Lockdowns are the equivalent of a car airbag, and only bad drivers need to keep activating them

Why Boris Johnson’s insistence that the UK’s unlocking is “irreversible” is a risky one.

Sign Up

Get the New Statesman\'s Morning Call email.

A telling trend is evident in the data on injuries and deaths from road traffic accidents. Whenever a compulsory safety measure is introduced – the wearing of seat belts in cars, or helmets on motorcycles – there is an initial drop in casualties. Yet over time, the statistics worsen again. This reflects the unconscious relationship between perceptions of safety and risk. A protective factor such as a seat belt creates a feeling of relative security. This leads to a tendency to take more risks with speed, for example, or with maintaining a safe braking distance from other vehicles.

According to an analysis by the Centre for Evidence-Based Medicine (CEBM) at Oxford University, in the month leading up to the first English national lockdown, the number of Covid cases in the UK was doubling every three days. On 23 February 2020 there were fewer than a dozen hospitalised patients; by 23 March that had grown to 12,000. Bad enough, but consider what would have happened over the ensuing fortnight. Given the three-day doubling time, by early April the number of Covid patients requiring hospital care would have exceeded the total NHS beds of any type in the entire country.

The first English national lockdown was the pandemic equivalent of an airbag detonated in a genuine emergency. It abruptly interrupted innumerable chains of Covid transmission. Having deployed it, of course, it became impossible to appreciate quite how bad things would otherwise have been. What the CEBM analysis shows is that the “light-touch” measures recommended prior to lockdown – repeated hand washing, stopping all unnecessary social contact – made little difference to the doubling time. The UK was a couple of weeks away from a crisis the like of which we have never seen. Had we not triggered the lockdown airbag, the consequences would have been beyond most people’s imaginations.

How much, though, did the experience of surviving that first, potentially cataclysmic car crash affect our politicians’ perceptions of safety and risk? During the summer lull, case numbers fell to modest levels. Was it that much easier for Boris Johnson to prefer the siren voices of the libertarian sceptics arguing that the pandemic was all but done, and dismiss those experts urging continued downward pressure to mitigate the inevitable autumn second wave? Did Eat Out to Help Out appear a risk worth taking? And when warned of the danger of mutations arising in an environment of continuing high levels of viral replication, was that spectre also more readily overlooked? In short, were those charged with steering the country through the pandemic behaving in an unconsciously more reckless way because of the sense of security that an emergency backstop brings?

The four-week November lockdown-lite can be seen merely as a heavy stamp on the brakes, intended – ultimately unsuccessfully – to allow Johnson to fulfil his promise of a Christmas social spree. But the lockdown imposed on 5 January this year was the real thing: a second emergency detonation of the airbag that has once again prevented even greater harm. Rely on the airbag more than once, though, and even the most foolhardy motorist must acknowledge that there is something fundamentally wrong with the way they’re driving.

[see also: Why children and parents should understand schools cannot be completely “Covid-secure”]

This explains both the slow speed and the abundance of caution characterising the government approach to the coming few months. The five-week intervals between stages of easing the lockdown allows plenty of time for adverse trends in case data to emerge and be acted upon. The repeated notes of caution from ministers suggests they have finally appreciated the unpredictability inherent in dynamic biological systems. Yet Johnson has still declared that this lockdown easing is to be irreversible. The airbag will never be required again.

Johnson will have been told that a third wave is to be expected. His confidence must be attributable to the new safety feature currently being retrofitted to the UK vehicle: vaccine-induced immunity. If the vast majority of those aged 18 and over have been immunised by the autumn, then the third wave will fail to take off among the adult population, in whom Covid causes its most noticeable havoc.

There are two potential risks. The first is the emergence of variants with resistance to the immunity engendered by the current vaccines. There has been a lot of attention paid to the prospect of importing such strains from abroad, hence the belated and imperfect hotel quarantine scheme. But mutations are as likely to arise at home. The presence of large numbers of vaccinated individuals while infection rates remain high is a potentially disastrous combination, creating the evolutionary conditions for vaccine-escape mutations. To a large degree we simply have to hope, but the chances can be minimised by continuing to bear down hard on case numbers while the vaccine roll-out proceeds. The libertarians have once again begun clamouring for a swifter easing of lockdown, even though we’re still confirming over 5,000 new cases each day. It is imperative that this time Johnson resists.

The other risk is from unequal immunisation levels between different social and ethnic groups. Vaccine uptake currently approaches 95 per cent in the most affluent areas (which are also the least ethnically diverse), compared with around 70 per cent in deprived communities with high BAME populations. Unless urgent action is taken, there will be localised epidemics next autumn among the very communities most at risk of serious disease and death. These may not constitute the nationwide disaster we faced in March 2020 or January of this year, but they will perpetuate the disproportionate toll that Covid has exacted as a result of the egregious inequalities we have allowed to become endemic in our society.

This column appears in the New Statesman's forthcoming Spring special, subscribe here

Phil Whitaker is a GP and the New Statesman’s medical editor. His books include Chicken Unga Fever: Stories from the Medical Frontline (Salt)

This article appears in the 24 March 2021 issue of the New Statesman, Spring special

Free trial CSS