This week, the UK has stepped up its efforts to mitigate the impact of the coronavirus pandemic by recommending that the public avoid all “non-essential” contact and “unnecessary travel.” In addition to advising household isolation for suspected cases, the government has asked people to work from home where possible and suggested that mass gatherings will not be supported by emergency services. These measures follow Boris Johnson’s admission last Thursday (13th March) that coronavirus presents “the worst public health crisis for a generation” and “many more families are going to lose loved ones before their time.” The measures will be welcome to many who have criticised the lack of intervention to this point. However, these advisory measures still fall short of some of the more extensive “social distancing measures” being implemented in many countries in Europe and around the world. Indeed, at time of writing, a total of 22 European countries had enforced either partial or full school closures, and many have implemented mandatory closures and lockdowns.
As to the question of whether the UK should have followed suit earlier and implemented such, in Johnson’s words, “Draconian” measures, only time will tell. The lack of scientific certainty that accompanies novel infectious diseases and emergent pandemics necessarily means that there is no “right” course of action (hindsight notwithstanding). Pandemic policy is at best, the result of an educated, albeit highly-educated, guess of scientific advisors.
In my research on pandemic influenza policy, I found that an important role of scientific advisers was to communicate the scientific uncertainty surrounding the virus to policymakers, who would in turn communicate it to the public in “plausible” ways. Although pandemic viruses are, by nature, unpredictable, it meant that pandemic policy decisions were as much based on politics as they were on science. What has concerned me most about the UK’s response to the coronavirus pandemic so far is how eager the government have been to emphasise that their policy is based on “the science.”
One problem with Johnson’s rhetoric is that it seems to use the terms “science” and “scientific advice” interchangeably. For instance, in his March 13th speech, he argued at one point that “at all stages, we have been guided by the science, and we will do the right thing at the right time”. Yet, in the next sentence he states that “the scientific advice is that this [closing schools] could do more harm than good at this time.” Science, under normal circumstances, prides itself on its ability to provide objective answers to well defined problems, informed by well established, and often time consuming techniques of scientific research and peer-review. Scientific advice, as the social scientist Sheila Jasanoff has argued, “frequently fails to produce consensus over the use of science.” Scientific advisers have the unenviable task of translating and negotiating the technical knowledge of scientists and the political and economic needs of policymakers. And science is always much slower than policymaking, particularly when in a pandemic, as the need for a rapid response is greater than usual.
That banning public events will have “little effect” on the spread of coronavirus, and that closing schools “could do more harm than good” are bold statements that belie the inherent uncertainty of the available evidence. Despite their virological differences, pandemic flu is perhaps the best comparison we have for coronavirus, certainly from a policy perspective. Research on social distancing is far from conclusive, but does tend to contradict the government’s claim, so long as it is implemented in certain ways. For example, one review of literature on past influenza and SARS outbreaks found that when measures such as closing schools and banning public gatherings were implemented systematically, for long durations and, crucially, early in the outbreak, epidemic peaks and overall mortality were substantially reduced.
The government’s rationale for holding fire on more extensive and mandatory social distancing policies seems to be their belief that people will not be able to sustain compliance over the long-haul. The problem is that, as yet, they have not published the evidence upon which such assertions are made. I assume it partly derives from social science research on public beliefs and behaviours associated with past flu pandemics, where some studies have found that public compliance with preventative measures is far from guaranteed. There are however important caveats, including that intention to comply is linked to the public’s perception of the severity of the illness and of the reliability of government information. At present, it is hard to predict how severe the coronavirus pandemic will be and therefore to what extent the public will be willing to comply with preventative measures and for how long. A recent poll suggests that three-quarters of the UK public would be in favour of quarantining cities. What is clearer is that by not adequately communicating the scientific evidence base for policy, trust in the reliability of the government’s policy is likely to wane.
Ultimately the issue is one of responsibility. Handwashing, avoiding handshaking, sneezing or coughing into our hands, along with voluntary self- and household- isolation, are all critical components of a pandemic response. However, focusing on these individual behaviours in the absence of more interventionist social distancing measures puts too much responsibility literally, in the hands of the public, and too little in the hands of government.
Simon Williams is senior lecturer in the School of Management, Swansea University and Adjunct Assistant Professor in the Department of Medical Social Sciences, Northwestern University, Chicago. He has published on a range of public health issues, including the UK’s policy response to pandemic influenza.
Competing interests: None declared