The dangers of ending the lockdown

The evidence is in. Lockdowns save lives. In one European country after another, the rate of infection has slowed after such measures. But now a drumbeat of calls to end the lockdowns is gathering force.

The New York Times ran a story on Thursday saying that the economic hurt from the US lockdown was growing, and the lockdowns would have to be relaxed soon. The Times is the paper for the mainstream center of business, government and professional people in the US.

The following day Trump said that he would begin to open the country as soon as possible. Much of the UK press said the same. The governments of the European Union made concerted noises about lifting the European lockdowns. Keir Starmer, the new leader of the UK Labour Party, weighed in with a video of his own.

Rich

Lifting the lockdowns is not impossible. But we will need a whole series of measures in place first: mass testing, contact tracing along with appropriate care, full pay and treatment for everyone who is positive.

Otherwise we will face a second wave of disease and death. The UK government is not planning to put those measures in place, for the same reasons that they delayed a lockdown far too long.

This article explains what is happening, and how to defend lockdowns that more or less work, so we can avoid a devastating second wave of contagion. Health workers will be central to any such campaign, because they now have enormous moral authority.

In places like India, South Africa, Sicily, parts of the US, Pakistan and many more, the present lockdowns will not work for long. This is because the governments refuse to give the people the money they need for food, housing, medical care and bills.

Hungry people are forced to go out hunt for work to feed themselves and their children. They meet immediate police brutality. This will swiftly create popular hatred for a lockdown that serves the rich.

Risk

Then calls from business to lift the lockdown will be met with relief from working situations. The politics of saving lives in these situations is different to the UK and the United States.

Lockdowns are still possible without financial support for those working. South Africa, for example, has a cruel and brutal lockdown, but a per capita income the same as China. The US and Sicily are far richer than China. There is everything to fight for. I will post a separate article shortly covering these situations.

In the UK our leaders and rulers want to end the lockdown before they have sourced enough ventilators for the patients who cannot breathe.

Without enough intensive care beds for coronavirus patients. Without enough intensive care beds for the patients who have been thrown out of intensive care to make room for the corona patients. Without enough operating theaters and normal beds for all the sick people whose treatment and operations have been cancelled.

With exhausted and despairing health workers, who need some sleep and eight hour shifts before they deal with the next wave of sorrow. Without enough dialysis machines for all the patients who have renal damage after coronavirus.

Our leaders and rulers want to end the lockdown without protective equipment for health workers, who risk their lives for us. Without enough for care workers, bus workers, tube workers, shop workers and all the other people who are most at risk.

Without tests for all the essential workers, who are the people most likely to have the virus now, and without tests for their families and housemates, who they must put at risk.

How We Got Here

Now we need some recent history, of how we got here.

In some countries lockdowns were delayed far too long. This has been especially true in some of the countries run by the far right. Trump, Putin and Johnson all delayed action as long as they could.

They feared that lockdowns would produce mass unemployment, a stock market crash and maybe a global financial crisis. About this, they were right. So they decided to let the epidemic rip and finish quickly.

Trump had extra reason to fear economic disaster because he was going into an election. Putin’s problem was that the Russian economy, and government revenues, are deeply dependent on oil, and a global lockdown would decimate oil revenues. As indeed it has.

Johnson was understandably afraid that a recession would be blamed on Brexit - and so on him.

Protect

All three leaders stalled on lockdowns. Because they were stalling on lockdowns, they could not allow their governments to admit what was coming.

If they stockpiled the masks, other kit and ventilators they would need, and began training all the staff they would need, everyone would know what was coming, and they would have to lockdown.

So Johnson, Trump and Putin did nothing, and lied, and got the worst of both worlds – a raging epidemic and economic disaster. No one has confidence in an economy run by leaders who cannot protect their people.

People in the UK, US and Russia could see the examples of the countries like China, Germany and South Korea, where governments at least tried to protect their people.

Dying

Eventually the writing was on the wall, and the public outcry was building. Johnson and Putin were forced to call lockdowns. In the US, the Democratic and then the Republican governors of individual states went around Trump and ordered lockdowns.

But tens of thousands, at least, will die who did not need to die.

The lockdown in the UK has been a thing of beauty. Most people observe it. Every time I go for a walk I see it. The young and the fit are staying home to save the lives of people like me.

It is an amazing example of organized, voluntary love. We must not give up what that love has won. We must fight like hell for what we need to keep each other alive.

Because even now, they are not making enough ventilators, masks and suits. When health workers are screaming for them. When shop staff and bus drivers are dying.

Could We Lift the Lockdown?

When we get sick in the next wave, they will tell us to go home and self-isolate. We will go home to our flat mates and families, and give them the virus. Will they even pay us? Will people be bullied into coming into work sick? All those families and flat mates, will they be bullied?

The governments imply that we could “cocoon” the groups of people most at risk. That means the elderly and those with “underlying conditions”.

But we have learned the third group most at risk is health workers, bus drivers and other essential workers.

They are exposed to more of the virus, because they see many more sick people, up close, and the more overloaded the hospitals, the longer sick people wait at home, and the more virus they breathe out when they come to the hospital.

We cannot cocoon those essential workers, or their families. But we also cannot cocoon the elderly and the people with conditions. For they live among us, they share houses and lives with people who bring the virus home.

War

The media say the government can open the lockdown and then, if the virus increases, slap it back down. Anyone think that will work?

I am not against opening the lockdown. Children need to play with children. People who live alone need companionship. People trapped in tense households need it. Teenagers need it. People need work, school, money, a social meal, a drink, laughter. Humans are a profoundly social species. We need each other. We need to touch and be touched.

And Tim Colbourn at the UCL Institute for Global Health has modelled what is needed – test everyone every week, and follow all the contacts of those who test positive. Isolate them and care for them.

This is perfectly possible, and would suppress the virus. That would mean testing 10 million people a day. Colbourn estimates it would be possible to cover 50 percent of the population by July and 90 percent by August. It would need 70,000 public health workers, and cost £32 billion over two years.

I am pretty sure that could be done even faster. When the US joined World War Two, the government closed all the car factories. Automobiles were the most important industry in the US. Three months later all those factories reopened producing planes, tanks, jeeps and ammunition. Not another car was made for the duration of the war.

Rule

It is so much easier to make the masks and respirators and testing kits we need than to make tens of thousands of planes for war, invasion fleets and hundreds of thousands of tanks. Far, far easier.

But in the UK, and in the US, the governments will not take over factories and workplaces. Trump has invoked the Defense Production Act, which allows him to order manufacturers to make respirators and ventilators and face shields, and order companies in the supply chain to do their duty.

But Trump, and the British government, cannot bring themselves to order corporations to do anything.

They will not disrupt existing contracts. They will not order companies to become manufacturers or suppliers. They will not send in the army to enforce compliance. They will not even send in two lawyers and an intern to enforce compliance.

Most of the governments in Europe are prepared to spend unimaginable amounts of money – numbers that make no sense – to pay benefits, to save banks, to save companies, to save stock markets. They are doing that.

But the place where they draw the line is this - they will not take control over any part of production to save human lives. They will not disrupt the rules of the market. They will do anything, kill anyone, before they do that. This has become such an accepted rule of modern society that hardly anyone comments on it.

Lifting the Lockdowns – What Would Work

The argument from governments and businesses is that it will not be economically possible to hold lockdowns until a vaccine is in place in 12 to 18 months, and people will not tolerate it for that long.

The argument is that we can reopen if we test everyone with symptoms, isolate them at home, trace all their contacts, and test them. Meanwhile the elderly and vulnerable would remain isolated. If necessary, the lockdown would be reimposed.

This worked, we are told, in South Korea and Singapore. But it worked starting from a small number of cases, with massive public health interventions and many, many workers tracing contacts. And now they have a second wave in Singapore, and the government has imposed another lockdown.

It might work in Austria, with closed borders, gradual relaxation, and very small numbers of people with the virus. But in the UK and the US we still have large numbers of contagious people among the essential workers.

What is happening now is that business, and governments, are repeating what they did when they delayed lockdowns, to save money and profits. And they are trying to do it without spending the money for the safeguards we need.

Patients

Let’s take the UK example. As Richard Horton, the editor of the Lancet, said in a tweet: "It’s wrong to say we don’t have an exit strategy from lockdown. We do. What is missing are the plans for its implementation: surveillance, early detection, isolation, contact tracing, monitoring CFR, social mixing, and real time estimates of Ro [the measure of the speed at which the virus is spreading]. These questions should be asked."

And answered.

A system based on testing could work. But we need many things in place. First, enough protective gear, including hazmat suits, for all health workers and everyone else working with the public. The rule of thumb could be – give them whatever they ask for.

To relax protection before we protect those people who are dying for us would be evil. Same goes for bus drivers and everyone else at risk.

Second, we need many more intensive care beds and ventilators than we have now. Italy has twice as many as the UK. Germany has ten times as many. This is key because so much of the mortality now comes not from coronavirus deaths, but from other patients who do not get ICU beds or hospital treatment.

Vital

Third, right now too many hospital workers are off sick or exhausted. Wait until they recover, and there are enough staff, and let them do eight-hour shifts.

Fourth, test everyone, isolate everyone who tests positive, trace and speak to all their contacts, test them, repeat the process, as in South Korea care for everyone who becomes sick and ill, and make sure everyone who is isolated has an income.

As I have said, Colbourn has modelled what is needed. Colbourn also argues: "Cocooning the elderly and vulnerable was an initial strategy put forward by the government and experts in mid-March to prevent large numbers of vulnerable high-risk people dying from the virus. We believe such as strategy is doomed to failure for three reasons.

"Firstly, many such vulnerable people do not live in houses or flats isolated from other non-vulnerable others making it impractical or impossible for them to observe. Secondly, and related to this first reason, we do not think it is acceptable to unleash the virus on the population, both because vulnerable people will still get exposed and because even people not deemed vulnerable have an appreciably high risk of death compared to their background mortality risk.

"Thirdly, it is also unlikely, even if herd immunity in the non-shielded population was attempted, that such vulnerable people can be kept isolated and shielded continuously for the four to five months required until herd immunity happens with rapid viral spread.

Money

"For all these reasons we do not believe this strategy is ethically acceptable or feasible. Indeed the government has also distanced themselves from such a ‘herd immunity’ strategy so we believe such a strategy is no longer politically feasible either. We therefore do not consider it as an alternative in our analysis."

Colbourn calculates that his plan will avert 353,000 deaths that would otherwise happen in the UK.

I would add one thing to Colbourn’s model. His assumption is that people who test positive will be told to go home and isolate, and then checked on by public health staff and police. 

But the data from China show that most transmission of the virus happens within families and households. To send someone with the virus home to other people without it raises the death rate unacceptably.

The alternative is that people are offered treatment and nursing care at a public facility. The advantage is that people will be much less frightened than at home, better cared for, and not really isolated, because they could socialize with other people with the virus. This again costs money.

Protective Equipment

We cannot end the lockdown until our health workers have the personal protective equipment (PPE) they need to keep both themselves and their patience safe. But defining what PPE is needed nationally is not simple.

Phil Buyum Jackson explains: "The issue of what personal protective equipment workers need is not simple. All workers deserve and should have the right PPE for the tasks they perform. And that should be dependent upon the science, not the supply.

"But PPE is also about fear and distrust toward a government that has consistently never listened to nurses. Bursaries were cut and pay rises were voted down in a public humiliation. Immigrant nurses who make less than £30,000, and nurses from the EU, constantly feel at risk of being thrown out of the country.

Train

"Judging what is the right PPE for the right procedure requires getting to a point of trust. And there is no trust when the voice delivering the guidance has shown you only disdain.

"Because it is about more than protection, the demands will escalate. For example, nobody outside of an intubation setting needs a hazmat scientifically. But for most GPs two surgical masks are fine - one for suspect patient, and one for the GP. Still, you do actually get demands for levels of PPE that are totally out of whack with evidence.

"Moreover, PPE always requires training. For example, full kit for ICU for an intubation requires two people to do full cross check, both donning and doffing. Cross infection and self-infection from not following principles in the use of PPE kills many more people than you would imagine."

For now, the principle has to be – give the people doing the work everything they ask for, and train, train, train.

What Do We Do in the UK?

The grassroots movement to save lives is growing all the time in the UK. We are now about to face a sustained push to end the lockdown. What can we do?

It would be a mistake to argue simply to hold the lockdown. Many people, for many deeply human reasons, want to get out. No-one wants to increase economic damage.

But we can argue that we need safeguards in place before we open. We need the facilities and the workers in place for testing, tracing, isolating, care, treatment, equipment and protection.

If we demand that, our leaders and rulers and media will reply that we cannot wait for all that to be in place. Never get lost in that argument.

They mean we will have to wait until the independence of corporations and the sacred laws of the market are willing to make what humanity needs. Bin that. Act with love, as if human life was sacred.

Members

Health staff will be crucial to stopping the lockdown. We love them, we respect them and we owe them. Much of this impact will be individual.

Health workers are already sharing selfies with placards and passionate messages with friends and family on social media. They need to get out the message – hold the lockdown until we are safe.

Collective action will have an even greater impact. The public protests by health staff in the US, Pakistan, Italy, Spain and many other countries have had an enormous effect.

On Sunday something of international importance happened in the UK.

Our Royal College of Nursing advised their 450,000 members to make the “difficult decision” to refuse to work without proper protective equipment, and said they would back their members who did so.

Lied

This is a call to industrial action by another, more moderate, name. And it has the potential to stop the government stalling and lying about personal protection.

I hope that members of the other health unions, like Unison and the BMA, advise their members to do the same. And the refusal to work without protection should also be adopted by other health workers.

Do not forget – this is about protecting health staff, but it is even more about saving the lives of the patients they would infect.

Nor should the rest of us rely on health workers to save our lives on this one, in addition to what they have already done. It is our duty to save them now.

Finally, we must not campaign for a promise that tests and protective gear and tracing and treatment will be in place. The government have lied, they are lying today, they will lie tomorrow, and they will lie next month.

We must rather insist that no lockdown is lifted until what we need is in place, and this has been verified by workers on the front line.

We can do this.

This Author

Jonathan Neale is a writer and climate jobs activist. He tweets at @NealeSayles.