I am hugely relieved to hear that the government is poised to announce national restrictions as a circuit-breaker to reduce levels of Covid-19. They have delayed too long. Action at an earlier stage would have prevented the large increase in viral spread we are now seeing and would have limited the appalling impacts of the current wave on health, on the economy and on society.
The political response to the Covid-19 in the UK is increasingly chaotic. There is regional and national fragmentation causing resentment and incoherence. Policies appear seemingly at random, driven by short-term reactions to events with no apparent long-term strategy. Measures to control this virus - social distancing, self-isolation and contact tracing - rely on people being clear about what they need to do and on individuals taking selfless actions for the collective good. The current confusion and loss of public trust is undermining these, our only effective tools.
My hope is we can use this moment to radically change the approach to the pandemic in the UK and prevent years of suffering and devastation. To achieve this, the government needs to restore public trust and then set out a clear long-term strategy to stop this pandemic ruining our country.
The key element is clear strong leadership based on an explicit request for national unity and on following the scientific evidence. The current approach has fostered conflict and division between regions and between countries. A false dichotomy has been introduced, characterised by people who are concerned about the economy being presented as being at odds with people concerned about health impacts. This dichotomy is both harmful and unnecessary. Everyone has a single shared aim – to minimise the health, social and economic impacts of this terrible pandemic.
Scientists do not advocate increased control measures because they like restricting peoples’ freedoms or want to damage the economy. Covid-19 is the single root cause of all the harms: controlling the virus tackles the root cause. Of course, there needs to be debate and differing opinions about how best to reduce spread, but this must not be allowed to undermine the unity of purpose that we share.
In the longer term, we need a strategy that plans for further waves of infection. If all goes as well as hoped, we may be able to initiate roll out of vaccines early in 2021. However, vaccines are likely to offer only partial protection from severe illness, and achieving population coverage will take time.
Even basic knowledge of how pathogens behave tells us to prepare for a likely third wave in the spring of 2021. The crucial thing will be learning from current mistakes. The approach to date of introducing incremental control measures as a response to increases in viral transmission is too little too late and is a double disaster. It inflicts severe economic and social harms, while failing to reduce infections. This approach will reduce the R value to 1 – in effect stopping further increases – but when introduced too late this only has the effect of maintaining high levels of infection for a long period, with large numbers of death and substantial morbidity accumulating. We can now reliably anticipate when and where infections are likely to rise. This means that in the future short periods of intensive control measures – like the one to be announced – can be planned in advance, giving people adequate warning to allow them to prepare and therefore minimise the adverse effects.
Used early, just as infections start to rise, epidemic waves can be curtailed, with long-term low-level control measures then being effective in preventing subsequent increases. The currently proposed short period of lockdown is needed but would have both been more effective and less disruptive if it had been pre-planned and introduced at an earlier stage.
Right now, we have the opportunity as a country to unite around a shared aim to control this pandemic and minimise the terrible harms it is inflecting. The danger is that in a few weeks we lapse back into an ineffective, chaotic response that sees the virus inexorably rise again plunging us back into crisis. We need to seize this pivotal moment to alter the long-term course of this pandemic and limit the devastating impact of Covid-19 on our health, our economy and on wider society.
Liam Smeeth is professor of clinical epidemiology and Dean of the Faculty of Epidemiology and Population Health at the London School of Hygiene and Tropical Medicine