Thank you for your analysis, I wish that more were doing this kind of work. I'm a little confused and want to better understand how we can keep from making the same mistakes again.
I understand that the UK (and most other countries) went to the 'extreme', in one way or another. It seems to me that the measures (as a whole) had an effect, but can we differentiate those steps that worked and those that didn't? How could a country response, to get the biggest effect? What steps were implemented, but had little effect?
A second question is the ROI (return on investment), or the cost of implementing the different measures. What measures are effective, but the cost is too high (such as China style lockdown, especially following the initial wave, school closures)? Are there measures that give us the most effect for the least cost, or inconvenience (Such as working from home, for those who can)?
My last question is about implementation - how can a society implement public health measures, without mandates (How many people would wear seatbelts, if they didn't have to?)? How do we present the measurers in a way that makes sense for people and is easy for most people to follow?
Is there a way to differentiate the response, according to the structure of the country?
Thanks David. There are no straight forward answers here. Quantifying the effects of different measures is extremely difficult, as they are so context dependant (e.g. closing schools is less effective if adults are already largely working from home, because a large portion of the effect of closing schools is forcing adults to stay home to care for them).
We can make some general statements. Vaccination is by far the most effective intervention. Providing resources (access to testing, sick pay, PPE) has a better cost:benefit ratio than enforcing restrictions. High quality and intensive test, trace and isolation procedures are almost certainly the most effective restriction, but are most effective at lower levels of transmission. School closures are extremely harmful.
Measures must take into account local social and cultural norms. I do not think masks will ever be as widely accepted in Western nations as they are elsewhere in the world, because people simply do not like them. They are entitled to feel that way, and we must work with the populations we have, not the ones we think we should have.
Societal "buy in" to these interventions seems largely built on mutual trust - that is state trust of its citizens and vice versa. This is also associated with better pandemic outcomes (although one can argue about the direction of this effect).
If there was a straightforward and simple answer, I would think that we would see it. And I know that most are context dependent (I would expect that the effect of school closure would differ depending on the % of school age children in society, the amount of multi-generation households, population density etc.). This makes it very hard to deal with the inevitable comparisons between countries
I agree that the issue of 'by in' is very important, but trust is only part. I see another part in the individualism of society. What are we willing to do for others?
I think that trust can be divided into a number of parts, including trust in the 'science' and trust in the people.
'Science' is complicated, and is sometimes incorrect or misunderstood. We need a willingness to accept that the 'science' will develop over time, and a willingness to correct our the response according to new developments. So trust must be more in the process, than in the results themselves. And an understanding that some things are unknown, or have high degrees of uncertainty, but that we have to deal with the pandemic regardless.
I see the part of trust in people as being even more complicated, and including trust in people's capabilities and intentions. We have seen a lot of people disparaging the motivations of who planned or consulted, beyond simple issues of competence. It's one thing to say the people are making the wrong decision, it's another to say that they're making the wrong decision on purpose. We see this with the call to arrest those involved in planing the response (I'm not saying the there were no mistakes, it's obvious that there were, just the issue of arresting them for those mistakes).
This is why I stipulate that reviews of mistakes made during the pandemic should be clear to differentiate between honest errors (e.g. based on wrong information) and bad choices where better decisions should have been made.
Broadly agree with your analysis - but surely the delay in the first lockdown should be filed under ‘bad’. We had epidemiologists on TV saying we shouldn’t move fast as this might panic the public.
Plus the preparedness of the country for a pandemic (be it flu or coronavirus) was inadequate. We didn’t anticipate vaccines could be delivered so quickly - which would have justified an initial quick lockdown.
Thanks Thomas. I agree regarding the timing of the first restrictions, and also regarding the lack of preparation. Indeed, the biggest mistake was the lack of preparation which left few reasonable options on the table other than restricting social contacts across the board. I have spoken more about this here
May I ask why lockdown earlier is the go to option, when this was never on the cards for any pandemic planning prior to this one? Stopping flights from countries where cases were known would have made sense earlier. This tunnel vision to follow a communist regime, who are currently failing to contain covid in Shanghai for example, is highly concerning to me.
Thanks Lisa. Essentially because of poor planning and late recognition of how high cases were in the UK, we were left with no other tools which would have big enough effect to avert possible humanitarian crisis in health system overload. That of course does not mean the “lockdown” needed to look the way it did. I have discussed it at length here, as I share many of your concerns
The fact that lockdowns were not utilized in earlier pandemics (not true, but that's for another time) should not, by itself, be any factor in its use today.
Thank you for your analysis, I wish that more were doing this kind of work. I'm a little confused and want to better understand how we can keep from making the same mistakes again.
I understand that the UK (and most other countries) went to the 'extreme', in one way or another. It seems to me that the measures (as a whole) had an effect, but can we differentiate those steps that worked and those that didn't? How could a country response, to get the biggest effect? What steps were implemented, but had little effect?
A second question is the ROI (return on investment), or the cost of implementing the different measures. What measures are effective, but the cost is too high (such as China style lockdown, especially following the initial wave, school closures)? Are there measures that give us the most effect for the least cost, or inconvenience (Such as working from home, for those who can)?
My last question is about implementation - how can a society implement public health measures, without mandates (How many people would wear seatbelts, if they didn't have to?)? How do we present the measurers in a way that makes sense for people and is easy for most people to follow?
Is there a way to differentiate the response, according to the structure of the country?
Thanks David. There are no straight forward answers here. Quantifying the effects of different measures is extremely difficult, as they are so context dependant (e.g. closing schools is less effective if adults are already largely working from home, because a large portion of the effect of closing schools is forcing adults to stay home to care for them).
We can make some general statements. Vaccination is by far the most effective intervention. Providing resources (access to testing, sick pay, PPE) has a better cost:benefit ratio than enforcing restrictions. High quality and intensive test, trace and isolation procedures are almost certainly the most effective restriction, but are most effective at lower levels of transmission. School closures are extremely harmful.
Measures must take into account local social and cultural norms. I do not think masks will ever be as widely accepted in Western nations as they are elsewhere in the world, because people simply do not like them. They are entitled to feel that way, and we must work with the populations we have, not the ones we think we should have.
Societal "buy in" to these interventions seems largely built on mutual trust - that is state trust of its citizens and vice versa. This is also associated with better pandemic outcomes (although one can argue about the direction of this effect).
Here is a nice review of a study on this topic https://www.bmj.com/content/376/bmj.o292
If there was a straightforward and simple answer, I would think that we would see it. And I know that most are context dependent (I would expect that the effect of school closure would differ depending on the % of school age children in society, the amount of multi-generation households, population density etc.). This makes it very hard to deal with the inevitable comparisons between countries
I agree that the issue of 'by in' is very important, but trust is only part. I see another part in the individualism of society. What are we willing to do for others?
I think that trust can be divided into a number of parts, including trust in the 'science' and trust in the people.
'Science' is complicated, and is sometimes incorrect or misunderstood. We need a willingness to accept that the 'science' will develop over time, and a willingness to correct our the response according to new developments. So trust must be more in the process, than in the results themselves. And an understanding that some things are unknown, or have high degrees of uncertainty, but that we have to deal with the pandemic regardless.
I see the part of trust in people as being even more complicated, and including trust in people's capabilities and intentions. We have seen a lot of people disparaging the motivations of who planned or consulted, beyond simple issues of competence. It's one thing to say the people are making the wrong decision, it's another to say that they're making the wrong decision on purpose. We see this with the call to arrest those involved in planing the response (I'm not saying the there were no mistakes, it's obvious that there were, just the issue of arresting them for those mistakes).
Yes I agree.
This is why I stipulate that reviews of mistakes made during the pandemic should be clear to differentiate between honest errors (e.g. based on wrong information) and bad choices where better decisions should have been made.
I'm very grateful for you taking the time to research and write about one of the most important issue of our time. Keep it up!
Broadly agree with your analysis - but surely the delay in the first lockdown should be filed under ‘bad’. We had epidemiologists on TV saying we shouldn’t move fast as this might panic the public.
Plus the preparedness of the country for a pandemic (be it flu or coronavirus) was inadequate. We didn’t anticipate vaccines could be delivered so quickly - which would have justified an initial quick lockdown.
Thanks Thomas. I agree regarding the timing of the first restrictions, and also regarding the lack of preparation. Indeed, the biggest mistake was the lack of preparation which left few reasonable options on the table other than restricting social contacts across the board. I have spoken more about this here
https://alasdairmunro.substack.com/p/covid-restrictions-how-we-lost-our?r=1fhhmw&utm_medium=ios
May I ask why lockdown earlier is the go to option, when this was never on the cards for any pandemic planning prior to this one? Stopping flights from countries where cases were known would have made sense earlier. This tunnel vision to follow a communist regime, who are currently failing to contain covid in Shanghai for example, is highly concerning to me.
Thanks Lisa. Essentially because of poor planning and late recognition of how high cases were in the UK, we were left with no other tools which would have big enough effect to avert possible humanitarian crisis in health system overload. That of course does not mean the “lockdown” needed to look the way it did. I have discussed it at length here, as I share many of your concerns
https://alasdairmunro.substack.com/p/covid-restrictions-how-we-lost-our?r=1fhhmw&utm_medium=ios
The fact that lockdowns were not utilized in earlier pandemics (not true, but that's for another time) should not, by itself, be any factor in its use today.