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Covid-19: Call for a rapid forward looking review of the UK’s preparedness for a second wave—an open letter to the leaders of all UK political parties

BMJ 2020; 369 doi: (Published 23 June 2020) Cite this as: BMJ 2020;369:m2514

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Rapid Response:

Preparing for a Second Wave of COVID-19

By mid June 2020, well over 40,000 people testing positive for the SARS-CoV-2 coronavirus had died in the UK. By the same time, and in response to a significant slowing down in weekly numbers of COVID-19 cases and deaths, the UK Government has announced repeated and significant easements of 'lockdown' restrictions. This includes the opening up of most retail establishments and the end of enhanced protective measures for people who are extremely clinically vulnerable to severe COVID-19 illness.

Warnings from health leaders about a 'second wave' of the COVID-19 pandemic have come as no surprise. There are a number of reasons why the UK is vulnerable in this respect.

First, data from the Office of National Statistics in June 2020 indicated that there is little evidence of widespread immunity. As of 13 June 2020, 5.4% of individuals from whom blood samples were taken tested positive for antibodies to the coronavirus. It is also unclear whether effective immunity is conferred by the presence of antibodies.

Second, while progress towards an effective vaccine has clearly been made, there is little evidence that it will be ready for a national roll out within 2020, and crucially, not before the winter season at which time any second wave will be most likely to overwhelm NHS and social care services.

Third, the national Test & Trace system, which is the primary way by which the chain of viral transmission can be broken, is still not operating as effectively as it needs to. Government reports indicate that, as of mid June 2020, contact tracing was not happening in more than 1 in 4 confirmed cases of infection. In addition, the Test & Trace app that was supposed to enable automated notification of contacts was reportedly still some way off being ready for implementation.

A second wave will only be managed effectively if we learn lessons from the first wave:

First, national and local agencies need to operate as one, seamless system, with Central Government taking the strategic role of Local Government and local NHS organisations seriously. Local outbreak plans must be properly resourced, not just with funding, but also with detailed, prompt data flows from national systems.

Second, there must be a recognition that a second wave of infection will bring with it a second wave of inequality. The greater impact of the pandemic to date on those who are socioeconomically deprived or from black, Asian and minority ethnic groups has been stark. Resources must be directed to those communities that most need them. In addition, work to protect vulnerable groups must be done with them rather than to them, fully engaging communities in decision making and utilising the skills and expertise they offer.

Third, we must learn that our pandemic response should not be displaced by politics. Rousing speeches and crass soundbites from national figures, whether they be in support or attack of the presiding Government, must be replaced by calm, factual and transparent leadership from all sides of the political divide. Decision making, and the data that informs it, should be elevated to a shared process that breeds confidence rather than suspicion.

In summary, while it is poses a significant threat to our health and economy, a second wave of the coronavirus pandemic is a second chance to get things right. That means taking this window of opportunity to step our efforts up not down, and working hard to get the funding right, the data sharing right, the contact tracing right and the involvement of local communities right.

Competing interests: No competing interests

24 June 2020
Lisa McNally
Director of Public Health
Sandwell Metropolitan Borough Council
Oldbury, West Midlands, UK