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A meeting of the government emergency COBR committee is due to take place today where it is expected that the UK’s lockdown measures will be discussed and most likely extended.
Prof James Naismith, Director of the Rosalind Franklin Institute and Professor of Structural Biology, University of Oxford, said:
“There is now evidence that social distancing measures are having the expected effect. Fewer people are getting infected which means fewer people will need intensive care which means fewer people will die. My own view is that, given where we are in the epidemic, the lockdown has some weeks to run to bring down the number of infections and reduce pressure on the NHS.
“However prolonging the lockdown will itself have adverse health effects, delays in treatment, missed tests, increased mental illness and general disruption to care. In addition to these effects, the economic dislocation will have delayed but no less real effects on the health of the population. Humans are social animals and social distancing is a burden that requires consent.
“Public support for social distancing has been critical to its success and to saving lives. I am encouraged that government has so far taken expert advice from medicine, science, social science and economics; they are all important here. It is to be expected that in this unprecedented fast moving pandemic, expert opinions will differ and they will change as we learn more; what was wise yesterday may be foolish tomorrow. This is how science (in its broadest sense) works. In a democracy it is for elected politicians, not unelected experts, to take decisions. To continue to ensure the public’s continuing consent, I would urge the government to take and share the most current advice from a broad range of disciplines, to outline the risks, benefits and costs of its decisions, to make clear what its decisions are meant to achieve and to be prepared to change its decisions as the situation changes.”
Prof Paul Hunter, Professor in Medicine, UEA, said:
Why are we in the UK still in lockdown?
“In the UK we have been advised stay in our homes except for a limited number of reasons since the 23rd March. Has this policy been effective and how will be know when we can start to relax the social distancing?
“Although it may feel like a lot longer we have only been in lockdown for two and a half weeks and it is still too early to say whether we are bringing the epidemic under control in the UK. With a median incubation period of about 4 to 5 days and a slow start to the illness we would not have expected to see an impact on new reported cases for at least a couple of weeks. Any impact on the number of deaths being reported each day are unlikely to become clear for another week or two. Nevertheless, there are early signs that the number of new cases being reported each day may be reaching a peak and if this decline continues for the next few days then that would be very good news.
“It is time to consider what the next steps should be. It is certainly too soon to recommend a slackening of the social distancing rules. There are still many cases of infection in the UK and lifting the restrictions too soon will almost certainly lead to a further surge in case numbers.
“At present there UK has not made it clear what our exit strategy will eventually be and there are very good reasons for this. We simply do not have enough information to make these decisions now. For example, we still do not have good data on the amount of asymptomatic illness in the community, knowledge that is vital to know what may happen after any relaxation of restrictions. This knowledge will have to wait for the roll out of one or more antibody tests. Nevertheless, it seems to me that there are very few possible options:
“1. We follow the Chinese example and keep lockdown until there are very few new cases being identified each day in the country. It is likely to take several weeks before we reach this state and after lifting, we would have to very carefully watch for new cases and rigorously manage each new case and identify their contacts.
“2. If we are able to roll out a good quality antibody test and find that a substantial proportion of the population is immune then we will also be able to relax the current restrictions knowing that the infection would not spread as rapidly.
“3. Wait until a vaccine becomes available, but this is unlikely to be until next year.
“There is one further unknown that may make a big difference. If one of the drugs currently being tested for their activity work in the majority of patients, this would be a big game changer. Whilst none of these drugs are likely to be a “cure”, all we need is a drug that can slow the progression of the virus long enough for the body’s own defence mechanism to defeat the infection. A drug that works by making the immune system more efficient may also work. If we can give these drugs early in the course of an illness we may be able to dramatically reduce the number of people becoming seriously ill and needing hospital beds or even critical care beds. As yet we do not know for certain whether such a drug will work. But if one does then the need for the lockdown would be reduced.
“We do not yet know when we do start to lift restrictions, whether this will be a sudden return to normal or something more gradual. I suspect it will be more gradual not with the total removal of all restrictions overnight. I think when measures do start to be lifted we will initially see an expansion of the number of industries encouraged to return to normal work, then the reopening of schools and, somewhat later, bars and clubs and other entertainment venues – but we are not ready for that yet. However, we will still need effective disease surveillance followed by isolation and rigorous contact tracing for some months.”
Dr Joshua Moon, a Research Fellow in Sustainability Research Methods in the Science Policy Research Unit (SPRU) at the University of Sussex Business School, said:
“On the lockdown and decision-making, there are a number of things that need to be said:
“First, data doesn’t just drop from the sky, it needs to be collected, collated, and used. This is why experts have been hitting the testing button so hard in recent weeks, you can’t use data that hasn’t been collected. Even with increased testing, there are still gaps and so it has to be assumed that we are missing a good portion of the cases. This is particularly given that guidance for covid symptoms in the UK is to isolate, not get tested.
“Second, collating the data isn’t necessarily a simple task – data must be presented in a similar formats by different testers. This is why the UK government has standard reporting forms, it better enables collation of disparate data points, as well as being clearer communication of findings. This is also dependent on what data is collected. If only the more severe cases are being collected, then the partial picture is likely different to reality in important ways.
“Third, once this partial data is collated, is there a general trend of dipping cases? A single day with lower cases than previous days could have many reasons behind it, but a sustained decline in new case numbers could be an indicator that lockdown is working.
“Finally, and this is likely the most important, how the data is used given these uncertainties. Data on cases and deaths, for example, can be used to inform modelling, but these will depend on various assumptions about the rate of underreporting and incidence. This does not mean the models aren’t helpful. To quote statistician George Box is that “all models are wrong, some models are useful.” So it is very important to consider the implications of how that data is used.
“On why the data is lagging behind measures, there are multiple factors at play: first, that the incubation period for the disease means that anything that stopped transmission, there would be a lag from that perspective. In addition, the full lockdown restrictions were only introduced a couple of weeks ago so we aren’t likely to see a change in incidence until Monday, and even then there is a need to see sustained drop-offs in new case numbers before thinking about loosening the current restrictions. Finally, the initial lethargy in testing means that there may also have been a backlog in the number of tests requested so new case numbers are lagging because of that as well. This is why taking the above into consideration is important – you need to know the limitations of the data you are using to be able to use it properly.”
Prof Keith Neal, Emeritus Professor in the Epidemiology of Infectious Diseases, University of Nottingham, said:
“The measures are in place as it is the only current effective method of reducing spread of COVID-19. We do not know how long the lockdown in its present format should be continued at the moment. Key pieces of information in making the decision is clear evidence of a decline in new infections (currently based on hospital admissions with COVID-19) and the capacity of intensive care facilities to deal with any increase in patients when restrictions are slowly relaxed. This capacity issue also needs to consider what the NHS does all the time.
“There is a lag in any downturn after implicating control measures as we have to allow for the incubation period, time to develop severe illness and for death this can be many weeks from date of acquisition (infection). If the measures are relaxed too quickly too soon then the rebound in cases will again threaten to overwhelm the intensive care capacity even though it is and continues to be expanded.”
Prof Brendan Wren, Professor of Microbial Pathogenesis, London School of Hygiene & Tropical Medicine, said:
“Yesterday 938 unfortunate further hospital deaths were reported. The continued lockdown should be announced immediately so that there isn’t false hope of it being lifted soon. The COBRA meeting today will surely discuss the length and scale of the lockdown. It will take a while before the effect the measures have had so far start to be seen in the numbers of deaths, but until we see a significant downturn in the epidemic we need the lockdown to continue.”
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
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