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expert reaction to the publishing of the evidence and advice from SAGE on COVID-19

The government has published the evidence and advice they have been given on COVID-19 by the Scientific Advisory Group for Emergencies (SAGE).

 

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

“The UK government’s response to COVID-19 is informed by the scientific evidence, as it should be.  We would like the scientific evidence to be robust and definitive, but we are dealing with a virus we have never encountered before so, inevitably, there are many gaps and uncertainties and our understanding of COVID-19 and how best to respond to it is evolving very quickly.  Through good science, the evidence base will strengthen over time, but these are still early days.

“Nonetheless, however imperfect it may be at this stage, the scientific evidence that informs UK government policy must be made rapidly available for inspection and critical evaluation.  Only then do we have transparency over the basis for policy decisions which affect all our lives.  After a slow start, this is now being done and that is a very welcome step.”

 

Prof Sheila Bird, Formerly Programme Leader, MRC Biostatistics Unit, University of Cambridge, said:

“Dissemination is hugely welcome.  Next, please, we need epidemiologically-coherent tracking of test-results by route into testing: at least for a subset of major test-routes, such as: a) hospital-based testing; b) testing of index case in quarantined healthcare-worker-household.  Testing capacity and test-focus change week by week and these changes need to be controlled-for when interpreting test-results.  Daily numbers test-negative VERSUS test-positive are insufficient to unscramble the effects of the pandemic and of changes in testing (capacity and focus).”

 

Prof Martin Hibberd, Professor of Emerging Infectious Disease, London School of Hygiene & Tropical Medicine, said:

“The SAGE evidence publication is a welcome discussion on the science behind the policy announcements and reflects the difficult balances that have been taken into account to reach them.  The science is not unexpected, indeed much of this has been established over the years in response to actual and potential outbreaks, although often this has been prepared with a novel Influenza virus in mind.  With two major strategies described, suppression and mitigation, the policies associated with each are rather different.  Clearly the UK initiated on a course reflecting mitigation; taking the long term view that suppression would be difficult over the long period of time that the modelling shows to be required and the worry that subsequent waves of infection could be as bad as the initial wave if suppression policies were relaxed.  This view is in contrast to many countries, who have at least aimed for suppression policies.

“The difficulty with mitigation, recognised in the document, is that the surge requirements for ICU beds would hugely exceed NHS capacity.  While the government has rapidly tried to expand this capacity, this clear problem is perhaps behind the more recent government policies of extending mitigation policies towards suppression.

“Some of the assumptions made in this modelling may turn out (hopefully) to be overly pessimistic, in that pharmaceutical or vaccine interventions may occur faster than the proposed 18 months.  This would tip the balance further towards suppression policies and the hope that the intense social distancing methods could be lifted earlier than planned in the current document.  With this in mind, the rapid build-up in testing capability and in particular the use of SARS-CoV-2 antibody detection diagnostics, together with isolation of those people capable of transmission, should be highly encouraged.”

 

Prof James Naismith, Director of the Rosalind Franklin Institute, University of Oxford, said:

“The underlying data demonstrate more than anything else the complexity of the challenge we face.  Although one strand of evidence indicates the need for social distancing for very long periods to curb the virus, it would be negligent to ignore the social costs and economic risks of such a policy.  I was encouraged to see the government taking all these considerations in the round by calling on experts across social and laboratory science.  A plan which does not consider human nature is not a plan at all.  The effectiveness of health systems is tightly correlated to economic prosperity.  I would urge people to appreciate the complexity of what confronts us.”

 

Prof Stephen Reicher, Wardlaw Professor of Psychology, University of St. Andrews, said:

“One of the most heartening things about this crisis is how the medical and behavioural scientists have been working hand in glove – and this is clear from the papers.  The virologists, epidemiologists and modellers can tell us what measures would be most effective in combatting the disease.  The job of the behavioural scientists is then to provide insights as to how best to get people to comply with these measures and thereby make them as effective as possible.  It is only by combining biology, medicine and psychology that we can get people to do what is necessary to save lives.”

 

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

“Building and keeping the trust of the public is so important, to ensure high levels of compliance with these significant and disruptive public health measures that will be in place for some time to come.  Transparency and openness about ‘why are we doing this’ is key to sustaining that trust.  Therefore, it is excellent to see the release of the evidence base upon which important decision-making is made.  Governments of other countries should also be encouraged to release their own evidence base, to promote trust with their citizens and to allow further scrutiny and analysis from research and policy experts.”

 

Prof Willem van Schaik, Professor in Microbiology and Infection, University of Birmingham, said:

“The transparency of the government is to be applauded.  There is no doubt that the steps undertaken in recent days to promote social distancing to minimize the spread of Covid-19 are solidly supported by scientific advice.

“After this pandemic has passed, I am sure political scientists and historians will look into the content and messaging of the Prime Minister’s press conference on Thu 12 March and the processes that led to the subsequent change in policy and tone that we have seen this week.  However, at this point we really have more urgent issues at hand than to look back on past events.

“I note that the government and academics are currently closely working together to develop interventions that minimize the spread of the virus, invest in high-throughput testing strategies, study drugs and vaccines and support those that work in the NHS.  It is heartening to see that these massive collective efforts are undertaken to protect the British people from Covid-19.”

 

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“The release of the scientific evidence underpinning government policy is to be welcomed.  Clearly epidemiological modelling has played a key role in informing the government, but modelling is based on assumptions and, in the absence of sound underpinning scientific knowledge of the way the virus is behaving, it is little more than a complex mathematical guess.  It is clear from some of the expert meeting minutes that those present were well aware of the key issues that needed to be resolved – things like the prevalence of asymptomatic or mild disease and its role in virus transmission and the potential role of children in driving this pandemic.  The only way to get a handle on these fundamental issues is to do the hard science – to actively pursue the virus in the community and work out how it behaves.  One could argue that urgency around fact gathering was replaced by misplaced hope that number crunching would provide the absolute answer.

“The good news is that the last week has seen a major shift in impetus and we will soon be in a position to start addressing this shortfall; crucially we will see increased testing, out in the community.  The scale of the outbreak in China, then experiences in places like Korea and Italy, were a warning.  Hopefully, by gathering better data, and increasing our understanding of the virus we will be in a better place if and when the virus reappears.  But for now, we have to deal with the problem in hand and, in the absence of vaccines and treatments – which will hopefully appear one day – we have to take the social distancing advice on board and slow the spread.”

 

https://www.gov.uk/government/news/coronavirus-covid-19-scientific-evidence-supporting-the-uk-government-response

https://www.gov.uk/government/groups/scientific-advisory-group-for-emergencies-sage-coronavirus-covid-19-response

 

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

http://www.sciencemediacentre.org/tag/covid-19

 

Declared interests

None received.

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