When I first interviewed Devi Sridhar on 22 October, she told me that England’s rising hospitalisation rate made a new national lockdown “inevitable”. Nine days later (31 October), in a remarkable volte-face, Boris Johnson duly announced a second lockdown. Following the Prime Minister’s announcement, I spoke once more to Sridhar (professor and chair of global public health at the University of Edinburgh) to get her response.
Were you surprised by how quickly the government U-turned?
I wasn’t really surprised, I’ve been puzzled since September because you could see the pick-up starting then and it was just getting worse every day. It seemed like none of the softer interventions – such as asking people to work from home – were working and so the longer you delayed, the worse it was going to become, so for me it was inevitable. Now my worry is that people are going to be fatigued about going into such a harsh lockdown.
Do you think a lockdown until 2 December will work?
I don’t think it’s long enough, unless they really build the testing and tracing. Germany’s quite interesting, they didn’t go into such a harsh lockdown, they just shut their restaurants and bars. But they’re already seeing a downward trend in cases and I think that’s because they’re doing the testing and the tracing, they’re using the lockdown to buy time, which means you can enter and exit quickly. The question for England is how fast can they build their testing and tracing and get it up and running. That will help you shorten the lockdown period, just as it will help you avoid going into a lockdown.
And obviously no one is in favour of lockdowns – the key is to have a strategy to avoid them.
Exactly. And in some ways, the people pushing for “herd immunity” are forcing us into these lockdown-release cycles because you end up in a reactive position by underestimating the spread of the virus and the hospitalisation rate.
Why do you think the tiered approch failed?
I think because they [England] had such a high level of infection going into it. I think compliance overall is a problem, I think we underestimate the impact, from a public health perspective, that the Dominic Cummings episode had. And people thinking “actually this isn’t that serious and we’re being taken for a ride” and also the emphasis on “he protected his family because of his circumstances, it was permissible”.
And I think what we have now is a lot of people bending the rules because they think, in their circumstances, they’ve made the best call for their family. And all of a sudden we’ve turned from “we’re doing this for all of us” to “what’s best for my situation and my family”. I think that’s a problem throughout the UK, the whole of the UK was watching and the message clearly sent by the government was “if your circumstances mean that you want to be a good parent or good to your family then you can break the rules”. And that of course means compliance is an issue now.
I think what’s really been devastating in the UK has been these pseudo-scientific debates around “is Covid like the flu?” Do we really need to debate that again? Obviously we’ve never had society paralysed in every country across the world over flu and Wuhan wouldn’t have locked down over flu, we knew clearly from mid-January that this was not the flu.
The next issue is PCR tests – are they all false positives? No, they’re not. We have a lot of Covid around. Next thing, are all the death certificates being forged for Covid-19? No they’re not, people are dying of Covid, this is real. I feel like in the UK all of the airing of these debates by the mainstream media has led to widespread confusion and people picking and choosing, rather than the very clear message we’ve heard in other countries: “this is a dangerous virus, you don’t want to get it, you don’t want to pass it on, even if you’re young. And these are the ways you can avoid getting it and still live your life.”
And in the summer, to try and get the economy going, they [the UK government] needed to underplay the virus to unscare people, to get them back into restaurants. But you can’t scare people and then tell them “you don’t need to be scared” and then say “you need to be scared”. Then people just lose interest. We don’t want to tell people “you need to be scared”, we want to tell people “this is a virus you don’t want to get, this is how we’re going to manage it” and just be factual rather than all of the spin.
What’s your response to those who call for the government to focus more on non-Covid deaths and job losses?
This is a complete false dichotomy, it’s like people who say “oh, the choice is do we choose the cancer patient or the Covid patient” when health services are for all, they’re trying to cope with both. And same thing here, we can publish it, it’s good to have the data on job losses and other harms but they’re not caused by the restrictions, they’re caused by the virus. Non-Covid harms are probably going to increase with Covid going up, that’s what they’ve seen in every country. The path they’re [government critics] proposing will lead to more non-Covid harm.
What does the UK need to do to avoid an endless cycle of unlocking and locking down?
You need a testing and tracing system and to support isolation. You need better benefits for isolation by paying people to stay home so that it becomes their full-time job. Scotland tried this and it seemed to work, “you’ll get your wages but you’ve got to stay home, that’s your job”. People say that costs a lot but given what we’re spending on test and trace [£12bn], it’s probably cheaper if you do the cost-benefit calculations.
The next thing is border restrictions, real border restrictions, actually testing people at airports, asking them to quarantine for a few days and then testing them again. I know they’re doing this in India at airports as well, they’ve been doing this at African airports for months, so I don’t know why we’re not doing it and you have to make it free. People getting tested are a benefit to others – you can’t tell people you have to pay £80. Or you can ask them to have a negative test result 72 hours before they fly.
The third is getting back to core messages. We need real engagement with people about this virus, combating misinformation over why this is a serious virus, why you don’t want to get it. I think the press briefing was so complex that many people couldn’t follow, with all the graphs, we’ve really got to simplify it.
The other thing I’m increasingly convinced of is that Europe isn’t co-ordinating well enough. If we look at East Asia and the Pacific countries, they’ve been really good at co-ordinating their responses, the African Union has been co-ordinating Sub-Saharan Africa responses and across the continent to make sure they’re aligned, whether it’s travel policies, movement policies, restrictions. Europe has been a free-for-all, every country is doing its own thing… We need to work with Europe on a broader plan for how countries co-ordinate, or all we’re going to keep seeing is this domino effect in Europe, which is not happening in other places because they are co-ordinating and communicating and trying to get ahead of the virus.
I also think elimination was taken off the table too early. European countries saw this and said “impossible”, whereas African countries said “we’re going to try” and East Asian countries said “well, actually we can do it”. And so it almost became a self-fulfilling prophecy because they [Europe] said it’s uncontrollable, it’s going to become endemic, we’re all going to get it and that’s kind of what happened.
New Zealand started going for this in February, I think I did a tweet at the time saying “watch New Zealand carefully, they might create this island paradise and go back to normal life”. And I got so much hate from Twitter users, saying “impossible, there’s no chance they can do it, it’s like eliminating the flu”. New Zealand did it.
This article appears in the 04 Nov 2020 issue of the New Statesman, American chaos