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Covid-19: Easing lockdown could risk second spike, say public health doctors

BMJ 2020; 369 doi: (Published 02 June 2020) Cite this as: BMJ 2020;369:m2193

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  1. Adrian O’Dowd
  1. London

Public health experts have added their voice to growing calls for the government to reverse its decision to ease covid-19 lockdown restrictions in England that came into force on 1 June, saying that the change in policy was not “supported by the science” and could risk lives.

The Association of Directors of Public Health has issued blunt warnings that easing the restrictions could risk a spike in cases and deaths and that therefore the full implementation of what the government describes as its “phase 2” measures should be delayed.

From I June England is allowing groups of up to six people to meet outdoors, provided that strict social distancing guidelines are followed, encouraging more pupils to return to school, more businesses to reopen, and allowing vulnerable people to go outside once a day.

The Westminster government said the easing of the rules was part of its phase 2 measures, arguing that its steps were limited and cautious to avoid a second spike of cases.

The Association of Directors of Public Health has, however, taken the unusual step of directly questioning the approach, warning that a second peak of covid-19 infections could not be ruled out. Its president, Jeanelle de Gruchy, said, “Do we really want the same number of deaths again?”

In a blog de Gruchy said, “This is a new disease; evidence is still emerging and there is much uncertainty. Based on what is currently known, several leading scientists and public health experts have spoken out about a string of recent national policy announcements affecting England which project a degree of confidence that many—including ADPH members—do not think is supported by the science.

“The ADPH is calling for full implementation of all phase 2 measures to be delayed until further consideration of the ongoing trends in infection rates and the R [reproduction] level gives more confidence about what the impact of these will be.

“The risk of a spike in cases and deaths—and of the social and economic impact if we have to return to stricter lockdown measures—cannot be overstated.”

In an interview on BBC Radio 4’s Today programme on 1 June de Gruchy said that, despite what the government had claimed, its five tests for easing the lockdown had not all been met.1 These include being confident that there will be no second spike and that there are no problems with testing capacity and supplies of personal protective equipment.

On the Today programme she said, “We believe that the government needs to weigh up the balance of risks between easing the lockdown restrictions with the risk of causing a resurgence of the infection and the R going above 1.

“A lot of people, including local directors of public health across the country, are increasingly concerned that the government is misjudging this balancing act and lifting too many of the restrictions too quickly.”

Some scientific advisers to the government have already warned about potential risks of easing lockdown rules, such as John Edmunds, from the London School of Hygiene and Tropical Medicine.

Edmunds, who is a member of the government’s Scientific Advisory Group for Emergencies (SAGE), told Sky News on 30 May: “I think it’s risky. We still have a lot of cases here in this country so the numbers of infections that we have is about 8000 new infections every day in England alone. In my view, that is quite a high incidence.”

Jeremy Farrar, director of the Wellcome Trust and also a member of SAGE, tweeted: “Covid-19 spreading too fast to lift lockdown in England.”

The BMA warned against complacency. Its council chair, Chaand Nagpaul, referring to the 8000 new cases daily, said, “The risk from this highly infectious illness remains significant and if there is further spread thousands more families could lose loved ones before their time.”

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