The House of Commons Home Affairs Committee have released a report on Home Office preparedness for COVID-19, specifically the management of the UK’s borders.
Dr Andrew Freedman, Reader in Infectious Diseases, Honorary Consultant Physician, said:
“This is a very thorough report which is highly critical of the UK Government’s policy in relation to border measures since the start of the Covid-19 pandemic. It is easy to be wise after the event and we cannot be certain how many fewer infections there would have been, had things been done differently. However, it is hard to disagree with the conclusion that the removal of any requirement for arriving travellers to self-isolate in mid March, as well as the lax arrangements earlier on, did lead to a large influx of imported cases. The UK policy was clearly at odds with those of many other countries in Europe and around the world.
“The report also highlights the lack of transparency in relation to the evidence behind the decisions that were being made, as well as the more recent mixed messaging around travel corridors. It rightly criticises the failure to appreciate fully the difficulties faced by travellers when decisions are made at very short notice and communicated poorly.
“It is right also to question the reported level of compliance with current quarantine regulations given the lack of enforcement measures and monitoring in the community.
“Given that Covid-19 is going to be around for the foreseeable future, it is vital that the UK develops a smarter approach to border measures which can adapt to changing patterns of infection around the world.”
Dr Simon Clarke, Associate Professor of Cellular Microbiology at the University of Reading, said:
“This new report has criticised the lack of such restrictions for most of the first 3 months of this year, highlighting that 10,000 people carrying the virus entered the country in March. 18 million people entered the country in total over that period, with only 273 being quarantined.
“With a R0 number of 3-4 in the UK at that time, up to 40,000 individuals could have been infected subsequently, beginning many chains of infection that rippled through the population. Trying to suppress the number of infections in any country is futile if simultaneously, the virus is continually imported.”
Prof Paul Hunter, Professor in Medicine, UEA, said:
“The report of House of Commons Home Affairs Committee report on the handling of travel restrictions in the early phase of the current pandemic is a valuable discussion of one of the most contentious aspects of the management of the epidemic. This issue is one that clearly needs to be considered in depth and lessons learnt. However, the value of both travel restrictions and screening at ports of entry are interventions for which the evidence is very unclear. World Health Organization advice issued on the 29th February was that “WHO continues to advise against the application of travel or trade restrictions to countries experiencing COVID-19 outbreaks”.
“Travel restrictions and border closures have a long history going back centuries to the black death. In a systematic review of the evidence published in 2014, the authors (one of whom is a current deputy CMO for England) concluded that “Travel restrictions per se would not be sufficient to achieve containment in a given geographical area, and their contribution to any policy of rapid containment is likely to be limited”.1 One earlier paper concluded that “Suspension of 99.9% of air travel can only delay individual national epidemics by up to four months”.2 Both these papers concerned influenza. However, given the higher R0 of COVID-19 it is likely that such measures would be even less effective in the current pandemic.
“The European centre for disease control states “Based on evidence from modelling studies mainly related to influenza pandemics, border closures can delay the introduction of the virus into a country but only if they are almost complete and are rapidly implemented during the early phases of an epidemic, which is only feasible in specific contexts (e.g. for small, isolated, island nations)” https://www.ecdc.europa.eu/sites/default/files/documents/Considerations-related-to-measures-for-travellers-reduce-spread-COVID-19-in-EUEEA.pdf
“The other issue that is often discussed is screening at the port of entry. This is another area where it has been difficult to show any value. A recent systematic review found no real value of such screening for a range of infectious diseases.3
“Given the evidence in the literature it is doubtful that more vigorous travel restrictions would have had much impact on the spread of COVID-19 in the UK and the ultimate size of our epidemic.”
1 Mateus AL, Otete HE, Beck CR, Dolan GP, Nguyen-Van-Tam JS. Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic review. Bulletin of the World Health Organization. 2014 Sep 29;92:868-80D
2 Lee VJ, Lye DC, Wilder-Smith A. Combination strategies for pandemic influenza response-a systematic review of mathematical modeling studies. BMC medicine. 2009 Dec;7(1):1-8.
3 Mouchtouri VA, Christoforidou EP, Menel Lemos C, Fanos M, Rexroth U, Grote U, Belfroid E, Swaan C, Hadjichristodoulou C. Exit and entry screening practices for infectious diseases among travelers at points of entry: Looking for evidence on public health impact. International Journal of Environmental Research and Public Health. 2019 Jan;16(23):4638
Professor Linda Bauld, Professor of Public Health, University of Edinburgh, said:
“This report adds to emerging evidence on what went wrong, and when, in the UK’s response to Covid-19. A key public health measure to contain the spread of infectious diseases is travel restrictions, either locally or nationally. Cases can be high in one area and easily spread to others if freedom of movement is maintained. Measures at the border (testing, quarantine, contact tracing) are essential and some countries implemented these very early on. For example Vietnam implemented this in relation to travel from China on 25th January and from everywhere else in the world on March 7th (to date they have had just 670 cases and 8 deaths). Even Singapore, which is arguably even more dependent on international travel than the UK, implemented strict border control measures from China on 23rd January and a range of other countries from March 4th (to date 53,346 cases but just 27 deaths).
“Border measures are new to the UK and many other countries but this report highlights three key lessons that need to be considered in the months to come. The first is that we acted too late to introduce travel restrictions, particularly quarantine. This looks likely to have been down to incomplete information at the time and a strange (and not easily justified) decision to lift all border measures from mid-March to early June. So the key lesson from that is to act early if concerns are raised.
“The second lesson is that border measures are going to be key in the future – and I would argue the immediate urgency here is to consider the fact that many thousands of international students, from a range of countries, will be coming into the UK soon to commence their studies in Sept/October. So this isn’t just about where people go on holiday – or come back from – there are other very valid and important reasons why we need to continue to welcome people from overseas but in doing so have testing, quarantine and contract tracing measures in place and at scale to allow this to continue. Quarantine is a blunt instrument and difficult to enforce. So testing in airports and other border entry sites is going to be required. This will be expensive, and complicated, but needs urgent attention.
“The third lesson is about communication and transparency. Changes in FCO advice and border measures were communicated too late in relation to the removal of the travel corridor with Spain, for example (with over 1 million people from the UK originally due to travel there to the end of August). Progress has been made in terms of providing local dashboards on cases in the UK to alert and inform citizens in recent weeks, but the same needs to be applied to guidance on international travel. Thus the call for regular, publicly available updates from the Joint Biosecurity Centre’s traffic light system is welcome and should be taken seriously.
“Travel within the UK, and between the UK and other countries will continue to be vital to keep our economy going, families connected and, by extension, contribute to the health and wellbeing of our population. This report illustrates that we have seriously neglected the management of borders in our pandemic response to date.”
‘Home Office preparedness for COVID-19 (coronavirus): management of the borders’ the Fifth Report of Session 2019–21 by the House of Commons Home Affairs Committee was published on 5 August at 00:01 UK time.