Voluntary, unenforced quarantine isn’t enough for high-Covid19 countries

President Trump likes to congratulate himself on having closed the border to China in early February as an effective preventative measure against Covid-19. That he should do so isn’t too surprising: congratulating himself is his default setting and his administration has routinely adopted an anti-China stance, as part of Trump’s efforts to rebalance the trade deficit between the two countries.

Even so, while the measure was hardly sufficient, it was at least a step in the right direction. In truth, it didn’t prove effective because there were too many exemptions which the system couldn’t keep track of, and because the virus also found other ways in via alternative countries. Even so, it may well have been a significant factor in the first wave in the US developing around two weeks later than that in Europe.

For once though, Trump’s instincts were right, albeit that they chimed with his pre-existing prejudices: strongly policed international borders are essential if all the domestic efforts in combating the virus are not to be undermined by importing cases from countries which lack either the will or the capability to fight it.

Which brings us to the question the government should be asking – and indeed, which the public and media should be asking: why has the UK government not implemented outright bans on countries with high levels of infections?

At the moment, anyone entering the UK from outside the Common Travel Area (essentially, the British Isles), is supposed to self-quarantine for 14 days unless they’ve come from a country on the ‘safe’ list. However, whether people do or not is largely down to their personal sense of responsibility. The quarantine measures are not being closely policed and with no organised secure transport system between the international arrivals points and people’s places of quarantine, there are great big holes in the plan anyway.

That seems far too lax an approach when the consequences of importing new cases could be so severe and the costs so high – all the more so when the two of the prime reasons why the pandemic has become so bad in some countries are a political and social culture of personal liberty and a downplaying of the seriousness (and the transmissability) of the disease.

Perhaps to the surprise of some, Britain proved very willing to abide the lockdown restrictions when they came in in March. The result of that lockdown was a reduction in the number of identified new cases from a peak of around 5000 per day in mid-April to about 600 per day now. In truth, the real peak will almost certainly have been considerably higher because testing capacity three months ago was a lot lower than it is now and many more cases will have gone undetected then.

The UK’s current daily rate translates to around 9.0 new cases per day, per million population – which is perhaps the most useful comparable international metric. Is that low enough to justify the scale and speed of re-opening? The simple answer is that no-one knows. The government’s senior professional advisors throughout the pandemic – Prof Chris Whitty and Sir Patrick Valance – were notably cautious about it in evidence to the Lords yesterday. Some other countries reported lower rates before re-opening and have since suffered a serious second outbreak: Israel, for example, whose new infections fell from a peak of 68 cases per million per day to just 1.5 in late May, before taking off again to such an extent that the 7-day average hit 175 yesterday – the equivalent of close to 12,000 daily new cases in the UK.

However, with the right data and an ability to respond quickly to local outbreaks, the government in London is hoping it can keep a lid on the virus without the severe restrictions of the Spring. And dealing with those local outbreaks is key. The 9.0 per million per day figure is a little misleading when it can vary from zero in some authorities to 146 in Leicester, as last week.

But that’s where the international dimension comes in. Test, track, trace and respond is only effective within a closed system. Once you start sprinkling new cases from outside, the controls break down – which is the theory behind quarantining travellers from at-risk countries. The question is whether the practice can be relied upon to match the theory, to such an extent that the costs in lives and pounds should it fail are an acceptable risk. I don’t think it can.

But if it can’t be relied upon, what can we do? There are really only two options: either to place travellers from countries with a serious outbreak in a hard quarantine, or to ban them outright – although the two may in practice be much the same thing.

That’s the road that New Zealand, for example, has gone down. Its policy is to bar from entry almost all foreigners and to require those who can come to isolate for 14 days in a “managed isolation facility” before being able to properly enter the country. Even then, one blip four weeks ago enabled the virus to get back into circulation again after the country was briefly Covid19-free. It has not yet been re-contained.

(As an aside, New Zealand has a general election two months tomorrow. At the start of the year – before the Covid-19 pandemic – Labour, which leads the current minority government there, was neck-and-neck with the conservative National Party. Jacinda Adern’s handling of the Covid-19 crisis has transformed that, with Labour not having polled below 50% since March and with five of the last six polls giving Labour a 25-30% lead. Such are the chances that Donald Trump missed.)

Britain is not where New Zealand is but it’s doing far better than some other countries. For example, here’s a selection, using the same metric of daily cases (7 day average) per million of population:

• UK 9.0
• Brazil 164.2
• Canada 9.6
• France 9.1
• Germany 4.7
• Greece 3.2
• Italy 3.1
• Japan 3.1
• New Zealand 0.2
• South Africa 209.4
• Spain 19.4
• USA 204.0 (Florida: 552.1; Nevada: 342.5; New York: 47.0)

If the UK government has decided that it’s tolerable to live with a low background rate of Covid-19, and that it can manage that level through large-scale testing, tracking and targeted action, then there’s a reasonable case to allow free travel to other countries (or to other regions within countries) with a similar or lower rate of infection. The flip-side, however, must be more stringent restrictions on countries with more severe outbreaks – and the greater the rate of infection, the more stringent the restrictions need to be.

I would suggest that the government should introduce a three-tier, or traffic light system:

• – Green, for countries with less than (say) a rate of below 20: free movement.
• – Amber, for intermediate countries with a rate of (say) 20-50: self-isolation at entry/return to UK, as at present for countries not on the ‘safe’ list.
• – Red, for countries with rates of (say) 50+: no entry other than in exceptional cases – and those cases to isolate for 14 days at secure locations.

In practice, the rules would need to be a little more complex than that. You couldn’t have on-off cases changing by the day for borderline countries, for example. But those details could be worked out without affecting the underlying principle.

No doubt there would be a frosty reaction from those countries on which a ban was placed, most obviously from the USA, but the health of the government’s own country has to come first. Besides, it would be sensible – though perhaps not diplomatically possible – to try to get the EU to buy into the same policy, not least because the Republic of Ireland has a foot in both camps with its membership of the CTA.

The cost of the Covid-19 outbreak so far has been several hundred billions of pounds to the government, perhaps 60,000 lives and around a million redundancies (though that figure probably understates the true reality because of the government’s support for a great many jobs that are no longer viable), half a year’s schooling to the country’s children, and a great deal of anguish to millions, in so many different ways. Surely almost anything is preferable to going through that again?

David Herdson