Imagine watching the Euros as a Rugby Union fan. You would cheer every time a player took the ball beyond the by-line or booted it over the goal posts and you’d be surprised every time there was jubilation whenever the ball went under the bar. You’d be assessing the team’s performance by a different set of rules and a different goal.
That’s been one of the problems throughout COVID, people have been evaluating how we are doing by different standards. The assumption of many has been that our aim is to eliminate the disease and prevent as many deaths as possible. If that’s your understanding, then you are going to be pretty concerned at the moment and wondering why the Government are unlocking right at the point when cases are going up which is likely to translate into further deaths.
However, if you’ve listened to what the Government and its advisors have persistently been saying throughout the pandemic, you’ll realise that they are playing by different rules because they have a different objective. Context of course is important. You follow rugby union rules on a rugby pitch with men who have trained to play rugby but on a football pitch with trained footballers, you use different rules and have a different goal.
So, for example, if you are able to tightly control your borders due to distance from other countries and if you are able to encourage a high, constant and persistence of conformity with contact tracing and social distancing then Zero COVID is a sensible objective. That’s why countries like Australia, New Zealand and some East Asian countries are pursuing such a strategy. However, the US and Western Europe are in a different context. There are cultural differences which mitigate against social conformity and the nature of trade and migration mean that borders are often more porous. So from the start, it has been the expectation that COVID will become endemic and we will have to learn to live with it. This means there is an expectation that there will be cases each year and that will sadly lead to hospitalisations and death just as is the case with flu and pneumonia.
Therefore the aim throughout the pandemic has been to keep down as low as possible the number of cases that end up in hospital and particularly on ICU. That’s what the NPIs (social distancing, etc) were intended to do and that’s really what the vaccine is about. Once you recognise that this is the aim, it helps you to understand the Government’s decision making. Furthermore, it also helps you to ask the right questions.
You see, even with a different goal to the one assumed, that doesn’t mean everything is ticking along just fine. It means that we now know why reopening is happening when cases are increasing exponentially and it means that questions about how many cases and how many deaths are acceptable don’t compute with the decision makers. Their response is that, of course no level of death is truly acceptable, they don’t want anyone to die from COVID but they know that people will die from COVID just as they die from cancer, flu, sepsis etc in sadly high numbers each year too. For them, it’s not that a level of deaths is acceptable its that infections, hospital admissions and deaths are for the time being inevitable. With vaccine efficacy at about 60-80% against cases and 94% against hospitalisation, it is clear that there will always be people that are vulnerable to catching the disease. Even if we vaccinated all adults and children, there are still several million people who are at risk of catching COVID and going to hospital. The hope is that as with other viruses, as COVID becomes endemic, it will also become less dangerous as we are frequently exposed to it and build a level of immunity.
The aim is to protect NHS capacity. In effect the expectation is that we cannot stop the virus but we can delay its onslaught. This is why the Government and its medical officers have talked about flattening the curve and why in justifying ending lockdown now, they’ve argued that keeping rules in place won’t prevent deaths, it will only delay them. So, the focus is supposedly on managing demand in order to protect NHS capacity so that it can cope with cases.
This has two implications. The first is that when evaluating how things have gone and the Government’s response then the big question is “Was the NHS protected?” along with “At what cost?” Secondly, it means that opposition politicians, journalists, commentators and anyone who gets the opportunity should be asking the Government one question and it isn’t “What number of cases is acceptable?” or “What number of excess deaths is acceptable?” It’s “What is the NHS capacity?” We really need to know what the NHS thinks it can cope with in terms of COVID case load. Now that will have some variables. It will cope better with younger patients who spend less time in hospital, it will cope better if cases are spread evenly across the country rather than with one or two places taking the hit and it will cope better in the summer than in the winter. However, there is an answer to that question and it remains disappointing that it is neither asked nor answered.
Once we know what the rules are and what the goal is, it helps us to ask the right questions, it helps us to know what part we need to play and it helps us to know how we are doing. We are all on the same pitch, playing the same game, playing in the same direction.
You will realise of course that this doesn’t just apply to COVID and lockdowns. Frequently in life people, teams, organisations and churches struggle because different people and different parts of the organisation are pulling in different directions and they don’t realise it because they don’t realise that they are working to different rules and objectives.
On a one to one level, this can cause problems in pastoral conversations. If I’m asking you how I can get through, survive or even escape a particular circumstance and you are advising me on how to remain faithful and learn to be holy in that situation, then I will find your advice strange and you will find my response frustrating. Similarly, a youth worker may be being measured by parents and the leaders on how many teens she gathers into her youth Bible study. They may think she is failing as numbers go down but she may believe that she is seeing fruit because her aim is to make disciples and so she sees the goal as to get those youngsters out of her group and into the main church service. Or a church leaders may be wanting to see the church multiply by planting new congregations in unreached areas whilst the pastor thinks his job is to grow the congregation as large as possible. And so on.
So, three important questions need to be asked.
- Do you know what your goal/objective/terms of reference are?
- Is that known and shared by the rest of the team/community?
- Do you know how you are doing?