I wrote some time ago of the need to define our terms when it comes to “lockdown” and other aspects of the social restrictions we are currently living with. Of all of these, “lockdown” has probably become the most loosely defined.
Let us first return, however, to the R-number – the reproduction number, or the number of people an infected person infects (by definition in almost all instances within about 4-5 days of first being infectious).
The aim is to have R<1; at that stage, the spread of the virus is no longer accelerating. There is still spread, but it has slowed; this means, if the Health Service is currently managing, it is sure to continue to manage.
This is of course a crude measure. In practice, even if R<1 across an entire population, you may still find R>1 in certain regions or among certain groups (most obviously and riskily residents of care homes). If R>1 among people most vulnerable to the virus, you may still find the Health Service coming under pressure and the death rate rising, at least for a period, even though the rate of infection across the entire population is declining.
So the overall number is not a perfect measure – nothing about measuring this crisis is perfect of course – but let us run with it and how it relates to lockdown.
R=0: British Virgin Islands
With absolute lockdown, in principle you should be able to reach R=0.
In the British Virgin Islands, population 30,000, this is being attempted. If you lock down the entire population absolutely – i.e. by an absolute curfew – in principle there is then no way for the virus to spread. Initially, the virus can only spread within homes; but once everyone has either recovered or sadly died, then the virus no longer exists among the population and has been eradicated (at least, until you open your borders).
Absolute lockdown means what it says on the tin – no deliveries, no grocery shopping, no nothing. As soon as you allow any of that at all, your lockdown is not absolute…
R=0.2: New Zealand
If you reach R=0.2 or perhaps even R=0.3, you slow the spread of the virus to the extent that it is fully under control and there should be no further transmission which is not immediately traceable. New Zealand believes it has accomplished this.
New Zealand implemented an early “Alert Level 4” set of restrictions, what might be referred to as relative lockdown. Similarly to across the UK and Ireland, New Zealanders were allowed out only for exercise, groceries, medicine and laundry (and some other specific purposes), although there was also an absolute bar on takeaways, or on pre-cooked food being delivered.
New Zealand has now raised this to “Alert Level 3” (allowing takeaway food, for example, but also re-connection with family members and care givers).
This is an exception in this list given New Zealand’s geographic isolation – it is for this reason that its own public health advisers say that what it has done could not be achieved elsewhere.
Italy was the first European country to implement what may be described as a full lockdown, with the clear intention of protecting its health system and reaching R<1.
The exact details of the lockdown varied and vary from region to region, but broadly they involve an absolute curfew with people allowed out only to shop for basic necessities (groceries and medicines). Very limited physical exercise is generally allowed (although for a period in Lombardy it was not), but within a very small radius of home and strictly alone.
The hope is that R=7 in Italy although there is some evidence it has not in fact sunk that low across the whole country (R=8 seems likeliest). This has given the Italian Government confidence to plan some raising of restrictions, but as has been noted elsewhere on this blog, you never absolutely know the impact of any easing of restrictions for at least two weeks. So Italy’s plan is to go into fortnightly jumps – 4 May, 18 May, and then early June.
Spain and France both largely followed Italy, and so will most likely largely follow it out again. There is one notable exception in sport – Italy clearly intends to try to restart professional club football, but France has given up.
A very interesting question will be what happens in the period 4-18 May, a period during which Italy will basically have the same lockdown in place as the UK has currently…
R=0.8: UK & Ireland
The UK and Ireland currently have what may best be described as a relative lockdown, believed to be enough to move to R<1.
The lockdown is relative because there is still a considerable degree of freedom. People may go to work if they cannot work from home; many stores (not just for groceries, but also alcohol, takeaway food and hardware) are open; and physical exercise is relatively unrestricted (especially in England, Scotland and Northern Ireland). Nevertheless, social contact with people from outwith the household is prohibited, and on that basis “lockdown” still seems a reasonable designation even though strictly it could be argued this is merely “strict social distancing”.
The UK has stated that currently it believes it has reached R=0.5-1.0; Ireland has said 0.7-1.0. The concern is those lower numbers are actually an “Easter Effect” (see below) and in fact they are at the higher end – giving little room for maneouvre in early May.
I have a concern, which I will come to tomorrow, that the sudden changes in communications by the Irish Government symbolise evidence that despite “lockdown” in fact R=1 because testing has been returning too many false negatives (this is a particular risk with drive-through testing). If so, it gives very little room for manoeuvre – but also brings into question the efficacy of lockdown as implemented.
Germany’s “lockdown” was of course wildly variable from state to state, and has perhaps only become more confused since. Nevertheless, in broad terms, it is best described overall in the words of its Chief Virologist as a “mild lockdown” – restaurants and most shops were closed and social contact limited, but (at least away from Bavaria) there were significant freedoms still allowed which were not allowed in the UK, Ireland, France, Italy or Spain.
Initially it was thought a combination of these measures and the population’s stereotypical response even to treat guidance as strict regulation had been very successful, and that the country had reached R=0.7. However, this was subsequently dismissed as an “Easter effect” (Good Friday in particular is an absolute day of rest in Germany; cinemas and sports grounds do not open anyway, for example), and the figure revised up to R=0.9 by the time states had begun to insist on lifting some restrictions.
As a matter of pure personal opinion, the decision to open shops at R=0.9 baffled me. Germans in most states were already allowed to meet up with close family members and perhaps this could have been broadened (what the New Zealanders call “growing the bubble”) or at least made consistent; however, a lot now hinges on the Maskenpflicht (the requirement for nose-and-mouth-covering in enclosed public spaces. If it turns out that masks are as ineffective as the WHO seems to think, the decision to focus on shops rather than limited social contact could prove to be a profound error – but one, notably, forced through by state governments against the better judgement of some federal authorities.
States have now opened all shops subject to compulsory nose and mouth protection (albeit with various restrictions on their ability to trade or otherwise over a floor space of 800 square metres or in shopping malls). There is early evidence this has already led to R=1.0, although it will take some time to be absolutely sure.
Irish advisers have been very clear that R=1.2 is still manageable – the sort of level from which the virus can be brought back under control relatively easily to protect the Health Service; they believe R=1.6 is retrievable, but would require considerable intervention. Sitting at the midpoint of R=1.4 currently is Sweden. Sweden, of course, has no lockdown.
The Swedes themselves are sometimes frustrated at being seen as complete outliers – social contact is in fact restricted, through prohibitions on large gatherings and requirements to stay two metres away, even in restaurants (where in fact customers may not stand up). However, by the standards of Western Europe, outliers they are, as the only country which has not even attempted to get to R<1.
The Swedish authorities are quite overt that they judge there is an acceptable level of infection (and therefore, frankly, death) in return for fewer restrictions on society which can remain in place if necessary for years until a vaccine is found. They point to other countries, such as Denmark and Norway, now adopting their strategy in broad terms, accepting that lockdown cannot be maintained forever; and to Germany and Italy grappling with how to get out of lockdown without accepting that moving out means inevitably R>1.
Sweden has closed individual restaurants for breaching regulations, but there is no sign whatsoever that its “special course” will be fundamentally changed.
We can perhaps define “lockdown” therefore as an intentional attempt to use strict “social distancing” in order to slow the spread of the virus before pharmaceutical interventions (treatments, vaccines or whatever) become available.
Instantly, we can see the challenge, however. Lockdown is not forever. If you do it, you have to work out how you will get out of it; however, if you do not do it, it means tolerating more grief and suffering at the outset.
There are legitimate choices here, none of them easy. As Freddie Sayers writes superbly here, the debate about lockdown is not a debate between good and evil.