UCL Minds


Transcript: Episode 26

Will a national lockdown save the Christmas break?


people, virus, lockdown, ucl, restrictions, places, compliance, pandemic, infection, country, difficult, christmas, local authority, higher tier, government, question, tier, important, transmission


James Cheshire, Anne Johnson, John Tomaney, Vivienne Parry

Episode 26 banner with photos of speakers

Vivienne Parry  00:00

Hello and welcome to Coronavirus: The Whole Story where the podcast that gathers up UCL’s multi talented researchers from an extraordinary range of disciplines, knitting them together to better understand the pandemic and its many impacts. My name is Vivienne Parry. I'm a writer broadcaster and UCL alumna, and for the past six months, the host of this award winning podcast. Last week, it was the impact of Coronavirus on the US election. This week, we're firmly home again and right at the centre of the raging row about regional lockdowns, the rationale behind them on whether or not they'll work to shine light rather than heat on these vexed questions. Three fabulous guests join me in today's episode from the Institute for Global Health, the Bartlett School of Planning and the UCL Department of Geography. My first guest is the peerless Dame Anne Johnson and is a Professor of Infectious Disease Epidemiology, co-director of UCL Health of the Public, sponsors indeed of this podcast, thank you very much. And she's recently been appointed as president of the Academy of Medical Sciences, with her work on the NATS our Sexual Attitudes Survey, epidemiology and prevention of HIV AIDS and much more. And as a colleague said recently, to me, is probably the nearest thing to a social scientist that medicine has. She's been at the forefront of the UCL Academy response to the Covid-19 pandemic, including the development of the Academy of Medical Science report, preparing for a challenging winter 2020 to 2021. with hindsight, that title is a master of understatement. My second guest is Professor James Cheshire, Professor of Geographic Information and Cartography and Director of the UCL Q-step centre. A quantitative data Skills Training Centre for UCL social science students, James uses big data to understand the way the world works, and interesting data visualisation techniques to help explain it. He's the co-author of London, The Information Capital, and Where the Animals Go, and recipient of numerous awards, including the prestigious British cartographic society award. And last but not least, my third guest is Professor John Tomaney. John is Professor of Urban and Regional Planning, who researches the development of cities, and how public policy is used to manage them. He's published over 100 books and articles on the subject of regional planning and as a regular commentator on this subject in the UK media. So let's start this episode by talking about the new tiered system. And what's the rationale behind it? And do you think it'll work?


Anne Johnson  02:40

Well, the rationale behind the tiered system is that where you have very different levels of infection, incurring in different parts of the country, you need to vary your response in order to the level of infection, and unclearly. In doing that, you're trying to balance the, if you like the restrictions on individuals and their lives, and titrate them against the severity of the public health response. The question then is the critical one, does it work? Now regrettably, in most of the areas where there have been high levels of restrictions, we're still well, in all areas, really, we're still seeing very significant rises in infection, we tend to see glimmers of hope that perhaps in the northeast, there is some flattening of that rise. But generally, there is a continuing rise throughout the country. So the debate that's going on now is if you realise that, as in a sentence, we predicted is perhaps too strong a word. But yes, pointed out in July, that winter was going to be a time for many reasons where the virus was spread more effectively. And if you think you get the first sense that you might be losing control, and the R is going up very substantially, there is an argument that you must intervene sooner rather than later. Because once you let the thing go, which is very much more difficult to bring the levels of infection down. And that's part of the big debate that's going on and all that, of course, has to be balanced against livelihoods and other aspects of health.


Vivienne Parry  04:24

Do you think that in some places, we will be able to get it back? Or do you think that there have to be even more restrictions?


Anne Johnson  04:33

Well, I think I mean, I'm not been privy to all the most recent modelling. But I think there are concerns and we've heard the chief medical officers say it that, you know, these restrictions are unlikely to be adequate or sufficient to really bring the are down below one, which is what we're trying to do. And therefore there is now a lot of talk about having some kind of implementation of restrictions that would last forever. a relatively short period of time talk as a circuit breakers and so on, in order to get back some control, but I think we have to be realistic with everybody that that does help you to, to, you know, to bring the level of infection down, that's very important and stop you overwhelming the health system. But of course, as soon as you stop those restrictions, you've got to really maintain as much as possible of all the social distancing and other other elements. Because your your, once again, you'll be increasing contact patterns, which is what will drive the virus up again. So what you're trying to do, I guess, with these circuit breakers, is to bring that level of infection down, and then be able to sort of get back to some reasonable life, but being very careful, and then recognising that you might have to do it again. And that is the problem with this virus, which is so easily transmissible, and you know, very difficult to get under control. So I do think we need to be thinking about the long term, if we get a vaccine in the spring, which everybody is very much hoping we have to also recognise that that is not going to be a silver bullet. And we really are in the business of trying to collectively bring ourselves back together, again, to all contribute to the various elements of intervention, which brought together we hope might push the rate down, but I think we tend to be too much stuck on the one thing that's going to fix it, there isn't one thing that's gonna fix it, it's the combination of things we can do, which, you know, we have to do to try and keep things under control.


Vivienne Parry  06:38

So it's about managing it, and living with it in a way that doesn't allow it to get completely out of control. But also recognises that we can't stamp it out completely.


Anne Johnson  06:52

I think I mean, it's this is such a, you know, this is a really question, I don't think we're being clear with everybody, or perhaps with ourselves about what we're trying to achieve. there clearly are countries who are in the business of stamping it out completely, including China and New Zealand. But actually, with the level of infection, now we've got across Europe stamping out a virus that is so infectious, from a society at this stage, I think is going to be extremely difficult. We've only ever done it for two or three, believe even, you know, one or two viruses that we've eradicated from human societies, notably smallpox, so we are going to be having to look at this in the longer run. And I think the question really is, when a new virus is introduced into a society, it often has, you know, these incredibly serious effects. And over time, if we can manage to keep some level of control over it, and particularly if we can push it down to lower levels, we are more in the business of living with it than then completely getting getting rid of it. I think it's a reality.


Vivienne Parry  08:06

Let's go to you, James, do you think the tiered system is working?


James Cheshire  08:11

I think the data are telling us that the numbers are still going up in quite a few regions where there are higher tiers. And I also think that it's clear that the scientific advice implies that we may be going for slightly tougher restrictions within some of these tiers, or at least at the top tier if we're really going to be able to stamp down on the increase in cases. So I think the jury's out. And I think one of the reasons for that is that there's a tremendous complexity in the messaging around some of these tiered systems. And also, we tend to rely on sort of these things called administrative geographic units, which are things that the Coronavirus doesn't really conform to itself. You know, COVID-19 doesn't mind whether which local authority it's in the only minds about the people it's travelling with. And so my view is that we need to think more carefully about flows of people in and out of these areas between different tiers, and what those impacts are on infection, but also how the people within each of the tiers might be might be behaving differently the through necessity or through a misunderstanding about the regulations that apply to them at any time. So I think it's a complex picture. And I think it's only going to get a bit more complicated as each region negotiates its own slightly different regulations, which apply to the people that live there.


Vivienne Parry  09:46

And it certainly throws up some anomalies. Dominic Rob's own constituency has one street with one end in tier one and the other end in tier three. JOHN, what are your thoughts?


John Tomaney  09:57

I agree that that's an incredibly complex picture. And I think Jim's draws attention to one of the real difficulties, which is the way in which much of this, much of the negotiations about the introduction of tears is conducted with local authorities, but the boundaries of local authorities are often not a good fit for managing this this process. So that's, that's a really significant problem to overcome. We've seen examples of some of the tensions that that gives rise to in places like Greater Manchester, where the conflict between the mayor there and the mayor of Greater Manchester, Andy Burnham, and the government was partly about who makes the decisions and how those decisions are made, and how the consequences of those decisions are mitigated. That's a highly political process and creating Coalition's political Coalition's across these borders to manage all of this, it's proved to be one of the most tricky aspects of introducing introducing this system of tears. Because the other thing which is happening with the tears is that on and on, on the face of it, we have three tiers now, which is meant to clarify and make easier, make it easier for people to understand what they need to do, both in terms of official organisations and ordinary citizens. But in reality, introduction of those tears, involves lots of local negotiations, and we're getting tears within the tears as it were. So whether this is an effective means of stopping the spread of the virus, I think is really an open question. And what we've seen, obviously, in France over the last few days, is the abandonment effectively, of a regionalised approach to managing this, and instead the imposition of a national lockdown. And it's hard to see how we're going to avoid that in the UK at the moment.


Vivienne Parry  11:50

Because James, there was a suggestion there from john about it, the actual allocation of the tiers is extremely difficult, even within a tier who is actually making the final decision on what gets included in which tier.


James Cheshire  12:05

What I think it comes down to a negotiation between, you know, what the research is saying, and what the political ambitions are in terms of, you know, what their politicians and decision makers, both in the local level and the national level, what they think the population are able to sustain themselves, but also, you know, this idea that somehow you're, if you're not addressing, or if you're coming down too hard on restrictions, and then that can have economic consequences. But it's becomes very messy. I mean, I think the idea that you're able to restrict the spread of covid 19, within a local area, makes a lot of sense. So if you're thinking about something that a classic disease outbreak or something like that, that, you know, if you've got good monitoring in the area, of course, it makes sense that if the outbreak occurs in a city, you know, the Northwest, you're not affecting sort of the far southwest tip of England, you know, that's the logic there makes sense. But of course, the political reality and the sort of complexity of the real world really steps in and you mentioned them, Dominic, Rob's constituency, I mean, on my parents own road, they have to pass through a higher tier in order to leave their street because they're one of these so called split postcodes, where effectively, they're in one local authority that has a lower tier, and then there's another one that has a higher tier adjacent to them. And so even just trying to establish the information around that, because the NHS app says that they are in the higher tier, in fact, they're not based on their local authority, you know, effectively, it came down to who collects the bins, you know, which Council is doing, they're been run, and that was the one that kind of established which one you're in. So on the ground, these realities are really complicated. And I think that's the, the mess that we find ourselves in, in some of these cases where, you know, the logic is there that you can control things in a local way. And you should be adapting things locally to the people that live there. But the reality is that, you know, the world's a lot Messier, and people are moving around between places, and there are certain political imperatives one way or the other that are contradicting or pushing the scientific advice one way or the other as well. And so the simplicity of a national lockdown means that you do erase a lot of that complexity, because we're all under the same circumstances. We're all in the same boat. But of course, that then has the trade off, which is that, you know, there are some areas of the country that will still have relatively low rates, but we'll still be under quite tough restrictions in order to help simplify that messaging.


Vivienne Parry  14:54

And john, I wonder if, I mean, firstly, wondering whether there were any urban planners or geographers on any of the stage or advisory committees, and it's the flow of people, as James has already mentioned, that is a critical part of all of this. So is there something about areas that have high flow rather than, you know, it's dictated by their built environment? Or that their geography that make them more of a risk? Should we be thinking about tearing with regard to some of those factors?


John Tomaney  15:28

Yeah, I think there are some geographers around the edges of these debates in the various committees, which are advising the government, I think that's very important because geography matters as, as gems, as in suggested in lots of different ways in the organisation of this pandemic floors matter. You know, we're in the early stages of understanding what's actually happening here. And there'll be lots of analysis to be done afterwards. But I think even at this early stage, it's becoming clear that there are certain kinds of communities which seem susceptible to this virus in the same way that they're individuals have underlying health conditions, certain kinds of communities seem to have those underlying health conditions too. And that's, that's part of what makes all of this deeply political issue really is. It's not just a case of simply following the science because in terms of designing lockdowns, the science is very helpful, but it's not necessarily very helpful in helping us to understand what the economic impacts of these lockdowns will be because they are hit. They're hitting different social groups and different places in quite different ways. So there's I think there's now enough emerging evidence to suggest that it's the poorest areas which have been hit to some extent, hardest by the pandemic, but more particularly, I think, by the economic consequences of lockdown to not complicate the picture of both how we understand the the longer term impacts of all of this, and what we we do about them, and I think it also contributes to what you might call the recent politicisation of the pandemic, notably the way in which strong voices are emerging, which is suggesting that in the north of India, that the government's attitude to the north of England has been in a sense discriminatory now, whether whether or not you agree with that, whether you'd like to add more nuance to all of that seems to me almost secondary at this point, there's a widespread sense in parts of the country that we have a government of politicians, civil servants and scientists sitting in SW one, as it were, even if virtually, and making decisions which have impacts in places far away, which can dramatically change the life chances of people over the long run. So you know, so I see this is the emerging issue really, which isn't going to go away in a very, in a very easy way.


Vivienne Parry  17:43

And so john, the, the way that you measure the success of lockdown, from what you said, is not simply about whether the number of cases are falling, or the number of hospitalizations, but actually a much longer term effect.


John Tomaney  18:00

Indeed, so for instance, you know, when we were all told earlier in the year to, to work from home, stay at home to our lives, that was much easier for some social groups than others. And that's something that which we need to understand more about. And we need to mitigate in terms of the way in which we respond in terms of economic policies and so on. We also know that if the workforce in certain place in certain places find a larger proportion of the workforce in certain places find it easier to work from home. So there are certain cities, which have, let's say, a large professional workforces were working from home as a as an easy option for from a very large chunk of the workforce. But in places which lacked that large professional workforce, that's much less of an opportunity. So a lockdown, whether it's national or its local, whether it's tiered or not has highly uneven geographical impacts which go beyond the medical sphere into the into society, the economy and so on. In we live in a country with very large inequalities, including large geographical inequalities, that not self divide, I suppose there's an obvious metaphor for these Lords REL is probably a bit more complicated than that. And one early prediction that I will make is that this pandemic will probably entrench and even deepen those inequalities in ways that will make dealing with them even harder in the longer run.


Vivienne Parry  19:28

Indeed, and we've had a whole episode of this podcast on inequalities which have had a real spotlight shone on them. You're listening to Coronavirus, the whole story a podcast brought to you by UCL Minds and if there's a question about Coronavirus you'd like our researchers to answer email us at minds@ucl.ac.uk or tweet at UCL. The UK isn't the only country using a regional lockdown system, where else has the tiny been employed? And how do we compare with other countries? I mean, we mentioned earlier that, you know, some countries have done very well. New Zealand is a great example or Singapore, some of the other Asian countries. But what about countries like us?


Anne Johnson  20:20

How are they doing in Europe? You mean, you're talking about Europe primarily? Yeah. So well, of course, Italy was the first place in Europe to have a severe epidemic. And they imposed a regional lockdown during the first wave. And then arguably, they had a much more regional epidemic, we got a very generalised epidemic. Because we had multiple introductions from all over Europe during that half term week, last February, primarily, I think, people coming back from all over Europe, and that cause much more of generalised epidemic in the first wave. Interestingly, some countries like France who seem to have a more localised epidemic are now arguing that they want a more generalised epidemic this time around. So it is really interesting to see countries that seem to be doing incredibly well, then letting up their guard and having really serious problems. I mean, the most interesting example is check here, one of the most interesting examples which had high levels of social distancing, and use of face coverings, and really high levels of control during the first wave did very well. And then they all celebrated, that the virus had gone away, and they had a big party. And now they've got some of the highest rates in Europe. So if you it's not, it's not clear that there's one formula, and you certainly can't afford to let up your guard. Now, Germany, of course, did much better, better, you know, had much lower death rates, they had early introduction of testing, very good test and trace capacity, probably pretty high levels of compliance with all the the social distancing measures, which would be nothing difficult here. But now they are again, seeing a rapid rise. But you can see them now taking quite restrictive interventions and Angela Merkel on on the radio yesterday, and recognising that they are have now got a surging epidemic. But having said that, they have still got much lower infection rates. And we have here


Vivienne Parry  22:18

one of the most interesting things with regard to test and trace because once Of course, an epidemic of pandemic gets completely out of hand test, and trace is no longer of any value. But I know that we've discussed before and this idea that actually what you need to do is look at the, you know, look at it backwards as it were, because the more we discover about the virus, the more we discovered that some people are super spreaders, and that going back to find out who people got it from, is really important in trying to damp down those super spreaders.


Anne Johnson  22:54

Yes, people talk a lot about super spreaders. And I think what we have to look at are super spreading events. And that's important that some of the ideas of backward contract racing, but actually, to me the information we really need is to understand where are the prime source environments of transmission. Okay, so in of the 23,000, having the cases it was we've had in the last few days, I can't remember yesterday's number, but it's those sort of levels of infection. Where are people getting this virus? Is it you know, what proportion of them are occurring in universities and university halls of residence, what proportion are occurring in care homes, wash proportion, they're occurring in NHS settings among staff and amongst patients? What proportion are occurring in work places and so on. And some of them will be super spreading events because we know people bury it in infectiousness. But equally, you know, if you have a large number of people living together in a hall of residence, and you get infection introduced, and everybody isn't quite sticking to all the rules, it is very easy to get massive outbreaks, as we've seen. So we shouldn't overemphasise the spreading events. But we should try and understand what what the what the key environments are. Because if you understand those environments, then you can work with those environments and with those communities, to try and dump down transmission in specific places. But now, if you're looking at the data coming out of the React study, and I'm sure we'll be getting data tomorrow from OMS, what we're seeing is a continuing rise and really very widespread infection. So that kind of tracking down, you know, specific outbreaks is an important part of this. But once you've got widespread community transmission, then you know that is a that is a that's a more difficult call because you're going to get people infected in situations that aren't those kind of super, super spreading events or restricted to particular environments.


Vivienne Parry  24:59

It feels feels like there's been more of a pushback to these particular lockdown measures than during the first lockdown both politically and amongst the public. Do you get that sense, too?


Anne Johnson  25:11

Yes. And I think there's quite a lot of data to support that. I mean, during lockdown, I think many of the social scientists were quite surprised at the level of compliance with lockdown. And also this tremendous sense of community spirit and people working together and praising the NHS workers. And remember, we sat on our balconies, and we clapped. And it was all, you know, very tough for many people, but something of a novelty and and and people, you know, were compared prepared to comply, I think, with some sense of promise that this would solve the problem. And of course, we did, it did, it was extremely effective. I mean, the virus rates came down for very low levels, and we kept them low, continued to decline, actually, even as we crept out of lockdown, and all the cautiously. But then, of course, we didn't. I mean, my own view, and I, you know, with this could be debated is that, as we came out of lockdown, we didn't sustain the messages that the virus was still out there. And if we went back to life, as it had been, then, you know, as nightbot, follow Dave courses, virus has spread by close contact and the number of contacts we had, we increased our number of contacts, we opened up, you know, various environments where people could mix with one another and a virus like this, unfortunately, it's in its biological nature, to survive in human populations, whether sufficient contact for the art to be above one. And so from an art that we got down below one, well, you know, 2.8, or even lower, then we saw the epidemic driving, dying away. But as soon as you go back to those old behaviours, of course, the virus will tend to come back, which is what's happened now. And I think, you know, the public got very confused. On the one hand, you know, you can enjoy the summer, there's bad winter coming, but going enjoy the summer, we didn't sustain those messages over the long run, which I think other countries have been better at. And so we've got into a sort of boom and bust situation, which is exactly where we don't want to be having said that, you can see that countries across Europe are struggling in exactly the same way.


Vivienne Parry  27:28

JOHN, do you have briefly a view as to why that might be the case?


John Tomaney  27:33

Yeah, I think you're you're getting a very strong pushback from some political leaders, particularly in North of England. I mean, I watch closely the events that unfolded in Manchester a week or so ago, in which there was a standoff between Andy Burnham and other leaders and the and the government. And I saw that it's very significant, the notion that the north or communities in the north have been left behind left out and neglected, ignored. It's been around for quite a long time. It was a it was a an element of the story around Brexit, I suppose. And we know that there have been deep regional inequalities in this country for a long time, arguably, much larger than in other rich countries. We see the members, members of the EU and so on. But what I think was significant, there was the way in which political leaders in the northwest of England in Greater Manchester really strongly and passionately articulated a sense of grievance, which brought a new dimension to politics in England, we've seen that sort of politics in Scotland and Wales, and that's led to radical devolution of political power


Vivienne Parry  28:37

that also fuels this kind of push against compliance, doesn't it?


John Tomaney  28:42

It does, because I think what it what the key the key notion and all of this that I think is the motivator in the way that people respond to what's required of them by the state is the notion of fairness. And people feel that they've been treated unfairly, I think it's it's very difficult to ensure their compliance. And there's lots of ways in which individuals and politicians feel that their area has been treated unfairly in this process. Or you can argue whether you know how, how fair that assessment is, as it were, but there's no question that that sort of mood is abroad, you can find it in all kinds of polling in the way in which the media in places like Manchester and other parts of the North are giving expression.


Vivienne Parry  29:25

And you're also seeing it in Acts of petty defiance anyway, I saw that somebody had registered himself as a company, because you can have input any number of employees at a work event,


John Tomaney  29:37

you know, people are also responding to absurd conspiracy theories, which are, which are circulating on the internet and so on. And there's evidence again, that some of those conspiracy theories have a greater appeal in some places than others. So it's a complicated picture, but I think at the core of it is, you know, what, what generates the maximum of compliance among the largest number of people is the sense that the Rules are being applied fairly. And if people don't believe that, and they have evidence to support their beliefs, then I think that's a really big problem in ensuring social compliance.


Vivienne Parry  30:10

James, do we have a way of measuring compliance?


James Cheshire  30:14

So very controversial question. I mean, there are interesting ways you could go about it, I mean, in a very kind of specific technical sense, then you could establish the extent to which, you know, there's there's activity within within particular areas, or even particular individuals within areas, if you're looking at a mobile phone call records, or data where you can see, you know, basically how many people are moving around, you could, of course, integrate information, some kind of surveillance technology type stuff into some of the tracking and tracing apps and so on. But very sensibly, there's a strong resistance to that idea. And the government haven't pursued that route in their own app, and only one or two other sort of countries have some of that data collected. And so I think you can do it at that level, you can, of course, look at it across other metrics. I mean, there's, there's lots of information about the extent to which public transports being used the extent to which there's traffic on the roads, you know, you can even look at basically how busy certain areas are. And so I think the technology exists, but I think we do have to keep in mind that compliance isn't, is a very grey concepts now. Because, you know, some people are just unable to comply with some of the regulations in the way that others might be able to, we all have our own individual risk calculation. And, you know, the ingredients that go into that are going to vary from one person to the next. And so within the measures and the restrictions, I think, you know, we have to assume that some people are going to be more compliant than others. But overall, if on average, there is a sufficient level of compliance across the population. That's what will get us to where we need to be in terms of reducing the numbers.


Vivienne Parry  31:56

Unfortunately, we've reached very much the end of our time. But I wanted to ask you all for a brief response to the question, what's going to happen at Christmas,


Anne Johnson  32:07

I don't know what's going to happen at Christmas, you know, we're in a difficult situation. Now, you're seeing across Europe, government's putting in more interventions to suppress the virus. Because if you're going to act, as I said, with all infectious diseases, if you if you once you know, you're going to need to act, you're going to need to act, you have to do early, because the wind is much better. Because you're starting from a lower base when you suppress it, we also need people to try and do everything they can individually and collectively to reduce transmission. I think it's incredibly important, as you've heard me say before, to try and absolutely minimise transmission in care homes and transmission of the virus between patients and staff, staff and patients, patients and patients, staff and staff, in hospitals. Because those are where they're really vulnerable people are those where the rates are going to be high. Those are where the deaths occurred. And so if you want to limit the number of deaths, it's really important to get in control of that. Really important to work with the public and to hear your public voices about how we can work together. Testing Yes, really important. If the public are prepared, most important to go home, stay out the way Try not to transmit to their families, which we don't give enough emphasis to when they when they're sick. That's that's the biggest contribution, one of the biggest contributions to stopping viral transmission. So that compliance with staying home when you're sick, and then is really important, but then the government side of that, or is the service side of that is being able to offer them a rapid test for the rapid result, the more infection that happens, the more difficult that is to do. So when you can see yourself getting out of control, early intervention is the key. And that's going to be I think, the only way if we've got to try and try and get on top of this now, or it'll be very difficult to have anything close to Well, I think, in any way, it's gonna be difficult to have a normal kind of Christmas, but clearly, some kind of get together would make an enormous difference to everybody. And maybe that's the reward for what we've got to do now,


Vivienne Parry  34:24

dear listeners, my take from that down toward the turkey for 12 quite yet. JOHN, let's go to you what's gonna happen at Christmas?


John Tomaney  34:32

I think we're going to see a severe strain on complaints at Christmas, larger and larger proportions of the population of subject to more and more restrictions, that's going to be very difficult to enforce over Christmas. If at that point, I think people will start making trade offs between the risks of infection and the quality of life and in particular, how they sustained family relationships. So I think it's going to be it's going to be very difficult. I think the government has extraordinary are tricky decisions to make in the coming weeks.


Vivienne Parry  35:03



James Cheshire  35:04

Yeah, I'd agree with that. I think we may be incentivized to be more compliant in the run up to Christmas in the hope that the numbers come down. And so that there can be some relaxation, whether when the time comes, we've got there, I just don't know. And I'm going to of course, Christmas is the landmark we might be aiming for here. But then there is still some way to go after Christmas. And so got the kind of the dark days of January to come when morale always drops anyway, people feel less happier during that time after the the fun of Christmas is over. And so if you're in a situation where there's still this uncertainty, and we're still going along with these different lockdown restrictions, and so on, and it's not kind of well communicated or managed, I think people are going to start feeling extremely unhappy during that period as well. So Christmas, of course, is important, but I think we know we're in this for the long run still, and we shouldn't be too enthusiastic to have a kind of a full family Christmas, if it means that we're going to pay the price for that particularly sort of in the early months of 2021


Vivienne Parry  36:11

and interesting particularly for the elderly near the over 80s who are thinking well how many years have I got left to have Christmases? And should I trade off having a Christmas which is really important to me against perhaps death sooner rather than later and a lot of elderly people want to make those decisions for themselves. But anyway on that Robert gloomy and thank you so much and and to john and to James, you've been listening to Coronavirus the whole story This episode was presented by myself Vivienne Parry, produced by UCL with support from the UCL Health of the Public and UCL Grand Challenges and edited by the splendid Cerys Bradley. Our guest today were Professor Dame Anne Johnson, Professor James Cheshire and Professor John Tomaney. If you'd like to hear more of these podcasts from UCL Minds, subscribe wherever you download your podcasts, or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds, bringing together UCL knowledge, insights and expertise through events, digital content and activities open to everyone. Hope to be with you again soon. Bye for now.