Live free or die: the trade-offs in loosening Covid restrictions

As the government plans to end the Covid-19 restrictions, a fine line is developing between the trade-off and living with the pandemic.

Man walking past a COVID rainbow mural bearing the words 'Stay Alert, Save Lives'

As the UK lifts all restrictions due to Covid-19, for some, freedom day could not have come too soon. Others worry about the quick lifting of restrictions, with accusations of the government having abandoned science, and remind us that Covid is not done with us. These opposing viewpoints often represent reasoned and nuanced arguments, trading off (for example) the costs of Covid restrictions on personal liberty and its consequent toll on mental health against the worry that a quick lifting will cause a surge and once again overwhelm the NHS and further delay non-Covid treatment. However, not surprisingly, some of the debate on social media has been polarised and that, unfortunately, includes unscientific name-calling between eminent scientific figures.

What is the Covid-19 divide?

It is worth summarising where the divide lies. At the risk of simplification there are three schools of thought: those who suggest we should completely suppress the disease (the so-called zero Covid school), others who have argued for restrictions only for the vulnerable while letting the rest of the population live normally (articulated in the so-called Great Barrington declaration) and a third group (that includes one-time proponents of the zero Covid strategy) that suggests Covid is no longer the dangerous disease it was thanks to vaccines and medication and while some surveillance remains essential, one should treat it like other infections rather than let it cause major disruptions any more. While they all look at the same data and have recourse to the same information, the disagreement arises in how they interpret the data as well as the (often implicit) way they put weight to the harm caused by Covid versus that from Covid suppressing measures.

Governments cannot just ‘follow the science’?

This can genuinely put policymakers in a bind even when they want to follow scientific advice. That said, there is no doubt, governments do ignore scientific advice.

Many argue that England’s full re-opening was rushed and driven more by political compulsions than based on science. But ‘follow the science’ is not a clearly laid out plan that governments can follow blindly. While it makes for a good slogan, it is far from clear what it means.

When there are scientific disagreements, it is not clear whose scientific advice should be followed. Even if we are to go with the majority scientific opinion (when there is one), how scientific advice translates into a political decision involves weighing the costs and benefits of different types of interventions. For example, there may be a consensus among public health experts that a stringent lockdown would be best for suppression of Covid but that may affect not only the economy but treatment of other diseases, as indeed seems to be the case with (for example) delayed diagnosis and treatment of cancer during the lockdown. Thus, even when scientific consensus exists on issues, each policy comes with trade-offs and involves weighing different interests. Thus, there is no simple way to follow science. Even a seemingly clear-cut directive such as ‘vaccinate everyone’ involves decisions: who to prioritise, whether to go for boosters when other countries are struggling with their first dose, how to handle key workers who refuse vaccination. And this is after abstracting for more contentious issues such as the vaccination of small children or the necessity of fourth doses. For Covid, ‘follow the science’ has been even more problematic because of the evolving nature of scientific evidence in the face of a novel disease, but in the best of times ‘follow the science’ is not the silver bullet one imagines it to be.

So should we be opening up?

As one can imagine, there is no simple answer to this as one cannot ‘just follow the science’. However, given the mental health and other tolls of the restrictions along with the impact on the economy, a move towards opening up was inevitable. Further, the only way to judge how the disease progresses is to open up, as recently argued in a paper on optimal lockdowns. Several papers, including a recent one, links the level of lockdown with factors related to how one values death due to Covid i.e. the trade-off between health and wealth. Many are concerned that an opening up that also removes the self-isolation requirement is premature. Others are concerned around the distributional impact. While a vast number of people will continue to voluntarily self-isolate, others may not be able to afford to do so.

Opening up or Levelling up?

All of these are important questions but miss more fundamental issues, whether it be the longer-term framework for pandemic planning or ways to reduce the glaring inequalities in society which were exposed by the disease. These are some of the important questions citizens should be challenging the government on, rather than focusing too much on whether the lifting of lockdowns was a shade too early.

The issue of the unequal impact of Covid has often been muddied. Government messaging around Covid has tried to suggest that the virus does not discriminate, both the prince and the pauper can be infected. But this is far from true, Covid outcomes differ and deprivation plays a role. Similarly, the impact of Covid restrictions has been far from equal-whether on educational outcomes, employment or mental and physical health. Indeed, this Covid does not discriminate mantra brings to mind Animal Farm: ‘all animals are equal but some are more equal than others’.

As we enter a ‘post restrictions’ phase, the first big challenge is how one deals with a future pandemic (including new variants of Covid) without either letting the disease run wild or containing through draconian lockdowns. This needs a true harnessing of the scientific knowledge we have gained with logistic expertise so that the trade-off between life and liberty is not so stark. The second is in creating the opportunities that enable individuals and families to escape from a cycle of underachievement. Serious work needs to go into this if ‘levelling up’ is to become more than a slogan. Questions around these two substantive challenges need to take centre stage and become part of how we hold the current and future governments accountable, while peering cautiously at a ‘new normal’.