March 14, 2020

expert comment on UK government response to COVID-19

Comments on UK government’s response to COVID-19 outbreak.

Prof Brendan Wren, Professor of Microbial Pathogenesis, London School of Hygiene & Tropical Medicine, said:

“There may be some positive elements within this difficult situation that it’s important we don’t forget – in particular, the excellent hygiene advice that is permeating into the population will most likely mean that there will be less other infectious diseases around (e.g. influenza, Tb and gastrointestinal diseases). Better hygiene may also mean that those unfortunate to get infected with the coronavirus may have a low infectious dose and go on to have mild symptoms.

“There is an argument for, in a way, letting nature run its course, but in a controlled manner (and the government actions may allow such control) such that we naturally mass vaccinate the population. This will be important for future coronavirus epidemics with a higher fatality case that we don’t have a naïve population with no protection. The government advice at the moment is correct that the infection needs to be controlled as far as possible to prevent a mass outbreak overwhelming our health facilities.

”The legacy of COVID-19 may be improved hygiene and less transmission of infectious disease in the long term. The negative aspect is that mass panic impinges on all our daily lives with the knock on global economic effects. Keep calm and keep hand washing.”

Dr Ann Kelly, Reader in Global Health, King’s College London, said:

“I believe the government is following appropriate measures according to the current stage UK outbreak. The decision to cancel mass events does not constitute a U-turn, but is in accordance with the government’s plans to escalate the response according to emerging epidemiological data. More strict social distancing measures have always been on the cards, it merely a matter of when they are introduced.”

Professor Alan McNally, Professor in Microbial Evolutionary Genomics at the University of Birmingham, said:

“I believe that mass gatherings could and should have been banned earlier. I can’t say if it’s a U-turn as only the government will know if this was the next phase of their plan or not. However the lack of action last week did receive robust and just criticism and the decision of organisations such as football and rugby authorities to cancel sporting fixtures has rather taken the decision out of the governments hands.

“Social distancing is required urgently, unless the government can provide data and models that counter that argument. Social distancing has worked in China, Singapore and other countries. However it is also important to note that this alone will not be sufficient. The decision to abandon community testing is I believe ill advised, and there needs to be combination of social distancing and extensive testing followed by quarantine of infected individuals to contain the epidemic. That quarantine should not be at home, where we will see large levels of familial transmission but in dedicated quarantine facilities.”

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

“The evidence base used to make the UK decisions draws on the international evidence base, but importantly has a specific focus on the UK context. There are good reasons for that. At this current time, I think the Uk response is appropriate.

“Do not underestimate the impact of social and behavioural responses in infectious disease outbreaks. Really, the epidemiology is a little easier. Judging how people will respond individually and en masse is much harder, and unlike epidemiology, social science doesn’t have a straightforward ‘number’ or easily digestible soundbite result for people to assess. Thus, in my view, behavioural scientists are the most underrated people around, and are often mocked because they provide perceived soft wavy answers where soundbites demand things like death rates and p values.

“So, the evidence base around how people respond in urgent situations is difficult to assess. Here in the UK, it’s partly focused on 2009 swine flu pandemic (since we as a country don’t have many opportunities for real live practice) though it is regularly reviewed in between outbreaks.  

“The UK population by and large have significant control over their daily life. You choose when to pop out for a pint of milk, or if you’re off to the concert. Significant disruptions greatly reduce that control and thus need high population acceptance and compliance. You won’t get that over a long period of time. As a taster for what’s to come, people already can’t be trusted to buy toilet-roll properly, so how about long-term compliance when significant levels of freedom and control are removed, when fun is temporarily cancelled and there’s a need to stay indoors for long periods of time?  How will compliance be then? The evidence base, as we have it right now, suggests it will decline.  

“Thus, when do you introduce shutdown measures? Not too early. We are still very early in the outbreak. So, for as short a time as possible, at some point in the coming weeks.

“It’s understandable if the perceived lack of a response appears to be counter-intuitive, when there’s opportunities to “DO SOMETHING BIGGER!”. But, counter-intuitive means its harder to get your head around, not that it’s wrong.

So for example, other European countries policies, are they

a) evidence-driven in their own local context

or b) politically (and thus knee-jerk) driven?

“I genuinely don’t know the answer to that. What evidence are Norway, Ireland, Italy and the others using? It’s quite hard to find (it shouldn’t be). So, what is being considered elsewhere, and is it specific to their context, and why would it be relevant in the UK context?

“The UK approach is driven by evidence that is appropriate for the local context. And what other countries are doing with their populations, with subtle or markedly different cultural and social expectations and habits, does not mean the UK is doing the wrong thing. “They’re-doing-something-different” is in itself not a good reason for doing the same here. Decision-making has to be more nuanced than that. Context-specific evidence. That’s what we need. We are certainly not China, or Iran. We’re not even Italy or Ireland. We can all learn from each other, but don’t be surprised by the presence of locally-driven responses that are quite different.

“More stringent interventions (shutdowns etc) will come, potentially very soon. We know that. We’ve been told that. But, even though it might be counter-intuitive, going-gung-ho right now does not appear to be the best response. Many people are vocal, saying gung-ho should be the UK response. The usual justification that comes with that is “because they’re doing it over there”.

“That’s not providing the evidence base that supports those views. So if you disagree with the UK response then, as we sometimes say, ‘citations required’. I think a plain English summary from the Department of Health around decision-making and the evidence it is using would be helpful in guiding public understanding.

“Decision-making is an imperfect art, using imperfect evidence and so requiring pragmatic views. The evidence base as it stands tells us to manage the increases in cases carefully with a variety of factors (including self-isolation, the potential emergence of herd immunity etc) influencing a smoother path forward that might otherwise be the case.

“Here’s one final thought – decision making here in the UK is very overseen by the Chief Medical Officer (and other senior colleagues and advisors of course), who is a supremely intelligent experienced and thoughtful individual, backed up by an excellent team of analysts, researchers, policymakers etc. Just because he is pragmatic and softly-spoken, and not shouting as loudly as the next person, why assume he is wrong?”

 Full comment can be found here: http://bit.ly/covid19headm

*Dr Michael Head has also provided some links that may be of interest:
See the evidence base review around government pandemic planning:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/215666/dh_125333.pdf 
Other links worth looking at include: 
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213717/dh_131040.pdf 
https://www.gov.uk/government/publications/review-of-the-evidence-base-underpinning-the-uk-influenza-pandemic-preparedness-strategy 
Links around behavioural response during influenza outbreaks:
https://blogs.bmj.com/bmj/2020/03/03/behavioural-strategies-for-reducing-covid-19-transmission-in-the-general-population/ 
https://www.ncbi.nlm.nih.gov/pubmed/20630124 
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2812%2970206-2/fulltext


All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19/
 
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