Sunday, March 7

‘Data, not dates’: Expert views on how to lift England’s Covid lockdown | Health policy


BOris Johnson is due to chart a course out of England’s third national lockdown on Monday, which is expected to begin with the reopening of schools from March 8. Details of the plan are likely to be finalized Sunday. What do experts think the prime minister should do?

Professor Gabriel Scally, chair of the epidemiology and public health section, Royal Society of Medicine

“The prime minister should outline his goal of reducing the infection rate to a minimum and keeping it there, restoring the normal functioning of much of society and the economy.

“To do that, the lockdown must be stricter for six weeks, but it must also be the last. All international arrivals [not just from the government’s “red list”] undergo controlled isolation for 14 days.

“The failed and expensive test and trace system must be replaced by a comprehensive search, test, trace, isolate and support system, adequately resourced, managed by the NHS and run locally by directors of public health.

“A green zone system should be used in England, whereby areas with near elimination of Covid are protected by buffer zones through which travel is restricted for non-residents. Local authorities with the highest residual levels of the virus should be given additional resources and powers.

“An agreement must be reached to allow travel restriction across the Scottish-England border so that Scotland can reach its zero Covid target as soon as possible.

“Finally, the Prime Minister and the Irish Taoiseach, Micheál Martin, should agree to pool vaccine supplies, as it is in the best interests of both islands to vaccinate their populations quickly.”

Professor Karl Friston, computational modeler and neuroscientist at University College London

“I would announce three things. First of all, with your numbers in good shape, you should seriously consider unlocking sooner rather than later.

“When you model mitigated responses to the virus, as opposed to the worst-case scenario of unmitigated responses, we may come out faster than some of the rhetoric implies. But that is crucially conditioned on careful and mitigated unlocking that is sensitive to the prevalence of local infection.

“Second, we should allow local authorities to control the removal of measures, and the central government to issue the general direction in terms of criteria. Criteria for local unlocking (schools first, then retail, etc.) will have to be sensitive to local infection levels.

“I wouldn’t announce that ‘on April 1 we will do this and on May 8 we will do that.’ It would be more: “These are the criteria that we would have to see before taking the next step in a gradual process towards normality.” The current sentence is “data, not dates”. That is absolutely true.

“Third, base those criteria on a simple principle: contain viral spread. In short, you can apply a critical incidence threshold in your local area that would cause restrictions to be increased or decreased. “

Prof. Rowland Kao, an epidemiologist at the University of Edinburgh and a member of SPI-M, who advises the government

“In terms of metrics [for when to relax restrictions], their cases in the population and hospitalizations. One of the reasons why vaccination of the elderly is not the criterion for removing restrictions is that most of the burden on hospitals is due to long-term care of those under 65 with Covid.

“The cases are important because they mean that at least if we get a little wrong and the R rises too high due to relaxation, then correcting the course becomes even more difficult and the possibility remains that the course of the epidemic will continue. far from us. It also means that any variant with higher transmissibility is more likely to go unnoticed for a longer period of time.

“Dates [for lifting curbs] they are important from a planning point of view. Nevertheless, [they] they have to be tied to metrics that, if not met, would mean that relaxation could not occur.

“Schools are already the obvious [first step]. Any gathering outdoors in small numbers will also be relatively low risk and will provide people with opportunities for social contact. Initially, keeping travel distances short will help keep outbreaks more localized, although there is always the possibility that you may still pop out due to some essential travel. Last things should be big indoor gatherings. ”

Dr. Zubaida Haque, former director of the Runnymede Trust

“Black, Asian and Ethnic Minority Communities (BAME) have been caught in the perfect storm of disadvantageous factors. We knew they would be overexposed due to the types of front-line, lower paying, and less secure jobs in which they are overrepresented.

“That is why the government should focus on financial support to isolate itself. Making low-income people choose between putting food on the table or isolating themselves puts them in an impossible position.

“Providing shelter for people to isolate themselves would also help BAME communities. You can understand why the virus spreads rapidly in overcrowded and multi-generational homes.

“I don’t understand why making schools safe hasn’t been the biggest problem because it means safer communities. If schools were to open, the lack of space needs to be addressed. The government has done nothing to requisition or rent buildings so that the children can disperse. Teachers must have priority access to vaccines before they are told to return. “

Dr. Kit Yates, professor of mathematics sciences at the University of Bath

“This confinement must be the last. Allowing the infection to spread among the younger, unvaccinated population still runs the risk of overwhelming health services. Even before vaccinations began, about three-quarters of people in intensive care were under the age of 70. Hospital occupancy has recently returned to levels lower than the peak of the first wave. Not to mention the potential impact of prolonged Covid, which is believed to affect 5-10% of those infected.

“I am as interested as anyone in seeing the schools open. They have been the first to open and the last to close, so it is surprising that so little has been done to reduce the transmission potential within them. Wearing masks in classrooms, better ventilation, and smaller bubbles could make a real difference, as could a rotation system with half attendance one week and half the next. Schools must be the test case that allows us to assess when and how to ease restrictions further.

“In the long term, ensuring that vaccines are distributed to the entire population is important to reduce severe cases. Widespread testing, coupled with a locally driven test, trace, and isolation system and enough support for people to self-isolate, could quickly suppress outbreaks. Covid’s safe accredited environments will help reduce potential transmission, while tighter border controls will limit the possible introduction of variants that can evade vaccines. “

Professor Susan Michie, Professor of Health Psychology at University College London and member of SPI-B

“We need to maintain the restrictions long enough to reduce infections to a safe level for reopening. Then we must keep them low to avoid future national lockdowns.

“That requires a radical overhaul of testing, tracing and isolation to bring it into public health, primary care and the NHS. Self-isolation needs financial and practical support. In other countries, people are paid a decent percentage of their salary for isolating themselves and are visited every day and offered help in obtaining supplies, as well as psychological support.

“Another key point is effective border controls to replace the current leaky system. People are entering the UK from countries where there may be new Covid variants, or they may have traveled indirectly from countries with known variants.

“We need a comprehensive strategy to target zero Covid, with quantified milestones, so we can be clear about what needs to happen.”

Professor Graham Medley, Professor of Infectious Disease Modeling at the London School of Hygiene and Tropical Medicine and a member of SPI-M

“As vaccination is implemented, keeping R (and therefore prevalence) low depends on measures to reduce the amount of person-to-person contact. There is a lot of uncertainty both in the vaccine and in the impact of the relaxation of the measures.

“It is impossible to predict exactly what will happen, so it is impossible to predict the best time to change the measurements. While it is much more difficult for individuals and businesses to cope if the dates are not given, having a set schedule is a hostage to fortune. “

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www.theguardian.com

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