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Screening the healthy population for covid-19 is of unknown value, but is being introduced nationwide

BMJ 2020; 371 doi: (Published 19 November 2020) Cite this as: BMJ 2020;371:m4438

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The Second English Lockdown - Data and Wider Health and Economic Consequences

Dear Editor

We read with interest the paper by Angela Raffle at the University of Bristol and her concerns with the policy and data underlying mass testing. Raffle A 2020 “Screening the healthy population for covid-19 is of unknown value, but is being introduced nationwide” BMJ 2020;371:m4438

This echoes our own concerns re the second national lockdown, the data behind the lockdown and the potential harms to the economy and population in relation to all cause health related problems. When announcing the national lockdown on the 2nd November, the Prime Minister told MPs that there was “no alternative” and that without the new measures, the NHS would be overwhelmed. [1]

We are concerned that this statement was not justified either by the data available at the time or by more recently published information.

Evidence from the COVID Symptom Study App [2] suggests that daily new infections started decreasing towards the end of October, before the lockdown was announced and that value of R has already fallen below 1. The decrease is most pronounced in North West England, the area where hospitals have been most under pressure.

For example, Merseyside has seen the number of positive tests halved since they peaked on 7th Oct. [3] Notably that decline started well before even the introduction of Tier 3 measures, let alone the national lockdown.

There is a lag between infections, positive tests and hospitalisations, but we have already seen Covid-19 hospital admissions fall in the North West over the past 2 weeks, again before the lockdown could have an effect. We can expect this to feed through to reductions in ICU patients and deaths in due course.

These data are consistent with trends in other countries. For example, cases and hospital admissions have fallen in Northern Ireland and Scotland without national lockdowns being imposed. The Republic of Ireland imposed a 6-week national lockdown on the 21st October, positive tests were declining from just before this point implying actual infections had been falling for some days before the lockdown. [4]

Taken together, the data are clear both that national lockdowns are not a necessary condition for Covid-19 infections to decrease and that the Prime Minister was incorrect to suggest to MPs that infections were increasing rapidly in England prior to lockdown and that without national measures, the NHS would be overwhelmed.

The overall position of “stay home protect the NHS” may be far less likely to achieve this but to seriously question the ability of the NHS to deliver health for all going forward into 2021 and beyond. UK’s GDP in August 2020 was a staggering 9.2% lower than it was in February 2020. [5] This comes amidst a period where the percentage of GDP spent on the NHS has been the lowest since the first decade of the NHS and where growth in real terms has steadily declined. [6] Health spending is a proportion of GDP spending with the NHS budget consuming some 7.2% of GDP. [7] Less GDP means less available funds to support the NHS going forward, 7% of a large cake is considerably more than 7% of a cupcake. Whilst the stay home message persists the position is hardly going to be improved underlined by the rapid rise in unemployment some 4.8% (July to August 2020). [8]

Worryingly, whilst the focus stays primarily on Covid-19, the health of our nation is littered with the collateral damage of this approach. In mental health, in elective surgeries cancelled and in the very destruction of the fabric of society.

Set in context even given the year 2020 has been unprecedented, Covid-19 only has a 3.9 fatality rate [9] with the average age of death for Covid-19 standing at 82.4, higher than the average years of death for non-Covid-19 deaths at 81.5 [10]. In the majority of the population Covid-19 is not a death warrant and is outstripped in the top 10 of deaths in the UK by the likes of Dementia, heart disease and flu and pneumonia. [11] One of the key lifestyle choices highlighted by BUPA for robbing the population of years of life is smoking. As such the risk of premature death from smoking is greater than that of Covid-19. Whilst we are told to stay home for fear of contracting Covid-19, cigarettes are freely available. [12]

Lockdowns, have never previously been used in response to a pandemic. They have significant and serious consequences for health (including mental health), livelihoods and the economy. Around 21,000 excess deaths during the first UK lockdown were not Covid-19 deaths. [13] These are people who would have lived had there not been a lockdown.

Millions will be impacted by reduced screening and assessment services across health conditions with many premature, avoidable deaths. [14] Businesses have closed, never to reopen and livelihoods have been lost. No impact assessment has been completed by the government to weigh the benefits of the lockdown with the costs.

It is well established that the first lockdown had an enormously negative effect on mental health in young people as compared to adults. [15] The more we lockdown, the more we risk the mental health of young people, the greater the likelihood the economy will be destroyed, the greater the ultimate impact on our future health and mental health. Sadly, we know that global economic recession is associated with increased poor mental health and suicide rates. [16]

We are truly worried that the effective extension of the lockdown on the 2nd December by severely restrictive tiers could cause considerable harm. We would appeal that the Government shifts strategy away from relying on lockdowns and legal restrictions and towards public health guidance, good local information and targeted action to assist hospitals which are under pressure and allow the economy to flourish.

6. The Nuffield Trust A Decade of Austerity.
10. The Times 10th October

This letter is the opinion of the three authors and not the University of Nottingham.

Competing interests: No competing interests

30 November 2020
Marilyn James
Professor of Health Economics
Professor David Paton (Professor of Economics) University of Nottingham and Professor Ellen Townsend (Professor of Psychology) University of Nottingham
University of Nottingham
School of Medicine, University of Nottingham, Nottingham, NG7 2UH