Section 6: what policy to adopt now?
We apply a similar cost-benefit methodology to consider policy options for the level of restrictions applied in the UK over the next 3 months (July-September 2020). The options we consider fall under two broad headings:
  1. Carry on with only very limited easing of restrictions
  2. Move quickly to minimal lockdown (easing restrictions rapidly and relying on existing tracking of the cases/deaths to help prevent re-emergence of the virus)
We consider the following scenarios for the consequences of each policy for the evolution of COVID-19 deaths:
  1. Very limited easing of restrictions results in a continuing steady fall in the death rate over 13 weeks down to single figures per week at the end of three months. Each week deaths are assumed to be 0.7 x deaths of the previous week.
  2. For the policy of rapid easing of restrictions we consider three possible scenarios:
  1. Deaths continue to fall but at a significantly slower rate than with a slow and limited easing of lockdown; each week deaths are 0.9 x deaths of the previous week
  2. Deaths continue at the start-June level of 1,230 per week and do not fall further
  3. Deaths steadily increase back up to levels seen at the height of the UK pandemic; each week they are 15% higher than the week before.
The assumed paths of deaths under the 4 scenarios are shown in Table 4. In each case, we set the initial level of deaths in the week prior to each scenario at the last ONS recorded figure for UK deaths in the week to June 12th (1230 deaths).
The implied cost of the extra deaths from the easing policies (under scenarios i, ii. and iii) are shown towards the bottom of the table. These are the projected excess deaths under each easing scenario relative to the policy of continuing with the lockdown multiplied by the lost QALY per death and valued at £30,000 per QALY. These numbers are in £ billion and should be set against the estimated benefits from easing the lockdown.
Our low-end estimate of the (narrowly defined) cost of the March to early June lockdown was 10% of GDP – a figure of £200 billion. One might assume that a continuation of the lockdown over the next three months with only a very limited easing of restrictions generates a further cost of the same size. But the rapid easing of restrictions is unlikely to generate zero costs. Such costs may still be substantial, though likely far lower than a continuation of lockdown policies. A conservative estimate of the benefits of quickly easing the lockdown is that the £200 billion costs under lockdown might be half that size. This would generate a benefit from easing of £100 billion over three months to be set against any extra lives lost.
Based on that assumption under all scenarios the cost of easing restrictions is a small fraction of the benefits – the maximum cost of £14 billion should be set against an estimate of benefits of £100 billion. One would need to value QALYs at £220,000 - over 7 times the NICE guideline value of £30,000 to make a continuation of the lockdown warranted in the scenario of the greatest number of live years not lost with costs / QALY much higher for less live years saved. That runs counter to agreed UK policy on the economic viability of health interventions (20).