Getty Images / Chris J Ratcliffe / Stringer
On Monday June 1, the government eased the lockdown rules. In England, groups of up to six people can now meet outdoors or in private gardens, those classified as clinically “extremely vulnerable” can now go outdoors, competitive sport is set to resume and, as planned, some primary schools in England have reopened for some children. (Rules in Wales, Scotland and Northern Island vary slightly – decisions for easing lockdown rests with each national government.)
After a week where the government found itself mired in the Dominic Cummings scandal, easing the lockdown has provided a welcome distraction for beleaguered politicians. But independent scientists have criticised the government for neglecting to follow its own guidelines laid out by Boris Johnson on May 10, arguing that the UK is leaving lockdown too early. But how early is too early?
The lockdown’s easing has been received with some consternation. The Association of Directors of Public Health (ADPH) said the new rules, including allowing groups of up to six people to meet outdoors and in private gardens, were “not supported by the science”. Professor John Edmunds, a member of the UK’s SAGE (Scientific Advisory Group for Emergencies) committee, expressed concern over the change and the high number of cases still being reported – 8,000 new infections per day in England alone between May 11 and May 24.
The government’s plan for easing the lockdown is divided into five “alert levels”. Our coronavirus alert system remains at Level 4, which indicates a high or rising level of transmission and requires enforced social distancing, rather than Level 3, where the virus is considered to be in general circulation and social distancing can be relaxed.
This week, it was revealed that all UK chief medical officers rejected lowering the virus threat level because it contradicted evidence that showed the virus was still widespread. Yet the government still eased social distancing. “The government’s position has been that it would look at the evidence and then make the decision – they gave us alert levels and worked on the premise that each alert level will be independently scientifically verified,” says Bharat Pankhania, senior clinical lecturer at Exeter Medical School. “To preempt and say, ‘Oh, we’re making these changes because we are transitioning’ is a little bit unscientific.”
The government’s decision has been guided in part by the R number – which measures the rate of transmission of the virus – as well as the number of cases per day and the death rate. On March 23, the day when Boris Johnson announced lockdown, there were an estimated 100,000 new infections occurring each day in England. Now, there are around 8,000 daily infections, while the R number lies somewhere between 0.7-0.9 (it was around 3 when lockdown came in). So in this sense, the timing of the UK’s lockdown may be premature. “It’s clear to me the virus is deeply embedded throughout the UK, the genie is well and truly out the bottle,” says Brendan Wren, professor of microbial pathogenesis at the London School of Hygiene and Tropical Medicine. “These are huge numbers.”
So how does this compare to other countries? This is a difficult comparison to make because different countries have eased lockdown in different ways. A study from the University of Oxford examined four of the six checklist criteria the WHO has recommended countries fulfil before leaving lockdown.
The UK ranks among the worst in the world at three of these – controlling cases; testing, tracing and isolating; and managing imported cases. Overall, only Syria, Iran, Algeria and Nicaragua are ranked in worse shape for leaving lockdown. Christina Pagel, a mathematics professor at UCL, pointed out on Twitter that the UK opened its schools far earlier than Germany and France, which waited until they were well below 1,000 confirmed cases a day before reopening. “We are not in a position to lift the lockdown,” says Pankhania. “We need clear evidence that the number of cases is falling and at a very low level. And we need evidence that we are extensively testing. We are neither extensively testing, nor is it significantly falling, it’s plateaued.”
One thing to bear in mind is that other countries have gone way further with easing their lockdowns, says Keith Neal, professor emeritus of epidemiology of infectious diseases at the University of Nottingham. “We’re doing a lot less – Germany has museums and zoos open,” he says. “I think we can learn a lot from what’s been going on in Europe in the last month, and they haven’t seen a problem. So why would you expect there to be a problem in this country?”
Another sticking point has been the way the UK has re-opened primary schools. Since 23 March nurseries, schools and colleges have remained open only to a priority group of children and young people, children who have a parent who is a critical worker, and vulnerable children. On June 1, all children in nursery, reception, year one and year six returned. So far, head teachers are reporting “highly variable” levels of attendance, ranging from 40 per cent to 70 per cent. And unions raised fresh concerns on Tuesday, after a school in Derby was forced to remain closed this week when seven members of staff tested positive for Covid-19. “I couldn’t understand the rush to go back to school,” says Wren. “Why not go back in September when we have a lot more data on the virus itself and its transmission.”
One study, which was considered by Sage, showed children were 56 per cent less likely to be infected than an adult if they were in contact with an infected individual. Children of healthcare workers have not shown a significantly different rate of infection than other children, says Neal. “We know that schools have reopened across Europe using social distancing and that schools have had three weeks to learn from Denmark, and ten weeks to get things ready, and some have reopened,” he says. “What works in Denmark and German schools is probably going to work in British schools.”
Easing lockdown might give the public the wrong impression that everything is hunky-dory, particularly in the aftermath of the revelations about Cummings’s trip to Durham. On May 31, a De Montfort University survey of 1,201 people found that the number of Britons flouting social distancing guidance because they didn’t agree with the rules had more than doubled – from four to nine per cent. “I think it’s more about sending messages,” says Wren. “Because I do agree that with outdoor activity, you’re highly unlikely to catch the virus.”
“It is a worry,” says Pankhania. “I’m concerned because while we have not got on top of the infection, we appear to be saying ‘all is well’ and therefore we can expect a surge in new cases.” There are also discrepancies into how the British public should act when outside. People in England will only be required to wear face coverings on public transport from June 15 – a measure that was only announced on June 4. Multiple other countries introduced compulsory face coverings in public spaces earlier and in a wider range of scenarios – Germany, for instance, made wearing of face masks compulsory when on public transport and shopping.
“The government has been very clear that any easing of lockdown measures has to be done slowly and cautiously to avoid a second peak of the virus that could overwhelm the NHS,” a government spokesperson said.
The efficiency of our contact tracing system is also a major concern. Channel 4 figures suggest that fewer than 40 per cent of contacts were contacted within the first four days of the scheme’s operation, well below the estimated 80 per cent we would need to halt the virus’s spread. Here, we lag far behind other countries – Wuhan, for instance, conducted 1.4 million tests on a single day on May 23. “Other countries have been doing a lot more diagnostic testing and a lot more tracking and tracing, for example, Singapore, South Korea and Hong Kong,” says Wren.
At the moment, we simply aren’t doing the tracing necessary to follow the virus’s spread. This is basic epidemiological practice, says Wren. “If we still have so many cases, I can’t understand why every new case while we don’t ask the question, why did this person get it? Where did they get it from? Who were they in contact with?” he says. “The information is not getting out there that will inspire confidence. I feel like this is the wrong decision, sending the wrong message at the wrong time.”
But whether or not the system is ready, if we have come out of lockdown too early, the testing system may be overwhelmed. “My word of warning here is that once you have generated an overwhelming number of cases, the so-called contact tracing system will also fail because contact tracing only works well when your case numbers are low,” says Pankhania. “So, if your case numbers are not low, and you are continuing to generate more cases, then your contact tracing won’t work properly. So it’s almost a case of you failing before you have started.”
Will Bedingfield is a staff writer for WIRED. He tweets from @WillBedingfield
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