The Public Understands “R” but Does Not Understand End Goal

May 14, 2020
Coronavirus | Healthcare

As some confusion has set in over the UK Government’s changes to the lockdown measures and newest slogan, a new and complicated term is entering our coronavirus lexicon, adding to the many new terms and phrases we have adopted in the last months as ‘flatten the curve,’ ‘viral load,’ ‘PPE,’ ‘herd immunity,’ ‘antibody testing,’ and ‘contract tracing.’ The newest term is R. It refers to the rate of spread of a virus or disease.

In his speech on Sunday evening, Prime Minister Boris Johnson dedicated a few minutes explaining that how strict or loose the lockdown measures are will be determined by the R for coronavirus. If R is low, measures will continue to be relaxed. If R is high, especially if R is above 1, measures will be tightened. In measuring R and responding appropriately, the UK Government hopes to ‘control the virus.’

For such a critical reference point in determining the extent of the social distancing measures in the United Kingdom, it’s important for the public to understand this term. On Tuesday, we at Redfield & Wilton polled a representative sample of 1,500 respondents and asked them whether they understood this new term now used by the Prime Minister, other members of the Government and journalists. 76% of respondents said yes. 24% said no.

As a follow up, we provided respondents with our own best explanation of the term. 95% of respondents then said they understood the term.

After providing this explanation, we asked a few follow up questions to those who now understood the term. In particular, we asked respondents whether they thought ‘R’ could be measured at a quick enough rate to allow for the UK Government to adjust its policy at the right time, given that it usually takes a few days for those carrying the virus to contract symptoms. A plurality said no.

There were some partisan differences in responding to this question. A plurality of those who voted for the Conservatives in December 2019 (n = 631) said yes, whereas a majority of those who voted for Labour in December 2019 (n = 395) said no.

At the same time, others have pointed out how R can increase when the situation on the ground is  improving. The R in two different locations can differ, such that when the R in one place decreases, the overall R for all infected cases increases. We must be very careful in how this new term is broadly understood by the public.

Another issue involves the properties of R. R is an average. If 100 people infected with coronavirus infect another 100 people, R will always be 1 despite the various ways this can happen. If everyone in that group infects exactly 1 other person, R will be 1. If, instead, only 10 people within that group of 100 each infect 10 others, while the other 90 individuals infect no one, R will still be 1! Such differences raise critical questions about whether R serves as a useful measure.

Boris Johnson said in his Sunday evening speech that the R for the United Kingdom altogether was estimated at somewhere between 0.4 and 0.9. We asked respondents what they thought about this estimate for R and the current level of social-distancing measures.

Respondents were largely split as to whether the estimated R was at an acceptable level and the current social distancing measures strict enough or the estimated R was not low enough and the current social distancing measures had to be even stricter. Again, we see some partisan differences in this interpretation. Nevertheless, the number of members of the public thinking the measures are too loose is high, and this number does include nearly a third of respondents.

Nor does this response have much to do with the term R. In an earlier question, before asking respondents about R, we asked them about the partial relaxation of the lockdown measures. Here, too, respondents were split on whether the partial relaxation was about right or too much.

Thinking further along the lines of this term R, we asked respondents whether they thought it was indeed realistic to expect R could be reduced even further such that there would be few or no new cases of coronavirus sometime in the coming months. A small majority of respondents (50%) said this was an unrealistic expectation, while 40% deemed it realistic.

This question was about expectations within a certain timeline. What about overall strategy and purpose? What did respondents think was the end goal of the UK’s coronavirus strategy with respects to its rate of spread (another description for R)?

Here a majority of respondents seemed to contradict the central implication of ‘control the virus.’ As we said before, ‘control the virus’ implies that the UK will have to learn how to live with the virus––it’s threat will always hang over the population and would need to be ‘controlled.’ It does not quite imply eradication of the virus. Yet, in our Tuesday poll, a narrow majority of respondents appear to believe that the current end goal is towards there being no or few new cases of coronavirus on any given day, rather than that there would never be too many new cases of coronavirus on any given day, which would ‘protect the NHS.’

And what did those respondents think the end goal of the UK’s coronavirus strategy ought to be? Here, opinion shifted even further towards the former, with more than two-thirds of respondents preferring a strategy that comes closer towards eradication than towards ‘control.’

Public sentiment so far has been reportedly used by Number 10 to predict the extent to which people would understand, comply with and approve of the lockdown and other social distancing measures. However, it is not clear whether public sentiment has been used to determine what the public themselves think ought to be the optimal strategy to confront this pandemic. Instead, the Government has relied on epidemiological modellers, such as Neil Ferguson, for its decision-making. Hence, the introduction of ‘R’ into public discourse.

As Nassim Nicholas Taleb has noted, the UK Government has made use of “epidemiological models that were designed to show us roughly what happens when a preselected set of actions are made, and not what we should make happen, and how.” If the public continues to demand a certain outcome, it will not matter what the epidemiologists say is the optimal outcome. Rather, it is for the epidemiologists to explain how and at what costs certain outcomes can be achieved.

Looking at how some other countries have responded to the pandemic, respondents thought Australia had done particularly well. There, the numbers have stayed low, such that having no or few cases is indeed the end goal for the government. Germany, thanks to mass testing, masks, and other social distancing measures, has also been able to reduce overall numbers at a rapid rate and therefore receives high marks from the British public.

In these uncertain times, regardless of modelling, other countries provide the United Kingdom’s Government with plenty of different examples to determine its strategy. Going forward, it may be easier for the Government to explain which country or countries they seek to emulate and, if there are differences in strategy, to explain why these differences exist. Instead, the UK Government has sought to avoid comparisons with other countries, especially after the death toll in the UK surpassed every other nation in Europe.

More transparent explanations would go a long way further than sloganeering and references to modelling. The public, as we have shown, is quite capable of understanding what R and these models mean. Rather, it is the purpose and intended outcome of measures that remains obfuscated. “Stay Alert. Control the Virus. Save Lives” is more confusing to the public than “Stay Home. Protect the NHS. Save Lives” not because of the differences between Stay Home and Stay Alert, but the differences in the ultimate purpose implied by these slogans.

Data tables for this research can be found here. To find out more information about this research contact our research team. Redfield & Wilton Strategies is a member of the British Polling Council and abides by its rules.