An effective response
On 16th April, the UK government set out five conditions needed to lift a national lockdown which was further extended to 7 May at an estimated cost of £2 billion per day.
Although on first inspection the conditions seem sensible it is apparent these are primarily downstream indicators. Research finds that people dying in critical care wards today were infected on average one month ago.
Moreover, given the lack of real-time local surveillance in the wider community, mathematical models of infection curves are calculated backwards from observed deaths to estimate transmissions that occurred several weeks prior, allowing for the time lag between infection and death.
Given the lag of 2-3 weeks between when transmission changes occur and when their impact can be observed in trends in mortality, this is akin to driving the government’s coronavirus action plan through a rear view mirror.
An alternative approach would be to identify conditions to incrementally lift the lockdown once critical upstream capacities have been put in place (see table below). These would support a transition away from blunt nationally applied directives to more contextually-appropriate risk-based measures applied by decentralised disaster management structures.
Whilst it is well recognised that good preparedness is important for effective response, it is less understood that the way response measures are designed can have a direct bearing on the effectiveness of the recovery. Response measures should be designed to establish and reinforce local capacities to offset vulnerabilities, which lay the foundation for an early recovery. The UK government comment “it’s too early to talk exit strategies” highlights the separation of response and the recovery planning.
At an estimated cost of £2 billion per day, the UK quickly has to find a way to transition from a national lockdown to an early recovery. The first step in doing this is to design the response phase to meet needs, reduce vulnerabilities and strengthen resilience, thereby laying the foundations for an early and sustainable recovery.