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The government have announced new lockdown restrictions for England, which they plan to implement from next Thursday, to help slow the spread of COVID-19.
Comment from MQ Mental Health:
“There must be a focus on the nation’s mental health and wellbeing during the second Lockdown.
“As 56 million residents in England face a second lockdown, joining Wales and Northern Ireland, the focus must be on far more than just controlling the spread of Coronavirus says Lea Milligan, CEO of the charity MQ Mental health.
“We have seen from the first lockdown that tough restrictions affect people’s wellbeing. We have seen severe mental health conditions rise by 8.1% as a result of the pandemic, disproportionately affecting young adults, women, the economically disadvantaged, medical staff and key workers and those with pre-existing conditions[1]. But still, little focus has been put on researching, treating and preventing mental health issues in the Governments pandemic response strategy.
“A rapid review of 24 quarantines, carried out earlier this year, found that the vast majority had impacted negatively on the wellbeing and mental health of those isolating.[2].
“We already know there is a bidirectional relationship between COVID-19 and mental health as 1 in 17 people have a first psychiatric diagnosis within 3 months of infection with the disease. This means that there is a 65% increase in patients with COVID-19 being diagnosed with a mental health condition (including anxiety and depression) over those who have not been infected[3].
“These statistics show that the impact COVID-19 is having, not just to those infected with the virus but also those disproportionately affected by lockdown restrictions, cannot be ignored.
“MQ Mental Health is supporting a number of urgent studies into the impact COVID-19 is having on different mental health conditions. MQ is urgently looking for participants to volunteer to take part in these studies which can all be found here: https://participate.mqmentalhealth.org/coronavirus-mental-health-research-studies/
Further comment by Lea Milligan, CEO MQ Mental Health: “The impact to mental health should always be a consideration especially as we still don’t know the full impact Coronavirus has on an infected patients’ long term mental health.”
“Up to one in four people will suffer from a mental health condition in their lifetime . This is the other pandemic our nation faces, but this is one that we know how to respond to; by focusing on research and developing treatments. It just requires investment.”
[1] Institute for Fiscal Studies. (2020) The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK. https://www.ifs.org.uk/publications/14874
[2] Brooks S, Webster R, Smith L et al. (2020) The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence. The Lancet 395: 912-20. https://www.thelancet.com/article/S0140-6736(20)30460-8/fulltext
[3] Taquet M, Luciano S, Geddes, J R, Harrison, P. (2020) Bidirectional associations between COVID-19 and psychiatric disorder: a study of 62,354 COVID-19 cases. MedRxiv. https://www.medrxiv.org/content/10.1101/2020.08.14.20175190v1
[4] Psychiatric Morbidity Survey. (2007) The Office of National Statistics https://www.mqmentalhealth.org/news-blog/post/the-other-pandemic-why-world-mental-health-day-is-more-important-than-ever
Prof Trish Greenhalgh FMedSci, Professor of Primary Health Care Services, University of Oxford, said:
“Lockdown came too late. Let’s make sure it’s not also too little. Restricting people’s movements and the number of people they interact with for 4 weeks will not, in and of itself, eradicate the virus. We need to use these four weeks to do four additional things: a) optimise and integrate the test-track and trace system to ensure that people are quickly diagnosed and their contracts efficiently traced and quarantined; b) improve the physical and social environment in workplaces, schools and universities – for example, by increasing ventilation, spacing people out as much as possible and supporting as many people as possible to work remotely; c) support businesses to stay closed if opening would put people’s health at risk; and d) develop and convey a clear and consistent public health message about the key interacting factors which spread the virus: it’s not about a single variable (e.g. masking or not masking); it’s about increasing ventilation AND reducing crowding AND limiting speech/shouting/singing AND maintaining distance (as far away as possible – not just 2 metres) AND reducing duration of contact AND masking.”
Prof James Naismith FRS FRSE FMedSci, Director of the Rosalind Franklin Institute, and University of Oxford, said:
“No one can be happy with a new lockdown.
“An analysis of the number of infection and covid19 deaths I hope can help people understand what is happening and what to expect.
“Track and trace has failed. There is no evidence that experiment of local lockdowns has bent the curve anywhere near fast enough, infections are rising with a doubling time of between 2 and 3 weeks.
“New medicines, high throughput tests and the vaccine are on their way, but we have to get through this winter first.
“Almost every scientist from as early as March, has warned that the winter was going to very difficult.
“We know from April that a lockdown works to reduce the spread of the virus.
“It has been clear since early September that the virus is spreading rapidly, clearly the social distancing measures in place have slowed it down from the doubling every four days we saw in March.
“If we look at ONS data for the week ending 8th October, the headline was 28, 000 (22, 00 to 38, 000) infections per day.
“Just over three weeks later, we reached around 300 deaths per day. This is consistent with a death rate of just under 1 %,
“Antibody testing estimated that around 6 % of the UK have been infected, this is around 4 million people. 1 % of this number is 40, 000 roughly the number of deaths from covid19.
“There is no great mystery about these numbers, they are same in the UK, US and EU. For every 1000 people infected, on average 4 to 8 people die around three weeks later.
“We do not know yet how many infections per day have occurred this week that has just ended, but it is very likely to be above 60, 000 infections per day (using ONS, REACT and Nowcasting reports).
“Therefore I am very sad to say that, based on those figures, we should expect and not be surprised to see a rise in deaths to around 500 per day over the next three weeks until we start to see the new measures take effect.
“This has been the consequence of the human desire to “wait to be certain” before acting.
“If we make no change for another doubling period (around two weeks), then by around Christmas we would be unable to stop 1000 deaths or more every day.
“The Prime Minister has announced a lock down, provided we follow it, we will avoid these awful numbers in December.
“The deaths I estimated assume every person admitted to hospital gets the best the NHS can offer and benefits from the breakthroughs in science and medicine.
“If our hospitals full and are forced to resort to triage, then one can easily imagine a doubling in fatalities.
“It is regrettable to see the fact that we have avoided previous worst case scenarios misused as an argument against using scientific predictions to avoid future ones.
“When we drive onto a motorway, the fact that we haven’t crashed before is not an argument against looking carefully, indicating, adjusting speed and then crossing into the lane.
“No one is saying lockdowns are not harmful, they will cause misery and death. We do know that population health is correlated with economic health, being poorer as a country means we will be unhealthier. We know despair and isolation take lives. We know delays in treating some diseases will increase deaths.
“It is for social scientists, psychologists, economists and public health experts to estimate the damage of these lockdowns. I lack the expertise to do this, however the government does take this advice.
“I would note that in the first wave the actual measured number of deaths from covid19 was much higher than every credible estimate of death from the lockdown.
“Scientists advise, in a democracy elected politicians must decide. I think these will be amongst the most enormous decisions that our politicians will ever make.
“Should some politicians wish to argue against a lockdown because of their political beliefs, they are perfectly entitled to make that case.
“However, they should either explain how they will avoid 7000 deaths a week or why 7000 deaths a week is worth it or why the lockdown will be worse.
“What is wrong is to pretend that 1000 deaths a day won’t happen if we don’t act.
“Scientists, like everyone else, are entitled to political preferences.
“However, I do not think it helps inform the public, when scientists make ideological arguments masquerading as science.
“Scientists can and should propose new theories, I support their right to go against the tide, however many theories are wrong irrespective of who proposes them.
“Richard Feynman said “Science is the belief in the ignorance of experts’. What he meant is that the ideas scientists have, can be wrong and it is up to science to provide the evidence to back them up or disprove them. Evidence comes from experiments, measurements and analysis, to determine whether that idea holds weight or not.
“Albert Einstein was wrong about the uncertainty principle, had science said “Einstein has spoken, that’s it” then there would be no GPS.
“There is no evidence that herd immunity by infection is attainable and there is no evidence that the UK can shield the vulnerable. There is good evidence against both these theories.
“Doing the experiment to test these ’theories’ is to recklessly risk the lives of tens of thousands of UK citizens.
“I can think of no plausible reason other than coivd19 cases are increasing that explains ONS data, assertion to the contrary requires evidence to be worthy of any consideration.”
Prof Igor Rudan, Joint Director of the Centre for Global Health and WHO Collaborating Centre, University of Edinburgh, said:
“The problem with the large second wave of COVID-19 pandemic in the whole of Europe, as well as in England and the UK, is that the objectives of national government responses are no longer as clear as they were during the first pandemic’s wave earlier this year.
“When the first wave struck Europe, the objective was clear: saving as many lives as possible, supporting the economy during lockdowns and learning quickly about the virus. We needed to understand infection-fatality rates and the speed of spread much better, as well as the modes of transmission and opportunities for prevention. Lockdowns in March and April were buying us time to develop tests for diagnosing both the presence and of the virus and the exposure status. They also bought us the time to develop and test PPE, improve guidelines to reduce transmission through so-called “precision public health”, provide health education on the pandemic to the general public, test the effectiveness of the existing medicines and accelerate the development of the new vaccines.
“However, in this, the second wave, the objectives are no longer clear. It is difficult to predict whether the risk of economic meltdown or even social unrest may eventually lead to greater damage than the public health crisis. We cannot say with certainty when we may get effective vaccines or medicines distributed broadly. As a result, a strategy is required which simply minimises the risk of either health system breakdown, economic meltdown, or even social unrest.
“The measures proposed by the Government today are simply trying to address the problem that seems the most imminent and pressing. European Governments are in a passive position, where they will be locked in a vicious cycle of trying to address the most pressing of those three problems until the pandemic ends in some way.
“In several years’ time, it may be possible to scientifically assess, based on different systems of values and using many different criteria, whether a strategy of less stringent measures for those of working age, while shielding the most vulnerable, would have been less costly or damaging to the societies of the western world in comparison to a full lockdown, or some “middle way” approach.” However, at this point in time, we cannot know this with certainty. Under such circumstances, taking a path that tries to balance between the risk for the breakdowns of the economy and the health system, and which addresses the most pressing one, seem sensible.
“There is also another approach worth mentioning, that has been used in the countries of Asia, which is reliant on very strong systems and procedures for testing, tracing and isolating, careful monitoring and tracking of all contacts, mask-wearing, social distancing and tight border controls. If we use the criteria of lives saved and GDP retained as the two main criteria, then their approach seems superior in its results so far to those that we are considering in Europe. However, as there doesn’t seem to be sufficient capacity in European countries to implement similar measures, nor sufficient support from the general public to implement such strict measures, then the strategy proposed by the PM seems quite transparent and grounded in what we learned so far about the virus.”
Prof Paul Hunter, Professor in Medicine, University of East Anglia, said:
“It was very clear from the data presented by the CMO and Chief Scientist that the situation with the epidemic nationally is deteriorating rapidly and rather more than was expected a month or two ago. With such a rapidly deteriorating situation it was fairly clear that some strengthening of the restrictions was needed.
“In many regards the new restrictions are similar to the lockdown that we went through in March and April but with some notable differences. To my mind, those that are more important are
1. Educational facilities remain open. Many would support this as the negative impact on children’s educations otherwise could have long lasting impact on our children’s life opportunities. But for students who are studying and live away from home they are not allowed to move back and forth between their University and their home during term time until the start of the Christmas break.
2. The definition of clinically vulnerable is now over 60. Clinically vulnerable people have to be especially careful to follow the rules an minimise contacts with others. This is a significant change from spring when the definition of clinically vulnerable was over 70. These changes will mean many hundreds of thousands of people will now be classed as clinically vulnerable when in spring they were not. Shielding has not been reinstated but it is important for people in this age group to realise that they are more vulnerable to severe disease if they catch the infection.
“These new restrictions have been implemented for four weeks. The big question is whether they will be sufficient to reverse the rapid increase we have seen in recent weeks. Any change in restrictions takes about two weeks before any impact is seen on numbers of new cases. Also as we saw in April and May, even with the full lockdown we had then, case numbers declined much more slowly than they had increased. Given that schools are remaining open it is likely that any decline will be even more gradual now than in April. Although we should see evidence of decline in cases after a couple of weeks, I doubt that case numbers will have fallen dramatically by the end of the four week period and if all restrictions were then relaxed it would not be long before case numbers started to increase again.
“Sadly we now have so many cases occurring in the community that even if we were to make big improvements in our contact tracing we would still not be able to contact sufficient people to make a big enough difference. To my mind the failure in our regional strategy was that we waited until it was obvious that the epidemic was out of control in local areas being imposing local restrictions, by which time it was almost certainly too late. If we changed this strategy and instead relaxed restrictions locally when after this four weeks are over but only when there was clear evidence of low and decreasing numbers of cases then this may be a more effective regional strategy.”
Dr Rupert Beale, Group Leader, Cell Biology of Infection Laboratory, Francis Crick Institute, said:
“The decision to enter a second period of national lockdown is a painful one but clearly necessary. I urge everyone to obey the rules: this will ensure we spend the minimum time under these very restrictive and costly measures. The Prime Minister mentioned the imminent arrival of new rapid tests. How effectively these are deployed, and how well our Test, Trace, Isolate and Support system can work will determine whether we will be able to avoid repeated lockdowns.”
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 seriously limiting our social interactions … This last one is the ultimate weapon in our fight. 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 mean we need to go harder at breaking the transmission. This second lockdown is all about that – us, not the government, hitting it hard. None of us want this at all. But 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.”
Dr Simon Clarke, Associate Professor of Cellular Microbiology at the University of Reading, said:
“The Prime Minister made a seemingly hurried announcement at the end of his news conference statement about a wider roll out of rapid coronavirus testing.
“While this may have been announced now purely as a way to provide some sugar along with the bitter medicine of lockdown, mass rapid and effective testing and isolating of infected people really is the best way for the country to get out of this nightmare. It highlights the terrible failure of efforts to improve the NHS Test and Trace system fast enough and to make it adequate over the summer after we emerged from the previous lockdown. The failure to keep pace with demand earlier in the autumn, which was the genesis of this second wave, meant people have been less likely to follow the rules. It has also meant that people without symptoms, but who were infectious, have been spreading the virus without any way of knowing that they are doing anything wrong. But the details on mass rapid testing still remains thin on the ground, and we will need to see some serious concrete plans and quickly, if we are not to suspect that the Prime Minister’s statement was purely about news management.”
Prof Jackie Cassell, Deputy Dean, Brighton and Sussex Medical School, said:
“The emphasis on what is needed to protect the NHS work – both COVID and non-COVID – was striking. The South West was mentioned specifically. It has a dispersed population and relatively small numbers of ITU beds, partly because much major elective surgery is done at a distance. The NHS trade offs are a huge driver for these decisions, with massive waiting lists in the system following the spring first wave and lockdown, as well as the huge mental health toll of lockdown. It was good to see much more emphasis on this now both in the presentation, and the answers to press questions. By contrast, in the May Cummings Barnard Castle press conference, no journalist even mentioned the pressure on NHS as a concern.
“There was a subtle and interesting dissonance between the way the Prime Minister and his scientific advisers’ formulated their optimism about the science. The PM emphasised testing and new testing technologies as a way forward. By contrast, Whitty pointed to the achievements of medical sciences generally in the field of infection through multiple approaches. This was followed by Vallance listing dexamethasone, vaccination and testing as advances, in that order.”
Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:
“There’s over 11000 COVID-19 patients in NHS hospitals, with more than 1000 patients being admitted every day, and increasing numbers of healthcare staff off work with a positive COVID-19 test. That is simply not sustainable. With so much resource dedicated towards infection control, a health service overloaded with severely ill COVID-19 patients cannot also fully accommodate (for example) cancer and stroke patients. Therefore, any intervention that reduces the burdens of COVID-19 is also good for other patients too.
“These measures should have been announced several weeks ago. However, even at this stage, these newly-announce measures should help to provide some level of control the community transmission. With any significant reduction in cases, the government simply has to use that ‘breathing space’ to fix the Serco-led contact tracing system. Control of this should be passed over to local health protection teams, ensuring that that more contacts of cases are reached, which will help to keep cases at a lower level and minimise the spread of new outbreaks.”
https://www.gov.uk/guidance/new-national-restrictions-from-5-november
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