Dominic Raab, the foreign secretary, said in the daily press briefing at No. 10 on the 13th April that it was unlikely the UK lockdown would change in the next week.
Dr James Gill, Honorary Clinical Lecturer, Warwick Medical School, and Locum GP, said:
“There were many people hoping that Thursday would see the lifting of some restrictions in the UK lockdown, those hopes were diminished tonight by the government’s comments, that changes to the UK lockdown are not to be expected. As painful as that many be for many to hear, let’s pause for a moment and consider the positives to this announcement: there are signs that the country wide restrictive measures are beginning to take effect with the number of new cases of COVID19 possibly showing signs of plateauing.
“In many ways this is as a result of the solitary, quiet resistance that people are showing at home. The health service is doing what it always does, stepping up and overcoming adversity whilst under immense strain, but UK residents as a whole are not accustomed to these intense pressures. The challenges of social isolation being faced in every household are allowing the NHS to respond and help the sickest. People at home are directly helping deal with this crisis.
“For a considerable number of people, the Coronavirus pandemic is something they are thankfully only experiencing through a screen, yet are still perceiving its society wide effects via their personal lock downs. The possible flattening of case numbers, if not the death rate yet, may be positive signs but this does not mean that the pressure can ease at home. To relax the movement restrictions now risks undermining every small downward pressure on the number of new cases we have achieved. It cannot be emphasised strongly enough that dropping movement restrictions now risks reigniting further spread of coronavirus.
“Evidence is key to any changes in our approach to the coronavirus pandemic. One of the strongest accusations levelled at officials has been related to not responding rapidly and cautiously enough at the emergence of the coronavirus outbreak. Judgements can only be made based on available data, and only in the post pandemic analysis will we be able to ascertain if those initial judgements were the right calls. Similarly decisions regarding moving away from the current coronavirus approach must be validated by the strongest data which can be acquired in these difficult times. The data on the effect of social movement restriction is still being generated and analysed. To act on it now, based on impressions and gut instinct is to decide act prematurely and without strong backing.
“To rephrase, you cannot decide a loaf of bread in the oven has been baking long enough based on impressions and instinct, merely because you want to take it out as fast as possible. To use such unreliable markers may risk taking the loaf out too soon, and the whole loaf collapsing. Instead, by gathering more information about how to cook bread, we can increase the chances of opening the oven at the right time, and having a positive success.
“We have clear data from countries where lock downs are being effective, in contrast we only have exceptionally limited data about the likelihood of a second wave in this pandemic. Attention is currently keenly focused on China, and the Wuhan districts, where restrictions were lessened five days ago. We have the ability to learn, again, from countries which are further down the pandemic journey from ourselves, and ensure our decisions are based on evidence, data and scientific analysis, not hope, impressions and gut feelings.
“In the same way the decisions on initiating our UK lock down where taken based on observed changes in numbers of cases, the same will be true for future decisions, case numbers and death rates will be the main focus for direction actions. For now it is a case of continuing the stay at home and saves lives message.
“We may also find that this lock down has resulted in an unexpected lifestyle improvement for some. By trying to bring a routine to the days in lock down, more people are looking to try and be more active in the home, and also utilise their permitted daily session of exercise outside the house. Cycling Scotland for example has logged significant increases in their automatic cycle counters, with one sensor in Dunfermline registering a 215% increase in cycling over the last two weeks of March (https://www.cycling.scot/mediaLibrary/other/english/7715.pdf)
“Whilst that might sound counterintuitive to the advice of staying at home, if people adhere to only leaving the house when absolutely necessary, inclusive of their one permitted exercise session, and when doing so continue to strenuously avoid contact with persons outside of their household, the chance of someone inside that household contracting COVID19 is exceptionally slim.
“Ultimately whilst it would have been welcomed for life to start to return to normal, we can only, and must only be guided by the data on the actions taken during this pandemic. It will be the data which will indicate when is most sensible time to start lifting restrictions, and until then people can look to advice and guidance on how to maximise their health during these difficult times.”
Prof Robert Dingwall, Professor of Sociology, Nottingham Trent University, said:
“It would certainly be premature to relax the control measures before it was clear that the peak of the current wave on infection had passed. However, it is important for politicians to begin talking about their strategy for releasing controls, if we are not to repeat the initial mistakes in communications. For a variety of reasons, the political response was slow and never succeeded in convincing the UK population that there was a well-thought out plan for the pandemic. If popular consent for the lockdown is to be maintained, people must see that there is a plan for exit, even if this is likely to run over many months. People also need to understand that any release will come with a balance of risks – there will still be deaths into the foreseeable future – and that this is a virus that we will have to live with until a vaccine is available, which may not be nearly as soon as many enthusiasts claim. The plan must be evidence-based or begin collecting evidence ahead of future decision-points. It may require the assembly of another advisory group for SAGE, focussed on the route out of lockdown rather than the immediate management of the problem.”
Prof Linda Bauld, Bruce and John Usher Professor of Public Health and CPHS Co-Director, Usher Institute, University of Edinburgh, said:
“The British public are now steeling themselves for several more weeks of lock down. This is sustainable for the moment because we know public support for the measures remains high, compliance is generally good and concern about the virus is at the forefront of people’s minds. But this won’t last. The social, economic and health effects of lock down are accumulating. There will come a tipping point when the cost of the current restrictions outweighs the benefits.
“I am confident that governments across the UK are actively considering different scenarios to gradually loosen the current measures and monitoring what has happened in other countries who have been ahead of us in terms of community transmission and public health responses. Sooner rather than later, government needs to share the possible options with the public and be transparent about the costs and benefits of each, rather than continually evading questions on this, as is currently the case. We have seen increasing transparency in recent weeks (through daily briefings and rapid release of data) but this needs to continue and it needs to shift towards talking about the next steps. This transparency will help all of us to plan and to reassure our families. This reassurance is particularly important for our young people who feel huge uncertainty about education and employment options in the short term, as well as those experiencing the most adverse outcomes from the restrictions.”
Prof Rowland Kao, Sir Timothy O’Shea Professor of Veterinary Epidemiology and Data Science, University of Edinburgh, said:
“While there are positive signs that the epidemic curve is tailing off, there remains considerable uncertainty over the number of people who have never been exposed to Covid-19 and therefore have no immunity, compared to the number who may have had no discernible symptoms, but may have developed immunity. This is important because if the number with no immunity is high, then any relaxation of controls, exposing them to greater risk may result in a rise in cases. Thus while it is sensible to be planning for reductions in lock down, it must be done gradually, only initially considering the lowest risk and most vital activities. Each phased reduction should be followed by a period of continued surveillance with no further reductions in controls until the impact of the most recent one have been assessed. A further decision to change controls should only made when it is clear that the epidemic itself is continuing to decline. At the bare minimum, this would be several weeks between decisions points, and possibly longer, with some possibility that restrictions could be increased again depending on the available evidence.”
Prof Jeremy Rossman, Honorary Senior Lecturer in Virology, University of Kent, said:
“It is far better to delay lifting restrictions by one week than to lift them one week too early. Yes, delaying an extra week puts added economic and psychological strain on the country. However, if we exit the lockdown too early, then we risk nullifying all of the hard work and sacrifices each one of us has put into following the stay at home guidance. The restrictions are working and case numbers and fatalities appear to be stabilising, but there are still a large number of active infections in the country and relaxing restrictions now could directly lead to a resurgence of COVID-19 transmission in many areas of the country. A dramatic resurgence of cases could necessitate a second lockdown, which would be harder to implement and more difficult to maintain. We need to continue to stay at home while case numbers continue to (hopefully) decline, then we can begin the process of exiting the lockdown while still maintaining many aspects of physical distancing and scaling up our testing capacity.”
Prof Stephen Evans, Professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said:
“Data on cases and mortality are subject to inevitable delays in reporting. While this Bank Holiday weekend is not a usual one, it is vital to be sure that any changes in rates are real and not just changes in reporting, affected by the Bank Holiday. There is a need to be sure that the deaths that are actually occurring are known. The rate at which testing for Covid-19 is being carried out is not on a random basis across the whole population, so changes in reported numbers can reflect changes in testing policy or availability of tests, while what counts is what is actually happening. It would be foolhardy to make premature decisions over “lockdown” until really robust evidence is available.”
Dr Gail Carson, Director of Network Development at ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium), and Consultant in Infectious Diseases, University of Oxford, said:
“The reality is no one knows what is best for their country and the regions that make up that country. We are in a time of having to deal with uncertainty and restraints on how we manage that uncertainty due to lack of data, lack of knowledge and lack of key supplies. Whatever decision making is made the thinking behind it should be shared with the community.
“There is a clear role for science but also, for strong leadership, compassion, active listening to the community, pragmatic outbreak response decisions and working with global solidarity at the heart. It is ok sometimes to decide not to act, just communicate why and what it is that would help you to change to act.
“If I may be so bold to suggest that if I were on a decision making national committee I would think 6 months ahead and what the worst case scenario might be, then I would work backwards. Thinking about how do I avoid that situation by taking certain actions now and in the coming months. We might not have a therapeutic or a vaccine in six months but we could have ourselves an exhausted health service, a frustrated community and a weak economy. Work backwards and think which critical decisions have to be made to prevent the worst case scenario happening. Identify what information or data is missing as you consider those decision points and plan to capture the data. We appear to be very focused on looking forward week by week and pouring over recent data then applying it to models. All of this is indeed helpful and will help to make a decision. Perhaps, the decision makers are trying the approach I propose.
“To make the right decisions going forward I would work more as a global community. One recent example is DfiD’s financial contribution to various UN agencies including the WHO. Let the people who have an eagle eye on what is happening in the world help lead us out of this. It is affecting the world, work as the whole world. We know that we will be a World at Risk until the virus is contained everywhere or, until we have vaccinated most of the world. Therefore, if we could only work together better. Yes, it sounds idealistic but all of the components are present they just need coordinated as outlined in a background paper to the Global Preparedness & Monitoring Board written by David Heymann and Oxford University.
“Also, at country level we know that we have to remain alert and be able to test, isolate the positive cases and quarantine their contacts. Know when to recommend hospitalisation and have the capacity in hospitals to do so. If it looks like some countries are recovering sooner then they can help with the supply of essential medicines, PPE etc. to other harder hit areas. An outbreak response is only as strong as your weakest link this is a global outbreak…. We have a choice.
“However, there are apparent differences in intensity of the outbreak in different parts of the country therefore, a more nuanced regional approach might be required there but much of the above could still apply.”
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