May 10, 2020

expert reaction to Boris Johnson’s speech

Boris Johnson has announced the Governments strategy for reducing lockdown measures in the UK.

Dr James Gill, Honorary Clinical Lecturer, Warwick Medical School, and Locum GP, said:

“A key part of successful healthcare, is effective leadership. Whether that is by setting the course for an organisation, or helping a patient choose the best treatment option for themselves. 

“During the COVID-19 pandemic, there have been many examples of clear, and decisive leadership. This approach has enabled the U.K. and many other countries to have a clear effect on flattening the curve of COVID-19 infections. 

“Unfortunately today’s announcement appears to have lacked the clarity which has previously been key to good COVID-19 responses. This clarity has enabled difficult choices, informed by data and the best work of scientific experts, to be acted upon and accepted by the general public and employers at large. 

“Today’s announcements appears to lack that clarity and a demonstrable thread of scientific support underlying. Instead we have been left with a muddled message that feels like action for the sake of action, especially so given the differing approaches in Scotland, Wales, and Ireland. 

“I can only hope that caution informs the actions of both people and businesses to ensure safety whilst we await evidence backed announcements to give us the clarity needed to move forwards, both with our lives and restarting the economy. “

Prof Paul Hunter, Professor in Medicine at the University of East Anglia, said:

“The Prime Minister’s statement today certainly left a lot of questions unanswered. Whilst little seems to have changed for the rest of this month at least, it is still far from clear what the practicalities are of what we can and cannot do. Even with guidance on the DHSC website, the big problem is always how these broad statements are interpreted by businesses, by workers, and by ordinary members of the public. ‘How do these guidelines apply to my life?’ is the question that many people will be asking themselves. Can I drive to visit my close family if I can still adequate social distance when I get there? If I do not have my own transport, how do I get to work? What should I do if I have to use public transport? Is it OK to meet friends in the park providing we keep more than 2 metres apart? Hopefully in the next couple of days this will become clearer as more specific advice is published by the UK government.

“Despite the outstanding uncertainties, however, it was right that no major changes were made just yet as there is still substantial transmission of the infection in the UK and also debate about the value of the different distancing measures. Looking to June and July however, we were told substantive further relaxations are planned, provided the situation allows. Although the government keeps repeating that it follows the science, it has to be said that the science is still subject to significant uncertainty. For example, there is continuing debate about the importance of schools in the spread of infection with evidence both for and against this. Whatever we do, it is vital that we base our decisions not just on the modelling but on the observation of what impact relaxation of distancing measures has had on the disease epidemic elsewhere. Given that the UK was relatively late in instigating its social distancing measures, at least compared to many of our European neighbours, we will also be later in relaxing them. By the time we are planning to make further relaxation steps we should have a much clearer idea of what has and what has not been safe elsewhere.

“A major area that was not adequately addressed was the issue of the epidemic in care homes. It is becoming increasingly clear that the epidemic in care homes is the Achilles heel in the UK’s ability to control this epidemic. It may well be that whatever we do or do not do in moving out of lockdown could be undermined from spread back into the community from care home outbreaks. This issue has to be higher up the UK’s priority.

“Whatever we do, we need to proceed cautiously. But before any significant change, we need to ensure we have fully adequate testing services in place that are adequately linked to effective contact tracing and management and we need to monitor very carefully the impact of any changes on case numbers in the community to determine whether any change has put our citizens and our NHS at increased risk.”

Dr Rupert Beale, Group Leader, Cell Biology of Infection Laboratory, Francis Crick Institute, said:

“The broad strategy outlined by the Prime Minister – to keep the virus suppressed with R below 1 – is exactly right. The immediate next steps seem to be a very modest relaxation of the ‘lockdown’. The opportunity for additional exercise is welcome. However, I am concerned that confused messaging might lead people to relax their efforts too soon. It’s imperative that a really effective testing, tracing and isolation system is working before any significant change to the rules takes place.”

Dr Jennifer Cole, Biological Anthropologist, Royal Holloway, University of London, said:

“The Prime Minister is right in setting out a cautious approach. He gives not only a timeline for easing restrictions but also sets clear baselines for what will need to be achieved to ensure further easing, and what may require retightening. The plan puts a strong emphasis on the behaviour of individuals, offering the promise of greater normality in June as a reward for continued good behaviour across the rest of May. The element the roadmap is lacking, however, is one which, for many people, is the most important and the hardest to deal with at present: when can families see each other again? For grandparents who have been separated from their grandchildren and families who live many miles apart, often in different cities, the speech provides no clarity on when they will be able to meet in person again.

“This emphasis on reopening the economy rather than restarting family life is disappointing, particularly for those who are missing the first precious weeks of a new baby’s life, or who live alone. Online interaction is no replacement for a real hug. People care about these things much more than when the hospitality industry may be able to reopen. The public have been asked to make – and largely have made – significant sacrifices over the past few weeks. More acknowledgement of the human aspects of lockdown, rather than only the economic ones, would have been welcomed. When family gatherings might restart has not so much been left vague as completely ignored. This is a sad omission in a message that puts so much emphasis on caring for our NHS, key workers and vulnerable neighbours. Families care most about one another. Hopefully more clarity on this will emerge over the next few days. Separated families may not contribute to the economy, but it is essential that they are not forgotten”.

Prof Azra Ghani, Professor in Infectious Disease Epidemiology, Imperial College London:

“The announcement today focuses heavily on the use of the “R number” as a driver of the alert system, and hence the appropriateness of relaxing current interventions. R (the reproduction number) is the number of new infections generated by each infection and is therefore an indicator of whether the epidemic is growing (when R>1) or in decline (R<1). Provided R stays below 1 the epidemic will continue to decline, the further below it is, the faster it will decline. The threshold value of 1 is therefore the more important indicator; for this reason an alert system scale based on the estimate of R makes little sense to me (other than whether it is above or below 1).What it does provide an indication of is the percentage change in social contacts that can be “tolerated” before this threshold value is reached; unfortunately, given current (and uncertain) estimates, there is little room for manoeuvre, and this is clearly being seen as other countries across Europe have begun to relax their social distancing policies.

“It is also important to note that the R number is rarely measured directly – but rather is inferred from patterns in the surveillance data. It is distinct from the “infection rate” – the number of new infections per day – which can be measured and gives an indication of the magnitude of the epidemic and whether it is increasing or in decline. At present we are estimating both R and the infection rate from data on hospitalisations. These form only a small fraction of all infections and represent an estimate of transmission that occurred 1-2 weeks earlier – and are therefore a blunt monitoring tool. Without rapid testing of all suspect cases it will be impossible to estimate the true level of the epidemic across the country, or in specific geographic locations, with any degree of precision. Such testing should not be driven by an arbitrary threshold; rather it should be driven by need. Without this in place, it will remain challenging to monitor the effect of relaxing interventions in a timely manner. Equally, it will be very hard to respond to contain any surges in infection or local outbreaks without a strong community-based surveillance system in place.

“Models or model-based estimates (such as R) can be helpful in interpreting data trends but should never be viewed as a surrogate for good data; only with extensive surveillance and rapid testing of suspect cases in the wider community, in hospitals, and in care homes and other places at high risk, can we be truly confident that the epidemic is in decline and that it is safe to relax measures.”

Prof Neil Greenberg, King’s College London and Royal College of Psychiatrist:

“Whilst the Prime Minister has announced his Government’s roadmap for recovery for the UK population, what was notably absent was any mention of how the wellbeing of NHS staff, and other key workers, will be supported during the country’s recovery. Many key workers will have had to work in highly challenging situations which have included exposure to traumatic stress, moral injury and a relentless workload often in circumstances which were very different to their usual work. The government has quite rightly verbally applauded the critical work carried out by key workers since the pandemic began to ensure that the nation continued to function, however there is a risk that if these individuals are not properly supported during the recovery process then not only may they suffer significant mental health problems, but should we have a second wave then they will not be ‘ready to go again’ when the country needs them. In particular, NHS staff who have been working in often extraordinarily difficult situations will require a chance to recover before undergoing a graded return to work and the Nation should be made aware that the NHS cannot be expected to simply ‘catch up’ with the vast amount of clinical work that has been put on hold since the crisis began.”

Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:

“I am deeply concerned by the confusing message from the government this evening. It feels as though the ethos that advice from the scientific community should guide policy has been abandoned. We have achieved a plateau in new cases, not a significant drop, which means that the previously established pillars have not been met.

“With this in mind, I find it difficult to understand why it is necessary to announce potential changes ahead of time, whilst failing to provide specific criteria by which decisions will be taken. It is also troubling that the new message and tag lines are inconsistent with the rest of the UK when we know England has the vast majority of cases.

“One danger in announcing future intentions without a clear framework is that it promotes a message that the situation is now less serious. This is bound to affect the subconscious and could lead to people dropping their guard. We have seen multiple examples of the virus bouncing back in other countries where restrictions are relaxed, despite the disease being far less prevalent than here. We cannot and should not attempt to second guess this pandemic. It is essential that we obtain a clear understanding of community spread via efficient and widespread testing before any of the measures announced this evening stand a chance of success.”

Prof Trish Greenhalgh, Professor of Primary Care Health Sciences, Nuffield Department of Primary Care Health Sciences, University of Oxford, said:

“It looks like the PM is trying to implement the “have cake and eat it” maxim he popularised in a previous life. On the one hand, he says he’s not lifting the lockdown because he is determined to avoid a second peak. On the other hand, he appears very keen to lift the lockdown because he urgently needs to fix the economy. Anyone unable to work from home should now return to work from work (though they are also advised to avoid public transport, so it’s not clear how they will get there). I can’t see what the ‘guidance for employers’ is going to say, but employers won’t be able to generate 2 metres of distance between employees out of thin air. The government has yet to take a positive stance on face coverings, which (in addition to continuing handwashing) is probably the one public health measure that could enable us to ease out of lockdown more safely. Leaving aside who we’re allowed to play tennis with from Wednesday, this announcement seems to be pitching  at a middle ground that could give us the worst of both worlds.”

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“It’s very difficult to see how underlying science has informed the measures announced today, for example, the difference between primary or secondary school children as drivers of community infection.

“I think the reality is, this is a statement driven almost entirely by an economic agenda and in truth lacks clarity in terms of future control of the virus epidemic. Recognition of the importance of infection control through extensive testing and effective contact tracing was a welcome statement, but I am not convinced that the systems are really in place to do this.

“Hopefully clarity will emerge over the next few days.”

Dr Michael Head, Senior Research Fellow in Global Health, Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, said:

“The revisions announced by the Prime Minister are broadly what was widely predicted, with some industries encouraged to restart, such as manufacturing, and a later phased reopening of schools. However, we still await the detail behind these announcements, which will be so important. For these revisions to be successful, we need consistent communications from the government, and the new ‘Stay Alert’ messaging is ambiguous and lacks clarity. We also need the general public to continue to practice social distancing, but there were so many examples of parties and gatherings during the bank holiday weekend, and if that continues, that will only serve to increase transmission and delay the country full reopening.”

Professor Dame Til Wykes FMedSci, Vice Dean Psychology and Systems Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:

“The prime minister in his own words produced the “first sketch” of a plan which encourages people to go back to work if you cannot work at home and to do more exercise in the open air. Encouraging people to leave their homes is now going to be difficult with many people having followed the “stay home” message. Individuals who are anxious, and many are, will find it tough to respond to the plan and will need some evidence of how safe travelling or work will be. The risks will have to be communicated carefully and be based on the science of this pandemic.

“The communication plan of “stay alert, control the virus and save lives” – unlike the first step in the plan – is very confused. We need clear rules and messages that are concise, clear and accurate. This is just short. It is clearly a message written by a communications committee and was never tested in a focus group or with behavioural scientists. A woolly message will hinder not promote the next phase of this lockdown.”

Boris Johnson’s Speech: https://www.bbc.co.uk/news/live/world-52601754 

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.