SMART Lockdown 2.0?

Anti-lockdown protest in the USA. Some governments have accepted high levels of infection before introducing lockdowns or other restrictions.
Photo from wikimedia commons

Boris Johnson announced a second lockdown on 31 October, 40 days after SAGE had called for one. Was this a SMART move? In management-speak, there is an acronym for effective strategies: SMART stands for specific, measurable, achievable, relevant and timely. The second lockdown has not been timely and some of the restrictions do not seem to be specific or relevant.

Timeliness does matter: tackling a small fire results in less damage than waiting for the whole house to go up in flames. A number of countries took early aggressive action and have kept death numbers at low levels since March: this has allowed fewer restrictions and limited damage to the economy. Countries following this approach include China, Taiwan, South Korea, Japan and New Zealand.

Conversely, some governments have accepted high infection levels, with the introduction of restrictions only when their healthcare system is about to be overwhelmed. This approach has been driven either by a mixture of exceptionalism and libertarian ideology or by the failure to present a cohesive narrative. In the latter case, governments could not muster enough support – they failed to prove their narrative was relevant.

Sadly, the UK is in this second group – together with Belgium, Spain, Italy and France. This approach has resulted in more deaths and often more damage to the economy.

Here in the UK, a significant proportion of Covid-19 outbreaks are in educational settings and there is a high infection rate in school-aged children and young adults. Thus our complete failure to include these specific settings from the second lockdown will make it more difficult to achieve a sharp reduction in just four weeks.

Of course education is important and must continue. But extending the half term holiday from one to two weeks would have been timely, achievable and provided a useful firebreak, possibly followed by specific, more realistic policies to suppress infection in educational settings when they reopened. For example, some countries have mandatory face coverings in classrooms and have adopted school rotas for pupils above the age of thirteen, as advocated by our National Education Union.

School rotas allow the full curriculum and the normal number of lessons to be delivered, but to a class of half the size and with greater social distance, as half of the pupils follow the lessons online from home.  This need not be inferior to conventional teaching, provided that inequalities in online access have been addressed. As for universities, most courses could be delivered through distance learning with a reduced presence on campus.

Covid-19 is a respiratory infection primarily transmitted via respiratory droplets from the mouth and nose. There are three relevant control measures: distancing, face coverings and avoiding prolonged proximity. Thus during a lockdown we need to shut those places where it is difficult to implement all three control strategies, such as pubs and restaurants.

However, in the retail sector it is possible to implement all three control measures. If shops implemented controlled access to avoid crowding, as they did in the early phases of the exit from lockdown, and if everyone who could wear a face mask did wear a face mask there would be little to gain from the closure of non-essential shops.

Hairdressers and barber’s shops are more problematic, as the hair stylist needs to be close to the customer. However, when two hair stylists in the US were reported to have worked whilst suffering from Covid-19, none of the 139 customers or 6 co-workers exposed were cross-infected. The hair salon had used various control measures, including the stylists and their clients wearing face masks.

Yet it is difficult to extrapolate from a single case report. A prudent approach would require further precautions. Reusable, medical-grade masks are no longer in short supply and give a higher level of protection, particularly FFP2 and N95 types. Thus hairdressers and barbers could be kept open but required to wear an FFP2/N95 mask, together with a face shield and a disposable gown: this is the approach used in hospitals, which almost completely eliminates the risk.

An advantage of early lockdowns is that they can be shorter and more limited – more specific – as they keep the infection rate low enough to be controlled by Test and Trace. Germany’s lockdown started earlier than the UK’s: when its number of daily deaths was lower than the UK’s (112 on 2 November compared with 492 on 4 November). Hence Germany could afford to be more targeted: when Germany introduced its second lockdown, all shops and hairdressers were kept open.

As we have heard this week, a vaccination campaign is increasingly likely, but it still seems unlikely to be on any significant scale over the next two or three months. We therefore need to keep seeking SMART solutions to controlling Covid-19.

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