March 3, 2020

expert reaction to government’s Coronavirus action plan

In a press conference today, the Prime Minister Boris Johnson announced the governments action plan for tackling toe COVID-19 outbreak.

Dr Tom Wingfield, Senior Clinical Lecturer and Honorary Consultant Physician, Liverpool School of Tropical Medicine, said:

“Statements from England’s Chief Medical Officer and sections of the UK government’s action plan to deal with COVID-19 have both suggested that, while not required at present, interventions such as travel restrictions, curtailing of mass public gatherings, and other measures including household isolation may be put in place to mitigate transmission of COVID-19.  Given that the predominant way that COVID-19 is transmitted is through close contact and airborne spread, these interventions would seem a logical way to slow the spread of COVID-19 if sustained transmission were seen in the UK.

“On Friday last week, WHO advised that those at high risk of severe illness (e.g. aged over 60 years old, pre-existing chronic respiratory or cardiovascular conditions, or significantly impaired immune systems) to consider taking “extra precautions to avoid crowded areas, or places where you might interact with people who are sick”.  Moreover, early evidence from the outbreak in China appears to suggest that such measures may have been effective in beginning to reduce transmission in Hubei province.

“There is currently little evidence to support the use of face masks or gloves outside of the clinical setting (e.g. treating a patient) to prevent becoming infected COVID-19.  There is also no evidence to suggest that disinfection of Smart Phones or stopping postal services or courier deliveries will contribute to reducing transmission of COVID-19, although, as with any other infection, careful cleaning frequently used, shared, or touched surfaces (e.g. door handles, desks etc.) continues to be recommended.

“What there is consistent evidence for, across multiple airborne infectious diseases, is good hygiene for coughs, colds, and sneezes (including the “Catch It, Kill It, Bin It” campaign) and regular, thorough handwashing with soap and water and/or alcohol rubs.  These are the most effective ways to protect ourselves from COVID-19 and reduce transmission.”

Prof Sir Robert Lechler PMedSci, President of the Academy of Medical Sciences, said:

“I am pleased to see the government provide such open and accessible advice, and that this guidance contains a strong emphasis on how all decisions will be informed by the best possible scientific evidence.  The action plan also recognises the essential role research will play to find out more about this virus to help stop it spreading and to treat patients in the best way.

“Clearly there is a significant public health threat if the outbreak continues to spread widely, but in laying out this action plan the government have shown that they are prepared to respond appropriately to this novel coronavirus.  I think this advice strikes a good balance by proposing action but not over reacting – thereby preventing us doing more harm to ourselves and society as a whole.

“The clear message the government is sending out is particularly important in an age of multiple media sources and 24 hour news.  Misinformation could threaten the way in which we work together to deal with this outbreak.  Accessible advice will help empower the public to take sensible measures to protect themselves, such as handwashing, and avoiding putting trust in products that make false claims.  It will also guide people to adapt their daily lives in a way that is proportionate to the extent of the outbreak at the time.

“Science plays a vital role in shaping how we prepare for outbreaks like this and the way we respond to emerging diseases.  We have the benefit of many more biomedical tools to track the spread of infections than we have ever had before.  However, for the best possible patient and public outcomes we need researchers of many different disciplines to work together across healthcare settings, academia, industry and alongside policy makers in the UK and globally.

“I would like to commend all of our Fellows and the researchers we support who are taking valuable time to share their expertise and latest research findings with health care staff, policy makers and the media.  The Academy itself will continue to work with researchers, policy makers and health experts around the world to limit the impact of this global health threat.”

Dr Toni Ho, Consultant in Infectious Diseases at the MRC-University of Glasgow Centre for Virus Research, said:

“This coronavirus is a new virus, which none of us have prior immunity to.  Therefore most of the UK population are susceptible.  It appears to be very infectious – much more so than flu – as evident by the high number of healthcare workers that have been infected globally.

“13,911 COVID-19 tests have been done in the UK, and 51 have been positive.  The Government’s proposed measures, including current and planned phased response is sensible.  At present, we are in the ‘containment’ phase, where early cases are isolated and contacts traced to prevent onward viral transmission.  These measures are aimed at slowing the spread in the UK and avoiding a surge in healthcare demand, as seen in Italy.  From published case series, around 15-20% patients require hospital admission, and around 5% need intensive care.  Those who have severe disease tend to require prolonged hospitalisation and ventilatory support, which will cause considerable strain to the NHS.  UK hospitals are currently making contingency plans for high numbers presenting to care.  Given the high rate of hospital transmission observed in China and Italy, protecting healthcare staff by ensuring a supply of personal protective equipment will be key.

“The stringent population quarantine and social distancing measures are thought to be responsible for the decline in new cases in China.  Without effective vaccines or antivirals, isolation and social distancing measures are all we have to mitigate transmission.  If containment proves ineffective, school closures, encouraging people to work from home, and limiting mass gatherings may be necessary to further limit spread.  Key focus is on the continuity of essential public services.  The mitigation phase is the worst-case scenario, which may not happen, but we should prepare for.

“We should be worried but there is no need to panic.  For the UK public, frequent handwashing, good cough and sneezing etiquette, avoid touching your face and close contact with anyone who appear unwell remains the key measures to avoid infection.  Furthermore, keep up-to-date with evolving FCO travel advice and Government advice, look after vulnerable family members and friends, and ensure you are up-to-date with vaccinations.”

Prof Paul Hunter, Professor in Medicine, UEA, said:

“Although the government action plan does not contain any great surprises it is a very valuable document summarising the possible range of actions that the government could do if needed.  What is does not do is tell us what will definitely happen over the course of the next weeks and months.  What actions will be taken will so much depend on how the global epidemic progresses.  How many cases are being identified in the UK, how quickly those cases come, whether those cases are concentrated in a few towns and cities or spread throughout the country, and what proportion of cases develop severe disease.  What we in the UK do will also depend not only on what is happening in the UK but also how the disease is spreading globally and in nearby countries.

“Whilst it is not possible to be certain about what will exactly happen, we can be fairly sure that if an epidemic does start to spread within the UK then various of the social distancing strategies discussed such as school closures, delaying big entertainment or sporting events will be implemented.  It is also likely that an epidemic will put a substantial additional pressure on the NHS partly from the increased number of sick patients but also from staff having to take time off because of their own illness or need to self-isolate.

“Although not a full part of the document, readers are directed to additional resources around the need for everyone not just health services to plan for how they will ensure the continuity of their businesses during the epidemic.

“In my opinion this is a valuable start but much remains to be learned as the outbreak progresses.  It is critical that the government keeps the public informed about its developing strategies, plans and procedures and the reasoning behind them.  It is also critical that all of us whether as individuals or leaders of businesses and other organisations think through how the epidemic could affect us and what we can do to best protect ourselves, our friends and relatives and our businesses.”

Prof Sian Griffiths, Emeritus Professor, the Chinese University of Hong Kong, said:

Are these proposed measures (both current and next steps and phased response) sensible and evidence-based?

“These measures seem proportional and are evidence based.  There is always a need to balance the socioeconomic impact of some of the measures proposed with the threat of the disease.

How will we know if and when some of the proposed measures will need to be implemented?

“Implementation will depend on the unfolding pattern of disease – and the judgement that can then be made about how to best protect the public, particularly vulnerable people.  There is no way one can have a forward plan in such circumstances and, advised by the Chief Medical Officers, senior politicians, policy makers and health authorities such as NHSE and PHE will need to make decisions based on evidence and circumstance.

What is it about the virus and how it spreads that means these things may happen or may need to happen?

“The virus is a new disease and so people have no immunity.  The disease can also be mild, and may be infectious without symptoms in the early phase, so it is spread easily through droplet spread.  This is why the hygiene messages – hand washing, correct us of tissues, avoiding touching mouth and eyes, keeping a distance from those with cold like symptoms – for the public are so important.

Is there anything we have learnt from places like China and Italy in terms of what containment measures are effective?

“The WHO report from China gives some very useful information and lessons – https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report

What are the best things for the UK public to do?

“Take advice and guidance from reputable sources as recommended in the plan published today, and reducing the impact and spread of misinformation by relying on information from trusted sources, such as that on www.nhs.uk/, www.nhsinform.scot, www.publichealth.hscni.net, https://gov.wales/coronavirus-covid-19 and www.gov.uk/

How worried should the wider UK public be about the virus?

“Keeping informed and aware whilst carrying on as normal is important – for 80% the disease will be mild and people will recover in a couple of weeks. By containing the disease as far as possible, and by delaying its impact as recommended in the plan, pressures on the NHS will be less.  There is no blueprint for the disease, but the principles of response are already tried and tested.  Keeping its risks in proportion with potential disbenefits of overreacting is important.”

Dr Gail Carson, Director of Network Development at ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium), and Consultant in Infectious Diseases, University of Oxford, said:

“The UK COVID-19 plan representing preparedness and how to respond for the whole of the UK is considered and as evidence based as it can be.  This is a new virus and the whole world is learning about it at the same time.  Thankfully there are good international coordination mechanisms and agencies in place to ensure we learn from each other.  This is not a time for pride, ego, political or other agendas.  Put aside any criticism, differences and work well together for this response.  This approach can be replicated across governments globally, across political parties, across the media and across our communities.  Thus, the plan may have to change from time to time to adapt to new information and allow for a tailored response.  As this is a new virus a large number of us might become infected but already in other countries many have recovered and the majority infected did NOT require hospitalisation.  However, in a proportion of us a period of time in hospital might be required for example because of shortness of breath due to pneumonia.  In an even smaller group, which tends to be the elderly who also have other long-term health issues, some may die.  Many of you will be worried about your children but the current information from other countries is that the illness is rare under the age of 20 years.  Also so far, there is no obvious sign that pregnant women are more likely to be seriously affected.

“Such plans can always read coldly for example, the bullet pointing does not put across well empathy for a worried population, but it does show collaboration across government and a strong and ready government response.  The plan outlines what we, as the public, can do.  Keep ourselves up to date as these outbreaks can change at short notice, get practicing your hand hygiene, educate your kids on how to cough and sneeze to prevent spread of infection and how to wash their hands thoroughly, think today what you would do as a family if one of you has to self isolate, or becomes ill.  What steps will you take to contact the appropriate services for example.  Look out for the vulnerable groups, for example the elderly.  For those who have staff, be supportive to your staff if they have to self isolate.  Please, be accepting of the advice issued by public health and the governments, it is always considered before issued.  There are some changes to legislation to allow for quarantining of infected individuals IF required.  This is not an entirely new approach and sometimes it has to be used for example multi drug resistant Tuberculosis.

“There is a global effort being coordinated by the World Health Organisation to expedite the development of treatments, vaccines and diagnostic tests.  At the moment we do not have a COVID-19 vaccine or a drug treatment but the hospitals can provide what we call supportive care and the UK hospitals are good at that.  We have super health care workers, who are dedicated to us.  There are groups such as ISARIC who I work for that is helping internationally by providing tools to researchers and clinicians to collect data to describe this disease and how it progresses in hospitalised cases.  The drug treatments and vaccines will come in due course.  Our Chinese colleagues have already completed one drug trial and are doing others.  We ought to hear results of those completed soon once the data is analysed.  If we have hospitalised cases in the UK they might be asked to take part in clinical research to create new knowledge to feed into patient care and policy.

“Many of the measures in the plan are to stop and delay the outbreak in the UK that helps the NHS and our community services to serve us well.  Therefore, all the measures that are focussed at us the community can help slow the outbreak.  A time may come when sustained community transmission from person to person occurs.  This plan outlines and reassures how our country will act to support health care and other emergency services.  We might need to hunker down together for a few weeks to see this through.  Maybe, just maybe the change in temperature and humidity as the Spring comes might help delay spread.  But we do not know at this point.  And, even if there was a seasonal affect there might still be a subsequent wave of infection and we would prepare for that too.  This plan and the actions taken behind it puts us in a strong position to tackle COVID-19.”

Prof Paul Cosford, Emeritus Medical Director, Public Health England, said:

“We all need to take a common-sense approach to helping limit the spread of novel coronavirus.  Wash your hands regularly and if you are not well with a cough or flu-like symptoms, stay at home.  As we start to see more spread in the community, there may be other things we recommend the public does, such as limiting social activity, keeping families at home if anyone has symptoms or restricting access to venues where large groups of people attend.”

Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:

“The UK government’s coronavirus action plan correctly states that “the course of the disease… cannot be predicted accurately at this point”, implying that the public heath response needs to flexible so we can adjust to changing circumstances.  The plan describes a phased response starting with containment and progressing to delay and then mitigation.

“We are currently still in the containment phase with its focus on identifying and isolating cases and preventing onward transmission.  Should the number of cases increase significantly some containment actions – such as contact tracing and mass quarantine – will no longer be feasible.  The next phase will be delay.  The plan allows for the future use of school closures, restrictions on mass gatherings and encouraging working from home, and continuing advice to self-quarantine.  These are known as ‘social distancing’ measures and are designed to reduce contact rates and slow the spread of infection.  These may well be necessary but are problematic: finding the right balance between the competing aims of minimising the potential health impact of COVID-19 while at the same time minimising the potential impact on society (and the economy) will be delicate.

“It is important that decisions on when to introduce social distancing measures and, just as importantly, when to relax them are based on sound evidence, evidence not only on the public health benefits but also on the societal costs of the measures used to tackle the disease.

“The plan recognises that in the ‘reasonable worst case’ social distancing measures may not be enough to prevent COVID-19 imposing a huge burden on the UK’s health services.  In that event, the mitigation phase involves protecting vulnerable populations and supporting health workers.

“Overall, this is a sensible and measured plan for responding to COVID-19 in the UK.”

Prof Devi Sridhar, Professor of Global Public Health, University of Edinburgh, said:

“The UK currently has under 40 confirmed cases – but as we’ve learned from China, the more time we have to prepare and the quicker we can respond to COVID-19, the more effective containment could be.  Projecting ahead the concern is that the UK could be in a similar situation not only to China but also to Japan, Hong Kong, South Korea, Italy, Iran and Germany which have all seen cases increase in a short amount of time and in some localities, health services quickly overwhelmed.  Therefore now is the time to ‘get organised, get educated, and get working’.

“The government plan sensibly lays out four steps: contain, delay, research and mitigate.  In terms of containment, it is great to see widespread awareness about hand washing but we should also remind people that the two most important symptoms are fever and dry cough (not a runny nose).  Also to alert the NHS either by phone or online if they think they have the virus.

“The UK is also in a better position than other countries because we have the NHS in the UK, unlike the U.S. where individuals are going heavily into debt by having to pay for COVID-19 testing, as well as having to pay for quarantine.  In the UK, people can access the services of the NHS for free with no worry about bankruptcy or financial obstacles.

“In addition, part of the challenge in Iran is heavy citizen distrust of what the government is saying and whether this is true.  We are fortunate to have Chris Whitty, CMO England, who is highly respected by scientists, and who was clear and honest in laying out what we know, what we don’t know, and what steps will be taken in the coming days and weeks if necessary.  He is right in that measures like closing schools and workplaces have major social and economic costs, and therefore should not be taken lightly but with full consideration of the stage of the outbreak that we are in.

“Finally, the UK is fortunate to be able to learn from other countries and to have had several weeks to learn from other responses unlike the Chinese government which had transmission of the virus in Wuhan before the novel coronavirus was even identified.”

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

“As the plan states, the current outbreak falls completely with the planning parameters for pandemic preparedness in the UK – a case fatality rate of less than 2% – and so in emergency planning terms, this is a scale that has been anticipated in planning assumptions, planned for and exercised extensively.  The plans that have been in place for years have been ‘dusted off’ in living memory – for the 2009 Swine Flu pandemic – and emergency planners have had two months now since the initial cases to consider the existing plans and to begin to think about how they should be implemented.  This confirms this.

“This means that this is not a ‘new’ plan – it is the existing plan reoriented from influenza to coronavirus, which will require minimal readjustment as the characteristics of both illnesses are very similar – and means that additional agencies that will provide ‘surge capacity’ to a stretched healthcare sector, such as volunteer agencies, the military, should be familiar with what will be required of them, and infrastructure such as supermarkets, utilities, schools etc. should also have existing contingency plans they have already drawn up, practised and considered.

“In short, no-one should be starting from scratch with this plan, they should be using it to refine their own existing ones.”

Professor Tom Solomon, Director, NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, said:

“This Government’s Action Plan look like a series of sensible measures, which will be implemented in a stepwise manner.

“We have seen from northern Italy how countries in Europe can be affected if control measures are not implemented promptly.  It is almost certain that the number of cases in the UK will continue to grow.  The key priority is to slow this growth as much as possible.  Even if large numbers of people will be affected overall, the NHS can cope much better if this is number is spread out over many months, rather than over a few weeks.”

https://www.gov.uk/government/publications/coronavirus-action-plan

All our previous output on this subject can be seen at this weblink:

http://www.sciencemediacentre.org/tag/covid-19

The SMC also produced a Factsheet on COVID-19 which is available here:

https://www.sciencemediacentre.org/smc-novel-coronavirus-factsheet/

Declared interests

None received.