It has been reported that the government will soon announce a new national lockdown to prevent the spread of COVID-19.
Dr Shaun Fitzgerald FREng, Royal Academy of Engineering Visiting Professor at the University of Cambridge, said:
“We know how this horrible virus is transmitted. The means we have to intersect the modes of transmission are washing hands, wearing face coverings, keeping our distance, ventilating rooms and … limiting our social interactions. This last one is the ultimate one. If we aren’t mixing, the virus hasn’t got a chance of spreading. We are spending more time indoors which is compounding our ability to keep the spread at bay.
“The numbers right now are such that we need to go harder to break the transmission. So we will need to use more restrictions on our movements. None of us want this at all. But it now seems there is no choice if we are to avoid letting thousands and thousands more die, and the health service swamped to an extent that even non-Covid patients are seriously affected.”
Professor Sir Robert Lechler PMedSci, President of the Academy of Medical Sciences, said:
“We are all fatigued by this virus and weary of adjusting our lives around COVID-19, but I believe we have no other choice than to move back into a national lockdown. All of the evidence points towards this being the only step we can take together to prevent the high number of deaths predicted.
“A national lockdown will buy us some time to get back on track and bring the R number down. It will not be a complete fix, but it is a crucial way for us to regain control, regroup and develop further interventions.
“This second wave will be harder for many reasons – there are the feelings of déjà vu and despair which are compounded by the other challenges the winter months bring, such as dark nights and more time indoors. Each action we take to minimise the transmission of COVID-19 will help us all in the short and long term.
“We can get through a second wave by working together – young and old, North and South, families and workplaces. I urge everyone to remember how grave the COVID-19 health risk is and to take any new measures seriously. We all have a part to play in protecting our society. Compliance with current measures has fallen and understandably there has been confusion following the frequent changes. Decisions to abide by the new measures should transcend politics and focus on protecting lives and safeguarding the NHS. We must bring people along with us and develop interventions and public health messages with communities to create the best environment for support and maximum national effort.
“In The Academy of Medical Sciences July report, Preparing for a Challenging Winter 2020/21, we warned that winter conditions and the reduction in restrictions over the summer could lead to a severe second wave which could be worse than the first. Regrettably, we have not maintained the suppression of the virus over the summer and the second wave is now upon us earlier than we anticipated and at this stage it is of a magnitude similar to our worst case scenario.”
Professor Sir Simon Wessely, Regius Professor of Psychiatry, King’s College London and Director, Health Protection Research Unit in Emergency Preparedness and Response and the King’s Centre for Military Health Research, KCL, said:
“There is no “right time” for a lock down. Great harm results from not locking down, and great harm results from locking down. Either option is a dreadful one, and we should refrain from saying “I told you so”, and accept that lockdown is a political, and not solely a medical, decision. The costs of a full lockdown are by now predictable – a further deterioration in mental health, greater and more long lasting damage to people’s livelihoods and future prospects, especially if they are young, and further damage for those with other illnesses, both mental and physical. Nor does it seem that our close neighbours have a magic formula that has somehow eluded us. All we can do now is support each other, which might include those who find it harder to comply with new restrictions at all time, and trust that come the spring there is more hope from either vaccines, an effective track and trace system, or sufficient (even if temporary) immunity, because otherwise this whole ghastly saga will repeat itself once more.”
Dr Amitava Banerjee, Associate Professor in Clinical Data Science and Honorary Consultant Cardiologist, Institute of Health Informatics, University College London, said:
“As we again contemplate national lockdown, entirely predictable and predicted, we now have convincing evidence from this country and abroad to support urgent policy in three areas to gain the most benefit from any lockdown. First, framing the debate as “opening the economy” versus “suppression of the virus” has under-played the impact of constantly changing tiered measures and continuing uncertainty for the most vulnerable in society, as well as the huge economic effect of rising infection rates. Second, we cannot prioritise “COVID care” OR “non-COVID care” (including cancer and cardiovascular disease); they are both urgently required, and it is unchecked infection rates that led to health system strain and indirect effects on non-COVID care. Third, whether lockdown or tiered interventions, potential benefit is countered by an inadequate test and trace system. Therefore, aiming for a minimal infection rate and total rethinking of our national test and trace process are crucial for physical, mental and economic health of the nation.”
Prof Ilan Kelman, Professor of Disasters and Health, University College London, said:
“It is up to us to avoid the continuing rise in cases and to make any form of lockdown work, locally or nationally. No matter what, we must keep our distance from people in the streets, wash our hands, not touch our faces until our hands are washed, and wear face coverings in indoor public places. The more we act as individuals, the more we help everyone else and those who cannot take all such measures. Together, we must each do whatever we can, so that we balance lives and livelihoods without overwhelming the NHS.”
Dr James Gill, Honorary Clinical Lecturer, Warwick Medical School, said:
“Politically, governments don’t like to be shown to change their minds. However, in medicine and science, we react frequently based on new data or research, whether that being new information from a patient’s own results, or the release of a new study that leads us to question our current practices. Change for changes sake should rightly be treated with scepticism, but adjusting our actions and our clinical decisions based upon new information and data is to be championed.
“The Government is currently faced with the sorts of decisions that no one wants to have to make. Decisions taken to minimise virus impact on businesses, schools, and the economy have not been effective. Any COVID 19 decision now will have huge ramifications across the country, but in evaluating the choices currently available, it is not a case of choosing the best option, but the least worst.
“Medicine often requires accepting the least worst option. Whether that is suggesting a patient needs to go for life saving surgery, whilst acknowledging that the surgery itself carries a high risk. Or that a patient’s condition has deteriorated so that a new medication is needed, but with the knowledge that the new medication itself often carries significant side effects.
“Thankfully most people will not have been in the position of having to make these sorts of choices in the past, however this does make the current evolving COVID situation much more stressful.
“Trust is a difficult commodity to find when we are concerned, frightened, and anxious about the future. As a patient, if you were becoming more unwell, you’d trust your doctor to look you. To change their management plan for your best outcome and discuss with colleagues about evidence-based ways to bring about a recovery.
“We have currently tried balancing scientific with political need in several different approaches to handling the second COVID19 wave. These have regrettably not seen significant improvements in case numbers. Thus, responding to the current data by changing our current countrywide management plan is the right thing to do. We do not know for certain which is the right option to take at the moment, but given the current rise in COVID19 numbers, and the growing strain on the NHS, change must come. A further national lock down is the next logical, if very painful, step. There is no right option currently, but it appears that another lockdown is the least worst medically, even if potential economic side effects are severe.
“As with any adjustments in a patient’s care plan, those changes also need to be reviewed based on subsequent reactions, new data, and developments. By following the data and the science, change has to be accepted, because the only alternative is to “let nature take its course” and that is often the most worst option.”
Dr Jeremy Farrar, Director of the Wellcome Trust, said:
“This isn’t a decision any government would want to make. No one envies the job ministers have right now. The evidence is stark but this is still a very tough call and the government deserves credit for changing its approach in the light of a very fast-moving epidemic.
“This has been such a tough year already. Tough beyond belief for millions across the country, and across the world. And while we knew that the virus would come back in a second wave, actually seeing it happen is the last thing anyone wanted. My experience from other virus outbreaks is that the second wave is always harder. Everyone is worn out, healthcare workers in particular. It can feel more hopeless the second time round. We wish it would just go away. But we have to remember it isn’t hopeless and what we do will make a difference.
“The sooner we act, the sooner we can start to recover. It will be a very difficult few weeks now and no one can underestimate the toll that will take on people. But the consequences of sticking with the current insufficient restrictions would have been much worse.
“I think this year we’ve all learned to appreciate so many little things that we’d taken for granted. I want to go to a football match, I want to go to bonfire night, I want to meet my friends in the pub. But unless we suppress the virus now, it will be a lot longer before it’s safe to do any of this again.
“And I’d like nothing more than to have a normal family Christmas. If we can steel ourselves now for a few weeks of greater restrictions, there’s a chance we could ease up a little between Christmas and New Year without the virus getting out of control. But if we’d let it continue to multiply, we’d be in a terrible situation in December.
Current measures not sufficient – reported new measures will buy us time
“Doctors and scientists agree that none of the current restrictions have been enough to stop the virus spreading. Without a change, the NHS would have been overwhelmed within weeks and it would have been difficult if not impossible to cope in the winter months with the inevitable increase in caring for people with covid as well as non-covid illnesses. There’s absolutely no doubt that many more of us would have seen loved ones die, suffer with long-term covid symptoms or from other illnesses.
“The only way to get things back to normal quickly is to get the virus under control as soon as possible. The measures being reported today, if implemented and respected, will reduce transmission, get R below 1 and reset us to an earlier stage of the pandemic. This buys us time before we start to see treatments and vaccines in early 2021.
“We have to use this time well. The test, trace and isolate system remains critically important and needs all our support. We need enhanced capacity in the NHS, to protect vulnerable people, particularly healthcare workers and those in care homes, and continue to push on urgently to develop safe and effective treatments and vaccines.
“The measures have to be UK-wide to be effective enough. While the rates may be different across the UK, the virus is escalating in every area. And those areas which are not yet in crisis will in fact benefit most from greater restrictions now, before the virus gets out of control locally. They will now be able to return to normal fastest.
“Restrictions absolutely must come with the full and generous financial support people and businesses need to get through this and out the other side. We need public support for the restrictions to work, and we can’t expect that from people unless they themselves are being supported. The only choice for the government is between helping businesses stay afloat, or paying to pick up the pieces when they collapse. The sooner we bring the virus under control the sooner the economy can recover.
Treatments are coming
“And we definitely will get through this. There is light at the end of the tunnel. I believe we can be in a much stronger position in early 2021. In the new year, I’m confident we’ll have turned a corner on preventing and treating the infection caused by this virus. Our responsibility now as a country is to support these measures, keep the virus under control and make sure as few people as possible suffer until then.”
Dr David Strain, Senior Clinical Lecturer, University of Exeter, said:
“The Prime Minister is in the unfortunate situation of now having to bring the inevitable lockdown into force that was suggested by his medical and scientific advisors a month ago. In order to minimise the impact of the lockdown on the mental and physical health of the nation as well as the economy this needs to be accompanied by a clear exit strategy, including an overhauling of the test and trace system to ensure it is fit for purpose. We need to abandon the “rule of six” in favour of exclusive social bubbles and enforced mask use in all situations where physical distancing cannot be maintained. “
“Now could be the time to invite a National COVID-19 intra-action review (IAR) and to ensure that the lessons learned shape the exit and recovery from the any national lockdown or, indeed inform the response irrespective of lock downs. The World Health Organisation even have a package ready to help guide countries through such an activity. Technical experts from the Global Outbreak Alert & Response Network (GOARN), a network with 20 years of responding to outbreaks involving 250 institutions from around the world, could support a COVID-19 IAR. Not to take anything away from the joint inquiry that the Parliamentary Science and Technology Committee with the Health and Social Care Committee is doing. However, inviting an international outbreak response technical network could draw on lessons learned, experience from other countries and focus in on the technical response to deliver a COVID-19 IAR report quickly.”
Dr Julian Tang, Honorary Associate Professor/ Clinical Virologist Respiratory Sciences, University of Leicester, said:
“We’ve now tried the softer approach to preserve businesses and support education and other health services, but the virus is not being controlled by this.
“A national lockdown is the logical next step up to control the virus and to limit the burden on the NHS – though with the virus being so widespread and numbers of cases increasing so quickly now, a 4-week lockdown my not be enough – unless everyone complies as comprehensively as possible with the restrictions.
“This rise in COVID-19 numbers is not so surprising given the post-lockdown relaxations in June/July where we saw rises in case numbers in mid-August across the UK and other European countries – and now entering the cold winter months with more people spending more time inside and being less keen to open windows, and losing the outdoor options for various social/ recreational activities.
“But the government will need to support the businesses that will be affected by this national lockdown period – otherwise the economic hit will be significant, with many of them barely recovering from the previous first wave’s national lockdown.
“We also need to control the virus and numbers of COVID-19 cases to allow other non-COVID-19 healthcare services to continue as much as possible – as these patients also need support.
“However, one silver lining is that, based on the Australian experience earlier, we expect to see fewer of the usual flu and other seasonal respiratory virus-related illness this year – which will free up NHS resources to cover these other services.”
Dr Stephen Griffin, Associate Professor, School of Medicine, University of Leeds, said:
“The deja vu that the United Kingdom is about to endure was entirely preventable. Lockdowns are a last resort, enacted when an epidemic has got out of control. The societal and economic hardship endured as a result, disproportionately affecting those least able to cope means that this act must not be squandered. Those in authority have a duty of care to ensure that the sacrifices are worthwhile.
“And yet we are again facing a scenario with the potential to overwhelm the NHS and cause profound mortality and morbidity if drastic measures are not taken. It mortifies me that the ceaseless, and now growing again numbers of COVID victims are something to which many of us have become desensitised, or are prepared to use as capital during nuanced arguments around statistics.
“The resistance to further restrictions is completely understandable. Public spirit has been eroded by conflicting narratives and an overly complex, inconsistent series of supposedly targeted restrictions that have ultimately failed to re-establish control. The new tiers were another in a series of half-baked strategies, no-doubt intended to appease both public health and economic lobbies, yet in reality achieving little to satisfy either. As our nation showed in spring and at other times in history, it can unite behind a common, meaningful cause. Alas, this is now lacking.
“It is right for people to be angry and upset, and it is vital that we ask why we are now back at square one. Nobody is insane enough to “want” a lockdown, but when called for the obligation is ensure that it won’t need to happen again. Despite several baseless deadlines, COVID has not been “sorted”, neither did it ever leave us. Seemingly the lessons, equating to loss of life, around acting quickly, and being pro- rather than reactive have been forgotten over the summer. The virus was never suppressed to the right levels due to rapid unlocking, especially in the North. Moreover, our best weapon with which to counter further outbreaks, namely community test and trace, remains a dysfunctional and ineffective body, with a price tag that beggars belief. All this, whilst supposedly following, and yet simultaneously ignoring, the scientific advice foretelling a winter resurgence if these aims were not achieved.
“Yet again, the UK has been slow to act, delaying decisive action until the last moment. Much like a forest fire, the longer things burn, the harder they are to extinguish, and the more damage ensues from both the fire and the water. Ironically, by delaying, the harm done to industries and society will be far worse compared to had the advice of SAGE been followed in September.
“It is difficult to know how long it might take to reverse the growth of the new wave of infection, Christmas is obviously a huge consideration for many. However, regardless of how long it takes, I hope that this time around is indeed the last time. I hope that the time bought by locking down is used properly, and the UK can finally emulate countries where the epidemic is controlled and life is as near to normal as we can only dream of. Above all, make it count this time.”