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expert reaction to the Independent SAGE Report 7 on elimination of the virus from the UK

The Independent SAGE group have published their 7th report, this time into the elimination of the COVID virus from the UK

 

Dr Kathleen O’Reilly, Assistant Professor in Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, said:

“To propose the objective of achieving elimination of COVID-19 in the UK at this stage is bold. The report provides ‘planks’ for the suggested strategy, which refer to the tools that Independent SAGE suggests the UK could use to achieve elimination. These include; testing more and acting on the test, restricting movements until infections are fully controlled, a strategy to deal with new cases, restricting international travellers, and having a public health messaging campaign. These tools aren’t so different to what the Government are currently doing, but the important difference is that independent SAGE have specified the intended end result as elimination of COVID-19. In contrast, the Government published their recovery strategy in early June, with the stated aim of retuning life “as close as possible to normal” and to avoid a new epidemic.

“Elimination of infectious diseases is hard. The UK has eliminated polio, and measles in 2017. Both were achieved using case surveillance and an effective vaccine. It would be very difficult to achieve elimination without both these tools, and public support and trust in vaccines is essential. As a country we are barely 6 months into experiencing COVID-19, vaccines are being trialled but the safety and efficacy of the vaccines still need to be assessed. It is still too early in this pandemic to know whether the UK could eliminate the virus.  

“To provide advice to the Government that elimination should be the goal is commendable. However, the Government also needs sound advice on whether elimination is feasible, and what the disadvantages might be. For example, it seems that New Zealand may be close to achieving elimination of COVID-19, but this was at the cost of extreme traveller restrictions, damaging the tourism industry. Consequently, the “New Zealand approach” may not be palatable for many in the UK. Something in the middle might be a more sensible strategy, but the risks and benefits have not been fully assessed.”

 

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

“The report and plan put forward by independent SAGE represents a clear way forward for UK, and in particular England, to escape from the present limbo in which we find ourselves. The tail of our ongoing epidemic is considerable, and will cause unnecessary, preventable suffering and death over the coming months.

“Whilst economic considerations are clearly behind the ongoing relaxation of lockdown measures, the prospect of protracted lockdown cycles will represent far greater cost. Several examples of countries around the world show us that elimination is a viable strategy for controlling SARS-COV2, and Scotland appears to be on a similar path. Whilst we have endured a dreadful outbreak and the path back to normality will be proportionately challenging, ultimately we are an island and control of this disease should be achievable as a result. I sincerely hope that the Government will listen to this advice and allow itself to be led by science once again.

“Of particular relevance, upon appropriate reduction of prevalence by lockdown/distancing, it will be essential for testing and contact tracing to be robust and reliable, alongside appropriate quarantine measures designed to minimise imported cases. In this regard, the notion of limiting transport across the Scottish and Northern Irish borders feels appropriate.”

 

Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:

“Reducing the number of cases to as low as possible should be the aim.  Elimination has distinct advantages but it does not meant that the problem is solved.

“If COVID-19 is eliminated from England/Scotland/Wales or Northern Ireland/Republic of Ireland the big challenge is maintaining this COVID-19 free status. Both China and New Zealand that achieved best of all during the pandemic have key features that help but cases still keep getting diagnosed.  China enforces a strict supervised quarantine with state control not possible in the UK and New Zealand has fewer international travellers than most western countries for their population size and these are being quarantined.  For the UK our proximity Europe and dependence on lorries for food means that we are NOT an island.  We cannot quarantine every truck driver and if we don’t we risk re-introduction unless Europe is also COVID-19 free and then the question is which bit of Europe is treated as a single COVID-19 free area.

“The document claims that the national test track and trace has failed but the biggest failure so far is that 25% of cases who have arranged a test do NOT answer the phone.  This simply won’t be sorted by a local system ringing the cases as those not answering will not answer the local people either. 

“Each country is different and also there are large differences within countries.  What is right in one part of a country may well not be right in another part of the same country. 

“The lower number of deaths in the Republic of Ireland has been assisted by a population with a lower average age. 

“The report claims that Australia is a success but the population of Melbourne, Victoria where a lockdown has been re-imposed might well disagree. 

“Having a 12 month plan seems particularly odd as the plan should be to drive infection down as quickly as possible.  So much of the science and knowledge is changing almost daily at times so the plan could be outdated before it was published.  We know a lot more, and different things, since at the start of the pandemic.”

 

Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:

“The Independent SAGE report proposes a strategy of COVID-19 “elimination” from the British Isles. Elimination means zero cases. This is a worthy but extremely ambitious aim; neither China nor South Korea has yet achieved elimination, and they were the first countries to bring their COVID-19 epidemics under control. To achieve elimination for the UK and Ireland within a reasonable time frame would presumably require a contact tracing system as good as South Korea’s and a lockdown as strict as China’s. The former is already UK government policy but the latter is not; every country in the British Isles is currently attempting to relax lockdown as quickly and as safely as possible.

“Given the enormous challenge of achieving elimination the key questions are ‘how long would elimination take?’ and ‘how much additional damage would be done by extending the lockdown for that period?’. Before an elimination strategy is attempted it would be sensible to have answers to those questions. The Independent SAGE report does not provide them.

“The long term vision of the elimination strategy is equally unclear. There is no prospect of eradicating COVID-19 from the whole world in the foreseeable future. Even with a highly effective vaccine, this would be a huge challenge. So we may arrive at a position where regions of the world (small or large) have achieved elimination or something close to it, but the remainder have not. That dichotomy could only be sustained through extremely rigorous travel restrictions and quarantine regulations. New Zealand, currently the country closest to elimination, is already grappling with the implications of this for its tourism and higher education sectors.

“We need to think very carefully before embracing any COVID-19 response strategy that could result in more long term damage than can be justified by the public health gain. This is the case for any strategy to respond to this pandemic. The worrying truth is that, as of now, none of the available options are the least bit attractive. For all that we have been through in the past few months, the full impact of the COVID-19 pandemic is still to be felt.”

 

https://www.independentsage.org/wp-content/uploads/2020/07/A-Better-Way-To-Go-FINAL-proof-copy-1.pdf

 

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19

 

Declared interests

Dr Kathleen O’Reilly: “I declare no conflicts of interest”

Prof Mark Woolhouse: No Conflict of Interest to declare.

None others received.

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