Is there a lockdown alternative?

Will we see another full Covid lockdown? Could a population immunity approach work?
06 October 2020

Interview with 

Raj Bhopal, Edinburgh University


cartoon image of person holding a stay at home sign


Among the Covid news this week - US president Donald Trump announced that he and the First Lady are now self-isolating with the virus, and SNP MP Margaret Ferrier has been suspended from the party after travelling to Westminster despite experiencing Covid symptoms. But one of the most frequently asked questions across the media this week was “will we see another lockdown?” The government have described this as their “nuclear option” of last resort. Nevertheless, some are eager that we do go down that route to halt the spread of the coronavirus infection until we have a vaccine. The present strategy, though, is one of stricter local restrictions where there are hotspots and generalised control measures across the country. But, increasingly, as stories have been published of students spending their fresher’s weeks locked in their halls, the possible cancellation of Christmas, and the devastating impact on the arts, other voices are saying that we’re already going too far and that the present approach - to try to suppress the virus - is the wrong one. They’re arguing that it’s not going away; the prospect of a vaccine is too distant and too uncertain, and instead we need to learn to live with it. Chris Smith spoke to Raj Bhopal from Edinburgh University...

Raj - My name is Raj Bhopal. I'm emeritus professor of public health in the Usher Institute, at the University of Edinburgh. We've been hit by a very big pandemic that we've managed to control reasonably well. Considering the formidable challenges. We were slow to start, but once started, we have managed to control things, but we have a very long way ahead, and we cannot continue with the strict lockdowns and strict restrictions that we've seen over the last six months. We will have to change direction.

Chris - Why do you say that? Because if one looks at the numbers, you could say, well, look, the lockdowns in every country that's implemented one, have been incredibly successful. They brought the virus count from what would have been hundreds of thousands of cases a day to near zero.

Raj - I think it's absolutely amazing what's been achieved, but the cost has been very high. The financial costs, the restrictions on freedoms, the damage, not just to the economy, but to health services, care services, very important sectors of our lives. Theatre, cinema, sport, have been seriously damaged. We cannot live with it much longer. The public is voting with its feet. So we've done well, but we need to change direction. We can't keep on going in this direction forever.

Chris - And what direction are you advocating that we should consider pursuing instead?

Raj - Like everyone else I'm desperate for a vaccine. If we get a vaccine, I will be in the queue. Vaccines are not there to be discovered. They have to be invented. That takes a lot of work. Three vaccines I've examined that have been published in the Lancet. The side effects are very common symptoms that mimic COVID-19. Then we still don't know about the long term safety in terms of serious problems. And we don't know the effectiveness. By the time we understand all this, it is going to be a long time. Yes, we may well get vaccines that we can begin to use in spring, but their long term effectiveness, long term safety will not be clear for a very long time. If we get a vaccine that will be a game changer, but the game will change over a period of about two or three years.

Chris - So what is the alternative?

Raj - We learn to live with the virus, whereby we decide that we're going to minimise the damage while we keep our societies as open and functioning as possible. We have to remember that the single most important determinant of health is income and wealth. If we don't have income and wealth, our health will very quickly be damaged, and our health services will crumble. So it's not a case of health or wealth. It's a case of balancing these two things. So the alternative is that we change strategy, clamping down on whole populations is not really working, and it's not necessary. The one bit of good news I can bring is that this disease under 18 is much less severe than flu. After 25, it becomes a bit more severe than flu, but it's over 70 when the problems really start. But even then people over 80, 90% or more will survive. It's not a death sentence, as some people think.

Chris - What would you advocate then? Are you advocating for, almost where it feels like the UK government was sort of heading originally, before they then went down the full lockdown route, which was a sort of managed population immunity approach, where there's a slow trickle of the virus seeping through society. And leaving in its wake immunity. And that translates into a way of controlling the virus for the many in the long term, but it's much less painful economically, psychologically, and educationally than locking down a country, putting everyone on hold until we have a vaccine which might never materialise, let's face it.

Raj - That's exactly what I'm advocating. But I'm not advocating it in a, let the virus rip, or pay no attention to some people. Let's start with young people. They need to socialise. They need education, and they need freedom. They need to develop themselves. It's a huge need and they are hardly harmed by this COVID-19. So we must let them get on with their lives. If some of them don't want to take the risk of getting infections, we would have to respect that. But in their day to day lives, as we're already seeing, it's a high likelihood they're going to get it, even before a vaccine is available. Currently, people are not talking about that. We must start talking about that.

Chris - Raj, on the one hand, I can see what you're saying, but how do you propose to protect the people who are vulnerable so that we can allow this seepage of virus through the younger age groups who are at low risk, without taking risks for the older people? Because that's at the end of the day, why the government has implemented, they say, the present stringent measures.

Raj - Nothing in our society, or any society, is a blanket policy for everyone. Every policy is tailored. We don't give breast cancer screening to men. We don't give influenza vaccines to everyone. Everything is tailored according to need. And we have more than 12,000 deaths every week in the UK, they occur from diseases that are sometimes a lot easier to prevent and treat than COVID-19. But we live with them. Some level of death and disability is going to have to be accepted. Otherwise we will destroy our society.

Chris - Why do you think then, Raj, that the approach that's being taken, is being taken?

Raj - Well, I think there is a great deal of guilt. We were slow to start. We didn't do a good job on the care homes, but also at the moment there isn't a proper, honest dialogue. There's no one brave enough to tell the truth, but we have produced data on 137 million children in nine countries. And we can see what is really happening. The policy has been to petrify, in the hope that people will be so scared, they will follow all guidelines. We didn't use punishments to handle the AIDS pandemic, which is still with us, 32 million deaths, over 600,000 deaths last year across the world. We've had to learn to live with these things.


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