It has been confirmed by government that the city of Leicester will returning to a prior stage of lockdown to combat the local COVID-19 outbreak. Measures include the closing of shops and schools, and the cancellation of the relaxations the rest of the country will see on July 4th.
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“The situation in Leicester must be worrying for local residents and immensely frustrating for those looking forward to the further relaxation of lockdown measures. However, it serves to illustrate the potential for SARS-CoV2 infections to escalate within a relatively short time period, even when relatively conservative restrictions remain in place. We should remember that there has been a relatively slow decrease in infections across England over the past weeks and that many thousands of people remain infected with this virus at any given time. It will be essential to reduce local transmission in and around Leicester by community restrictions combined with aggressive testing and tracing in order to break transmission chains. Local authorities must be supported by the Government to work efficiently with the new Biosecurity Centre and Public Health England.
“It would be of interest to hear more details concerning the Health Secretary’s statement that there is an unusually high incidence of coronavirus among children in Leicester. We need to understand why this is the case and if children are a source of community transmission in this outbreak or if they are just becoming infected but not contributing much to the spread of the virus. Understanding what is going on could have implications for planned school reopening and the safety measures this involves. It will be important to learn as much as possible from the situation unfolding in Leicester to better prepare for other resurgences of the virus in the future.”
Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:
“There is clearly a very different picture of COVID-19 in Leicester than other parts of the country, 10% of cases in 0.5% of the population. When this has happened in other countries similar strategies have been employed. Each local situation is different and requires a locally targeted approach.
“We know widespread lockdowns work and what remains to be seen is how a local one will in the UK. In some countries local lockdowns have been enforced by the police to a degree that would not be tolerated in this country. The more social distancing measure that are adhered to the quicker this outbreak will be brought under control. With a high level of compliance, cases should begin to fall in 1 – 2 weeks although increased testing could also mask what is a real decline in new infections.
“Intensive contact tracing along with details on where people with COVID-19 might have acquired their infections is required. This will hopefully interrupt chains of transmission. Also by detailing possible places where people became infected particular local areas of high risk are identified and more targeted control measures used later.
“Other local increases have often been in care homes but the reported predominance of younger people strongly suggests community transmission. This is why interviewing cases to identify how they might have acquired infection is important.
“Drawing the boundary was never going to be easy. Including three surrounding areas will have upset some people in why these were included, but not other areas.
“Somewhere had to be first for a local increase in cases. It just happens to be Leicester.”
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:
“Local lockdowns involving local systems, local data and leadership working with UK Government are probably to be expected more, at a minimum to be prepared for.
“I am keen to hear more detail publicly about how that interface and feedback loop for timely local decision making works with e.g. between the new Biosecurity Centre, the Council and local public health.”
Comments issued on Mon 29th June
Dr Shaun Fitzgerald FREng, Royal Academy of Engineering Visiting Professor at the University of Cambridge, said:
“The re-introduction of some of the lockdown measures can be thought of as re-introduction of heavier mitigation measures, lighter versions of which we were asked to apply last week in the change from 2m to 1m ‘plus’ for distancing purposes. Keeping people away from places like non-essential retail is a firm way of reducing contact points, which will help reduce the rates of transmission.”
Prof Linda Bauld, Professor of Public Health, University of Edinburgh, said:
“We have already seen from China, Germany, Italy and Portugal that local lock downs – or re-imposition of restrictions – is a common response to spikes in Covid-19 cases in particular areas. However, it would be concerning if there was a narrative around the Leicester situation where fingers were pointed at local people. It would be wrong for them to be accused of not following guidance, or if it was suggested that the diversity of the area (with BAME communties) is to blame. Let’s be clear – the restrictions being re-introduced are not the fault of the local population. There is no evidence that their behaviour has been being ‘at odds’ with other parts of England.
“Instead, we need to ask real questions about the adequacy of the UK government’s response to this whole crisis and whether it has, most immediately, failed the people of Leicester. Have adequate testing facilities been in place? Are test results available quickly enough to make rapid contract tracing and isolation and support of contacts viable? Has the devolution of test and trace to private companies – rather than adequately resourcing local public health agencies – been the right approach? Has the national release of lock down in England been too rapid given the number of cases in the community? These are all questions that need answers. Learning lessons now could avoid other areas experiencing the same consequences with further damage to children who have recently returned to school, and to local businesses who have reopened and now need to close again.”
Prof Sheila Bird, Formerly Programme Leader, MRC Biostatistics Unit, University of Cambridge, said:
“One alert is a city’s number of new COVID-admissions to hospitals. Another is Leicester’s high percentage of all swab-test positive cases in the country. Closely related, the percentage of all swab-positives is apparently three times higher in the city of Leicester than “in the next highest city”.
“However, some city [out of how many comparators?] always has to have the highest percentage of swab-positives per million of population in a particular week. The question is: whether that highest percentage is higher than the top percentage should be? Extreme value distributions are tricky beasts and need serious statistical back-up. League tables always need qualification by measures of uncertainty.
“More importantly, in public health terms, swab-positive rate per million of population depends on how assiduously people who experience at least one key COVID symptom book a swab-test. How did the swab-test-booking rate per million of population differ between Leicester and comparator cities? It would be unsurprising, indeed rational, if the test-booking-rate per million of population was higher among Black, Asian and Minority Ethnic groups, for whom the consequences of SARS-CoV-2 infection are more serious.
“Transparency, weekly, about a) swab-test rates per million of population, b) swab-positive rate per 100 tested, and c) swab-test positives per million of population (each with uncertainty) is essential – not only for Leicester but for comparator cities – for the public and professionals to be confident about how alerts will be triggered as England emerges from lock-down. Public understanding of statistical science and of public health would be poorly served by anything less.”
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