Asking the unreasonable questions – Coronavirus

A little while back, I pointed out that we don’t ask the seemingly unreasonable questions and so we don’t get to do the real deep analysis that helps us solve problems. In that specific context, I was talking about the investigation into PHE’s reporting of COVID-19 related deaths outside of hospital.  I suggested that we try asking “why were there any deaths outside of hospitals at all for this serious condition where the end stages tend to require intensive care treatment.”

I want to come back to those unreasonable or unaskable questions as we continue our review on how the UK has coped with COVID-19.  When making such a judgement, it is right that we start by judging the Government on its own terms. From that point of view, we might argue that there was success. The Government’s aim was twofold.

  • To protect NHS capacity against a surge
  • To keep deaths well down below the worst case scenario.

However, we also have to push further and ask whether the Government’s goals were right. To some extent we accepted that a significant number of deaths were unavoidable.  We accepted that the virus could not have been killed off here.

But what is we had asked “Why not try to keep deaths as close to zero as possible?”

This might have led to different decisions. Here are some things that might have happened.

  • We might have locked down the borders immediately and introduced the type of quarantine measures we are seeing now.
  • We probably would have ramped up test and trace earlier.
  • We would not have allowed people to return to care homes untested.

I also wonder whether a shorter but more severe lockdown would have had a different outcome. To some extent, we towed a middle line between authoritarianism and libertarianism. The result may have been a softer but more extended lockdown.  For example, even when we had the most severe measures in place, we still allowed the “reasonableness” loophole to enable some to decide that they had exceptional circumstances. Construction workers were still onsite, the Tube was still running, key-workers’ children whose parents will have been treating coronavirus patients headed off to school. Shops were open and delivery drivers visited homes.  We were allowed out for exercise and some people used their personal discretion to decide that this meant they could drive places.

Additionally, it seems that we succeeded in protecting NHS capacity but this also meant the nightingale hospitals were hardly used if at all. Meanwhile many patients needing other treatments stayed home. So COVID-19 was still being communicated to others and at the same time people were at risk from other health conditions.

What if as a society, we had said that we weren’t going to accept a significant number of deaths or the ongoing transmission of the disease. We might have seen some different approaches. For example:

  • We may have seen specific cities locked down and quarantined off prior to the main lockdown
  • We could have got the Nightingale hospitals fully operational and kept COVID-19 patients and those treating them away from the main hospitials.
  • We might have opened up quarantine zones to help as well. A holiday at Butlins anyone?
  • We may have imposed a far stricter lockdown -perhaps requiring everyone to stay home for 14 days to see if we could not just suppress but suffocate the virus completely.
  • We would have done everything we could to get test and trace off the ground.

I recognise that such approaches would have led to an even more serious restriction of civil liberties. That is the point as we try to ask those unreasonable questions. We may conclude that achieving those alternative objectives was not possible without incurring other significant costs.  However, we would have at least thought through the other options.

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