Intended for healthcare professionals

Rapid Response:

Weaknesses in the UK Covid-19 strategy

Dear Editor
The Covid-19 update in the 14th March issue of the BMJ highlights some of the weaknesses in our current national policy.
The message given repeatedly to the public is that mildly symptomatic individuals do not even need to call NHS 111: they should just self-isolate at home. Testing will not be offered to them either, as the limited testing capacity will be focused on hospital admissions. However, without a call to NHS 111 and without a confirmatory test, it seems extremely unlikely that most patients will have either the information or motivation to comply with the complex preventative strategy for stay at home patients. Should we not have tried to build up the capacity for large scale testing, as it has been done in South Korea? South Korea has been affected by a Covid-19 outbreak at about the same time as Italy but South Korea’s strategy, based on large scale testing and few restrictions, has been notably more successful than the large scales use of lockdown in Italy.(1 )
The advice which has been repeatedly given to self-isolate at home for just 7 days, from the onset of symptoms, also seems inadequate. Covid-19 symptoms and virus shedding often continue for much longer than 7 days.(2)
Equally concerning is the reference to “herd immunity” by our chief scientific adviser Sir Patrick Vallance and the way it has been used by some political leaders as an excuse to delay protective actions such as banning mass gatherings.(3) The WHO has cast doubt over the validity of the “herd immunity” approach.(4) There is a real risk of repeating Italy’s experience: this country is now at a point when there is no longer hospital or intensive care capacity.(5) Bearing in mind that a number of potential treatment modalities for Covid-19 have been identified, which require further evaluation, it seems to be distinctively advantageous to join the herd of the Covid-19 patients as late as possible.

1. Parodi E, Jewkes S, Cha S, Park J. Special Report: Italy and South Korea virus outbreaks reveal disparity in deaths and tactics. Reuters. March 2020. https://www.reuters.com/article/us-health-coronavirus-response-specialre...
2. Fei Zhou, Ting Yu, Ronghui Du etal. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet published online on 11th March 2020. https://doi.org/10.1016/S0140-6736(20)30566-3
3. Boseley S. Herd immunity: will the UK's coronavirus strategy work? The Guardian. March 2020. https://www.theguardian.com/world/2020/mar/13/herd-immunity-will-the-uks...
4. Cockroft S. UK's 'herd immunity' approach to tackling coronavirus questioned by World Health Organisation. Evening Standard. March 2020. https://www.standard.co.uk/news/health/uk-herd-immunity-coronavirus-who-...
5. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet published online on 12th March 2020. https://doi.org/10.1016/S0140-6736(20)30627-9

Competing interests: No competing interests

14 March 2020
Giuseppe Enrico Bignardi
Retired Consultant Microbiologist
Dunelm Garth, Springfield Park, Durham DH1 4LS