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Covid-19: Act now to avoid second lockdown, says Independent SAGE

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3695 (Published 21 September 2020) Cite this as: BMJ 2020;370:m3695

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It's too late to avoid another national lockdown for this second wave, but we need to learn and act now for future resurgence.

Dear Editors

As I write this on 23 Sept 2020 AEST, the UK recorded 4,926 new cases of COVID-19 for the last 24 hours on 22 Sept (ref 1), with 37 deaths attributed to this infection. At this time there is an open slinging match between the government and the Independent Scientific Advisory Group for Emergencies (iSAGE), the latter formed out of concern for political interference on scientific recommendations on managing the COVID-19 pandemic in the UK.

The vox populi soundbites featured in the media seemed to shift the responsibility and blame to the mixed and apparently confused messaging by the government who had removed much of the restrictions associated with the March lockdown in an effort to restart the economy devastated by the pandemic and concurrent uncertainty from the Brexit divorce with EU.

This is incredible for a spectator outside mother England; perhaps it's easier for people like me to see the obvious and offer clear comment when they are not in the potentially disastrous UK response to the much expected second wave.

When Mr Boris Johnson in a televised national announcement detailed the measures of what turned out to be a national lockdown on the 23 March 2020 (while many of the restrictions were already in motion some 5 days prior), the UK had seen 965 new cases diagnosed as COVID-19 over the previous 24 hours with 55 deaths attributed to the disease (ref 2).

I am aware there is public fatigue in UK regarding messaging and restriction to cope with the COVID-19 pandemic, but since when and how had we become numb to such high numbers of transmission and accept these deaths to a preventable disease?

The UK government had locked down exactly 6 months ago for just a quarter of what now we are getting as daily COVID-19 cases, with similar numbers of deaths; yet neither the political leadership and the public has much stomach for another lockdown measure.

The March lockdown, though eventually effective at reducing infection transmission, took at least 8 weeks before some relaxation occurred in the face of a devastated economy. There was never a doubt that the second wave is going to come in this pandemic; I had previously expressed concern that efforts to get healthcare activities back on track is misguided when the initial impact exposed many deficiencies in the NHS yet to be properly acknowledged and addressed (Ref 3). 6 months after initiating national lockdown, with no effective track and trace network to show, clinician confidence in the NHS providing adequate measures and resources (including PPE access) to provide a safe working environment at an all time low, mixed and delayed messages on COVID-19 recommendations for the general public, the UK is heading for a train wreck, not just in terms of the scale of disease transmission but because of inadequate preparation for a widely predicted second wave.

In the meantime, much maligned Sweden with its relatively less restrictive and mostly voluntary pandemic strategy (ref 4) carries on, with some consideration to opening up access to age care facilities this October while many other countries on the continent fall over each other in their rush to contain the resurgence of COVID-19.

As I previously suggested, Sweden’s solution is probably best for the Swedes (ref 5) and ultimately a sustainable solution for the long run at that. Unfortunately the careless and callous responses from the general public in the UK as sampled by the media suggest the mature and considered approach by Tegnell, the architect of the public health response to COVID-19 in Sweden, will never work in the British Isles.

I disagree with iSAGE’s recommendation published on 20 Sep 2020; I do not disagree with the proposed measures per se, but the expectations that their recommended physical and movement restrictions will avoid another national lockdown reflects the disconnect with what is probably the true extent of new infection in the community as daily testing numbers have fallen short of target for some time while we are seeing exponential grow in confirmed cases. Perhaps iSAGE’s restrained restriction would have made a difference 6 weeks ago, but I think that a second national lockdown will be the only effective action to stop the recurrent COVID-19 resurgence in its track.

As for iSAGE’s strategy to (re-)build a functional testing system, the government will need to ensure political ideology and interference will not hamper efforts to put this in place. By the time this happens, it will be too late to address the second wave or prevent the second national lockdown but I have no doubt it will be needed and tested as we start the next year still in the same pandemic.

As they say, its never too late to mend (for the third wave, not the second).

References
1. https://news.sky.com/story/coronavirus-uk-records-4-926-new-cases-highes...
2. https://news.sky.com/story/coronavirus-further-46-die-in-england-after-t...
3. https://www.bmj.com/content/369/bmj.m2238/rr-0
4. https://www.theguardian.com/world/2020/sep/15/sweden-records-its-fewest-...
5. https://www.bmj.com/content/369/bmj.m2376/rr-13
6. https://www.theguardian.com/world/2020/may/06/boris-johnson-misses-coron...

Competing interests: No competing interests

23 September 2020
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia