The urgent priority – avoiding future lockdowns

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Anyone who has followed my thinking through COVID-19 will know that my consistent position throughout has been that the disease is a real and present danger that we need to respond to. I’ve had little time for so called COVID sceptics and anti-vaxxers. Therefore, I’ve agreed that measures have been necessary to respond to the pandemic. I’ve also argued that even if we disagree with specific measures, Christians should obey the authorities throughout. 

However, I’ve been a little bit more sceptical of the benefits of lockdowns and of their necessity. Even if we ended up with them becoming necessary (and even then I’m not sure), we could have taken better steps to restrict the spread of the virus without closing down shops, schools, hospitals and workplaces.  This would have required better border controls, contact tracing in place from the off and better protection for care homes.

Moreover, my opinion on lockdowns arises out of a view about the overall nature of the problem to be solved.  Once you argue that you cannot irradicate the illness or stop it from spreading in the community then the issue becomes about the capacity and capability of your healthcare systems to respond to the disease. This was explicitly stated by governments in the early day of COVID. Here in the UK we were frequently told that the reason for following guidance and regulation on self-isolation, social distancing and then lockdown was to flatten the wave in order to delay and manage the potential surge of hospitalisations.

There are two problems with this. The first is that if you are suppressing something, then as I argued throughout COVID it will eventually bounce back again. That is of course good news with regards to the economy. As I predicted, we have seen rapid bounce back overall after each shutdown. That is of course no consolation to those who were casualties of the lockdown and lost their jobs and livelihoods in sectors that have suffered more.  Furthermore, the poi8nt was that other less pleasant things such as anti-social behaviour and crime that were also suppressed would bounce back as would the virus itself because it was not irradicated. Indeed, we had the risk that it would bounce back more viciously due to mutations.

The other problem is that attempting to predict and to schedule demand isn’t the most efficient response to a capacity issue.  Those involved in manufacturing and even more in the service industry have learnt that this doesn’t work well over many years of both bitter experience and of trying something different. It is far better to make the system more responsive and flexible in order to meet demand as and when it arises. This is why the famous Just In Time production systems that we associate with Japanese manufacturing are pull systems and why those manufacturers prefer to have workers and machines waiting idle than to have inventory stopped in a logjam. 

Therefore, it is worrying to hear reports from Public Health England that there are threats about future winter lockdowns to respond to any further wave of COVID cases.  We should have been using the last 18 months to prepare for any possible winter crisis.  There are three elements to this preparation.

  1. We need to reduce the actual level of demand on the NHS by reducing the number of hospitalisations and ICU cases. That’s what the vaccine programme is all about. An effective vaccine will reduce the number of infections by making the illness less transmittable and it will reduce the number of cases that require hospital treatment.
  2. We need to reduce the level of “failure demand”. Failure demand is about demand on capacity that shouldn’t be there if the system was working properly. In normal business, it includes repeat visits because expectation hasn’t been met, repairs, complaints etc.  In COVID terms this means the number of hospital admissions that were not truly necessary. We need to pay attention right now to evidence showing that most hospital admissions are for less severe cases and result in shorter stays. WE should be asking the question “why are those cases going to hospital and is hospital the best place to treat such patients?” I suspect not and so my hypothesise that a mixture of tighter triage and better in community advice and care would probably reduce the number of hospital admissions we are seeing right now.  We can work on this towards the winter.
  3. We need to increase the capacity of our NHS to respond to surges in cases. This means first of all that we cannot get away any longer with running the service at full capacity through the winter months. We need spare capacity. In normal time there should be beds, ventilators, and staff free.  That may seem less efficient but is more effective and I think our we will find is more cost effective over the long run. Alongside that, we need to look at putting flexibility into the system.  So, to repeat a previous suggestion, we should now be ready at the drop of a hat to set up nightingale hospitals and wards. The crucial question is about how to find suitable medical staff to care for patients during their stay.  I propose that we set up a national medical reserve with NHS workers who have recently retired being kept on a kind of retainer in return for either a one-off golden handshake or an additional sum on their pension.  This means that if we see a surge in cases from COVID or from future threats that we can respond in a surge of our own by rapidly increasing bed capacity.

We now know that a pandemic like the one we are currently living through can be costly if we are not prepared for it. We’ve also seen that the cost of lockdowns on the wider welfare of the population is huge too. Let’s use the time now to prepare for this winter and beyond so that we never have to resort to such draconian measures again.

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