Coronavirus can take many forms. At one extreme, the illness can be mild and fleeting. At the other, and relatively rarely, it can kill. Most commonly, it produces a short respiratory illness, sometimes followed by a pervasive lethargy that drags on for months.
So it is with countries. In some, the first wave of the pandemic was brief and caused few or no deaths. In one or two regions (such as Lombardy, in Italy), its impact was catastrophic. And in countries such as the UK and US, an early peak has been followed by a long plateau and sustained – though reduced – mortality.
National economies are also sick. Lockdown has sent even countries such as Hong Kong and New Zealand, whose responses to coronavirus were swift and effective, into recession. But their economic shocks will be short-lived compared with those in countries such as the UK, whose coronavirus-related economic problems are becoming chronic.
Between the prime minister’s announcement of a national lockdown on 23 March and the partial easing of this lockdown on 10 May, the UK’s GDP plummeted by a quarter. At the height of lockdown, 8.9 million workers were furloughed; another 2.6 million self-employed workers were claiming financial support from the government – more than one third of the total workforce. The government looks set to borrow £300 billion, at least 15% of GDP, this financial year – the highest level of borrowing since the second world war.
The government knows the economy cannot remain on life support. With every passing day, more businesses fold and more jobs are axed. The OECD has predicted that the UK’s economy is likely to suffer the worst damage from the coronavirus crisis of any major developed economy. Recession is already deep, and recovery will be protracted.
There are a handful of related reasons why Covid-19 hit the UK particularly hard. A decade of austerity had eroded public-sector infrastructure, leaving healthcare, social care and local authorities understaffed and under-equipped even before the pandemic struck. Hospitals lacked beds, ventilators, personal protective equipment (PPE) and front-line staff.
Public Health England, whose regional structures for responding to emergencies had been fragmented, had fewer staff, limited data and no mandate to lead the local response in England. These problems weakened England’s response to the crisis, and will prolong its convalescence in the months to come.
But the prescribed treatment for coronavirus was poorly matched to the disease. UK pandemic plans were too closely modelled on influenza. Compared to countries which contained the pandemic early, our lockdown was too late and half-hearted. England’s testing and tracing programme, with its allegedly “world-beating” technology, didn’t exist on the day of its launch. And ministers seemed more concerned with meeting political targets (such as number of tests posted out) than ensuring the system actually worked. Care homes – which we now know were potential lightning rods for viral transmission – were given neither adequate guidance nor sufficient PPE.
As a patient, England was stubborn and headstrong, initially ignoring medical advice from the World Health Organization and failing to join its European neighbours in procuring PPE, ventilators and laboratory supplies.
Other European countries are now opening up their economies with bold recovery packages. But in UK, for all the battle talk of viral retreat, the patient has rallied only temporarily because of a prolonged and costly lockdown. The secretary of state for health may soon declare the UK “cured” and sign the country back to work – especially since the chancellor has already announced an end to the furlough scheme. But a mass return to the workplace is likely to bring on a recurrence of symptoms.
We face a perilous situation because the goal of getting the UK’s economy back on track is out of step with public health. It’s not inconceivable that in the months to come, the working population will oscillate between being ordered to report to work (for economic reasons) and to stay at home (for public health ones). To square this circle, we need to acknowledge some realities.
There is growing evidence that social distancing may be impossible in small shops and offices, as well as many bars and restaurants, which may explain the prime minister’s recent enthusiasm for shortening the two-metre rule. Working for long periods, in close proximity to others and in poorly-ventilated buildings, are well-documented pre-conditions for workplace-related coronavirus outbreaks. Production lines, small retailers and a range of other service businesses could face prolonged shutdown.
Economists have become interested in face coverings as one way to ease the lockdown. One peer-reviewed paper found that even a home-made cloth mask could dramatically reduce the number of viral particles in the vicinity of the wearer. A new study (not yet peer reviewed) from the German Institute for Labour Economics has shown that face coverings, which became compulsory in Germany on 6 April, reduced the daily growth of coronavirus cases by 40%. Another newly published study has shown that on the crowded military ship USS Theodore Roosevelt, the odds of a sailor catching coronavirus was 0.3 if he wore a face covering, compared to the baseline odds of 1.0 if he did not.
Both the World Health Organization and UK government have changed their guidance on face coverings in the last fortnight. However, as we ease the lockdown and allow more businesses to open up again, the current recommendation to wear face coverings on public transport may not be sufficient to contain the spread of the SARS-CoV-2 virus. There are good health and economic arguments for requiring them to be worn in workplaces as well, unless employers can demonstrate that spacing and ventilation is adequate without them. As the number of new coronavirus cases in the UK continues to fall, we should monitor the patient carefully as it begins its rehabilitation.
•Trish Greenhalgh is Professor of Primary Care Health Sciences at the University of Oxford.
•Andrew Sentance is Senior Adviser with Cambridge Econometrics and former member of the Monetary Policy Committee of the Bank of England.