It has been widely acknowledged that, while clinically justified, the UK’s Covid-19 lockdown is causing substantial disruption to people’s lives.
On the economic front, millions have already been made unemployed or are likely to become so in the coming weeks and months. Businesses are running out of cash, with more and more likely to cease operations the longer the lockdown continues.
On education, 99% of school children are losing essential time in the classroom. There is strong evidence showing that the impact is not equal: pupils from more disadvantaged backgrounds are less likely to be receiving instruction at home.
On the social front, the pathologies of loneliness, depression, anxiety and domestic violence are becoming increasingly widespread.
The UK has now passed the peak of infections, but is not out of the danger zone. There are still thousands more confirmed cases per day, indicating continuing widespread community incidence of the virus. The next step will be to find a way out of the current restrictions while preventing the virus from once again taking hold and potentially overwhelming the healthcare system. Such a situation would lead to calls for an even more damaging second lockdown.
Preventing this scenario will take a suite of measures, including continuing physical distance and hygiene, shielding the most vulnerable, “test, trace and quarantine” measures, border controls, mask wearing, expanded hospital capacity and improved treatment, and eventually vaccines.
But it will also take innovative solutions, rather than binary thinking.
In a new paper out this week, the Adam Smith Institute backs the “Four Days On, Ten Days Off” approach developed by the Weizmann Institute as an innovative solution for the public and private sector.
This model has been developed by Professor Uri Alon and Professor Ron Milo in collaboration with academic economists and public health and political policy experts.
While the modelling behind the proposal is complex, the conclusion is relatively simple. It works like this:
The population should be divided into two groups of households. Each group should work or attend school for four days, Monday through Thursday, and then enter a ten-day period off. Each group works or attends school while the other group is off. Individuals in the two groups do not interact with each other. This cycle repeats.
This approach hijacks the latency period of Covid-19 for our benefit. The evidence suggests that infected people secrete the virus between approximately days five and ten of the disease, and then become non-infectious even though they may still be unwell. This means that if someone gets the virus on their first day at work, they would largely not be infectious until they are back quarantining at home, and when they go back to work (on day 15 the second cycle) they will have passed the infectious stage.
Restarting the school system is central, because as long as children are at home many parents cannot go to work. The schools should enter a routine where half of students study Monday-Thursday and the other half in the following Monday-Thursday. This would have the added benefit of enabling smaller classes, which facilitate better physical distancing.
A cyclical model is being adopted by schools in Austria, where pupils will be split into two groups, one attending Monday to Wednesday and the other Thursday to Friday, then swapping the following week. Denmark too has reopened primary schools with split classes, and Germany plans to do the same.
This continued four-ten social distancing, if adopted across workplaces too, provides other advantages, such as limiting the numbers of people on public transport. It will of course be up to their operations managers to establish the most effective site-specific solutions, but the basic rota principle remains.
The benefit of two non-overlapping groups is that complex and longer-term operations such as experiments and fabrication can be conducted sequentially by the two teams. In the ten-day lockdown time, workers and students will be able to contribute to split-time activities from home.
A major advantage of this idea that it would allow us to escape from our current binary of lockdown or no lockdown. The number of working and off days can be varied depending on the latest epidemiological evidence. If there is an increased transmission rate, we could work two days; if there is a lower rate, we could work six in the two-week period.
It is possible for people who are able to work from home to continue to do so, while their children are educated four days a week in the physical environment of school and given instructions from their teachers for activities for the other six school days. This would be a substantial improvement on the status quo of zero days per week of schooling.
It is expected that essential workers would continue as currently. Selected sectors with low risk of infection can also work continuously. All non-essential workers would join their household group and work only during the designated four days per fortnight.
Four Days On, Ten Days Off would be in addition to other measures to limit transition and ensure that the health service is not overwhelmed, not a replacement for them. Hand washing and mask wearing should remain, and efforts towards “test, trace and quarantine” measures (such as the government’s app) should continue.
Nonetheless, intermittent work cycles should be an important extra pillar of the exit strategy. They are easy to explain and enforce, and the adaptive steps create trust and certainty because adaptation requires and is based on data from testing. This is a very important psychological driver and vital for our anxious population. The idea of local arrangements is also important – it encourages buy-in and team building within organisations as well as neighbourhoods.
This virus may have put us in a tough spot, but we can overcome the challenge. The time is now for smart solutions.
Professor Keith Willison, Institute of Chemical Biology, Imperial College London.
