- They are having difficulty keeping COVID-19 out of the country, because of:
- People arriving from abroad, for which they have a much stricter immigration policy than the UK, with dedicated isolation quarantine centres
- Possibly import of food (and its packaging) into cold storage facilities, where there have been infections
- People are already dying, as a second phase of infection takes hold, albeit at far lower rates than around Europe
- The measures needed to completely eliminate COVID-19 are very painful, and arguably unsustainable
It struck me at the time that whilst the objectives were laudable, this proposal was unrealistic. It would require restrictions that would be far too stringent for the long-term (unless and until there was an effective vaccine), and far more difficult for the British Isles in being geographically close to Europe.
That was before New Zealand's recent experience, which underlines the difficulty and answers the question the Independent SAGE group posed.
Here are four opinions expressed that say what I was thinking, plus more. I have underlined the key points:
Expert reaction to the Independent SAGE Report 7 on elimination of the virus from the UK
The Independent SAGE group have published their 7th report, this time into the elimination of the COVID virus from the UK
Dr Kathleen O’Reilly, Assistant Professor in Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, said:
“To propose the objective of achieving elimination of
COVID-19 in the UK at this stage is bold. The report provides ‘planks’
for the suggested strategy, which refer to the tools that Independent
SAGE suggests the UK could
use to achieve elimination. These include:
- testing more and acting on the test,
- restricting movements until infections are fully controlled,
- a strategy to deal with new cases,
- restricting international travellers,
- and having a [better] public health messaging campaign.
“Elimination of infectious diseases is hard. The UK has
eliminated polio, and measles in 2017. Both were achieved using case
surveillance and an effective vaccine. It would be very difficult to
achieve elimination without both these tools, and public support and
trust in vaccines is essential.
As a country we are barely 6 months into
experiencing COVID-19, vaccines are being trialled but the safety and
efficacy of the vaccines still need to be assessed. It is still too
early in this pandemic to know whether the UK could eliminate the virus.
“To provide advice to the Government that elimination
should be the goal is commendable. However, the Government also needs
sound advice on whether elimination is feasible, and what the
disadvantages might be.
For example, it seems that New Zealand may be
close to achieving elimination of COVID-19, but this was at the cost of
extreme traveller restrictions, damaging the tourism industry.
Consequently, the “New Zealand approach” may not be palatable for many
in the UK. Something in the middle might be a more sensible strategy,
but the risks and benefits have not been fully assessed.”
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“The report and plan put forward by independent SAGE represents a clear way forward for UK, and in particular England, to escape from the present limbo in which we find ourselves. The tail of our ongoing epidemic is considerable, and will cause unnecessary, preventable suffering and death over the coming months.
“Whilst economic considerations are clearly behind the ongoing relaxation of lockdown measures, the prospect of protracted lockdown cycles will represent far greater cost. Several examples of countries around the world show us that elimination is a viable strategy for controlling SARS-COV2, and Scotland appears to be on a similar path. Whilst we have endured a dreadful outbreak and the path back to normality will be proportionately challenging, ultimately we are an island [but see below] and control of this disease should be achievable as a result. I sincerely hope that the Government will listen to this advice and allow itself to be led by science once again.
“Of particular relevance, upon appropriate reduction of prevalence by lockdown/distancing, it will be essential for testing and contact tracing to be robust and reliable, alongside appropriate quarantine measures designed to minimise imported cases. In this regard, the notion of limiting transport across the Scottish and Northern Irish borders feels appropriate.”
Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:
“Reducing the number of cases to as low as possible should be the aim. Elimination has distinct advantages but it does not meant that the problem is solved.
“If COVID-19 is eliminated from England/Scotland/Wales or Northern Ireland/Republic of Ireland the big challenge is maintaining this COVID-19 free status. Both China and New Zealand that achieved best of all during the pandemic have key features that help but cases still keep getting diagnosed.
China enforces a strict supervised quarantine with state control not possible in the UK and New Zealand has fewer international travellers than most western countries for their population size and these are being quarantined. For the UK our proximity to Europe and dependence on lorries for food means that we are NOT an island. We cannot quarantine every truck driver and if we don’t we risk re-introduction unless Europe is also COVID-19 free and then the question is which bit of Europe is treated as a single COVID-19 free area.
“The document claims that the national test track and trace has failed but the biggest failure so far is that 25% of cases who have arranged a test do NOT answer the phone. This simply won’t be sorted by a local system ringing the cases as those not answering will not answer the local people either.
“Each country is different and also there are large differences within countries. What is right in one part of a country may well not be right in another part of the same country.
“The lower number of deaths in the Republic of Ireland has been assisted by a population with a lower average age.
“The report claims that Australia is a success but the population of Melbourne, Victoria where a lockdown has been re-imposed might well disagree.
“Having a 12 month plan seems particularly odd as the plan should be to drive infection down as quickly as possible. So much of the science and knowledge is changing almost daily at times so the plan could be outdated before it was published. We know a lot more, and different things, since at the start of the pandemic.”
Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:
“The Independent SAGE report proposes a strategy of COVID-19 “elimination” from the British Isles. Elimination means zero cases. This is a worthy but extremely ambitious aim; neither China nor South Korea has yet achieved elimination, and they were the first countries to bring their COVID-19 epidemics under control.
To achieve elimination for the UK and Ireland within a reasonable time frame would presumably require a contact tracing system as good as South Korea’s and a lockdown as strict as China’s. The former is already UK government policy but the latter is not; every country in the British Isles is currently attempting to relax lockdown as quickly and as safely as possible.
“Given the enormous challenge of achieving elimination the key questions are ‘how long would elimination take?’ and ‘how much additional damage would be done by extending the lockdown for that period?’. Before an elimination strategy is attempted it would be sensible to have answers to those questions. The Independent SAGE report does not provide them.
“The long term vision of the elimination strategy is equally unclear. There is no prospect of eradicating COVID-19 from the whole world in the foreseeable future. Even with a highly effective vaccine, this would be a huge challenge. So we may arrive at a position where regions of the world (small or large) have achieved elimination or something close to it, but the remainder have not. That dichotomy could only be sustained through extremely rigorous travel restrictions and quarantine regulations.
“We need to think very carefully before embracing any COVID-19 response strategy that could result in more long term damage than can be justified by the public health gain. This is the case for any strategy to respond to this pandemic. The worrying truth is that, as of now, none of the available options are the least bit attractive. For all that we have been through in the past few months, the full impact of the COVID-19 pandemic is still to be felt.”
IN CONCLUSION
On balance, the feedback from these four epidemiology professionals concludes that a strict elimination strategy, as being applied in New Zealand, is not a realistic long-term approach. That's unless and until an effective vaccine is available. It is certainly not appropriate for the UK yet. It's refreshing to see at least some academics applying real-world practical considerations, rather than just theory.
Yet there are laudable aims in Independent SAGE's proposal. Elimination would best reduce deaths and LongCOVID, let life get back to 'normal', and let the economy recover strongly.
But can we get near to elimination, before there’s a vaccine, without the side-effects of the restrictions like those adopted in New Zealand? Getting a better balance between the competing objectives of health, well-being and the economy? The latter is important for a whole host of reasons, not least that a strong economy leads on balance to better health and well-being.
Indeed Dr Griffin points out that the "prospect of protracted lockdown cycles will represent far greater cost" than running very low levels of infection around the country. The question is whether the investment needed to get to very low levels, such as by closing schools and sections of the economy again, would be sufficiently small to justify the financial and social costs of the measures needed to do it. That needs careful consideration.
But I believe that we can't carry on as we are, with regional semi-lockdowns springing up regularly and hordes of school children across the country being sent home.
Dr O'Reilly says "Something in the middle might be a more sensible strategy." That has to be right.
The answer in principle is #NearZero. We need to find a way of living with the presence of the virus in the world and in the UK, much like we live with the killer that is 'flu. But without the restrictions that are not working suitably in New Zealand. These would be the benefits:
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