This is the second half of an open letter sent by Independent SAGE to Chris Witty, Chief Medical Officer.
Independent SAGE has seen no evidence that the government has a considered strategy for the next stages of handling the pandemic in the UK. It is clear that the government has consistently failed to heed broad-based scientific advice, including that from the World Health Organization and the European Centre for Disease Prevention and Control, such as large scale testing with test results available within 24 hours or less, a strong Find, Test, Trace, Isolate and Support system to break chains of transmission and robust and continued public health messaging campaigns to reiterate the importance of personal protective behaviours (e.g. hand washing, social distancing, avoiding crowded spaces, wearing a face covering where you cannot avoid such spaces). Similarly, the government does not appear to have learned from the experiences of other countries that have been successful in achieving elimination or near elimination of the infection.
We fear that the government has given up trying to control the pandemic further and is hoping that by reacting to local outbreaks as and when they happen (e.g. the current Leicester lockdown), it can keep levels of infection at what they regard as a ‘manageable level’ (i.e their current quite high but not catastrophic levels). Independent SAGE believes that this is not acceptable, that we should not give up. Thousands of lives could be saved over the next year by a renewed effort to further suppress the virus.
The UK strategy should have at its heart a commitment to fully control the disease and to move towards elimination as soon as possible. The government must share that strategy with the public and seek their support and assistance in seeing it implemented. The four countries of the UK are not in the same position with regard to the pandemic and each part of the UK should develop its own programme of action in keeping with an overall goal of elimination of the virus, which is the achievement of a ‘Zero COVID UK’.
The planks of this strategy to achieve a Zero COVID UK should be to:
- Fully develop community-based and locally led Find, Test, Trace, Isolate, Support (FTTIS) programmes with expanded local laboratory provision, involvement of local public sector organisations and provision of all the resources necessary to enable adherence to the regulations on notification of infectious disease
- Restrict loosening of lockdown measures in any part of the UK until control of the outbreak has been achieved in that country
- Put in place well designed and scientifically based plans to act swiftly to contain and suppress completely and localise flare-ups in COVID-19 infections. Such plans to be exercised in simulation and well understood by the public before they have cause to be put into effect and implemented with full engagement with the communities affected
- Restrict incoming or outgoing personal travel internationally and within Britain and Ireland to the extent necessary to maintain control of the epidemic and, in particular to ensure effective isolation of incoming passengers.
- Combine all these measures with a systematic public information campaign stressing that things are not ‘back to normal’ yet, that premature removal of restrictions in the midst of a deadly pandemic threatens to squander all the sacrifices of lockdown and that strict compliance with restrictions now will make a full return to normality come sooner. The public messaging must be done in a culturally acceptable manner to reach all communities especially those that have been disproportionately affected such as the deprived and ethnic minority populations.
In Scotland and Northern Ireland (and also in the Republic of Ireland) both the numbers of deaths and the numbers of newly positive cases are very low. Both Scotland and Northern Ireland should continue to increase their efforts until control is assured and there is, in effect, a Zero COVID Scotland and a Zero COVID island of Ireland. In the case of Northern Ireland, an all-island approach to the pandemic should immediately be adopted using the Memorandum of Understanding already in place with the Republic of Ireland. As Scotland and the island of Ireland achieve full control, travel restrictions between them should be reconsidered alongside normalisation of social and economic activity.
It seems sensible that travel restrictions should either be instituted on public health grounds between England (and Wales) and Ireland and Scotland, or instituted if they are not already in operation. The Republic of Ireland has already instituted requirements arriving directly from Britain.
The achievement of a zero COVID Britain and Ireland will require the cooperation of the UK government in Westminster, the Scottish Government, the Welsh Government, the Northern Ireland Executive and, importantly, the Irish Government. The advantages would be manifest and wide-ranging, including the ability to lift all social distancing restrictions, revitalise economies, fully reopen all educational establishments and work towards unrestricted travel arrangements with similar Zero COVID countries.
If the UK government is not prepared to accept this advice, based as it is on the best scientific understanding of the pandemic, it must (as a matter of urgency) outline its strategic plan for the rest of the period of this pandemic and the analysis and advice upon which such a plan is based.