We are in a public health crisis unprecedented in living memory. We have written to the prime minister because we are very concerned for the safety and wellbeing of the public. There is ample evidence that effective epidemic control requires the public to trust and respect both the messages and the messengers who are advocating action. This trust has been badly damaged by the actions of Dominic Cummings, including his failure to stand down or resign in the public interest, and Boris Johnson’s subsequent unwillingness to remove him.

As lockdown is eased, public trust and high compliance is essential to reduce the risk of a second spike in infections and deaths. It is vital for all people in positions of power to follow the rules with the same discipline as the rest of the population. The public also needs to see that the necessary infrastructure and effective systems are put in place rapidly and effectively.

A national track and trace scheme is a major undertaking. This makes it even more crucial that there is complete transparency about likely time scales and the risks associated with the strategy and plan. The public mood is fragile and unlikely to cope with another over-optimistic target-based strategy that goes on to fail. We are also concerned that the needs of people primarily affected by non-Covid-19 diseases are being neglected. For example, since the pandemic hit, there has been a 70% or more reduction in cancer diagnoses and there is an estimated backlog of 100,000 undiagnosed or untreated cancer cases (growing by about 5,000 a week). Similar backlogs are evident in every non-communicable disease.

This exceptional situation also requires urgent and detailed planning and investment. We ask that the prime minister better harness the expertise in the NHS, social care, local authorities, academic institutions and the civil service to strengthen the response to Covid-19 and its knock-on effects on other health and care provision. We would be happy to assist in mobilising an effective strategic and operational response.

Professor Maggie Rae, president of the Faculty of Public Health, Professor Elio Riboli, Imperial College London, Professor David McCoy, Queen Mary University London, Professor David Hunter, University of Oxford, Professor Trish Greenhalgh, University of Oxford, Mike Gill, former regional director of Public Health, south-east England, Professor Raj Bhopal, University of Edinburgh, Professor Martin McKee, London School of Hygiene and Tropical Medicine, Professor George Davey Smith, University of Bristol, Professor Ruth Gilbert, University College London, Professor Neil Pearce, London School of Hygiene and Tropical Medicine, Professor Helen Ward, Imperial College London, Professor Mark S Gilthorpe, University of Leeds and Alan Turing Institute, Professor Adrian Martineau, Queen Mary University London, Professor Allyson Pollock, University of Newcastle, Dr Rochelle Burgess, UCL Institute for Global Health, Professor Paolo Vineis, Imperial College London, Anne Wilson, Liverpool School of Tropical Medicine, Dr Tim Colbourn, University College London, Professor Majid Ezzati, Imperial College London, Professor Deborah Ashby, Imperial College London, Professor Sonia Saxena, Imperial College London, Professor Richard Healey, University of Portsmouth, Professor Deborah A Lawlor, Bristol Medical School, Professor Guiqing Lily Yao, University of Leicester, Dr Nisreen Alwan, Southampton University

To continue  from www.theguardian.com

……..Just days after the health secretary, Matt Hancock, unveiled the new test, trace and isolate scheme to combat Covid-19, the top health experts say the public mood is “too fragile to cope with another over-optimistic target-based strategy”, and urge transparency over timescales and risks for the national scheme.

They say people need “to see with their own eyes that the necessary infrastructure and effective systems are put in place not just rapidly, but effectively”.

They also say there is now a high risk of an uncontrolled spike in new infections, hospitalisations and deaths from Covid-19 over the summer.

One of the letter’s main authors, Prof David McCoy, director of the centre for public health at Queen Mary University, London, described the test, trace and isolate system – which aims to quarantine people with Covid-19 and those who have been in contact with them – as “a mess”.

“It is not a system,” he told the Observer. “It is just a fragmented collection of different programmes with nothing really holding them together. We needed to have spent much of April organising the test and trace programme and that was not done. We have wasted the time we had bought ourselves.”

Part of that failure could be blamed on Dominic Cummings, he added. “Firstly he breached the lockdown rules but also as the chief adviser to the prime minister he has to take some responsibility for the failure of the government to make a proper response to Covid.”

These experts’ concerns were also shared by other scientists who worry that daily rates of new cases are still too high to make test and tracing programmes feasible. Current infection rates suggest tracking operations will be quickly overwhelmed, they say. “The total number of cases a day is still substantial and there is evidence of decreasing compliance to restrictions and people moving farther away from their homes, increasing the chance of spread to previously unaffected areas,” said Prof Rowland Kao, at Edinburgh University…..

……Prof Devi Sridhar, also at Edinburgh University, said the current daily rate of thousands of new cases was unacceptably high. “Watching carefully what’s happening in east Asia and combining this with what we know so far about this virus, it does indeed feel like mistakes are being repeated,” she said. Daily new cases should be cut to double digits, or low hundreds at most, she said, while test, trace and isolate procedures are put in place and core infrastructure built up.

Graham Medley, of the London School of Hygiene and Tropical Medicine, and a member of the government’s Sage scientific advisory group, agreed that the UK was taking a risk over the loosening of lockdown because of its current relatively high incidence of infections. “There is less room for mistakes,” he added. “The precautionary principle suggests that if you are unsure about the risks, especially when the outcomes have a large impact, then you should err on the side of caution.”

Four other members of the Sage committee, Prof John Edmunds, Sir Jeremy Farrar, Prof Calum Semple and Prof Peter Horby, all warned on Saturday that the government was taking a serious risk by easing the lockdown while 8,000 people a day were being infected.