New coronavirus outbreaks ‘inevitable without robust UK strategy’

Further outbreaks of coronavirus and rolling lockdowns are inevitable under government plans to ease restrictions and send people back to work in England without a robust strategy to suppress Covid-19, an independent group of scientists has warned.

The experts convened by Sir David King, a former chief scientific adviser, urged ministers to reconsider the “dangerous” strategy of managing the spread of Covid-19 and adopt widespread decentralised testing, tracing and isolation to tackle the epidemic across the UK.

In what was described as a rapid response to the government’s handling of the outbreak, the group added to growing criticisms of the unclear “stay alert” message and said the public health advice to “control the virus” was an “empty slogan”.

King set up the independent alternative to the government’s Scientific Advisory Group for Emergencies (Sage) amid concerns over the transparency of independent scientific advice reaching ministers through Sage.

In a report published on Tuesday, the group warned that simply ensuring the NHS was not overwhelmed was counterproductive and potentially dangerous. Without strong measures to suppress the spread of infections “we shall inevitably see a more rapid return of local epidemics resulting in more deaths and potential further partial or national lockdowns”, they said.

The report, which includes 19 key recommendations, will be sent to Downing Street, Sir Patrick Vallance, the chief scientific adviser who co-chairs Sage, the first ministers in Wales, Scotland and Northern Ireland, and Jeremy Hunt, the chair of the health select committee.

The experts call on ministers to reverse the 12 March decision to abandon efforts to test, trace and isolate cases of Covid-19 and replace the existing centralised testing approach, which relies heavily on the private sector. In its place, the group propose a decentralised strategy that puts GPs and local health teams at the heart of outbreak control. The report says the “overdependence on outsourcing” is unsustainable.

Under the proposal, local monitoring for coronavirus cases would focus on high-risk settings in particular, such as hospitals and care homes, and serve as an early warning for outbreaks that would immediately trigger widespread testing, contact tracing and isolation of the infected.

“There needs to be, as we move out of lockdown, a way to bring testing into settings where there can be an immediate, local response,” said Deenan Pillay, a professor of virology at University College London and a member of King’s group. “This cannot be done centrally. You need your local GPs and local healthcare workers and all the rest of it in play.”

He added: “This is is moving from the national top-down testing we have now to something much more responsive and flexible. Infections come and go, that’s how they work. You monitor for a signal locally, perhaps a few people in a care home, and then you take a local decision with the public health team to go and test more.”

As a first step, the government should rapidly invest in measures to stop the virus from spreading in high-risk settings, such as care homes and hospitals, prisons and migrant detention facilities, and homes that are overcrowded or contain multiple generations, the experts say.

The report goes on to criticise the government’s reliance on “inaccurate, incomplete and selective data” and confusing messaging, in particular the new “stay alert” message, and notes that ministers do not appear to be listening to advice from behavioural science advisers.

“It is not clear what people are meant to be alert for, nor indeed what they should do if they are alerted to something. Similarly, ‘control the virus’ is an empty slogan without an indication of how to do this. ‘Save lives’ is uncontroversial but without context in the rest of the message is likely to have little impact,” the report says.

Experts on the group include Prof Anthony Costello, a former director of the World Health Organization, Prof Susan Michie, the director of the centre for behaviour change at University College London, and Prof Gabriel Scally, the president of the Royal Society’s epidemiology and public health section and an adviser to the Irish government.

Even with an effective vaccine, the virus is likely to remain in circulation for the foreseeable future since no vaccine is 100% effective and not everyone on the planet will be vaccinated. In that situation, the virus will join the list of infections that humans learn to live with in other ways, Pillay said.

“Whilst wanting the vaccine to work and that be the end of it, we need to prepare for something that becomes endemic in our society,” he said. “We know it is very transmissible, we know it can cause severe disease, and therefore there needs to be monitoring in place that can deal with these sporadic outbreaks.”