The first third of this year was about countries adopting emergency measures to spare their people from the worst ravages of the coronavirus pandemic. The next third will be about countries trying to find ways of getting out of emergency care even while the virus itself is still at large – still impervious to antiviral treatments and only likely to be stopped in its tracks by a vaccine.
Although optimism that a vaccine will be found is growing and the first trials have begun, one that is both effective and safe is unlikely to be ready before next year. There is a growing fear that if countries are taken out of emergency measures too quickly or extensively, they will need to be put back into them again during the last third of the year, especially if the effects of the virus are aggravated by the onset of seasonal flu. By this time we will still be coming to terms with the amounts of social and economic distress resulting from the current, desperate state of affairs.
Governments began this crisis with different policies. A few, either because their first steps to contain the spread were successful, or because they believed it was possible to ride out the crisis without shutting down their economies, did not put their countries under extreme measures. Sweden is sticking to this stance even as fatalities rise (to 2,194 as of 26 April). Even Singapore, proud of the effects of its prompt measures, was caught by an outbreak among migrant workers. Those who did impose lockdowns can point with relief to the curves of cases and fatalities peaking, but the speed with which these numbers rose has not been matched by an equally fast descent.
There is still much uncertainty about the proportion of the global population thus far infected and how much infection confers future immunity, or indeed whether the tests so far available can gauge this with accuracy. The degree to which the elderly are worst affected remains striking: some 90 per cent of fatalities have occurred among the over-sixties. The World Health Organisation (WHO) has speculated that half of those who have died in Europe have been in care homes. Few young children have died, though their role as carriers still needs clarifying. But the irritating feature of this virus remains that its spread is difficult to detect. Those who get infected can soon infect a number of others before any symptoms show – which is why there are inherent limits to contact tracing (although it undoubtedly becomes easier when the number of cases has been dramatically brought down). If the general public wear masks when out and about, and learn to do so properly, that may help but probably only marginally.
Prudence might therefore dictate that the lockdown continues for months, but that is not an option. Around Europe a number of communities are showing signs of restlessness and a readiness to flout the rules. Individuals who have been cooped up for weeks, and businesses facing bankruptcy, want a way to return to something approximating normal life. A number of countries have made tentative steps to ease the pressure, some encouraging more shopping or visits to hairdressers, and setting rules for those venturing out in terms of keeping their distance. Others are looking to reopen schools. More businesses may be deemed essential and construction work may resume. Airlines are planning on keeping the middle seat in a row empty. But how mass transit systems can operate without people stuck together in close proximity is a mystery. It is hard to imagine coming together for theatre plays or sports events for some time.
Hence the dilemma facing governments. Any bold moves carry the risk of setting the whole thing off again, but some moves are becoming essential before the system of restraints starts to break down and the vast human and economic costs of lockdown outweigh the benefits. And they must work out their moves when there is still much to find out about coronavirus.
The UK government is now under enormous pressure to explain what comes next, especially now that the devolved governments have started to sketch out their plans. This pressure often takes the form of a demand for an “exit strategy”. The term was always problematic. There is certainly no quick exit from the pandemic. Nor can we expect some clear and logical sequence of steps leading to a return to the old way of living. At best we will get some cautious next steps. But the term itself is interesting because – like other terms borrowed from the military sphere – it can help highlight problems when developing policies for the weeks ahead.
The concept of an “exit strategy” first emerged in the late 1990s when governments were worried that humanitarian military interventions would turn into indefinite commitments. They wanted to limit their liabilities. Thus US president Bill Clinton wanted an exit strategy when he agreed to commit more forces to peacekeeping in the Balkans in the mid-1990s. So did Barack Obama when agreeing to “the surge” in Afghanistan in 2009. There were two basic approaches to an exit strategy. The first was to insist on leaving, come what may on an agreed date. But this soon appeared reckless because that might result in a return to the previous situation that had prompted intervention in the first place. The second approach was a conditions-based approach, which meant only leaving once certain goals had been achieved. This was what the British claimed to be following in Iraq in the 2000s. The problem with setting conditions is that they can prove too demanding, and so are never met, leading to them being relaxed and recreating the problem of the first approach. This is what happened in Iraq, where the conditions were eventually reinterpreted and declared to have been met.
There are obvious parallels with Covid-19. Abandon stringent measures too early and the disease may rush back. Define the ideal conditions in which they might be lifted and the moment might never come. At present, the UK government is following the second approach with the five tests set out by ministers for lifting the lockdown: can the NHS cope? Can we be confident that we have moved beyond a peak in deaths? Has the rate of infection decreased? Are we on top of testing and the provision of personal protective equipment? Can we be sure that adjustments to current measures will not risk a second peak of infections that will overwhelm the NHS?
With these tests, the scope for interpretation lies in how much confidence is enough. With the first four tests there will be reliable and possibly suitably encouraging evidence on which to draw. But the fifth question is the clincher and indeed the only one that is worth asking because it is only relevant once the other four have been answered positively. Yet this is the one surrounded by the largest uncertainties. Any claim that there is no risk of another peak is just a hostage to fortune.
As with military interventions, the only honest course is to acknowledge the uncertainties and so prepare for a long haul without quick results. “A marathon not a sprint” is the phrase now used. Of course, there are important differences, not least in that an exit strategy in this case does not provide the enemy with vital clues about what to expect. The big difference is that while it is possible to exit from a foreign country, we must live in our own and cope with a threat that can’t be banished. The timescales are more compressed. Other countries are also facing these decisions and some have taken action already, so the UK can learn from them. But the long haul may well mean a period of trial and error, perhaps occasional returns to “lockdown”, and some permanent changes to how we live and work.
Demands for an exit strategy that offers a predictable future will lead to even more frustration. Moreover, some of the most difficult questions to be faced will not be about the risks the government is taking but the ones that we as individuals will be taking in adapting to a new level of risk in our everyday lives. Routine activities may appear hazardous for some time to come. How do we accept greater dangers in our own lives without also putting others at risk? Can there be a set of guidelines, designating what activities are essential or reasonable, and describing how they might be conducted? Having been alarmed into social isolation can we be persuaded to venture out?
For the moment, it is hard to look much beyond the next stage in the management of this pandemic. At some point, hopefully sooner rather than later, when a level of immunity has been achieved, we will emerge a changed country, with different priorities, new ways of working and interacting, and fewer resources. There will be questions about social care, resilience, supply lines and the role of the state in the economy. It is too early for a strategy for this eventual stage but not too early to start thinking about what it might entail. It is not unreasonable, though, for people to ask for more clarity about the coming weeks. Government scientists and ministers are not the only ones who need to prepare for the next stage. We all will have to develop our own coping strategies.