The uncomfortable questions facing ministers about ending coronavirus lockdown

The government must start turning to its exit strategy, writes Sean O'Grady – but there are difficult decisions to be made

With the country stuck inside, ministers begin planning their endgame (Angela Christofilou)

They call it the “exit strategy”. Especially these days, that is a rather depressing-sounding name for what is, in reality, a joyous thing – how the country is going to return to normal life: the time, you might say, when “we will meet again”.

Ministers are working on it right now, but obviously no decisions are yet made. They cannot be when the number of cases and fatalities have not peaked, and we do not know when they will. Indeed, at the moment there is more talk of toughening up the partial British lockdown (for example, by a ban on outdoors exercise) rather than relaxing it.

Even so, some European countries ahead of the UK on the spread of Covid-19 are now openly discussing easing travel and other restrictions in the near future, if only because their waves of cases have been so horrendous.

An exit strategy needs to balance three factors, themselves all uncertain. First is the epidemiological evidence, the “science”. That is still unpredictable without good data on infection rates, for example.

Second is the economic evidence, the rising costs of the protracted shut down in the economy. That is huge but imperfectly estimated because we don’t know for how long the government will have to pay the nation’s wages bill.

The third factor is more or less meteorological and certainly behavioural – how long people will stay cooped up and separated from loved ones with bright sunny weather tempting them outdoors. There is a grim calculus at work here.

The truth is that the only sure way to prevent all deaths from Covid-19 is to make everyone stay indoors until they’ve developed a vaccine – which could take a year or more – and until everyone has taken the vaccine.

That is plainly impractical because we’d starve first. More realistically, a lockdown cannot persist because of the economic damage (threatening lives in different ways) and because people would rebel, say, long before they had to spend Christmas 2020 in self-isolation, their children uneducated in the intervening period.

So if deaths are inevitable, the calculation arises about what an acceptable level of mortality amounts to. In essence, it is the level that is consistent with people who need intensive care and ventilators being able to access that care. That means that in this coming peak (expected in a week to 10 days), and any subsequent peak, the number of people in intensive care stays below the 13,000 to 18,000 ventilators capacity of the NHS. Around a half of such patients may not make it, so that gives an indication of the mortality rate. In the past the experts have spoken of 20,000 being a good result, relatively, and it could be below 10,000. Had we not had the lockdown it would have been far higher; with no action at all, according to the Imperial College study, it might have hit 250,000.

Deaths are inevitable because there is no cure for this disease; but the policy aim is that no one should lose their life for want of care, gasping for breath. There should be no “needless” deaths in that sense. Aside from anything else each would be politically damaging, the blame easily placed on earlier government errors or complacency.

If the peak passes in the next few weeks then some relaxation might be warranted. It could be relaxed for London first, say, where the peak arrived first, or for younger people without underlying conditions. If an immunity test were reliable, anyone who had had Covid-19 and survived could get back to work as soon as possible.

As the months go on and more people get through a Covid-19 illness (some hardly noticing it) then “herd immunity” will certainly grow and the chances of transmitting or catching it will start to decline markedly. Again, this is an inevitable process as the number of recoveries overtakes the numbers of new cases – but the speed and extent of the process is highly uncertain. The ultra-accurate testing process being run by the Porton Down labs will help officials take a view on how the balance of these movements of people in and out of disease are evolving. That, in turn, will dictate the speed of the exit strategy.

The exit strategy will need to be gradual and flexible – and quickly reversible if the numbers of new cases and deaths start to climb again. A sudden abolition of all restrictions would risk a new, even higher peak arriving in the autumn or winter. A more gradual, cautious approach would mean less chance of that and less chance of another hard lockdown. If all goes well, especially with vigilant social distancing and a rising herd immunity, it will get progressively safer for the more vulnerable to eventually venture out. Even so, such fine-tuning of a nation of 66 million people is tricky. In any case, Covid-19 will still probably be claiming lives in 2021 and perhaps beyond, if it mutates successfully. The coronavirus may never in fact exit the scene.