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The British Medical Association (BMA) have called for policy that will lead to the ‘near elimination’ of COVID-19, this came at their Annual Representative Meeting.
Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:
“In today’s press release, the BMA have re-introduced the notion of “near-elimination” of COVID-19 in the UK. This idea has been discussed extensively by the epidemiology and public health communities in recent months. In practice, it is little different from a lockdown-release-lockdown-release cycle that was being modelled as long ago as March. The distinguishing feature is that the lockdowns would have to be stricter and more prolonged in order to drive COVID infection levels to very low values. The argument is that during the ‘release’ phase more restrictions can be relaxed for longer. The benefits of this trade-off are not easy to assess and, given the accumulating evidence of the various harms that lockdown causes, it is far from clear that this is, overall, a ‘better’ approach.
“The BMA do not highlight the need for further lockdown in their statement. Four of the measures they identify as central to the achieving the goal of near-elimination are better messaging, clear targets for infection levels and trigger points for local interventions, mass testing, and stricter monitoring of COVID security. All of these could indeed play a meaningful role in the UK’s pandemic response. The fifth measure – partial closing of borders – is more contentious, but has been implemented elsewhere.
“However, as recent experience in New Zealand and elsewhere has shown, achieving and maintaining near-elimination is very likely also to require prolonged, strict lockdowns. Given current levels of infection in the UK and across much of Europe, it is likely that these measures would have to remain in place for many weeks, possibly months. To achieve near-elimination such measures would be necessary even if the public health burden – in terms of hospitalisations and deaths – was already very low. It is highly debatable whether the immense cost of prolonged, strict lockdown could be justified when the immediate public health gain would inevitably be small.”
Prof Rowland Kao, the Sir Timothy O’Shea Professor of Veterinary Epidemiology and Data Science, University of Edinburgh, said:
“The attainment of ‘near-elimination’ of COVID-19 would be a difficult but worthwhile goal, and likely to be more difficult than for other countries like Australia or New Zealand, with challenges of greater population density and health care.
“The combination of a high transmission rate, the role of pre-symptomatic individuals in transmission, and evidence of transmission across a broad range of age groups all present substantial challenges we cannot easily solve.
“The problem is exacerbated by the fact that we are not close to those low numbers yet, and likely to be made harder by increased transmission risks through autumn and winter. Thus in order to accomplish this, it would require clear messaging from government, and a sensible application of our understanding of the scientific evidence of the requirements for control, that is also balanced against other important societal needs. It will require a strong commitment from the public.
“As a complex epidemiological, social and economic problem, there is no silver bullet that will accomplish this – only a multi-faceted and consistent approach. Thus while ‘near eradication’ and a return to a form of normalcy is very welcome, this will almost certainly have to require identification of new norms rather than simply a return to the old ones.”
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“This call from the BMA echoes those from the Independent SAGE group, Professor Devi Sridhar and others, and is an approach that I wholeheartedly support. At present the best way to achieve this aim is via reliable, accurate and rapid testing and contact tracing of SARS-CoV2 infected individuals, combined with mitigation measures designed to minimise community spread. Moreover, an effective quarantine policy must be applied to UK visitors once cases are controlled. Naturally, the availability of an effective vaccine would provide an ideal complement to these strategies.
“The best opportunity to have attempted this aim was over the summer months following lockdown, when community transmission was much lower than in spring, or indeed now. Thus, there is an appreciable mountain to climb in getting the current resurgence of cases back under control. This will require an urgent improvement in the testing system, and if the “rule of six” is not successful in curtailing virus spread then additional restrictions may be necessary on a national scale.
“Critically, the potential benefits of this approach should apply to all of society if successful. The half-measures currently applied to the opening of businesses and industry could be relaxed and normal activity resumed without the cyclical uncertainty of local lockdowns, schools and universities could operate normally, and the NHS needn’t divert as much of its precious resource to COVID patients and the safety of healthcare workers. However, perhaps most importantly, the vulnerable members of our society that have had no choice but to isolate and shield themselves from normal life since march, with no apparent exit strategy, could re-engage with society once more.
“Ultimately, we are an island and eliminating SARS-CoV2 community transmission should be achievable. However, it will require clear messaging and significant investment from the Government, co-operation between the NHS and public health, but also critically the buy-in from the vast majority of society in a collective effort to tackle this epidemic.”
Dr Simon Clarke, Associate Professor of Cellular Microbiology at the University of Reading, said:
“The BMA’s call for near-eradication of Covid-19 in the UK is an appealing one, but how that could be achieved needs careful consideration. This spring, a national lockdown saw the vast majority of the population in the UK confined to their homes, and that failed to eradicate the coronavirus. It therefore seems unlikely that lighter-touch measures would succeed and reasonable to assume that a lengthier and possibly more restrictive lockdown might be necessary to achieve this proposal, and that it would be followed by draconian surveillance of infected people and removal from their families, as seen in South Korea. Testing, while vital, is not an end in itself and can only reduce transmission if it leads to more frequent and larger scale isolation. I’m not sure that there is the appetite amongst the general public for such severe measures, or that the ambition is particularly realistic.”
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Prof Mark Woolhouse: “No CoIs to declare. I am not a member of the BMA.”
Dr Stephen Griffin: “No conflicts.”
None others received.