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The Government have released their 60 page strategy for easing COVID-19 lockdown measures.
On the whole document
Prof Paul Hunter, Professor in Medicine at the University of East Anglia, said:
“There is much common sense in the report and it is clear that although there is some relaxation of the current rules there is not much change at least for the rest of this month. One of the important themes is the importance of introducing relaxations to the current rules gradually with full and appropriate monitoring of the impact of any change on the trajectory of the epidemic.
“On page 39, the document states, “Anyone with symptoms should isolate immediately, alongside their households, and apply for a test. If a negative test is returned, then isolation is no longer required”. Given that apparently there are false negatives with these tests, this raises concerns that people who are symptomatic and infectious may then be allowed to go about their daily lives. Many/most of these false negatives may be due to an ineffective sampling technique rather than a problem with the laboratory tests. In my view, it is dangerous to rely solely on a single test in somebody with typical symptoms. Although as the epidemic is brought further under control and the incidences of the infection become low the probability of getting a false negative will fall, the potential damage from a super-spreader causing many infections because he/she felt they were clear could be large. When someone with symptoms books a test, there needs to be a judgement made as to whether their symptoms and history are typical of COVID-19 or not. This does not have to depend on an individual clinician making that judgement but could be automated. In my view someone with typical symptoms should self-isolate but one negative test at least needs a further test before it can be assumed that they no long need to self-isolate. Someone with non-typical symptoms and a negative test could still be reassured.
“The advice on page 50, “If you can, wear a face covering in an enclosed space where social distancing isn’t possible and where you will come into contact with people you do not normally meet. This is most relevant for short periods indoors in crowded areas, for example on public transport or in some shops”, does make sense in my view. This is in line with the conclusions of the systematic review that my group published a few weeks ago. The really important thing here is that this does not remove the need to need to do everything that we are currently being asked to do. There is a real risk that should people believe that wearing a mask gives them sufficient protection then they would increase their risky behavioural practices.
“Also, there are now a number of studies that have been reported into what are and what are not effective home-made masks. We do know that some materials are better than others and also that the fitting of the mask affects its value. You only need to see how people wear face coverings in public to realise that not everyone wears their masks in a way that would provide any real protection to themselves or to other people. The US CDC website give some good advice on how to make an effective facemask.
“The issue of “meeting up” outside is still confusing as shown by changing statements from a government minister earlier on Monday. The general statement is that “people can now also spend time outdoors subject to: not meeting up with any more than one person from outside your household; continued compliance with social distancing guidelines to remain two metres (6ft) away from people outside your household; …” So a literal interpretation of this is that if a young couple living together want to meet with her parents outdoors, they cannot do this as a group of four, even though there are only two households. A mother and child wanting to meet up with the child’s grandfather would not be breaking the rules, but the Grandfather would as he would be meeting with two people. I can personally see no real value in this restriction and it would be difficult to enforce. In the first case, does the woman meet with her mother whilst her partner meets with the younger woman’s father even though they all still have to be only two meters apart? Or is it the case that the woman can get close to just one person a day out of her household, so she can hug her mother but not her father until they meet again the following week? It seems to me that this is the area of the entire document that people are most interested in and what it is saying is far from clear to me. To my mind close family members living together should be allowed to meet with one other group of close family members living together each day providing that they are outdoors and that they still maintain two metres distancing. Such an interpretation of the rules would be of huge benefit to many people’s mental wellbeing without increasing the risk of infection.”
Prof Ivo Vlaev, Professor of Behavioural Science, University of Warwick, said:
“On social distancing and masks, it is very important HOW the government goes about informing and instructing the public on when to keep spatial distance and when to put on a mask. They should not give vague advice or suggestions. Clear and specific guidance is crucial, best presented as simple IF-THEN rules (if you’re in situation X, then do Y). Information will generally be necessary, but insufficient, for whole population behaviour change because this also requires motivation and the opportunity to implement change. Nonetheless, information is important and must provide clear and specific guidance for exactly what behaviour individuals should adopt to implement social distancing. Being precise means giving precise advice about what behaviour or behaviour change is needed; and presenting concrete examples of what following and not following the advice would look like.
“Sticking to those changes also depends on how well the government, and other organisations, manage to communicate the importance, or WHY, of social distancing. There is evidence that communication of threat is particularly effective when combined with communication about how to respond. There is an ongoing scientific debate about whether ‘fear appeals’ generate long-term behaviour change. However, the consensus is that they are more effective when perceptions of self-efficacy (belief that one’s own actions make a difference) are high.
“More broadly, emotions play an important role in such circumstances. Fear tends to increase perception of risk, while anger (e.g. when an individual feels they’re being treated unfairly during the crisis) can reduce it. We need to balance the need to inform and motivate against the danger of inciting unnecessary fear.”
Prof Keith Neal, Emeritus Professor in the Epidemiology of Infectious Diseases, University of Nottingham, said:
“Outside social distancing should be very easy as there is plenty of room and even being close to a fellow walker as you pass if 2m is not possible is essentially no risk. Standing and talking with that person closer than 2m clearly could be.
“Household social distancing is essentially impossibly unless you are in different rooms. People with COVID-19 symptoms have been encouraged to do this where possible.
“Inside other places is less easy. In workplaces where people are relatively static such as a production line then procedures can be reorganised in order to achieve as much distancing as possible. Screens and separators may also help. Businesses have had over 6 weeks to think about this.
“Where people are mobile, this is intrinsically harder. Businesses should look at what food shops have done. 2m distancing outside and queuing for the tills. Whilst moving around the shop you can be less than 2m but importantly for very short periods only (otherwise personal space is invaded if it gets to 1m in most workplaces) Each business will know how to do this best themselves and no amount of government guidelines can be created for each individual workplace.
“The R number is crucial but there is not just 1 R. If the R can be kept below zero, then the number of new infections drops. Recently there has been talk of R going up because of care homes and hospitals. This is an incorrect use of R as these cases are unlikely to spread outside the confines of the care home (residents don’t go out) except to staff. Hospital patients can be tested before discharge if going to high risk places and recent data from ONS show healthcare workers not to be at increased risk of dying from infection and so presumably not acquiring it. To control COVID-19 in care homes and hospitals the answer is infection control not social distancing. Care home residents are already social distanced. R should only be used for community transmission and to monitor the effects of any lifting of restrictions. Places are lifting it slowly so as to monitor the effects of small measures at a time. It is also important that there are lots of different Rs but currently the absence of locally reported new cases means this cannot be independently evaluated. It is quite likely that some parts of the country have much lower Rs and fewer cases. These places could have test, track and trace earlier and restrictions adjusted accordingly.”
Prof Robert Dingwall, Professor of Sociology, Nottingham Trent University, said:
“The Prime Minister was somewhat unfairly criticised for not giving much detail in his TV address on Sunday evening – this would never have been appropriate within such a format. However, we do now have some of the detail. It is the usual mixed bag of following the science and following the politics.
“However, there are two very important themes. First, there is an open acknowledgement that SARS-CoV-2 is unlikely to be eradicated from human populations any time soon, if at all. We have to live with this infection, much as we live with seasonal influenza. Second, detailed regulation is not the way to control the spread of this infection unless the science becomes more certain. At best, the government can create a framework of information within which people can make their own assessments and manage their own risks, with a focus on the ends rather than the means. This approach may, though, be undermined by other institutions, who impose their own conditions regardless of the lack of science, like requiring face coverings or 2-metre distancing as a condition of entry to premises or use of public transport facilities.
“Within the plan, there are still anomalies. Nothing is said about dental or veterinary care, although both are used to working with infection control: if my chiropractor can open, surely these can. Similarly, personal care services like hairdressers, nail bars and beauty salons will also remain closed, although, again, all of these enterprises are used to working with high standards of hygiene. It is hard to resist the conclusion that this decision rests on the latent public health puritanism underlying the earlier disapproval of sunbathing and household games in parks. If outdoor transmission is not thought to be important, why are children’s playgrounds in parks staying closed while primary schools and day care reopen? Will fit over-70s increasingly emphasise that the government is offering advice on self-isolation – and choose to act within the spirit of the plan, make their own risk assessments and engage fully with everyday life? We may all drive off to beauty spots for our exercise – but will the car parks be open, let along the public toilets. This might not be good news for the hedgerows of the Peak District…”
On the section regarding facemasks only
Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said:
“The government’s guidelines agree that there is no evidence that wearing masks protects wearers from coronavirus infection, which is in line with WHO guidance and all major studies. There is some limited evidence that mask wearing could have an impact on preventing spread of infection but ONLY as part of a range of measures to enforce compliance among population, and mask wearing is much less important than social distancing measures and proper hand hygiene. If not universally enforced as a recommendation it will do virtually nothing to prevent spread, and the risks of increasing infection might even outweigh the benefits. It should be noted that the guidelines are very particular regarding the wearing, handling and cleaning of masks and unless they are stringently observed, coverings will quickly become nothing more than a dirty handkerchief strapped to people’s faces.”
Dr Antonio Lazzarino, Department of Epidemiology and Public Health, UCL, said:
“The benefit of face covering is supported by neither scientific evidence nor common sense. The saliva droplets that face-coverings are supposed to stop have very little responsibility in the spread of COVID-19, which we now know is transmitted through minuscule particles. That is the reason why hand washing is extremely important; the virus can survive in the air and on surfaces, and our hands are one of the main routes of infection for ourselves and for others.
“Although the Government indicates that “it is important to use face-coverings properly and wash your hands before putting them on and taking them off”, it is virtually impossible not to touch your face-covering for several reasons that I have explained in my BMJ letter (https://www.bmj.com/content/369/bmj.m1435/rr-40). The Government’s instruction will never win against the natural impulse of touching your face-covering.
“Therefore, instead of helping us contain the virus, face-coverings may just help the virus spread across the world.”
Prof Trish Greenhalgh, Professor of Primary Care Health Sciences, Nuffield Department of Primary Care Health Sciences, University of Oxford, said:
“I’m delighted that the government has changed its position on face coverings for the lay public. The science on this is clear: Covid-19 is most commonly transmitted by droplets emitted when we cough, sneeze, shout, sing and even just breathe in close proximity to others. Cloth face coverings are highly effective at blocking droplets coming out of the mouth and nose. They’re not perfect, but if you can stop 90 or 95% of the droplets this will cause a very dramatic reduction in the number of people who catch the virus.
“Face coverings, which can be made out of a double layer of cloth, are a crucially important measure for bringing the country out of lockdown, since in reality few of us can get properly back to work without getting within 2 metres of other people (either while travelling to work or in offices and factories). We can’t stay behind our front doors forever, and nobody wants a second wave of Covid-19, so covering our faces will become the new normal in public places, workplaces and on public transport.
“Incidentally, I think it’s better not to call them masks, because medical masks are what doctors and nurses wear. A medical mask is scratchy and uncomfortable, and isn’t designed to be kept on all day. Make your own face covering out of an old t-shirt or cloth. We’d all prefer not to have to wear these but if most people do wear them, we’ll flatten the curve a lot more quickly, reduce pressure on the NHS, and help the economy recover. Remember, cloth face coverings are for source control: my face covering protects you and your face covering protects me.”
Government Strategy Document – Our Plan to Rebuild: The UK Government’s COVID-19 Recovery Strategy
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