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Covid-19: Experts recommend two week circuit break to reduce transmission in the UK

BMJ 2020; 371 doi: (Published 16 October 2020) Cite this as: BMJ 2020;371:m4038

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  1. Elisabeth Mahase
  1. The BMJ

A two week lockdown in the UK could “put the epidemic back by around 28 days or more,” the government’s Scientific Advisory Group for Emergencies (SAGE) has said.

Documents published this week1 show that, on 21 September, SAGE recommended a two to three week “circuit breaker” to reduce the reproduction number to under one. But the UK government has not, so far, announced such a measure.

This is despite researchers estimating that such a break could reduce deaths by around 29% to 49%. In a preprint, a team from UK universities used simple analysis and age structured models matched to the unfolding UK epidemic to investigate the action of precautionary breaks.2

The researchers suggested that the break could be combined with the school half term holiday in October but said this same logic could also be applied to the Christmas holidays by extending them for a week into 2021, or to the spring half term.

“Both simple analytical approaches and an age structured model fit to a range of UK data show that planned precautionary breaks could be highly effective short term control measures,” the paper said.

The researchers stressed that such breaks are “not in themselves long term solutions, but may allow other methods that work best with low numbers of cases (such as test, trace, and isolate) to reassert control and they may be more sustainable than other non-pharmaceutical approaches.”

They added that these short term precautionary breaks will also only be effective if the associated societal harms and economic losses are minimised, there is good compliance with the measures, and the reduction in cases is used to “regain control and bring the growth rate down.”

SAGE recommends that all contacts between households within the home, except for support bubble members, should be banned and that restaurants, bars, cafes, personal services, and gyms should be closed until prevalence has fallen.

The Labour party leader Keir Starmer has backed SAGE’s advice. Speaking on 13 October, Starmer said, “There’s no longer time to give the prime minister the benefit of the doubt. The government’s plan simply isn’t working. Another course is needed. That’s why I am calling for a two to three week circuit break in England in line with SAGE’s recommendation.”

A YouGov poll of 3390 UK adults released on 14 October reported that more than two thirds (68%) of respondents somewhat or strongly supported a two week nationwide lockdown at the start of the school half term in October. Some 20% either somewhat or strongly opposed, and 12% said they didn’t know.3

Paul Hunter, professor in medicine at the University of East Anglia, said, “No plan is guaranteed to work. A circuit breaker would certainly have some effect but if it only delays things it’s still open to uncertainty whether it would make a big difference overall. Yes, we have to act and to act decisively, but no single thing is a full protector.”

The government in Northern Ireland has already announced a four week circuit breaker starting 16 October.4 The restrictions include closing the hospitality sector apart from deliveries and takeaways for food, and closing close contact services such as hairdressers and beauticians. The half term holiday break for schools and colleges will also be extended from one to two weeks from the 19 to 30 October.

The UK government has so far announced new restrictions in areas such as London—which will be placed under tighter restrictions from 17 October, meaning that people in the capital will not be able to mix households indoors.

In a statement, mayor of London Sadiq Khan said, “The virus is now spreading rapidly in every part of our city, and hospital and intensive care admissions are steadily rising. It’s better to act earlier than to act too late—which would cost more lives and damage more livelihoods.”

Khan backed calls for a short national circuit breaker. “This would allow us to get the reinfection rate down to a manageable level and give the government more time to finally get a grip on the failing test and trace system,” he said.