It has been reported that from Monday 14th September social gatherings of more than six people will be banned in England.
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“Introduction of measures on a national level to curtail the recent resurgence of SARS-COV2 infections is welcome and timely. As Prof Van Tam mentioned, the increase in SARS-CoV2 transmission is an issue for the UK as a whole and it would be wise for all the nations to co-ordinate in their response, and to learn from each other where various approaches have been successful.
“It is unhelpful to castigate various social groupings for the recent increase; this is a complex issue and should be a matter of taking responsibility rather than blaming and shaming. The public need urgent clarity concerning public health messaging, and it is encouraging to see recent efforts in this regard after the confusing and complicated culmination of rules after “unlocking” over the summer. This is especially important as winter draws near and should be underpinned by ensuring that our testing and tracing capabilities suffer no further setbacks, and are in fact significantly improved. This is all the more vital now to safeguard the return to schools, universities and workplaces.
“It is also important for the government to address unhelpful complacency and conspiracy around the potential severity of resurgent COVID-19. Whilst testing populations differ now to those in spring, the recent trends point to a concerning increase within the community that has the potential to get out of control, albeit perhaps less rapidly than in Spring due to mitigations such as (supposedly paused) shielding, distancing and face coverings. Nevertheless, we know from other countries that increased hospitalisations and deaths follow after a lag time of mere weeks, meaning that we have a limited window in which to act.
“Moreover, it is critical that we remember the significant numbers of erstwhile shielded individuals and other vulnerable members of the population that are likely to experience severe, potentially life-threatening consequences following SARS-CoV2 infection. A way forward must be found such that people in this predicament are not further disadvantaged and left behind as others are allowed to return to near-normal activities. In addition, younger and otherwise healthy individuals can also experience severe and/or long-term issues following infection with this virus, and this ought not to be minimised. Both of these aspects will return as considerable issues as infection continues to spread through our communities. Ultimately, the only safe way to get back to normal will be to massively suppress community transmission, ideally to the point of eliminating this virus from UK shores.”
Dr Gail Carson, Deputy Chair of the Global Outbreak Alert & Response Network (GOARN), said:
“As I have mentioned before and others have too, community engagement and trust is key to any outbreak response. There are excellent behavioural scientists in the UK who can advise the Government on messaging. I am keen to avoid a blame game and to understand why some COVID rules may have been ignored by some, and to work with those reasons to ensure community engagement going forward. Start by listening to those identified involved in any clustering of infection. Let’s remember that our young folks have had a rubbish 2020 to date and need understanding not alienation through a blame game. WHO has consistently emphasised that we all have an individual role to play in this outbreak response and we need to be involved and empowered until we all see this through to when the virus is under control, globally.
“A useful reference Back to Basics from the Global Outbreak Alert & Response Network (GOARN). The first point is community engagement. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31760-8/fulltext”
Prof Sian Griffiths, Emeritus Professor at the Chinese University of Hong Kong and past president of the Faculty of Public Health, said:
“The spike in positive tests amongst those 15 to 29 highlights the need to get the messages across to this group in the population – which includes many students starting university and colleges- that we all need to take the threat of coronavirus seriously and abide by the Hands, Face and Space then if positive Test and isolate guidance. The new public health campaign is to be recommended for its focus on increasing the understanding of the scientific thinking behind these messages .At the same time, by introducing new legislation the government is highlighting that gatherings of over 6 people are a risky situation with the virus at current levels – and making it easier for the police to intervene. Together these initiatives, coupled with robust action by local public health teams and authorities should help to reinforce the message that Covid is still in the population and that whilst most but not all young people have mild symptoms the most common route of spread has been within households and therefore if infected they risk spreading the infection to older relatives and vulnerable people who are at greater risk of hospital admission and ICU care. The UK figures appear to be several weeks behind those in France and Spain where the uptick in figures is beginning to be followed by an uptick in hospital admissions and deaths . Hopefully today’s action will prompt all age groups to “stop and think “and help to avoid further exponential rises and national lockdown.”
Dr Julian Tang, Honorary Associate Professor, Respiratory Sciences, University of Leicester, said:
“Unfortunately, the rise in COVID-19 cases is not surprising – given the various recent incentives ‘eat out to help out’, opening pubs and restaurants, the encouragement to return to work, and schools re-opening.
“With most of the population bring still susceptible to the virus – with much more social contact, the spread of the infection is likely to continue through the winter months.
“Although many of the COVID-19 cases we are seeing now are in the younger age groups requiring little or no hospitalisation – there is always the risk that this could spread to the more vulnerable elderly group and those with multiple comorbidities – particularly in BAME populations.
“But we can only do more of the same – maintaining social distancing and masking indoors (and on public transport) where there are more people in poorly ventilated areas, limiting the size of social gatherings, etc.
“The one silver lining resulting from all these COVID-19 precautions is the likely knock-on effect of reducing winter flu cases – which may be quite substantial – as they have seen in Australia already (https://www.google.co.uk/amp/s/amp.abc.net.au/article/12480190) and which will likely apply to all other seasonal respiratory viruses like RSV and parainfluenza.”
Prof Liam Smeeth, Professor of Clinical Epidemiology, London School of Hygiene and Tropical Medicine, said:
“Sadly the current reproduction number and infection incidence rates are not as low as had been hoped – indeed they are beginning to rise. I strongly believe that getting children back into school successfully needs to be an explicit national priority: we have a generation of young people with severely disrupted education and we need to be doing everything we can to help re-start their schooling. A national effort to tighten up on social distancing and steps to reduce viral transmission are needed if schools are to remain open. The reminder of the basic measures everyone needs to take to reduce transmission and the tighter restrictions on social gatherings are needed to try and keep the pandemic under control. This might even mean politically unpopular steps such as closing pubs and limiting travel – but some short-term inconvenience and sadly further economic hardship for some people may be what is needed. The political response to the pandemic has become fragmented and confusing, with a loss of public trust. We need to re-unite as a nation in a collective shared response to reduce viral transmission. Acting together we can get the pandemic under control, minimise the impact of the virus on peoples’ lives and keep our kids in school. We can do this and we need to do this.”
Dr David Strain, Clinical Senior Lecturer, University of Exeter and chair of the British Medical Association’s Medical Academic Staff Committee, said:
“The resurgence of COVID in the community is not a surprise. The nation’s success in establishing control was based on change in our behaviour rather than biology of the virus. The virus itself is unchanged, therefore our behavioural approaches move back towards “normal” it is to be expected that the pandemic would recur. The cornerstone of easing lockdown restrictions is a robust test and trace system, yet there have been repeated failures in the system, highlighted yesterday when Sarah-Jane Marsh, the director of testing at NHS Test and Trace, admitted that people are unable to access COVID-19 tests because of labs reaching capacity.
“Since the easing of lockdown 2 months ago, a decision made predominantly on economic grounds, there have been mixed messages about the need for physical distancing, face masks, social bubbles, indeed, even whether it is best to work from home or use transport systems to attend a physical workspace, leaving the country without clarity. It is therefore little wonder that an entire generation has interpreted the lack of guidance to their favour, causing the predictable rise in new cases among those aged 17-39. Fortunately these individuals are at a low risk of adverse outcomes, such as requiring intensive therapy unit support and death, although we are rapidly learning that the impacts of “long-COVID” are independent of the severity of the original disease, potentially harbouring a time-bomb. This “low risk” infected population, however, serves as a reservoir for the virus. As we move indoors due to the colder weather, this puts the older generation of parents and grandparents at risk of infection and a repeat of the high excess mortality seen over summer.
“Even now, with cases growing exponentially, the government is deferring action for 5 days, permitting further spread of the virus and thus making the role of disease elimination (or at least near elimination – i.e <1 new case /1,000,000 population day) even more difficult. There will be inherent risk of an approach aiming for near-elimination, namely that the economy will suffer in the short-term, although the long term gains will provide relative health and economic benefits.
“In order to achieve near elimination there are several key control measures that would be required including:
“It will only be through an aggressive policy that life can return to any semblance of normality or, indeed, even make it through the approaching winter with the potential “twindemic” of influenza with the existing coronaviral load.”
Dr Bharat Pankhania, Senior Clinical Lecturer, University of Exeter, Medical School said:
“We welcome the timely move by the Gov. in restricting numbers of people who may gather in social groups. Now that schools and businesses are opening, it is important that all possible infection control measures are undertaken. It is still of much concern that with people going back to work from their offices, there is the potential for spread of infection on crowded public transport and in the work place setting, it is better to reduce numbers on public transport and in offices and thus it would be better if people were also enabled to continue to work from home, it is also better from a planetary sustainability point.
“In the schools settings, the “bubble” can also be seen as a social gathering, these “bubbles” are often the whole year group making it a very large group, it is impossible in such large groups to maintain infection control and when a case arises, contact tracing in such a large group is also not feasible, it also knocks out of circulation a very large group. I would advocate that schools should establish much smaller “bubbles”.
“Whilst the number in a social gathering has been reduced it is important to pay attention to sources of infection and of concern are pubs and restaurants. In a crowded place with both music and many voices talking it is inevitable that people will talk with raised voices to be heard. This is an infection risk in an enclosed place, thus restrictions also need to be placed in these settings, fewer people, no music, clear directives not to talk in a loud voice or grasp the nettle and accept that alcohol consumption especially in pubs is not conducive to good infection control. Unfortunately, with alcohol, it imperceptibly enables the dropping of the guard, it is very difficult to continuously maintain good infection control practice.”
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