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Covid-19: Leading doctors argue against local lockdowns

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3959 (Published 13 October 2020) Cite this as: BMJ 2020;371:m3959

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  1. Jacqui Wise
  1. London

The UK government’s own scientific advisers and other leading experts argued against a policy of increased restrictions in local areas to control the covid-19 pandemic, instead calling for a national short period of lockdown or “circuit breaker,” documents show.

The newly released documents reveal that the Scientific Advisory Group for Emergencies recommended on 21 September that such an immediate circuit breaker was the best way to control cases.1

Rumours about SAGE’s advice had been circulating for some weeks,2 but the minutes were officially released only after the prime minister announced a new three tier system for England, with Liverpool facing the most stringent restrictions.3

The SAGE documents also suggested:

  • Advising people to work from home if they can

  • Banning all contact within the home with members of other households

  • Closure of all bars, restaurants, cafes, indoor gyms, and personal services, and

  • All university and college teaching to be online.

Of all the measures SAGE proposed, only one—advising people to work from home—was implemented by the government at the time.

SAGE said, “The more rapidly interventions are put in place, and the more stringent they are, the faster the reduction in incidence and prevalence, and the greater the reduction in covid-related deaths (high confidence). Both local and national measures are needed; measures should not be applied in too specific a geographical area.”

David Nabarro, World Health Organization special envoy for covid-19, has separately appealed to government leaders: “Stop using lockdowns as a primary means of controlling the virus. Develop better systems for doing it.” Speaking in an interview with Spectator magazine he said, “The only way that lockdowns are justified is to buy you time to reorganise, regroup, rebalance your resources and protect your healthcare workers.”4

On 11 October Anthony Costello, professor of global health and sustainable development at University College London and a member of the Independent SAGE group, wrote a long thread on Twitter arguing against local lockdowns and calling for a national circuit breaker together with immediate reform of the test and trace system.5

“We’re in a mess. Cases, hospitalisations and deaths are rising,” wrote Costello, a former WHO director. “It’s too late for test and trace to stop it. Things will just get worse.”

He wrote that local restrictions (rather than a full national lockdown) risked increasing numbers of cases and deaths, with possible exponential spread. “It also means we shall reach a new state of ‘endemecity’ with repeated surges and falls until such times as the virus has eaten its way through all exposed and vulnerable people.”

He said a circuit breaker should stop transmission of infection within and between communities and might also break the oscillation of surges and falls in infections. However, delaying a circuit breaker risked an exponential increase in cases like that in March. “Without major reform of Find, Test, Trace, Isolate, Support (FTTIS) the UK will be back in trouble in two to three months,” he predicted.

Costello said that the current test and trace system programme, “based on centralised, privatised and ineffective companies,” had “failed miserably.” He called for Dido Harding, the current head of NHS Test and Trace, and England’s health secretary, Matt Hancock, to be removed and an experienced minister such as Greg Clark or Jeremy Hunt and a strong public health leader and independent public health team put in place to lead a test and trace programme.

He called on the government to fund local test and trace systems, to be run through local district outbreak management teams that included local public health, virology, primary care, and local authority leaders, backed by volunteers if necessary. The government must cover salaries in full of people asked to isolate, he said, and compliance with isolation should be monitored through calls, home visits, or an app, as in South Korea.

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References

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