here are no silver bullets, clever models or easy answers for how to control the coronavirus. But neither is it rocket science. Governments have three choices in how they respond. The first and most difficult path is to contain the virus through a programme of mass testing, contact tracing and isolating. This requires a huge effort: building a large infrastructure to monitor cases of the virus and identify hotspots, ensuring this system runs efficiently, providing adequate PPE to everyone who needs it, and deploying border controls to vet who is entering the country. The second path is far simpler. It involves slowing the spread of the virus by using timed cycles of lockdown and release, with the government issuing guidance on how much social distancing is required. But the side effects of this path are very costly: it risks wrecking the economy, straining health and social care systems, and creating social unrest. The third and easiest path available to governments is simply to do nothing. The virus sweeps across the population, the economy remains open and whoever makes it through is lucky to still be alive. It’s almost impossible to decipher which path the UK government has chosen. Over the past months, its response has vacillated from the third approach to the second and, more recently, to the first. While Boris Johnson’s address on 10 May made clear he has recognised the dire position in which the UK finds itself, the government’s confusing new advice – that people should “stay alert” to the virus, work from home when possible, but go to work if working from home isn’t possible – exemplified the mixed messages coming from the government. The confusion turns on an internal struggle between two opposing camps. The first seems to think the government should attempt to get over the worst of the pandemic by allowing the virus to spread through the population, albeit at a slower pace to ease the strain on the NHS, and by creating more hospital and mortuary capacity to cope with a spike in deaths. The second camp wants to drive down the number of coronavirus cases and reduce the rate of infection – or R – to as close to zero as possible. It recognises the uniquely dangerous nature of this virus, and the emerging evidence that it can cause long-term health complications in survivors and that immunity may only be temporary. These are clearly two different goals, with two different strategies behind them. The confused messaging from the government is a worrying illustration of the lack of consensus on which of these objectives and strategies should be adopted, both within Westminster and across the four nations. But this debate misses a more fundamental point: containment (the first path) is the best strategy for public health, the economy and society. The decision in early March to shift from containing to mitigating the virus was disastrous on all three of these fronts. By the time the government introduced a lockdown, the number of coronavirus cases had already increased exponentially, making prolonged quarantine necessary. Now, the key challenge facing the government is to replace this lockdown with a package of public health interventions involving mass testing, surveillance and real-time data to identify clusters of the virus and quarantine those who are infected. This will mean providing adequate PPE to those who need it, enforcing border controls and instigating a phased relaxation of social-distancing measures. Rather than putting everyone under lockdown, these measures would give health authorities information about the spread of the virus, allowing them to identify hotspots and target interventions where they’re needed. Without these measures in place, the past seven weeks of lockdown will have been completely pointless. As quarantine measures are lifted, the virus will continue to spread, the number of daily cases will rise and a second peak will become inevitable. Everyone agrees that we need to get out of the lockdown as soon as possible, but doing so will require massive investment in public health infrastructure. Countries such as South Korea, Hong Kong, Taiwan, New Zealand and Australia have already built this capacity, allowing them to ease measures while retaining control over the virus and identifying who has it, who has had it and who could be exposed to it. The social costs of lockdown are severe. Seven weeks in, we’ve witnessed the increased use of food banks, delayed care for those needing NHS services, the closure of schools, rising cases of domestic abuse and bankruptcy among small-business owners. So why has the government made such little progress in building the public health infrastructure necessary to control the virus and ease the lockdown? You could be forgiven for thinking that the lockdown was simply a way to reassure the public that the government was “doing something”. We need to be asking: what measures has the government put in place to ensure we’re in a better position to release the lockdown and prevent a second wave? Everyone wants to know when the lockdown will end and life will go back to “normal”. The better question to ask is how we ease lockdown measures in the coming months and years while preventing a second wave of infections and keeping R well below one. There are a number of endings to this story. First, an accessible and affordable vaccine could become available within the next 18 months; second, the government could embark on a resource-intensive and gruelling campaign to eliminate the virus, particularly if emerging data proves coronavirus is as dangerous as diseases such as smallpox and polio; or third, antiviral therapies could become available to treat Covid-19 that make it a mild illness, so the population would gradually and safely build up natural herd immunity. But on our current path we seem destined for a disastrous ending. Lifting lockdown without the public health infrastructure in place to contain the virus will allow Covid-19 to spread through the population unchecked. The result could be a Darwinian culling of the elderly and vulnerable, and an individual gamble for those exposed to the virus. This should be avoided at all costs. • Devi Sridhar is chair of global public health at the University of Edinburgh