Intended for healthcare professionals


Covid-19: England plan to ease lockdown is “confusing” and “risky,” say doctors

BMJ 2020; 369 doi: (Published 11 May 2020) Cite this as: BMJ 2020;369:m1877

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  1. Ingrid Torjesen
  1. London, UK

Prime Minister Boris Johnson’s roadmap outlining how England will take its first steps out of lockdown, unveiled on 10 May, risks a second spike in cases, doctors have warned.

More stringent lockdown measures will remain in Scotland, Wales, and Northern Ireland, where governments are setting slower routes out of lockdown and will retain the “stay at home” message being abandoned in England.

Johnson said that, in England, there will be a change of emphasis from “only go to work if you must” to anyone who can’t work from home, for example, those in construction or manufacturing being “actively encouraged to go to work.”1 Commuters should, however, avoid public transport if possible, he said, although pictures on Monday morning showed trains and tube stations packed with commuters attempting to get to work.

From 13 May the public will be encouraged “to take more and even unlimited amounts of outdoor exercise” outside. They will be allowed to drive greater distances to take exercise, sunbathe in parks, and play sport with members of their household.

The second phase of easing will be implemented from 1 June at the earliest and will include the phased reopening of shops and primary schools. During the third phase, which may happen as early as July, the government hopes to “reopen at least some of the hospitality industry and other public places.”

Johnson emphasised that social distancing measures will remain in place and that the plan, and especially its timetable, was “conditional” on science and data. Progress will continue to be assessed through its existing five tests plus there will be a new five-tier covid alert system determined by the level of the reinfection rate (R) and the number of coronavirus cases. The country is currently at level four (severe—community transmission, NHS coping) with five the highest (critical—disease spreading rapidly).

The government has changed the strategy slogan from “stay at home, protect the NHS, save lives” to “stay alert, control the virus, and save lives” to reflect the change in emphasis for England. The new slogan has, however, been described as “vague” and “confusing” and is being rejected by the other UK nations.

Although the once a day exercise limit is being removed in Scotland and Wales from today, other measures there will not be relaxed.

Wales’ first minister Mark Drakeford said people in Wales should stay home “wherever you can” and that exercise must be local to home or people could face fines. Northern Ireland has already extended its lockdown to 28 May.

Chaand Nagpaul, BMA council chair, said that the plan for England was “too fast, too confusing, and too risky” and allowed the chance of a second spike of the virus.

“Much of the government’s management of the pandemic has been inconsistent and lacking the absolute caution needed. We need to see clear plans and be confident that the shortcomings of the past are not repeated in the road map out of lockdown,” he said.

“It is imperative that we do not risk people mixing with each other without the ability to rigidly adhere to social distancing.”

Criticisms levelled at the plan include its lack of detail over how those returning to work will be protected from infection, how workers who can’t cycle or walk or have a car will travel, how social distancing will be monitored and enforced as restrictions are lifted, and how the spread of infections will be monitored when testing is below the capacity needed and a testing and tracing system has not been rolled out.

Niall Dickson, chief executive of the NHS Confederation, said that the NHS was still treating thousands of patients with covid-19 and there is a tragedy unfolding in care homes.

“This is certainly not the moment to throw away the gains made in controlling the virus,” he said. “We have not yet cracked the personal protective equipment challenge nor access to testing, and we are not ready to roll out the test, track, trace strategy.”

Stephen Griffin, associate professor in the School of Medicine, University of Leeds, said that he was “deeply concerned” by the confusing message. “It feels as though the ethos that advice from the scientific community should guide policy has been abandoned. We have achieved a plateau in new cases, not a significant drop, which means that the previously established pillars have not been met.”

He said that it was “troubling that the new message and tag lines are inconsistent with the rest of the UK when we know England has the vast majority of cases” and warned that announcing future intentions without a clear framework “promotes a message that the situation is now less serious” which “could lead to people dropping their guard” resulting in “the virus bouncing back” as it had in other countries where restrictions were relaxed.

In a 60 page document published on 11 May called Our Plan to Rebuild,2 the government advised the public to wear face coverings in enclosed public spaces where social distancing was not possible or when people were likely to come into contact with others they didn’t normally meet, such as on public transport or in shops. Covering the face could help reduce the spread of covid-19 from people who were without symptoms, the document said. People should make their own masks or use a scarf to cover their face and not use surgical masks or respirators, which should be reserved for healthcare and other workers.

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