branch of health economics. The National Institute of Clinical Excellence (NICE) in the UK has a threshold for whether it will fund a treatment. This threshold is not a fixed published number, but a value of £50,000 per year of fully enjoyed life – is arguably well above the level used by NICE. I will leave it for others to do the back of envelope calculation about the value placed on life that officials might actually be balancing against the economic costs of lockdown.
From this humble doctor can I suggest a classic playbook based on the past form of various politicians?
Classic ‘Goldilocks’ exit: neither too soon nor too late. Many eyes will be watching countries that are the first to exit lockdowns. Trump’s strategy is interesting here – easy to castigate and hence difficult to follow even if the US ultimately succeeds.
Leading from behind: try to seem ahead of events but in reality end a lockdown when it feels like the mood of the country has shifted sufficiently to being nearly bankrupt or simply bored of lockdown.
Shades of grey: move from complete lockdown to partial lockdowns of particular demographic groups – creates plausible deniability if it all goes horribly wrong.
Try to seed a popular potential exit strategy without being overly associated with it: use well placed individuals who are nonetheless not members of the government to suggest exit points to see if they are politically feasible. Suggested forms could be ending the lockdown “once we are over the peak”, “once we have NHS capacity”, “when deaths are below xx per day for a certain period of time”.
Find an expert to blame later: find an overly confident or glory seeking scientist to propose an exit. If possible one that can be based on a ‘scientific model’ that simple folk wouldn’t understand. Explain loudly that your role as a government is to be guided by experts.
Downplay the testing and vaccines as part of any exit: stop talking about tests of any sort as part of exit. Refer to past pronouncements as evidence of the government’s commitment to being led by the scientific evidence, and that they were always only ever part of the longer term strategy.