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:
- Carry on with only very limited easing of restrictions
- 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:
- 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.
- For the policy of rapid easing of restrictions we consider three
possible scenarios:
- 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
- Deaths continue at the start-June level of 1,230 per week and do not
fall further
- 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).