April 8, 2020

expert comments about oncologist Prof Karol Sikora’s tweets about how we could exit the lockdown

There have been questions from journalists about the feasibility of the exit strategy outlined by Prof Karol Sikora, an oncologist and the founding Dean and Professor of Medicine at the University of Buckingham’s medical school, on his Twitter account.

Prof Matt Keeling, Professor of Populations and Disease, University of Warwick, said:

“I find the potential exit strategy outlined by Prof Sikora very concerning.  The only reason the peak will be soon (hopefully), is because of the current lock-down – there are still very many susceptible individuals out there, and if controls are relaxed too early then cases will begin to rise again.  Although we know that the country is making a huge effort, and can measure this in transport and traffic data, it is still too early to see a strong signal of the lock-down in the COVID-19 data sources.

“Once the critical measures (such as ICU occupancy or deaths) are starting to decline, we can begin to think about exit strategies.  However, while there are still lots of susceptible people in the population (and we haven’t reached herd immunity) the disease has the potential to increase.  In the longer-term, there will need to be a very careful balancing act between maintaining control of the outbreak and allowing some activities.  There is currently insufficient knowledge to say how each of the ‘four-steps’ proposed by Prof Sikora will impact the spread of infection.  The most precautionary way out of lock-down will be slow and sequential, evaluating the impact of any change in policy over 3-4 weeks before any other changes can be considered (or if the cases rise too quickly if measures need to be re-instated).

“I therefore feel it is far too early to be placing a time-frame on easing restrictions.”

Prof Rowland Kao, Sir Timothy O’Shea Professor of Veterinary Epidemiology and Data Science, University of Edinburgh, said:

“While the staged removal of restrictions is a sensible approach, it is unwise to propose a relaxation of restrictions on a specified date before you have assessed the evidence at the point of decision.  Staging does allows us to assess the impact of removing what are probably the less risky and more pressing activities first, but the timing of these stages must depend on the circumstances.  At the bare minimum, we must have clear evidence that the number of cases are on the downturn before any relaxation of restrictions.  Even if that is true, any of these stages could increase the number of cases at that time.  So we must be safely beyond the point where such an increase would put our health services under greater stress, due to the potential impact on mortality rates.  Finally, the proposed timing for each successive stages as proposed is too short; it must be long enough to show that after the previous stage, the case rate continued to decline.  At the minimum this should be around two weeks between stages, but again the decision to lift restrictions should depend on the circumstances and available data at the time.”

Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:

“I think this typifies the government’s dilemmas with many people making suggestions of exit strategies.  There are so many possibilities of how we get out of the lockdown and clearly a staged exit strategy is the most likely response based on what we know about how this and other viruses spread.  It is probably too early today to call the peak but the number of new cases appears to be heading in the right direction.  (We still do not know if any of the new cases reported are health care workers which would inflate the figures as they were previously only hospital admissions).

“One factor that is important is the NHS’s ability to manage the workload which will take a bit longer for those patients already ill to work their way through their illness and be discharged.  For this reason Prof Sikora is probably optimistic on timelines.  This requirement will delay the lifting of restrictions well after a decrease in daily cases.  This is important so other conditions need to be treated and we need space for the probable increase in cases when restrictions are slowly lifted.”

https://twitter.com/ProfKarolSikora/status/1247839541890818048?s=20

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