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Covid-19: England will return to regional restrictions amid rapid testing push

BMJ 2020; 371 doi: (Published 24 November 2020) Cite this as: BMJ 2020;371:m4577

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  1. Shaun Griffin
  1. London

England will move to a revised system of regional, tiered restrictions when the current national lockdown ends on 2 December, the prime minister has announced.

In a statement to the House of Commons on 23 November Boris Johnson set out a covid-19 winter plan,1 confirming that current national restrictions would revert to a modified version of the previous three tier system.

In tier 1 of the new regional system Johnson said that people should work from home wherever possible. In tier 2 alcohol may be served in hospitality settings only as part of a substantial meal. And in tier 3 indoor entertainment, hotels, and other accommodation will have to close, along with all forms of hospitality except for delivery and takeaways.

The winter plan sets out indicators to help determine which tier each area will go into, including latest data on case detection rates in all age groups, the rate at which cases are rising or falling, the positivity rate in the local population, and current and projected pressures on the NHS.

It also pledges an extra £7bn (€7.87bn; $9.35bn) “to expand testing and improve contact tracing,” bringing the total expenditure on test and trace to £22bn this financial year.

Alternative to isolation

The plan outlines the government’s intention to introduce frequent, rapid testing as an alternative to the need for self-isolation for people who have had close contact with someone who has covid-19.

Instead, contacts will be offered regular tests as an alternative to isolation and will have to self-isolate only if they test positive. The approach will initially be trialled in Liverpool, followed by care homes, health settings, universities, and workplaces before the end of 2020, ahead of a nationwide roll-out from January.

Johnson said that piloting the use of rapid lateral flow tests in Liverpool had contributed to a “very substantial fall in infections” and that all local authorities in England under tier 3 would now be able to take part in a six week surge in testing. “If it works, we should be able to offer those who test negative the prospect of fewer restrictions,” he said.

But Chaand Nagpaul, BMA council chair, warned that the revised three tier regional plan was “full of risks,” adding that the government must heed the lessons from the failure of the previous three tier system to halt the spread of the virus.

“The prime minister says the new measures are tougher than October when in reality many are far more relaxed, at a time when infection rates and covid related hospitalisations and deaths remain high,” he said. “For doctors and NHS staff who are already working under incredible pressure, the potential impact on NHS services is deeply worrying.”

Sheila Bird, formerly of the Medical Research Council’s Cambridge Biostatistics Unit, questioned the veracity of Johnson’s claims around rapid testing. “I hope that the prime minister will publish the in-context evidence on which he relies when claiming the use of lateral flow testing to identify asymptomatic cases,” she said.

Bird also called for the publication of the Liverpool trial protocol, adding that the “evidence on which the prime minister relies in citing that the testing trial has contributed to a decrease in cases is clearly important and should also be in the public domain.”

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