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Boris Johnson is due to chart a course out of England’s third national lockdown on Monday, which is expected to begin with schools reopening from 8 March. Details of the plan are likely to be finalised on Sunday. What do experts think the prime minister should do?
Prof Gabriel Scally, president of epidemiology and public health section, Royal Society of Medicine
“The prime minister should outline his goal of getting the infection rate down to a minimal level and keeping it there – restoring normal functioning to much of society and the economy.
“To do that, the lockdown should be tightened for six weeks, but it should also be the last. All international arrivals [not just from the government’s “red list”] to undergo managed isolation for 14 days.
“The failed and costly test-and-trace system should be replaced by a complete find, test, trace, isolate and support system, adequately resourced, run by the NHS and led locally by the directors of public health.
“A system of green zones should be used in England, whereby areas with near elimination of Covid are protected by buffer zones across which travel is restricted for non-residents. Local authorities with the highest residual levels of the virus should be given extra resources and powers.
“Agreement should be reached to enable travel restriction across the Scottish-English border so that Scotland can reach their goal of zero Covid as soon as possible.
“Finally, the prime minister and Ireland’s taoiseach, Micheál Martin, should agree to pool vaccine supplies as it is in the best interests of both islands to inoculate their populations quickly.”
Prof Karl Friston, computational modeller and neuroscientist at University College London
“I would announce three things. Firstly, with the numbers looking good, serious consideration should be given to unlocking sooner rather than later.
“When one models mitigated responses to the virus – as opposed to the worst-case scenario of unmitigated responses – we may be coming out more quickly than some of the rhetoric implied. But that is crucially conditioned upon careful and mitigated unlocking that is sensitive to the local infection prevalence.
“Secondly, we should allow local authorities control over removing measures, with central government issuing overall direction in terms of criteria. Criteria for local unlocking – first schools, then retail and so on – are going to have to be sensitive to local infection levels.
“I would not announce that ‘by 1 April we will do this and by 8 May we will do that’. It would be more: ‘These are the criteria we would need to see before we take the next step in a gradual process towards normality.’ The current phrase is ‘data not dates’. That is absolutely right.
“Thirdly, base those criteria on a simple principle: contain viral spread. In short, you can apply a critical threshold of incidence in your local area that would trigger an increase or a decrease in restrictions.”
Prof Rowland Kao, epidemiologist at the University of Edinburgh and member of SPI-M, which advises the government
“In terms of metrics [for when to relax restrictions], it’s cases in the population and hospitalisations. One of the reasons why vaccination of the elderly is not the criterion for lifting restrictions is that most of the burden in hospitals is due to longer-term care of under-65s with Covid.
“Cases are important because they mean that, at the very least, should we get things a bit wrong and R goes up too much due to relaxation, then a course correction becomes even harder and there remains the possibility of the course of the epidemic running away from us. It also means it becomes more likely that any variants with higher transmissibility will remain unnoticed for a longer period of time.
“Dates [for lifting curbs] are important from the point of view of planning. However, [they] have to be tied to metrics which, if they are not reached, would mean that relaxation could not occur.
“Schools are already the obvious [first step]. Any meeting outdoors in small numbers will also be relatively low-risk and provide people with opportunities to make social contact. Initially keeping travel distances short will help to keep any outbreaks more localised, though there is always the chance that it will still jump due to some essential travel. The very last things should be large gatherings in enclosed places.”
Dr Zubaida Haque, former head of the Runnymede Trust
“Black, Asian and minority ethnic (BAME) communities have been caught in the perfect storm of disadvantaging factors. We knew they would be overexposed because of the types of frontline, lower-paid and less secure jobs they are over-represented in.
“So the government should focus on financial support to self-isolate. Making people on low incomes choose between putting food on the table and self-isolation is putting them in an impossible position.
“Providing accommodation for people to self-isolate would also help BAME communities. You can understand why the virus spread quickly in overcrowded and multi-generational housing.
“I don’t understand why making schools safe has not been the biggest issue because it means safer communities. If schools were to open, the lack of space needs to be addressed. The government have done nothing about requisitioning or renting buildings so children can spread out. Teachers should get priority access to vaccines before they are told to return.”
Dr Kit Yates, senior lecturer in mathematical sciences at Bath University
“This lockdown must be our last. Allowing the infection to spread through the younger, unvaccinated population still risks overwhelming healthcare services. Even before the vaccinations began, about three-quarters of people in intensive care were under 70. Hospital occupancy has only recently returned to levels lower than the first-wave peak. This is not to mention the potential impact of long Covid which is thought to affect 5-10% of those infected.
“I am as keen as anyone to see schools open. They have been first to open and last to close, so it’s surprising that so little has been done to reduce the potential for transmission within them. Mask-wearing in classrooms, better ventilation and smaller bubbles could make a real difference, as could a rota system with half attending one week and half the next. Schools should be the test case that allows us to evaluate when and how to further ease restrictions.
“In the longer term, ensuring vaccines are rolled out to the entire population is important to reduce severe cases. Widespread testing, alongside a locally driven test, trace and isolate system and sufficient support for people to self-isolate, could quickly suppress outbreaks. Accredited Covid-safe environments will help to reduce potential transmission, while stricter border controls will limit the possible introduction of variants that may evade the vaccines.”
Prof Susan Michie, professor of health psychology at University College London and member of SPI-B
“We need to retain restrictions long enough to get infections down to a safe level for reopening. Then we need to keep them low to prevent future national lockdowns.
“That requires root-and-branch reform of test, trace and isolate by bringing it into public health, primary care and the NHS. Self-isolation needs to be supported financially and practically. In other countries, people are paid a decent percentage of their wages to isolate and are visited every day and offered help with getting provisions, as well as psychological support.
“Another key plank 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 travelled indirectly from countries with known variants.
“We need a comprehensive strategy of aiming towards zero Covid, with quantified milestones, so we can be clear about what needs to happen.”
Prof Graham Medley, professor of infectious disease modelling at the London School of Hygiene and Tropical Medicine and member of SPI-M
“As vaccination is rolled out, keeping R (and therefore prevalence) low depends on the measures to reduce the amount of contact between people. There is lots of uncertainty in both the vaccine and the impact of relaxation of measures.
“It is impossible to predict exactly what is going to happen, so it is impossible to predict the best time to change measures. Whilst it makes it much harder for people and businesses to cope if dates are not given, having a prescribed timetable is a hostage to fortune.”
Source: The Guardian
Keyword: ‘Data not dates’: expert views on how to lift England’s Covid lockdown | Health policy