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Covid-19: Government must change course or risk further wave of infections, scientists warn

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1917 (Published 12 May 2020) Cite this as: BMJ 2020;369:m1917

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  1. Gareth Iacobucci
  1. The BMJ

The UK government must alter its current strategy for tackling covid-19 or face a further wave of infections and subsequent lockdowns, a report from an independent group of scientists has warned.

The report by the Independent SAGE,1 a new group set up and chaired by former chief scientific adviser David King, said that the government must shift its focus from managing to suppressing the virus by implementing a policy of testing, tracing, and isolating cases, which it has so far failed to do.

“Exit from the current lockdown must encompass a strategy of searching for the virus wherever it appears,” it said.

“We detect ambivalence in the government’s strategic response, with some advisers promoting the idea of simply ‘flattening the curve’ or ensuring the NHS is not overwhelmed. We find this attitude counterproductive and potentially dangerous. Without suppression, we shall inevitably see a more rapid return of local epidemics and face the prospect of further partial or national lockdowns.”

The group, which was set up in response to what it saw as a lack of transparency about the advice the government claimed to be following from the Scientific Advisory Group for Emergencies (SAGE),2 said its report offered a “constructive” and evidence based alternative to the government’s current covid-19 strategy.

Among its 19 recommendations is a call to adopt “real time” or “generative” models when making decisions such as whether to lift or apply lockdowns. This approach, it says, would be more accurate for inferring current infection rates and informing surveillance and testing strategies than the currently used epidemiological models, which are based on data with a three to four week time lag.

On testing and tracing, it said the government’s centralised “top down” approach had led to an “overdependence” on outsourcing to private contractors and on digital solutions, and insufficient focus on locally led responses. Future long term management of the pandemic should centre on community based tracking, isolation, and follow up, led by local public health professionals and GPs, it said.

The report calls for a greater focus on protecting those at high risk, including stopping patients with covid-19 from being sent back to care homes, and tackling the disparate impact of the virus on older people and on black and minority ethnic communities.

The UK should also change its advice on self-isolation from seven days to 14 days after onset of symptoms in line with World Health Organization guidance, the group advised.

The report also criticises the government’s use of “inaccurate, incomplete, and selective data” and for its confusing messaging, including the new “stay alert” slogan which it says “is not a helpful message in terms of guiding behaviour.”

King said, “We have produced this report with actionable recommendations that we believe, if adopted, will help the UK bring this pandemic to an end as quickly as possible with the fewest fatalities, something that surely must be the government’s primary goal.”

At a press briefing to announce the report, The BMJ asked the group what would constitute success in the coming months. Anthony Costello, professor of global health at University College London and a member of the group, said in response, “Success, ultimately, is about suppressing the virus, not simply managing its spread through our country.

“At the moment we have, according to John Edmunds from SAGE, 20 000 cases a day. That’s not sustainable. We have to get those numbers down and then have an integrated, sustainable ‘find, test, trace’ policy linked to GPs and to local public health.”

The report also warned that it would be “foolish” for ministers to bank on the emergence of a vaccine soon. King told the briefing, “Obviously we all hope that a vaccine will emerge, but the government must prepare for recurrent local outbreaks for at least a year by investing now in local healthcare systems.”

The group’s recommendations will be sent to the government’s chief scientific adviser Patrick Vallance, to the prime minister, the first ministers in the devolved nations, and to Jeremy Hunt, the chair of the Commons health select committee.

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