More trials of public health interventions against Covid needed, says government adviser

More large-scale trials should be carried on the effectiveness of public health measures designed to contain coronavirus as the country tries to return to normality, a government adviser has warned.

Professor Graham Medley, a member of the Sage group, said arguments about the impact of some interventions could have been resolved by now if there had been more tests.

He told the Independent that such trials “are difficult to do in politically-charged environments and during an epidemic, but that is exactly when they are most needed”.

He added: “We have done very few proper randomised controlled trials of public health interventions. Many of the contentious arguments about hospitality, large events, schools etc could have been greatly informed by evaluation of different interventions and different policies.”

It was up to ministers to decide what trials should be carried out, he said.

“The priority for what is trialed is really determined by policy choices. If there are things that government would do if they knew they worked, then they are the priority,” he said.

His call was backed by Carl Heneghan, professor of evidence-based medicine at the University of Oxford. He said that when it came to drugs or vaccines “we do randomised controlled trials”. But there was a lack of evidence on the impact of many non-drug interventions, he said. “That means people’s opinions dominate the discussion.”

He suggested that trials could be carried out to assess the impact of Perspex screens, for example, or whether separate rooms in hospitals reduce the risks of transmission or whether or not offering greater financial and social support to people told to self-isolate would encourage more of them to stay at home.

Properly understanding the effects of some measures could allow ministers to “open up more quickly as well”, he said.

He called on the government to “come out and say we need to pursue such a strategy, because the funding is not unlimited. And I think it would be wholly advisable to go down that route.”

The government last week postponed plans to ease the final Covid restrictions in England, amid fears over a surge in the Delta variant, first identified in India. Boris Johnson has set a new date of July 19, though there are suggestions it could come earlier, depending on the data.

Even after lockdown measures are lifted fully, however, England’s chief medical officer Prof Chris Whitty has warned the public will have to learn to live with coronavirus.

Labour called on Boris Johnson to outline a ‘tried and tested’ plan for what that would would mean. Shadow health secretary Jonathan Ashworth said: “It’s not good enough for Boris Johnson to glibly insist we need to ‘learn to live with the virus.’ He needs to outline a tried and tested plan for what that means. “Decent sick pay is vital as it support for buildings to improve air quality given how important ventilation is. And health and care services need to be properly resourced and rebuilt. The public deserve better than trite statements from the prime minister.”

The calls comes in the wake of controversy about one such trial currently going on in around 200 schools and colleges across England. One group of the schools follows the nationwide guidance to quarantine the contacts of a positive case of coronavirus. The other group allows daily testing of contacts for a week, instead of isolation. But a group of 14 academics wrote to the BMJ this week arguing that “the assessment of risk of increased transmission arising from these trials is inadequate”.

A government spokesperson said: “Throughout the pandemic we have been guided by data and scientific advice and have acted quickly and decisively to save lives and livelihoods.

“Ahead of Step 4, as more is understood about the impact of vaccines on transmission and a far greater proportion of the population has been vaccinated, the government will complete a review of social distancing measures and other long term measures that have been put in place to limit transmission.”