At the daily press briefings of senior ministers, the medical and the scientific advisers, there is a reluctance to talk about a timescale for an ‘exit strategy’ from these unprecedentedly severe restrictions on our freedom to move around and see people – and even to discuss what that strategy might look like.
The understandable priority is to get us to commit wholeheartedly to the surrender of these basic rights so that the incidence of the virus can be slashed and many lives can be saved.
Among the senior medical and scientific advisers, who seem to be steering pretty much everything right now, any initiatives that aren’t about immediate virus suppression are deemed a potentially harmful luxury.
So, if there is one benefit to the boffins from the PM going to hospital, it is presumably that this is the most powerful symbol that avoiding all unnecessary contact with other people is not a game, but the potential difference between life and death.
All that said, if we don’t start planning now, urgently, to create conditions in which it is safe to leave our homes, the cure for the epidemic may turn out almost as disastrous as the epidemic itself – because if the economy and society remain in the deep freeze for too long, more jobs will be permanently lost, government debt will rise perhaps to levels that are costly to bear, revenues to fund public services will fall well beyond what’s tolerable, and there’d be a whole variety of social, economic and psychological harms for many people.
The choice facing Boris Johnson in his bed at St Thomas’ hospital is one devised by the devil. Lift the restrictions too quickly and appalling numbers will become infected and die, as the NHS collapses under the weight of those needing succour.
Lift the restrictions too late, and swathes of the UK’s jobs and tax revenues will be lost forever – with disproportionate damage for those who are poorest and frailest.
For what its worth, business leaders tell me they are already planning for wholesale redundancies in the early autumn when the government’s job support scheme is scheduled to finish because they expect the demand for their services and products to have been permanently reduced.
Scaremongering? Possibly. Safe to ignore? Definitely not.
The key to ending this lockdown is almost certainly not a population-wide vaccination programme, since none of the leading scientists expect that to be available until well into next year, if ever. Waiting for a cure may be waiting for Godot.
The optimal practical route out may, therefore, be a policy of testing everyone, coupled with technology that allows easy ‘contact tracing’ of anyone who has met an infected person in the previous few days.
Such a policy would combine smartphone apps, like the Singapore one that monitors and records everyone we come within a few metres of, drive-through Covid-19 antigen tests on an industrial scale, and home-testing antibody tests (the pinprick equivalent of a home pregnancy test).
In other words, lifting the lockdown probably requires accurate surveillance over months and possibly even years of those who have had the virus and enforceable rules for strict quarantining those who are unlucky enough to catch it in that future.
Now for the avoidance of doubt, the government is working on all these strands of prophylactic policy. The question is whether it is doing so with sufficient urgency.
The point is that even if the government hits its target of 100,000 tests a day by the end of April – and that is looking a stretch – at that rate, it would take the best part of two years to test us all.
And, to be clear, these would be largely the wrong kind of tests for returning life to normal, because – according to John Newton who has been put in charge of expanding testing capacity – these would all be antigen tests that show whether we are carrying the live virus, not the antibody test for whether we have had it and may be immune.
As he told me, the government has not yet identified an antibody test that works, though he is confident his scientists can work with the manufacturers to find a breakthrough. He just can’t say when that eureka will happen.
The analogy with war, especially the second world war, is overdone. But if this were a war, a huge part of the public and private sectors would be mobilised to do almost nothing but concentrate on creating the medical tests and information technology to enforce mass community screening.
The problem, as far as I can see, is a lack of the ruthless centralisation by government of managing, commissioning, procuring, and authorising that would be necessary and expected in this time of such acute crisis.
I am aware of numerous, largely philanthropic, private sector initiatives to provide tests and technology. One is Project Little Boat, led by the businessman Nick Markham. It is trying to set up drive-by antigen testing here based on the Korean model and is waiting for government approval for and purchase of the testing kits it says it has secured from Korea.
Another initiative is an order brokered by an entrepreneur for one million antibody ‘rapid lateral flow test strip’ kits, that I’ve referred to in an earlier note, from Wondfo of China.
Neither of these kits have been approved for use by the relevant British scientists and regulators. And nor have any other of the innovative approaches to testing that have been imported.
I don’t remotely doubt the good faith of ministers in resisting the temptation to be rushed into authorising tests like these for use. As the Health Secretary, Matt Hancock, doesn’t tire of saying, a bad test may well be worse than no test at all.
But the business people who are involved in trying to develop mass community testing fear that the British civil service and the medical establishment are too wedded to the traditional approval processes and that they are being too conservative and cautious.
I would not presume to have the medical knowledge to adjudicate. But I do recall a phrase that Michael Gove employed for a different and lesser crisis, the Brexit one, which was not to let the best be the enemy of the good.
At this historic juncture where so much is at stake, we must hope (and even perhaps pray) that the government and its advisers are not sacrificing a workable solution in the pursuit of a perfect one.
Got something to add? Join the discussion and comment below.