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Covid-19: Wales tightens Christmas restrictions as four nations’ rules diverge

BMJ 2020; 371 doi: (Published 17 December 2020) Cite this as: BMJ 2020;371:m4906

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Rapid Response:

COVID-19 response – retrieving sanity.

Dear Editor

Since March 2020, the world seems to be stuck in a mad dance – we have realized the band is playing completely in the wrong genre, but it seems they have forgotten the notes of any other tune. The changes in our understanding of the COVID-19 pandemic in recent months should translate into a fundamental change of approach, but they are not. We just replace apparent failure with stricter measures. This is killing people.
Increasing evidence, first from Wuhan,1 then a meta-analysis of household spread,2 have demonstrated that asymptomatic spread plays only a minimal role in transmission. Even within household environments, Madewell et al.’s findings indicate that it contributes less than 1% of cases.2 Secondly, confirmation of the very low transmissibility of cases with higher PCR ct values indicates that cases, and deaths, are greatly over-reported if we consider cases to be actively infected, symptomatic and /or infectious people.3 The recent urgent notice from WHO, that high ct value results should be treated with suspicion and cases should be defined based on virological and clinical evidence, demands urgent reform of the definitions on which many Western countries are basing their responses.4
Together, these findings undermine the much of the basis for the twin strategies of universal lockdowns, and mass community testing of asymptomatic people on which current mass-scale test and trace strategies, and national case figures, are based. They do, however, point strongly to the institution of previous pandemic guidelines cast aside hastily in early 2020.5
Lockdowns can be expected to kill through increased poverty, delayed or denied medical care, and perhaps through psychological stress. Given evidence that asymptomatic people play little role in transmission, and current ‘case’ data poorly reflects infectiousness, and continuing transmission irrespective of lockdowns,6 the balance seems to have moved firmly into the range where harm will outweigh benefit. Public health strategies are predicated on achieving the correct balance. COVID-19 is a serious health risk – adding deaths from other causes is not going to make this go away. We need evidence-based, less harmful ways to cope.

1. Cao S, Gan Y, Wang C, et al. Post-lockdown SARS-CoV-2 nucleic acid screening in nearly ten million residents of Wuhan, China. Nat Commun 2020;11:5917. doi:10.1038/s41467-020-19802-w. pmid:33219229
2. Madewell ZJ, Yang Y, Longini IM, et al.. Household Transmission of SARS-CoV-2: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2031756. doi:10.1001/jamanetworkopen.2020.31756
3. Jaafar R, Aherfi S, Wurtz N, et al. Correlation between 3790 qPCR positives samples and positive cell cultures including 1941 SARS-CoV-2 isolates. Clin Infect Dis. 2020 Sep 28:ciaa1491. doi: 10.1093/cid/ciaa1491. Epub ahead of print. PMID: 32986798; PMCID: PMC7543373.
4. WHO. WHO Information Notice for IVD Users. Nucleic acid testing (NAT) technologies that use real-time polymerase chain reaction (RT-PCR) for detection of SARS-CoV-2. Geneva, Switzerland. World Health Organization. 2020. (, Accessed 17 December 2020.
5. WHO. Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza. Geneva, Switzerland. World Health Organization. 2019. ( Accessed 17 December 2020.
6. De Larochelambert Q, Marc A, Antero J, et al. Covid-19 Mortality: A Matter of Vulnerability Among Nations Facing Limited Margins of Adaptation. Front Public Health. 2020 Nov 19;8:604339. doi: 10.3389/fpubh.2020.604339. PMID: 33330343; PMCID: PMC7710830.

Competing interests: No competing interests

19 December 2020
Public health physician
Independent consultant