A Coventry Moment
There is a story that Winston Churchill let Coventry burn under German
bombing in order to protect the secret that the Nazi Enigma codes had
been broken. He made a hard decision to spend lives now, in order to
promote the greater good later.
On TV recently we have seen Boris Johnston looking Churchillian, having
apparently made a similar sort of decision about the coronavirus
epidemic - spending 400,000 British lives now in order to gain some
future advantage.
The problem is that we don't know what that advantage is. It all seems a
bit nebulous.
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At the start of the epidemic, when we thought that it would prove
impossible to stop the infection, the policy of delay made some sense -
spread the peak to decrease maximum hospital load and thereby save lives.
That 400,000 or so (a million in real numbers) people would die was
unfortunate, but inevitable. There was nothing we could do about it.
But then the Chinese stopped their epidemic, showing that there was no
need for 400,000 people to die, and everything changed. Except the policy.
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Herd immunity is just what happens if you don't do anything to stop any
disease which leaves the patient immune after it has run its course. It
is at best a distraction.
One possible line of Government thinking is that after we implement
strong containment we would then have a still-vulnerable population,
giving rise to the fear that we might have to continue strict measures
indefinitely.
Possible, but what measures? Strict universal isolation is almost
certainly not necessary once the disease is under control, though strict
attention to detail will still be necessary.
Proper control of entry to the country with quarantine where appropriate
is the major continuing need; but other countries will be doing
something similar, and international travel will not be easy for years
anyway.
Better social distancing - the elbow or foot tap, enlarging personal
space, avoiding contact where possible; protective measures like
handwashing and handrub, masks and respirators, perhaps gloves and
goggles; widespread testing and diligent contact tracing once the
epidemic is under control (with short-term but mandatory
isolation/quarantine for those testing positive) are probably all that
is needed.
But we can follow the Chinese example as they relax controls, and limit
measures here to those which are necessary and which work.
Medium term, if people get "isolation fatigue", and the disease spreads?
We would still be better off if we implement strict confinement now. We
would have had time to make a billion masks, time to prepare a hundred
million tests, time to open hospital beds, time to get the needed
equipment - and most of all time to research the disease.
For instance, how much would closing schools help? To answer that we
need to know whether and to what extent children get the disease in a
very mild form and pass it on, or do they just not get it at all - and
we do not know the answer to that question.
How long does the virus stay active on various surfaces? We don't know.
What are the most important secondary and minor routes of infection? We
don't know.
Why are older people more likely to die, and can anything be done to
prevent this? We don't know.
How do we immunise the population? We don't know.
How do we cure the disease? We don't know.
But we do know how to stop it.
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Mr Johnston is not Winston Churchill. Churchill himself never faced the
"Coventry Dilemma", that was just one of many similar teaching stories
used to emphasise the need for secrecy at Bletchley Park. It wasn't
real. Many hard life-and-death balancing decisions were made by
Churchill during the war, but the "Coventry Dilemma" was not one of them.
As for COVID-19, there is no sacrifice here to be made for the greater
good. Any sacrifice of lives would just be an unconscionable waste,
somewhere between manslaughter with reckless disregard for life and
pointless mass murder. There is no greater good to be had.
We can kill the disease. We do not need to kill the population, or
400,000 or a million of it.
The Chinese have effectively killed the disease in China. Pretty soon
they will be thinking about quarantining people entering the country, if
they aren't already. That is the kind of turnaround we should be trying for.
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As an aside, the real hard decision would not have been to focus efforts
on amelioration at the cost of many lives, for some greater eventual
good; but instead to implement strong confinement on ethical grounds,
even if we thought it couldn't work.
But we know strong containment can work. It has been done. It worked.
There is no obvious downside to doing it.
There is no hard decision to make. There is no Coventry Moment. There
never has been.
Peter Fairbrother
