Avoiding another lockdown will require not just a roadmap, but a very effective early warning system, writes Maggie Rae

With covid-19 infection rates falling across the UK and our vaccination programme making good progress, the public will be pleased to see an apparent route out of the current restrictions with the government’s announcement of a new “roadmap” out of lockdown.

In the past weeks lockdown has helped us to make progress in tackling the spread of covid-19, which has, crucially, been accompanied by a reduction in the number of people with serious illness. Yet we must remain vigilant in tackling the immediate threat of the pandemic and recognise that there are still major unresolved challenges.

We have seen already that if local and regional public health teams do not have the tools available to tackle outbreaks, the virus can take off at an alarming rate and spread beyond control. This is especially true as we now see new, more virulent mutations of the virus emerging—a trend that is likely to continue.

For the government’s roadmap to succeed, and for recent progress in tackling the pandemic to continue, we need to fix the problems that we have with infection data to ensure that we can accurately monitor the spread of covid-19.

It is worrying  to see how the results of Imperial College London’s REACT study and the Office for National Statistic’s infection survey still do not tally with the data we have coming out of Test and Trace. To enable public health teams to take effective action to prevent infection rates rising, we need to fix these problems. Public health teams need fast access to accurate, granular data—as opposed to the delayed access to inaccurate data that they currently receive—so that they can quickly spot where localised outbreaks are taking place and mount an appropriate response.

Test and Trace can only provide infection data on those who come forward to be tested and can only trace the contacts of those who usefully co-operate with contact tracing teams. We know that many people are avoiding coming forward for testing due to the insufficient provision of economic support if they are required to isolate as a result of their test—inequalities compacting upon inequalities.

Moreover, we know that public health teams are facing problems in accessing the data that are being generated by Test and Trace, with systems that are technically insufficient and information that is too slow in filtering through.

Roadmap or not, to be successful in tackling the pandemic, public health teams need better data. Early warning systems will help alert teams to spikes in infection rates before they rise out of control, as well as helping to identify new mutations of the virus.

To this end, it’s important to have effective early warning systems about rises in infection rates. Wastewater analysis (already used globally for poliovirus surveillance) could be an approach that provides more comprehensive and less biased data on the population being sampled. Use of these data could prove an effective tool in quickly monitoring infection rates, alongside other surveillance and monitoring data. It will be important in the coming months to continue to identify new strains of the virus, helping teams quickly understand how transmission is occurring and which strains are becoming dominant.

The public and health professionals across the country have worked together relentlessly to tackle the spread of covid-19, and our combined efforts are now leading us to a place where we can see a way out of the restrictions we have faced for so long. We must remember that at the foundation of our exit from lockdown must be timely and reliable data, without which we cannot hope to return to “life as normal” as the government hopes.

Avoiding a fourth lockdown will require not just a roadmap, but a very effective early warning system about rises in infection rates and, most crucially, timely action from the government in response to keep the virus under control.

Throughout this pandemic, government action has been slow and the virus has run ahead, leaving the government scrambling to catch up. Experience has shown us how this virus can take off “like a rocket.” If we want to prevent these spikes and avoid a further lockdown, we need to start acting quickly and decisively, based on active monitoring of good quality data.

Maggie Rae is the president of the UK Faculty of Public Health.  

Competing interests: None declared