Intended for healthcare professionals

Rapid response to:


Covid-19: Experts divide into two camps of action—shielding versus blanket policies

BMJ 2020; 370 doi: (Published 21 September 2020) Cite this as: BMJ 2020;370:m3702

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An open letter to the UK’s chief medical officers

Rapid Response:

Re: Covid-19: Finding a better approach

Dear Editor

As ever, Professor Bhopal's selfless attitude and willingness to embrace debate are most welcome. The strategy he outlines is based on the 'careful acquisition of population immunity'. Unfortunately this has become incendiary language to some but perhaps if the strategy put in place is sufficiently well constructed then population immunity is not actually required to make it a viable long term solution.

The system outlined elsewhere in the BMJ (1) and on the website Greenbandredband is designed to provide a sustainable way for societies to function while Coronavirus remains a threat to certain groups of the population. It aims to break the chain of transmission to those who assess themselves as vulnerable, not by isolating the vulnerable, but rather by asking all people to use existing protective measures such as distancing, face coverings and hand washing when interacting with those requiring protection. However, unlike currently, those who assess themselves as being at low risk - or who choose to accept the risk - may interact together unrestricted.

The strategy behind the system is based on the essential characteristics of the virus that are most accepted. Namely that 1. It is capable of rapid spread and 2. The more elderly, those with certain underlying health issues and those with certain other risk factors are at considerably greater risk of harm and even death than the majority who are not in those groups.

A suppression approach - whether cycling lockdown/unlock or elimination to zero - seeks to battle the virus on one of the grounds it is strongest - its ability to spread. But a targeted mitigation approach like that of greenbandredband restricts that battle to a much smaller field and makes it far easier for us all to target resources and energy to the most important part of the fight, namely protecting our vulnerable and making people feel safe. The fact that we can largely identify the most at risk, and that they form a minority of society whom we would already identify as vulnerable, makes this approach feasible without requiring the large scale interventions and disruptions that we have seen over the past months.

By taking this approach we avoid the harm and suffering that lockdown measures or imposed isolation would cause and we restrict the damage to mental health that ensues from the ongoing presence of these restrictive measures.

We also immediately regain a large degree of the freedom that people crave. Everyone has a choice as to how to assess their risks and the level of protection they will ask of their fellow citizens. There is no imposition of an arbitrary line. The role of authorities would become an advisory one, helping people to assess their risk rather than attempting to exercise tight control over that risk.

The result would be that each community would feel slightly different depending on the breakdown of its residents. And any individual moving between communities would need to respect and take into account the attitudes that they find. An ability to adapt to the cultural differences of different societies and environments is hardly unfamiliar in a world of global travel, so it is not unrealistic to expect individuals to exercise respect for those around them where that is required.

An incentive for individuals to show that respect comes from the very fact that for low risk individuals, many of their interactions are likely to be free of restrictions. As a society we would be asking for less compromise by the low risk, and by doing so would make it easier for them to comply with the measures that do remain when they are required to do so. More carrot and less stick.

Greenbandredband is a strategy requiring virtually no delay or cost in implementation. It would give people the opportunity to choose their own way forward, with very simple boundaries in place to ensure that no-one need feel exposed. Rather than rely on politicians with competing interests to decide on and impose a given course, responsibility would pass to the people they represent, allowing leaders to concentrate on supporting and enabling those choices. In the words of Professor Bhopal the idea might initially seem 'zany', but it merits its place in a 'detailed and reasoned discussion'.


Competing interests: No competing interests

25 September 2020
Steven Sieff
Veterinary Practice Manager
Hertfordshire, UK