When will we get back to normal?

Image by s1n on Unsplash.

This article is a personal view. Although I work for a health charity, this is just my opinion.

Now that we have ‘tiers’ of restrictions on what daily behaviour is permissible, political debate appears to be going through a phase of fixation on when different areas will leave their current tier for a lower one. On one level this seems extraordinary: the direction of travel is for more areas to move up the tiers, as the new wave of the pandemic continues to escalate. But even looking beyond the immediate context, it’s a bit misleading and unhelpful: moving down the tiers is not, of itself, a route back to ‘normal’.

But a return to normality is what so many people understandably crave, and seems to be underlying much of the anxiety being expressed about the prospect of a long winter of social restrictions — whether that’s out of concern for the knock-on effects on people’s wellbeing, or a desire to question whether the emergency measures are the best course through the pandemic (or, in some cases, lunatic denial that an emergency response is necessary at all). For many, it seems to be difficult to accept that the emergency measures of the spring were not a one-off, and that we might have to do much the same again. But we at least have the new year to look forward to, and this seems to be framing thinking on the subject for many people, consciously or unconsciously, as surely 2021 will be when all this gets sorted out. Won’t it?

With all that in mind, this is uncomfortable to face up to: we shouldn’t expect much normality next year. For me, COVID-19 has meant an absence from spring 2020 onwards of live music, taking part in planned running events, going to football matches, and of course my commute to work. Everyone will have their own list of what has particularly been knocked out of their calendar by the pandemic. But I don’t expect to return to doing those things — certainly not at any scale — in 2021. Here’s why.

What is ‘normal’ and what happened to it?

This is true not just in terms of the mechanics of disease transmission, but in terms of human behaviour. Currently, you know that if you spend a couple of hours sitting next to someone in the cinema, or an hour on the train, or even 20 minutes while you grab a burger in a busy McDonald’s, you can be reasonably sure of this: if they’ve got coronavirus when you sit down, you’ll have it by the time you leave, and will be likely (though not certain) to develop a nasty short-term illness or, if you’re somewhat (but not massively) unlucky, a debilitating medium to long-term illness. Of course, all of those venues have taken steps to ensure you won’t be sitting directly next to a stranger, so it’s a hypothetical scenario for now. But to return to ‘normal’ we need to restore those real-life scenarios that we know are currently very risky.

That basic knowledge has driven rational behaviour changes on a large scale. Most people are not keen now to spend two hours next to a stranger in a cinema, or an hour on a busy train, or 20 minutes in a McDonald’s, even if they were able to. A ‘return to normal’ means, at its most basic, the return of a situation where an informed, rational person does feel confident to do those things. And really, formal rules and regulations are secondary to that: people will be moderating their behaviour to a substantial degree (though not universally — some people just don’t care, as has become evident) until that confidence returns. And it won’t return without good reason.

So, what might a scenario look like in which people feel confident about going about their regular day-to-day business without social distancing? The answer is that every part of the calculation must be addressed, ie the calculation that if you spend any substantial time in proximity to a stranger, there’s a meaningful chance you’ll come away with a nasty illness. That means giving people confidence that the stranger is unlikely to have the illness; that if they have it, they are less likely to pass the illness on; and also that if you are unlucky enough to get the illness, it won’t be all that nasty.

Taking the first part first, there are several practical routes to increasing people’s confidence that the stranger sitting next to them is unlikely to have a nasty illness that they might pass on. The first is to reduce the infection rate across the board, so that people know there aren’t all that many infected people knocking around in the first place. Realistically, that will mean reducing the infection level to below where it was in the summer of 2020, which was clearly not low enough to prevent the disease from flaring up again. A second plank in this approach is to reassure people that most of the people who are carrying the infection are stopping at home, and not wandering around to infect others: that is where a really effective test, trace and isolate programme becomes important, with high rates of contact tracing and high rates of compliance with instructions to isolate (with financial support available to ensure people in precarious situations can afford to self-isolate).

Taking the second element: a highly effective vaccine will mean that even if you are exposed to the coronavirus from the person sitting next to you, you won’t go on to develop COVID-19. But it’s not clear that any vaccine that becomes available will be that effective. It might just reduce the severity of symptoms. And maybe only for a short time. And it might not be made available to everyone anyway: healthy working-age adults who are not at an elevated risk of exposure are not certain to be given any new vaccine, and will certainly be at the back of the queue if they get it at all. But in principle, that’s the way to address that part of the calculation. And we should remember that the development of a vaccine is not a given: the current trials are, like any clinical trials, experiments; and experiments can always return a result showing that something doesn’t work, as well as a result showing it does.

And finally, the prospective nastiness of the disease can be reduced. Again, a vaccine should do this to some extent. Also, we have discovered more effective ways of treating COVID-19: it’s less likely to kill you now. Slightly. The more experience health systems across the world get with treating COVID-19, the better they will get at it — though this will be a slow, incremental process.

So, we can see what we need in order to return to normal, broadly speaking: a baseline low infection rate; a vaccine, the more effective the better; an effective test, trace and isolate (TT&I) programme; and improved treatments. The answer to the question ‘when will we get back to normal?’ depends on when each of these things is put in place.

There’s a further factor to keep in mind: the virus is seasonal. We don’t know the strength of this seasonal effect: did the infection level shoot up this year as soon as the weather got a bit colder, wetter and darker because of the seasonal effect, or is that correlation but not causation? It seems likely that the start of the second wave was driven as much as anything by students returning to the universities, with northern cities particularly badly affected because the infection level didn’t drop as low in those areas over the summer as it did in the south. But while the extent of the problem isn’t clear (and second waves are happening even in countries not noted for policy blunders of the sort we’ve seen here), we know that the seasons are currently working against us, and that won’t change until the spring — and of course, that will be true for all future years.

Possible chronologies

Perhaps we might see infection levels plateau over the winter and start to drop quite quickly in the spring. At that point, the TT&I service (whether improved from its current state or not, but hopefully so) is less likely to be overwhelmed, and more likely to have the capacity to trace everyone who needs to self-isolate.

In this scenario, we might be able to bear down heavily on the coronavirus over the summer, reducing infection levels well below what they were at their mid-2020 lowest.

But then what? Is that the point at which we can declare an end to social distancing and a return to normal? Well, obviously not. We still won’t know whether our progress is sustainable into the next winter. We still won’t know whether we can bring the students back in September without repeating the disaster of this year. Perhaps social distancing will be ended anyway at this point, and perhaps it will be a success — so, the very very best case we can see is for ‘normality’ returning in the second half of next year. But more likely we will proceed a bit more cautiously, bearing in mind how badly things went this year when we let our guard down late in the summer.

If we can make it into the autumn with social distancing in place and without the infection rate rising beyond a mild seasonal effect — and in particular, with death rates not particularly rising — then we might feel confident to declare success. Maybe Christmas 2021 would be a good time to allow an experimental end to social distancing rules, and see what happens — and it’s a sobering thought that at some point there will be a lifting of social distancing rules that will be essentially a real-life experiment. But if it goes well, then perhaps by the time the seasons turn favourable again in 2022, we can declare COVID-19 beaten.

Even in this scenario, bear in mind the permanent changes that will endure. Very likely the vaccination programme will have to be a rolling one, to keep people ‘topped up’ and also to roll out new and more effective vaccines that might become available in the future. Venue check-ins and a permanent TT&I scheme will be essential for taking anyone exposed to the coronavirus out of circulation quickly. Deep-cleaning regimes in entertainment venues and on public transport will probably persist, for reassurance as much as out of clinical necessity.

But it’s easy to see a more pessimistic version of this scenario. The vaccine (or vaccines) might be of very limited effectiveness — better than nothing, but offering only a modest impact. We might repeat previous mistakes: adherence to rules might get lower and lower; flare-ups might happen again as students are allowed to return; the TT&I programme might continue to be ineffective for the level of cases it is being asked to deal with. In this sort of scenario, we might effectively repeat the cycle of 2020–21, but at a reduced volume: infection levels rising and falling with the seasons, albeit not quite as bad as the last time. We might repeat that pattern in 2021–22, 2022–23, 2023–24… you get the idea.

We also need to recognise that even the more positive scenario above won’t work for everyone. Around three million people were classed as ‘clinically extremely vulnerable’ (a clumsy and condescending tag that many resent) because they are at particular risk of serious consequences from COVID-19, including death, because of pre-existing medical conditions. (Contrary to popular myth, people aged over 70 were never included in this group on a blanket basis.) The risks associated with catching COVID-19 will remain for this group, and so the calculation above will not have been fully addressed: the person sitting next to you might now be massively less likely to give you COVID-19, but the consequences if you’re really really unlucky will still be very grave. The prospect of a major chunk of the population effectively being permanently segregated is an appalling one, but it’s not clear what the route to avoiding this will be, other than a highly effective vaccine, at the upper end of what science can plausibly deliver.

We should also expect, even in the more optimistic scenario, for regional data to continue to be used, and a ‘tier’ system to continue throughout the period when restrictions are eased. In other words, some parts of the country will return to ‘normal’ later than others. In the English scheme, a new ‘tier zero’ indicating ‘low’ risk could well be added — but it would still be possible for areas to move up the scale rather than down. It may be that social distancing and rules such as masks in shops and on public transport will be brought in and out of use for periods of months, over numerous years.

And finally, the largest caveat of all to the above: it rests on national decision-makers behaving rationally, with a view to minimising the impact of the pandemic. The current Government does not have a track record of behaving in this way, but instead of acting with a view to maximising favourable media coverage of itself (though it is increasingly struggling to achieve even this). It may be tempted into overly optimistic action, such as declaring a national ‘VE Day’ over coronavirus and ending social distancing in one big bang when rates are low but our ability to keep them low is not yet certain (say, in August 2021 under the ‘optimistic’ scenario). It has also developed a strikingly poor track record on large logistical exercises, so any programme to vaccinate tens of millions of adults in Q1 2021 could well be a shambles. It may also try to vaccinate everyone even if the science doesn’t support it — while that might not be an actively bad thing in principle, we can expect it to generate more uncertainty, frustration and disappointment as it inevitably descends into a black farce on a national scale.

Conclusions

For another thing, we won’t ‘return’ to normal at all: I’ve avoided the phase ‘new normal’, but the truth is that this crisis will have an enduring effect on the country, and the world. New patterns of living, working and travelling will settle in over the long term. Exactly what they will be, what the consequences are, and how well policy-makers will respond to them are all further areas of enormous uncertainty.

But looking just into next year for the time being, we can say that if the first vaccine to become available proves a super-effective blockbuster that stops COVID-19 dead in its tracks (ie provides reliable and total protection against infection if you are exposed to the coronavirus), you can largely forget the above. If no vaccine emerges at all for several years, even the above will look ridiculously over-optimistic. It seems most likely that events will follow some course in the middle, and in that scenario we should be prepared for 2021 not to offer much in the way of ‘normality’ — but, perhaps, also allow ourselves to pin a modest amount of hope on 2022.

But if I could offer just one tip for 2021 about which I feel genuinely confident it would be this: in all seriousness, make sure you have a good stock of toilet paper ahead of January. But this isn’t an article about Brexit.

Working in public policy and writing here about politics, infrequently, in a purely personal capacity.

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