Transcript: Episode 3

What are the lockdown exit strategies?

Vivienne Parry 0:07

Hello and welcome to Coronavirus: The Whole Story. This is week three of a series that tries to understand Coronavirus and its impact through the lens of UCL research and expertise. My name is Vivienne Parry. I'm a writer and broadcaster, and for today your Coronavirus Guide. Every week we talk remotely with UCLA researchers about their groundbreaking work and what it can add to our understanding of this crisis. Previously, we've seen what it takes to find out the true extent of Coronavirus infection in the population. And we've also taken a look at life in intensive care. And if you didn't hear them, there's still time - details at the end.

Now this week, we're going to bring you the perspectives of an economist and a geographer specialising in disasters, getting their take on perhaps the most discussed and difficult Corona subject of all - what is the exit strategy from lockdown.

So let me introduce today's guests. David Alexander is professor of Risk and Disaster Reduction at the UCL Institute for Risk and Disaster Reduction. He's been researching disaster since 1980 and specialises in emergency planning and management. His department offers By the way, one of the most intriguing of all UCL degrees one I want to do - earthquake science with disaster management. Paul Ormerod is an economist, author, entrepreneur and a visiting professor in the centre for decision making at UCL. Earlier this month, he and fellow economist, Gerard Lyons, proposed the traffic light model for ending the lockdown drawing on research in epidemiology.

And I just want to start with a quick question to both of you were so used to thinking of this crisis in medical terms. So just briefly describe for me, if you would, how you see this from the perspective of your particular discipline.

Paul Ormerod 2:00

Well, I've been I'm an economist, but I've been interested in work in other disciplines for a long time. And in the past I myself have worked on using the analytical framework of epidemiological models. And so, my perspective is to look at these models and say, yes, they have genuine scientific value. But, they they make, they need to make assumptions about behaviour to produce meaningful forecasts, and of course, its behaviour and behavioural change, which at the very heart of the discipline of economics, so I think we can add a lot of value both to the forecast and to the policy discussion by bringing this perspective along.

David Alexander 2:52

my speciality is emergency planning and management. Therefore, I tend to see this in terms of emergency planning - which needs to be done on a very broad basis, which is to say we need to look at everything from the epidemiological to the economic and beyond. And we need to construct a scenario for what is going on, which should be the basis of planning. The purpose of planning is to apportion responsibilities for doing things to foresee needs, and to work out ways of satisfying those needs when we're in the crisis.

Vivienne Parry 3:29

Paul, first of all, tell me what you mean by a traffic light phased into lockdown. And why do you think this would work?

Paul Ormerod 3:38

Well, I mean, essentially, this is what the governments are carrying out. I notice, I thought the Welsh Government have actually explicitly adopted the phrase. And what we're really mean is that is a staged process. I mean, things are moving very rapidly in this crisis. And now it might seem obvious that that's the thing to do. But certainly going back to early April, when we put this forward, it wasn't people couldn't see a way out. They were really thinking in terms of either there's a lockdown or there isn't. And so what we're saying is, we're actually got we partly experiment, but we're partly guided by the medical evidence by the epidemiological evidence, as well as activities which are at least risk of transmitting the virus. So let me give a practical example of the one which is least likely to be open, which would be right at the end of the process would be no large crowds, not Premier League games with full stadiums. That's something which will come right at the end.

Vivienne Parry 4:45

The whole lockdown is often presented as being a binary choice, isn't it between, on the one hand lives, on the other hand, livelihoods, but it's really more subtle than that, isn't it?

Paul Ormerod 4:58

Well, that's another point in which actually Economists spend most of their time working on the idea that there are trade offs. For an economist, we see people making trade offs all the time. Most of these, certainly compared to the virus are wholly trivial. But when you make a decision to spend money, say, by going to the pub, you're deciding to do that you're trading that off against some other activity that you could be carrying out. So the whole of economic theory is about trade offs. But certainly from a societal level. society makes implicit trade offs involving lives all the time, and a good example is that of road accidents. So currently, there is something just under 2000 Road deaths a year in the UK, and 25,000 very serious injuries. Now as a society, we could void that if the government abolish motor vehicles, but we don't we say the benefits, there's a trade off between the benefits we get from the use of motor vehicles. And one of the costs of there may be others as well. There's all sorts of arguments about pollution. But one of the costs are the deaths and serious injuries which result. Now, of course, you try to minimise those. And that's what successive governments have done, because if we go back 50 years, then road deaths when there was much less traffic, road deaths were 8000 a year, and now they're just under 2000. The volumes of traffic have increased. But we make trade offs in every single minute of our lives, most of which are trivial, and some like this are very serious.

Vivienne Parry 6:47

Now, one of the things that's been proposed quite often is that, you know, we're all in this together and so therefore, every part of the exit strategy should apply to all groups. Is that a reality? Do you think? Or do you think what we'll see is, for instance, younger people getting out of lockdown earlier? And perhaps older groups staying at home, or certain regions of the UK that don't have much spread of the coronavirus being allowed out from lockdown earlier?

Paul Ormerod 7:24

Well, I think it's difficult to make these segmentations. And first of all, I mean, thinking about the geographical is certainly the case that some of the more remote Scottish islands could it could almost certainly be really strong locked down today because I think on the Western Isles, for example, there hasn't been a single case of Coronavirus, still providing their controlled entry through ferries. They could restore full economic activity tomorrow. But the problem on the mainland is of course that people travel around and we can't stop erecting physical barriers between, say the southwest and the southeast or London and anywhere else in the country. So geographical segmentation is rather difficult in a very densely connected country such as the UK. Now, the idea was floated sometime early in the crisis that say the 20 year olds should be released fast, because they have a much lower risk very much lower risk of of death. I think there are two points against that one, which is a purely economic one, in that they are and it's not a criticism often because, you know, we've all been young, they're the least productive part of the age cohorts of the labour force, and that people in their 40s and 50s in general earn a lot more than people in their 20s.

Vivienne Parry 8:55

also the most economically disadvantaged by this crisis, aren't they?

Paul Ormerod 8:59

Oh, Well, I mean, that's the that's one of the reasons we should be all in it together. But the idea we could release souls to revive the economy, but there's also the epidemiological point in that, for the virus to work through a group completely would take, you know, two or three months. And so we can't have the rest of the economy in a complete standstill, more or less complete standstill, while while it's well, the virus spreads through the 20 year olds, because as long as it's there, as soon as interconnection start up again, you know, it will then spread through the rest of the age groups once they're released from lockdown. So I think doing good on age grounds is also a bad idea and the logical way to do it is by different economic sectors and judging them by that relevance for for risk in terms of can we contain the virus opening in successive stages.

Vivienne Parry 10:02

but let's get back to your traffic light idea. Often it's also called hold, build and and shield. So the lockdown is, I guess, of course the red light.

Where do we go with the amber light?

Paul Ormerod 10:16

Well, actually we were the way we put it. We said the lockdown is now in the red light is the first phase of release. You know, when when we look and say, well, small shops. And I think a key point now is that there isn't we although we suggested some quite detailed areas of activity in red and amber. And these are all always subject to revision because what's become clear is that the British public have learned very rapidly to adapt to their behaviour. They're not going to revert to pre crisis levels for a long time. So just they've learned for example, to queue outside supermarkets. So could they equally learn to queue outside garden centres and that's one thing that could be open or a wide range of small retail outlet outlets. So that will be the red phase. And then in the amber phase, we were thinking saying, well, let's make things like, you know, car transport, you know, unlimited, let's remove restrictions on that. I mean, always with the proviso that if people congregate in large groups that beauty spots or beaches or whatever, I mean, that that will have to be banned after be made illegal for a long time. Because it's in such large entities in large gatherings, that the propensity to spread the virus is it is at its most acute.

Vivienne Parry 11:45

Is there a worry that actually it's people's natural intention to to congregate in in groups and that they will do that once lockdown is is ended and it'll be really Very hard. I mean, there are, of course, a dedicated number of people who I suspect will be very wary of any interaction with others for a long time to come. But for a lot of people, it's get out there and resume life as normal.

Paul Ormerod 12:16

Well, I don't think that's true. Actually. I think most people that say they they've learned really quite rapidly to change their behaviour. I think if we go back to the response of the week in the week of the 16th of March, when the Prime Minister announced, if you like a purely voluntary compliance, people, this is looking at it from the perspective of economics. Many people then chose to make the rational decision to social distance. Because he was a he was a great deal of uncertainty and unknown virus. And the data we had coming out of China, suggested the death rate Might be as high as three or 5%. So is entirely rational to carry out, social distancing. And we can see during that week when it was voluntary, we can actually see traffic, you started to decline quite rapidly. And this interesting, a walk from a centre of Oxford showing that respiratory diseases of all kinds, not just a virus of all kinds also started to fall sharply during that week, indicating that people were, you know, acting rationally on the basis of the information they were given. And that information sets evolve, but they can still see that the virus is a serious risk. And it will be extremely surprising if the majority of people revert to pre crisis behaviour. But take your point that obviously there are attractions to people of being in large gatherings as a natural human tendency. This is the primary. This is a primary danger in terms of the gradual release from lockdown. So that's why, along with job lines are suggesting initially relatively small scale activities, or one in which social distancing and queuing might work, let's give the example of garden centres again, and only gradually starting to allow larger gatherings to, to build up. And that will be a key message to try and get across to people. It's there that you're most at risk that somebody with a virus or a large crowd could easily affect, in fact, eight or 10 people in the space of a few hours.

Vivienne Parry 14:46

Do you think people though, the longer lockdown goes on, the less compliant they become?

Paul Ormerod 14:54

Well, we can see some fraying of the lockdown and certainly that was about big concern in, you know, in the middle of March that a form of compulsory lockdown wouldn't last very long. But now here we are six weeks into it. And there's still very considerable support for lockdown. And we can see, you know, changes at the margin. But I think these changes are people again acting really quite sensibly because they've worked out. Like I say they're thinking, well, if we if we can queue outside a supermarket, why can't we do a outside different retail outlets? Why can't be que se even though the lot that that breath companies like Gregg's and McDonald's are opening and Costa Coffee, and people said, Well, we can queue there as well, in just the same way we've learned how to do this. We've learned how to adapt to the new environment. And presumably they're hoping that as the months go by, that will change but that's time being the willing to participate in that, through having learned appropriate behaviour.

Vivienne Parry 16:07

How long can we carry on doing this without completely destroying the economy and people's livelihoods?

Paul Ormerod 16:14

Well, maybe the answer is not very long.

But I mean, the data at the moment is still uncertain. And economic data comes in with a with a lag. So we don't know exactly what the what the impacts been. But we can it does look as if the slumping output has been the biggest since the Bank of England. The Bank of England has a database about book going back 300 years. And it looks as if this is a biggest single fall already in that 300 year history. And clearly that can't go on for very long. And this is this is a key point. Going back to your the discussion on the trade offs between the economy, and if you like health and lives, that unless you have a functioning economy, and people are generating income, out of which they pay taxes, it doesn't take very long before there can't be a health service that can't be schools and all the other public services on which real rely. So the stark Fact is, I mean, it's not economists being brutal or inhumane. To start factories, we do need a revival of the economy, precisely in order to be able to continue to finance and provide the health service.

Vivienne Parry 17:41

So in your view, or your opinion as an economist, when do you think that we should be instituting some going back when would you end the lockdown presuming that we've got the we've got the the number of cases are beginning to drop very substantially?

Paul Ormerod 18:03

Early mid May because we can see that the number of deaths are falling. Now the number of the number of new cases is, if we're very careful with this data because impart identified new cases will simply reflect on higher levels of testing. So we have to be very careful with that, we can see that the death data is clearly past its peak, we can look at bed occupancy in the NHS, with people suffering from the virus, and the countries moving at slightly different rates. But the London data suggests that the number of people in hospitalised with the virus is now half the level of its peak. So uh, once these things start to fall, just the mathematics of epidemiology say though, they will actually fall really quite quickly. And so within two or three weeks time, you know, there'll be it'll be it'll be very much lower. And that was will be the time to start reviving economic activity properly.

Vivienne Parry 19:04

Just a last question here are the things that you've seen happening in other countries as they've entered their lockdowns that you think that either we shouldn't do or alternatively that we should do because they've worked very well.

Paul Ormerod 19:19

Well, one thing that I've been very keen on for since the middle of March since I read some of the medical evidence is that wearing face coverings in the general public does seem to be very effective in preventing the spread of the virus. We can see the evidence from South Korea, but also much less well known as the Czech Republic and Slovakia, which have had much lower infection rates. And apart from health professionals who obviously we know or people are widely exposed to large numbers of people. For the general public the idea of a face covering not a surgical mask, a face covering is not To protect you from from the virus is to protect other people from you in case you've got it because when you sneeze or cough, the droplets will spread and infect people and some sort of face covering. Helps to help to prevent that. And even though I'm not a medic, the evidence just looking at empirical evidence. I mean, it seems overwhelming, that this should be the advice and I find it absolutely staggering, that the government's scientific advisors have not come out much more clearly in favour of this policy, in terms of helping Britain get back to work and help prevent the spread of the virus.

Vivienne Parry 20:41

So released in stages wearing our masks. Thanks very much for that, Paul. Now you're listening to Coronavirus the whole story it's a podcast brought to you by UCL Minds. And if there's a question about Coronavirus that you'd like our researchers here at UCL to answer please do email us at minds. At ucl.ac.uk or tweet at UCL.

Now, unfortunately, David, you were explaining that your perspective was about planning, but we seem to have got here and the planning doesn't seem to have been much in evidence there was obviously some but you know, not to the extent that we needed it. So where are we now? And how do we get out of this?

David Alexander 21:36

Right. Well, in an emergency there are three elements there are the plans the procedures and improvise ation the plans orchestrate the procedures, improvisation needs to be somewhat minimised. It can't be ruled out, because unnecessary improvisation is inefficient and indeed it might even amount to negligence now We had a pretty good scenario for the last well at least 12 years on what would happen if a major pandemic occurred. We've also had a number of smaller pandemics, SARS MERS, even a bola. And these have strengthened that scenario. But actually what the scenario tends to lack is an indication of just how we do get out of this. One thing that is clear from looking at past pandemics and previous history is that getting out of this will be a slow process. The pandemic influenza that occurred from 1918 to 1920, lasted 24 months in the world and about 14 months in Europe. But the recovery from it took at least five years. Now that was partly because the world was also recovering from the First World War people were exhausted and silver economies So on. But it was also because it is very difficult process to recover from these things, economies needed to be rebuilt and they will need to be rebuilt this time. For example, if you think of tourism, I think it will be some time before international tourism gets going. Tourism will probably restart with local and national tourism before international tourism really gets underway. And we need to ask what sort of state the international air transportation industry will be in after all of this and that is by no means clear, except that the forecasts by IC o and IATA have been somewhat bleak.

Vivienne Parry 23:42

So let's turn from air travel, which is, you know, on the distant horizon for many to the more pressing and immediate questions of how we get out of lockdown. What are your thoughts there? What have we learned from other emergencies?

David Alexander 23:59

Well, We have to bear in mind this that there could be a second wave in the second wave of influenza in 1980 to 1920. And in fact, the second wave was more lethal than the first wave. Now, I am not saying that that is going to happen this time, but it is always something that could occur perhaps in the autumn, which might mean that we need to go into reverse. In other words, rather than loosening up lock down, we need to tighten it up in the opposite direction. When locked down is gradually released, it will have to be a slow process and it will have to begin with those activities that are least likely to produce a surge in infection rates. Now, I think we can allow access to, for example, shops, offices, industries, where social distancing can be maintained, and whether or not likely to be huge concentrations of people. I think the last to be involved in in the world. Release of lockdown will be for example theatres and cinemas and things like that mass gathering and the sort of sporting fixtures where people arrive in very large numbers. These are potentially epidemiological bombs if we still have a substantial or a significant risk of infection. So there are some ways around that, for example, we already see plays being performed on line and so on. And matches could be football matches, for example, could be played in stadiums that are empty, but transmitted on television and by social media. And so so that is all part of the gradual process of getting back to normal. But during this time, we need to keep up and do to improve the rate of testing, tracing and tracking the epidemiological monitoring and control side of this, and we need to make sure that we have a very clear idea of what The disease is doing. And on that basis, if any of the relaxation means actually do lead to a resurgence of COVID, then they can be reversed, they would need to be reversed.

Vivienne Parry 26:16

Are you with people who've said that? Actually, if we have to go back into a lockdown that will be even more damaging for the economy?

David Alexander 26:29

Well, I think it would, yes, it already is extremely damaging. We've also had this very, almost bizarre situation where we've come from an ideological point of view that many governments were downsizing welfare and health systems or at least beginning to starve them of funds and there was austerity and so on, into a situation where they're forced to say that they love welfare. They'd love health systems and money is no object at all of this. And of course that has to be funded in that that's very difficult at a time when revenue has contracted as much as it has. So I do feel for politicians who are crushed between the rock of the disease and the and the shutdown the lockdown and the hard place of the economic stream Didge stringency at a time, when everybody is shouting at them to spend more, it is curious to see this abrupt change into a sort of Keynesian New Deal. So type of economy that we're having now, what one does, how long that can be sustained, given the amounts costs of it. But one thing one message is very clear in all of this, and that is that it requires international action, in many respects, not really medically, but also the economy. At a time where countries have suddenly become very inward looking, they've tended to close their borders. International Trade has been curtailed. To get us back to normal it needs to be massively ramped up. international migration has dwindled to most nothing against for example, there are sectors like agriculture, which have been dependent on migratory labour. And agriculture is part of the critical infrastructure of any country, the food supply chain, and so on. In a country like Britain, once described as being four meals away from anarchy, it produces only half the food that it consumes is therefore critically dependent on food importation and on a supply chain that extends well outside the UK borders. So in fact, we could say that getting an economy back on track depends also on how the economy's got back on track. In other countries, and China, for example, has a pivotal role in this. And we will see what happens there in terms of international trade.

Vivienne Parry 29:08

So David, I mean, this is an odd phrase to use, but you've seen a lot of disasters in your time. I mean, it's, you know, disasters or your stock in trade, as it were, and the subject of your research, but where, what are the things that you have seen that have contributed to the quickest recovery times?

David Alexander 29:29

And that is somewhat dependent on the type of society and the type of economy. For example, it does tend to differ between poor countries and rich countries quite considerably. However, I think one factor that is absolutely vital is democracy, democratic participation. I've been studying disasters for 40 years and with a very learned expert professor in Davis in 2015. We wrote and published a book called recovery from disaster in which you're the man we need. So well, possibly So, except that by and large, we were dealing with disasters and with experience that was really rather different to what we're dealing with now. Not in all its details, but in its overall picture and its scope. Most disasters aren't local, regional, national, they may be International, but not at the scale of something that is truly global, as we are seeing here. Nevertheless, it still requires democratic participation. That is to say we all need to have a say in how recovery occurs. We all need to feel that we are involved in that process. We all need to feel that we bear responsibility for it. That is true of risk as well but it is very much true of recovery. That is something we all have to do. We will have to participate in, if it is to work, or in fact if it is something that is imposed by We know very well, that many top down solutions to disaster fail to reach the local level, or they simply don't work at the local level. bottom up is pretty important in all of this, because disasters have however large they are as their Theatre of operations, the local area, no matter how large they are. And that means that the recovery is a local issue. It's something that must occur locally. It must also occur nationally and internationally and regionally and so on. But if it doesn't occur locally, it merely matters, not what is happening, the other scales, because it means effectively it's not happening at all, if it's not happening locally.

Vivienne Parry 31:42

Fascinating, and I want to finish by asking something about emergency planning. Now, you've written the book about the recovery, but you've also written the book about emergency planning. And we will have our minds focus very shortly. Play now on the need to ensure in the future that we do indeed plan for all types of emergency. But of course, we'll be doing at a time when the public purse is very much depleted. How do you think we'll prepare for the future? And how will this change what we do?

David Alexander 32:20

First and foremost, emergency planning is as much an art as a science it really respects it's the art of organised common sense. Now, perhaps it is difficult. But if it's difficult, it's largely because it requires one to remember so many different factors. And currently, for example, trying to compile a code defied record of what's going on in COVID from an emergency planning point of view. And that involves looking across an enormously wide range of things that are happening, and circumstances. We're also in the age of cascading disasters, which means that disasters happen network effects and they have chain effects through society. And we have to recognise that we are networked societies. And therefore what goes on in one place can have substantial influences in other places in other sectors in other realms in many different ways. And this really to study and to incorporate in the planning. However, the first thing about planning is it does not have to be terribly expensive in as much as if it is organised common sense. Well, let's get down to and think through what could happen. And planning emergency planning is about what can we do with the resources we've got. Now what it does tend to do is to tell you, well, you ought to have more resources than they ought to be of this kind. Okay, well, that in its own right might be helpful. It might be useful, it might be important and so on. But the first thing we have to do when we sit down to do an emergency plan is to say, well, let's find out what resources we've got. And let's work out How to put them to best use. For example, one thing that wasn't done despite having had about 15 years in which to plan for this, there are specific reasons why I say that, despite that, not totally what's the inadequate stockpiling of resources to manage this emergency in the UK? If you're not going to have stockpiling there, you need agreements to be able to create, to produce and to distribute the equipment and the materials that need to be produced at a high rate in order to satisfy demand. We could indeed we did. Indeed, we should have known what the demand was for certain things such as respirators, masks and gowns and things like that. The next question is okay, if we haven't got them, where would we get them in a hurry in an emergency of a crisis situation and how would we get them? How are we managed to convert production can we not go to a club pretty insane look in the instance in the event that there's another pandemic, would you be willing to convert your production from clothing or whatever it is to producing downs, or something like that I even got Gucci in Florence, where I am present, as Tony turned from fashion production into producing face masks and things like that. So, in fact, a basic human ingenuity, but what it requires is programming and planning in order to get into gear and to be ready. It's all about readiness.

Vivienne Parry 35:35

That's so interesting. I mean, I was involved in the 2009 pandemic planning for swine flu. And then we we put in our orders for vaccines, and we put in our orders for antivirals. And we got hugely criticised for having spent too much money on procurement. When Of course, had it been as bad as we all anticipated at the beginning. There wouldn't have been that criticism. But I think these are things always looked at with a retro escape. And I think we will have to focus as you suggest far more on planning for the future. It's been such a pleasure having you here today. And indeed, Paul Ormerod as well.

And you've been listening to Coronavirus the whole story and 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 Cerys Bradley. Our guest today were professors David Alexander and Paul Ormerod. And 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 that are open to everyone. Join me soon for yet another fascinating set of insights on Coronavirus: The Whole Story

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