Continual boom and bust lockdowns are not the way to manage the virus

The news that the first batch of Covid-19 vaccine is available in the UK and is being given to some of the most vulnerable and their carers is truly a cause for celebration.

The speed at which scientists have worked to understand this virus is unprecedented. It is hard to believe that it was only identified some eleven months ago, in early January 2020. Within days its genetic code was unlocked and, in less than a year, the end of the pandemic is coming into sight. But does this scientific breakthrough allow us to relax and finally enjoy some festive celebrations?

The honest answer is of course no. The virus is still circulating in our communities, and it remains extremely dangerous. As my colleague Dr Gabriel Scally so pithily said, “there is no point in welcoming your grandparents for Christmas only to bury them in January”.

In the rush to deliver the good news, we must not forget that it will take many months until we can hope to achieve widespread immunity through a vaccination programme. During this time, we will not be able to open up society safely and will still need measures that control and suppress the virus.

Last week, the All-Party Parliamentary Group on Coronavirus, chaired by Layla Moran MP, submitted its interim report on the UK government’s handling of the pandemic. One of the key recommendations is that the UK government should adopt the Covid-Secure UK plan. This plan is very much in line with measures that we at Independent Sage have been asking for since the start of the pandemic – the need for a locally led contact tracing service, suppression of the virus in our communities, and a redoubling of our efforts to find and isolate new cases at our international borders.

The report recognises that the outsourced test and trace service has failed. The report adds to calls by, among others, the Association of Directors of Public Health, for radical reform, investing in a locally led find, test, trace, isolate and support system.

Contact tracing will only bring infections under control if it reaches 80 per cent of contacts. Since the Serco/Sitel test and trace contract began on 28 May of this year, this target has never once been reached. It was never going to do so. A phone call from a distant call centre, even when it connected with the right person, was never going to be as persuasive as direct contact with a contract tracer with knowledge of the local community, offering advice and support.  

Local contact tracing, done face to face, such as we see in Scotland and in some English local authorities, regularly reaches more than 90 per cent of cases, some 80 per cent of which within 24 hours. Local public health teams have the knowledge of their communities and the expertise in contact tracing to identify and control outbreaks in a timely manner. 

By explaining face to face the importance of isolation, while understanding the issues that make isolation hard, and being able to offer tailored support, financial and otherwise, local contact tracers are much more effective in getting people to isolate. As a result, they are far more successful in breaking the chains of transmission and bringing down the number of cases.

In addition to controlling the virus within our communities, the UK government must follow the lead of some other countries that have been able to stop almost all new cases coming into the country.

We saw over the summer how restrictions reduced the incidence of the virus. Afterwards, however, many people felt they needed a holiday. On their return, there was no testing at ports and airports, and no means to control any new imported cases coming into the country. Inevitably, the virus spread rapidly, as we saw in the sudden rise in cases in September, and the return to tiered restrictions and lockdown in the Autumn. We cannot afford for this to happen again.

Elimination through vaccination is the final step in the Covid-Secure UK plan, with the goal of achieving widespread immunity. A vaccination programme is beginning, but immunity is still a long way off. As the roll out gets underway, we risk further lockdowns if cases begin to rise again. We must avoid the continual boom and bust lockdowns which have marked this year. We need to ensure that we can open up society in 2021, in a way that is safe and sustainable, that protects our economy, as well as our health and our NHS.

With the arrival of a vaccine, we can see a glimmer of light at the end of the long dark tunnel of 2020. But it is still some way ahead. Until that point is reached, I urge the UK government to adopt the Covid-Secure UK plan now. It is only when we have the proper control measures in place that we can open society safely and sustainably. At that point, there really will be something to celebrate.

Martin McKee is professor of European Public Health at the London School of Hygiene & Tropical Medicine and a member of Independent SAGE