Sebastian Walsh: We are asking the wrong questions about easing lockdown

Is it safe to re-open schools?” 

How can it be safe to re-open car show rooms when it’s not safe for me to see my family?” 

Questions like these have been on the front of several newspapers, asked repeatedly at the daily press briefings, and no doubt chewed over on many more Facebook pages and WhatsApp groups around the country. The answers from politicians and scientists alike always seem to be unsatisfactory and fail to bring people together. The reason for this lies not only with the answers given, but the fact that people are asking the wrong questions—for three fundamental reasons:

Firstly, the idea that it can ever be “safe” to do anything assumes either no risk, or that there is a level of risk which is universally acceptable. If, for example, the risk of a child becoming seriously unwell from covid-19 was 1 in 10,000, most would agree that the risk posed is minimal, that this is (on average) a very “safe” activity. But of course the risk to that one child is 100%, and for them it is categorically unsafe. 

Furthermore, it has never been “safe” to attend school. In the 2017-18 flu season, in which (unlike now) children were super-spreaders, 16 school children died. Were schools safe then? There has always been the risk of contracting an infectious disease, or of being injured on the journey to school, or of mental or physical harm caused by bullying. And these risks will always be present, though of course they can be managed or mitigated against. But despite the continued presence of these threats, it is not normal (outside of the current pandemic) to hear the safety of attending school being questioned. The same logic can be applied to any “normal” activity. At no point during the pandemic (or at any other time in history) has it been “safe” to go to a busy supermarket to buy groceries.

The second fundamental issue with questions like these, is an assumption that the status quo poses no risks. Of course this is not true. School closures have a detrimental affect on children’s education. Specifically, it has been suggested that school closures disproportionately affect children from deprived backgrounds who may have less access to learning resources, and whose parents may be less well equipped with the skills required to home school. This widening of socioeconomic and health inequalities will be seen more broadly from both the short-term impacts of lockdown, and the longer term economic impacts of recession. The longer the lockdown goes on, the greater the harm, and this relationship may be exponential rather than linear. This is, then, a complex risk assessment weighing the harms and benefits of lockdown, against the harms and benefits of easing restrictions.

Finally, these questions apply an individual risk perspective to measures which are designed through a population lens. In April, it was permitted for Mr Smith to buy groceries, for Dr Jones to send her kids to school, but not for Mrs Davies to see her grandchildren. This was not simply because the first two presented no risk to the individuals involved, or less risk than the third. But because, after holistically considering the risks and benefits of each of these activities to the whole of society, the first two were deemed necessary and the effect on the overall transmission rate acceptable, whilst the third was not. Instead, at this unprecedented time, the country has a budget of social interactions. If we spend some of them on allowing children to get back to school, we cannot afford to spend them on rock concerts, or seeing large groups of family – even if the direct risks to the individuals involved in each individual interaction are the same or less than those of the permitted activities. These are political decisions, partly informed by scientific understanding. 

So instead of asking “is it safe?”, we should be asking “weighing up the risks and benefits, and the opportunity cost, is this the right thing for us to be spending some of our social interaction budget on?” This may lead to much less catchy headlines, but a far more informed debate. And one that has a fighting chance of bringing people together at a time when national unity is needed more than ever.

Sebastian Walsh is a Public Health Specialty Registrar, East of England, Academic Clinical Fellow, University of Cambridge.

Contributor: Thanks to David Spiegelhalter, Chair, Winton Centre for Risk and Evidence Communication.

Competing interests: None declared.