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expert reaction to open letter on COVID-19 strategy written by Prof Karol Sikora, Prof Carl Heneghan, Prof Sunetra Gupta and others

An open letter has been sent to the Prime Minister by a group of scientists calling on him to alter the governments COVID-19 strategy.

 

Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:

“This letter will no doubt appeal to a great many people.  The idea underpinning it essentially absolves the majority of the UK, or indeed even the world population from the responsibility of having to deal with the consequences of the SARS-CoV2 pandemic.  This reaction is understandable as we again find ourselves in a very similar position to that in early March, with the beginnings of exponential spread of the virus across much of the country.  One could therefore rightly ask what the point of the last six months has been, especially when confounded with failings in the testing system, public money wasted on bogus private contractors, and the new resurgence in hospitalisations.  The letter rightly points out that messaging from government has been less than clear, and that the consequences of lockdown and the pandemic for the NHS were severe.  In addition, the lockdown had profoundly negative effects upon businesses, mental health and family life; nowhere was this felt more keenly than amongst the less affluent members of the UK population.  Nevertheless, despite assertions in the letter, lockdown certainly succeeded in buying time to prepare by driving down community transmission; what was achieved with this time is quite another question.

“It is important not to conflate failed government policies, the consequences of austerity and NHS underfunding, and the morally reprehensible increase in the poverty gap, with the potential for this still new virus to cause harm.  The underlying tone of this open letter is that the majority of the population can weather the SARS-CoV2 storm with little consequence, whilst we somehow protect those most at risk from infection and severe COVID-19 sequelae.  Sadly, this is little more than a thinly veiled return to a herd immunity strategy and the human cost for this has not changed since spring, nor is it likely to – one only has to look across to countries like the US, Brazil and India to see this reality.  I cannot recollect anyone ever stating that SARS-CoV2 is deadly to all, yet it is clearly deadly enough.  Furthermore, whilst certainly not the majority, we know that younger and otherwise healthy individuals can sadly succumb to the virus, plus it is becoming increasingly clear that long term effects, even in patients with relatively “mild” COVID, represent a significant clinical concern going forwards.

“Death rates may have remained low over the summer, but we know this occurs proportionate to community transmission and secondary to hospitalisations, which are now rising again.  Moreover, herd immunity in reality has not achieved control for the majority of viral diseases, historically requiring public health interventions to limit spread during the wait for a vaccine.  We also know that immunity wanes for SARS-CoV2 as it does for other human coronaviruses, and it is unclear whether such responses might be helpful, or indeed potentially comprise a hindrance upon subsequent exposure to the virus.  Similarly, the cross-reactive immune responses within individuals previously exposed to certain seasonal coronaviruses have a poorly understood impact upon SARS-CoV2 disease, yet as they seemingly do not prevent reinfection with these endemic viruses, any possible effect is likely limited to reducing, rather than preventing disease.

“The concept of being able to fence off would-be shielders and other vulnerable members of UK society conjures multiple issues, not least due to the sheer size of this population counted in the millions.  The shielding programme served an important purpose during the early months of the pandemic, but unfortunately no clear exit strategy was ever determined or acted upon.  Shielders have lives, livelihoods and families, come from a range of age groups and are linked to virtually every aspect of life in this country.  Moreover, they have already been cut off from society with no apparent way forward since March, and many of those less well-off, or with school-age children, now endure considerable risks as they are forced to re-engage with society amidst ever-growing community transmission.  The only genuinely safe option for this group is the suppression of transmission, enabled by effective testing and tracing, yet this remains to be achieved and the window of opportunity created by the lockdown is fading fast.

“Nobody in the UK wants another national lockdown, but at the same time COVID, public health, wellbeing and economic recovery are inextricably linked.  Rather than leaving members of our society behind, we must all take collective responsibility whilst enduring the forthcoming winter and ensuring that we limit the potential for the virus to spread.  This must be enabled by efficient, rapid testing and tracing, and by a clear public health guided message on appropriate, targeted measures to interrupt transmission.  It is clear that countries that have been able to control the virus supported by such measures are not only able to return to normal life in many respects, but are also able to rapidly deal with any new introductions and ensuing local outbreaks.  The UK must reinvest in its existing public health infrastructure and the NHS to ensure that all aspects of COVID- and non-COVID related healthcare can be met.  The way to endure a pandemic is through unity, rather than division, as described recently in another open letter in the BMJ: https://blogs.bmj.com/bmj/2020/09/21/covid-19-an-open-letter-to-the-uks-chief-medical-officers/.”

 

Dr Flavio Toxvaerd, University Lecturer at the Faculty of Economics, University of Cambridge, who specialises in the economics of infectious diseases and economic epidemiology, said:

“I think the letter makes a number of important points, but two stand out as particularly important.

“The first point is that the government should articulate and communicate what it sees as the big tradeoffs we are facing, in terms of health, inequality, welfare and economic outcomes.  Also, it should be explicit about how these tradeoffs guide policy choices.  Doing so will not only help clarify its thinking and enable better policy making, but will also make it easier to communicate to the population why certain sacrifices are needed to ensure we contain the epidemic.

“The second point is that we need to think hard about how to better target policies to cause the least possible economic damage while ensuring that we manage the spread of the disease.  At early stages of the epidemic, widespread lockdown was perhaps necessary to buy time and better understand the challenges we were facing.  But as we learn more about the disease, our policy tools and interventions should evolve and become better targeted and more sophisticated.  This may involve new interventions such as workplace and school rotations and the like.

“I think that if the letter helps focus the government’s attention on these issues, then it will have achieved something very useful.”

 

Prof Trish Greenhalgh FMedSci, Professor of Primary Health Care Services, University of Oxford, said:

“This is not a response to the Sikora letter, but I also wrote an open letter with some colleagues; for full list of names click link: https://blogs.bmj.com/bmj/2020/09/21/covid-19-an-open-letter-to-the-uks-chief-medical-officers/.”

 

 

 

https://twitter.com/ProfKarolSikora/status/1307972101463212032?s=20

https://www.spectator.co.uk/article/boris-needs-to-rethink-his-covid-strategy

 

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

 

Declared interests

None received.

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