As the rate of infection begins to slow and the number of vaccines delivered hits another milestone, the political clamour for the government to announce the date on which the current lockdown restrictions in England will be lifted grows louder.
But in reality, the government’s focus shouldn’t be on dates, but remain steadfastly on saving lives and preventing the NHS from being dangerously overwhelmed. Have we forgotten that just a few weeks ago we passed the dreadful mark of 100,000 deaths, the highest mortality rate in Europe?
While infections may be falling, they are doing so from dizzying and horrifying heights. And this decline masks the fact that the NHS remains in a precarious situation. Yesterday there were 20,000 patients in hospital with covid-19, and 2,700 fighting for their lives on ventilators—twenty times the level just six months ago.
The NHS is additionally facing its largest ever backlog of care, with over 200,000 patients waiting over 12 months for operations, millions yet to be seen in clinics, and even delays for life-threatening cancer care. Its workforce has been stretched like never before with staff exhausted and many burnt out. Put simply, our health service is unlikely to cope nor have the resilience to deal with another covid surge.
Which is why, on Monday when Boris Johnson sets out his roadmap for easing current restrictions in England, it’s vital that he doesn’t simply set an arbitrary date for the end of lockdown. To do so would risk a rebound in infection rates exactly as we saw last summer.
The current restrictions should be eased only when infection rates have been brought down enough to assure us that this really will be our last lockdown, with experts including former Health Secretary and current Health Select Committee chair Jeremy Hunt, NHS Providers chief Chris Hopson, and Wellcome Trust director Jeremy Farrar placing this threshold at roughly 1,000 cases a day.
A sufficiently low infection rate is crucial to allow the Test, Trace and Isolate system, with the support of public health teams, to effectively identify and contain any further localised outbreaks. Low infection rates will also help to ensure the effectiveness of current vaccines by minimising unnecessary exposure and reducing the risk that more mutant strains will emerge.
Lower infection rates will not only reduce hospital pressures, but will also mitigate against the longer term consequences of the pandemic on society itself. Long covid and enduring organ damage could mean high levels of long term illness and disability within the younger and working UK population, and it’s clear that the mental health impact will be long lasting with consequences for individual patients, the economy, and the NHS.
All this amounts to the NHS facing a challenge the scale of which has not been seen in recent memory—perhaps since the service itself was founded. Preventing further waves of infection will also allow for a sustainable economic recovery, without the risk of more disruptive and financially ruinous national or local lockdowns.
Boris Johnson must be crystal clear that the easing of lockdown won’t represent the end of our national response to the pandemic, even if it will mean that we have turned a crucial corner and are truly on the road back to life as we once knew it.
The government must learn from past errors of judgement which resulted in a rebound spread of infection—from encouraging people to “eat out to help out” and to go back to work to relaxing the rules over Christmas and its incoherent border quarantine plan—all of which the BMA spoke out against at the time.
That means ensuring rigorous infection control in public places through continued social distancing and the wearing of facemasks; specifications for covid-secure public settings (including with regard to ventilation); a plan to minimise spread in schools which is acceptable to both teachers and parents; and introducing further financial and practical support to enable self-isolation, particularly for those on low incomes, in insecure employment, or who have been advised to shield.
Taking steps to ease lockdown must go hand-in-hand with continued progress in vaccinating the nation, but even the speediest possible rollout won’t be enough to prevent further waves of infection if restrictions are removed while incidence remains high. Only once we have data on the vaccination programme’s full impact—including on curbing transmission—will we be able to make informed judgements about the level of risk posed by easing specific restrictions.
The BMA today publishes a new paper setting out the principles and policy ideas which we believe should inform a sensible and safety-first approach to easing the current lockdown.
It is abundantly clear—scientifically and morally—that taking a cautious approach to easing restrictions will benefit not just our physical and mental health, but also the social and economic life of our country.
We have all come too far, and all sacrificed too much, to lose our heads and rush into hasty decisions at this pivotal moment. For the sake of our nation’s health and wellbeing, we must proceed from this point with clear sightedness, caution, and resolve.
Chaand Nagpaul, BMA council chair.
Competing interests: none declared.