Intended for healthcare professionals


Covid-19: UK holds off closing schools and restricts testing to people in hospital

BMJ 2020; 368 doi: (Published 13 March 2020) Cite this as: BMJ 2020;368:m1060
  1. Elisabeth Mahase
  1. The BMJ

People displaying covid-19 symptoms—a new, continuous cough or a high temperature—should self-isolate at home for at least seven days, no matter how mild their symptoms are, the UK prime minister has said.

Addressing the country from Downing Street on 12 March, Boris Johnson said that this measure would help protect others and slow the spread of the disease. He also advised people over 70 to avoid cruises and said that schools should cancel international trips.

He was joined by Chris Whitty, chief medical officer for England, who said that the UK would no longer be testing mild suspected cases to confirm the virus but would instead “pivot all testing capacity to identify people in hospitals who have got symptoms.” Additionally, suspected cases will now be based on symptoms, regardless of travel history.

People with mild symptoms are expected to self-isolate at home unless they start to deteriorate. The BMJ understands that they will be managed by community services, either online or by telephone.1

Large public events

The address came after the Republic of Ireland announced that it was closing all schools. However, Johnson made it clear that the UK would not follow suit, at least not yet.

“We are not, repeat not, closing schools now. The scientific advice is that this could cause more harm than good . . . But of course we are keeping this under review,” he said. The government is also considering banning major public events because of the burden they place on public services.

However, Johnson also warned that “this is the worst public health crisis for a generation” and should not be compared to flu, because of the lack of immunity. “I must level with you: many more families are going to lose loved ones before their time,” he said.

While the government has not banned large public events yet, some organisations have made the decision anyway. Many royal medical colleges have cancelled or postponed their meetings and events or made them virtual, and the Premier League has postponed all football games until at least 4 April. Many other entertainment events, such as music festivals, have also been postponed.

Regarding whether the UK had responded to the pandemic with enough force, especially when compared with other countries that have taken more stringent action, Whitty said, “This is going to be a long haul: it’s very important we do not start things in advance of need . . . If you start too early the enthusiasm runs out at about the peak, which is exactly the time that we want people to be following these interventions.”

He added that the next stage of the plan would involve “a package of things which are about social distancing around the people who are vulnerable.”

Testing and contact tracing

After the announcement doctors and public health leaders took to social media to respond, and many raised concerns over a lack of action.

Devi Sridhar, professor and chair of global public health at the University of Edinburgh, said,2 “Part of my job is speaking truth to power. And the UK government is, in my view, getting it wrong. Other countries have shown that speed is crucial. There is a middle path between complete shutdown and carrying on as normal.”

She suggested that this could involve increasing testing and contact tracing—as happened in China, Singapore, and South Korea—as well as stopping large public gatherings, stopping non-essential travel, encouraging employers to allow home working, and giving clear advice on risk to people over 70 and those with pre-existing conditions.

“Why do we give up so easily on contact tracing and stop mild testing?” she asked. “Unless we’re accepting that many elderly and vulnerable people will die—which I don’t see any doctor or health professional agreeing to.”

Meanwhile, John Ashton, former regional director of public health for northwest England, told The BMJ that the government’s response had been “underwhelming” and “negligent.”

He said, “We have wasted six weeks. The prime minister should have been convening the COBRA meetings regularly over that time to get ahead of the game, anticipate what would be happening next, and share what he knew fully with the public, so they would be able to collaborate on an equal basis. None of that has happened.”

Ashton went on to raise concerns over the apparent lack of sampling in care homes and prison populations, adding that the UK should have learnt from Hong Kong and South Korea in terms of making testing accessible and communicating regularly with the public.

He also called for the government to share the evidence behind its actions and accused it of “treating the public like children” and therefore creating more panic. Referencing Johnson’s comment that the public should be ready to “lose loved ones,” Ashton said that the prime minister had been “reading too much Churchill.”

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