Lockdown

There might be much non-Covid-19 physical and mental suffering being endured now, but going undetected.

A surgeon's view of Covid-19's impact

I'm well aware that Covid-19 is nothing like seasonal flu, indeed a surgeon acquaintance sent me a text containing this yesterday, which makes interesting reading: “I don‘t think anyone should be matter of fact about Covid-19, although the stupid 20% do ruin it for all of us, which makes me furious.  I have too many colleagues who have sadly died, or nearly, and some really weren‘t high risk at all.  I hope that being fit helps (my resting heart rate is 46), and logically it should, but not always.  And it may ruin lung function for a while at least, possibly a long time, which would be a disaster for brass/wind/vocal musicians.  I don‘t think there‘s an easy or fast way out of it, sadly, unless the vaccine work succeeds. Medicine is a strange place at the moment, but it‘s true that we are lucky in many ways - we have a job at least and sometimes the right PPE!  We are a long way from being able to manage many more patients because of that - and despite the inaccurate BBC reporting of the letter to the trusts, we will not be able to provide elective surgery for a long time - certainly not in six weeks' time.  Even emergency surgery is difficult in these circumstances.  So... [one] benefit of lockdown for us is reducing demand for emergency stuff too. I really do feel for patients with mental health issues very much as it must put all normal strategies out of range...”

The economic cost of lockdown

However, I am troubled by the blanket lockdown approach.  I’ve been trying, without success, to find compelling research that supports it being applied outside major population centres, and the consequences of the economic stall will be severe, impacting on future health, education, social care and defence budgets (along with everything else, obviously).  We are taking a risk with our future to keep an infection curve manageable; but would that curve have ever been steep in most English counties?  And, without a vaccine, we will have to stay locked down or let the virus spread among the 'non-vulnerable' in order to attain the herd immunity that some say is the only alternative.  The Economist's latest headline is The 90% Economy and much of the contents is in consideration of how things may be in the near future.  The Briefing included this dark warning: "No one really knows for sure how long firms facing zero revenues or households who are working reduced hours or not at all, will be able to survive financially...a merely illiquid firm can quickly become an insolvent one as its earnings stagnate while its debt commitments expand.  A rise in corporate and personal bankruptcies, long after the apparently acute phase of the pandemic, seems likely, though governments are trying to forestall them".

Alternatives to full lockdown

I do, of course, understand that it is more difficult to say to people "you can continue running your business but only if you keep to social distancing rules" and "you can go out unless you suffer from heart disease, diabetes, emphysema, chronic obstructive pulmonary disease etc...or you have a person in your household who does."  But would it have been that difficult?  It's particularly worrying that the small-and-medium-enterprise sector is largely out of action; it’s a massively significant part of the economy and the risks of transmission could be managed in many small businesses.  Of course, theatres, sports stadia, concert halls, the festival circuit and all other 'people-dense' activities had to cease operating and the risks of transmission in cities, especially on public transport would necessitate distancing measures, but I fear that this lockdown could leave our nation with a permanent reduction in capacity across multiple sectors. 

Why the early lockdown delay?

It will be a long time, if ever, before we know why there was a six week stall from early January to late February, and the extent of Dominic Cummings’ role, if any, in this but there were clearly pressures other than Covid-19.  A senior Tory was quoted somewhere recently saying (I paraphrase as I cannot locate the quotation) "all they could think about was Brexit and making everything look like business as usual".

A hospital doctor on the lockdown

I expressed my frustrations in another text to a hospital doctor yesterday, and rather feared that I would get a hostile response but instead received this: “I completely agree with you about the restrictions. We have a very low number of cases in the South West, we would probably always have had a flat curve, even without the lockdown. My personal feeling is we are risking the education of the next generation, economic disaster and also huge mental health impact in order to protect the older generation. This seems wrong to me and we need to get the balance right very soon. The NHS has not been anywhere near overwhelmed at any point, even in London. We have not had the Italian disaster that was predicted but that’s because we manage our ITU beds differently. My hospital has been very quiet throughout, as have many others outside the big cities”.