Yo-yoing in and out of lockdown has harmed health and livelihoods. In 2021, we need to do something different, says Professor Susan Michie (UCL Psychology & Languages Sciences).
As the UK has yo-yoed in and out of multiple lockdowns, restrictions have harmed people’s livelihoods, businesses, mental and physical health, and their quality of life. In the first and second lockdowns, these restrictions proved insufficient to permanently drive down the prevalence of Covid-19. This time, we have been promised that all adults will have received their first vaccine dose by July - but its level of effectiveness, coupled with the potential emergence of new strains of the virus, means the vaccine rollout will not be a complete solution to the pandemic.
Roadmaps for easing restrictions across the devolved nations - with England’s due to be published on Monday - should be focused on avoiding the mistakes of the past 12 months. The UK must learn from what has worked in other countries that are now successfully returning to everyday life, such as Australia, New Zealand, China, South Korea, Singapore, Vietnam and Finland. They locked down early and hard, driving down transmission until it reached a level that could be managed by an effective system of test, trace and supported isolation.
Just because the UK hasn’t followed this strategy previously, doesn’t mean it can’t start now. We shouldn’t throw away the gains of the past few weeks, achieved through considerable hardship and sacrifice, by lifting restrictions before we can keep the virus in check. Opening up too early risks overwhelming the NHS, increasing the likelihood of new variants emerging that could evade vaccines, and creating a backlog of non-Covid conditions that must be treated.
The plans should focus on three things: maintaining short-term lockdown measures until infection rates are brought down to a manageable level; lifting restrictions according to the data available, rather than according to the date; and enforcing long-term measures that will be necessary to keep Covid-19 under control in the future. The overarching aim should be maintaining minimal cases of Covid-19 (a level of about 10 new cases per 100,000 people a week, for example, might be judged low enough).
In the short term, we face a trade-off. The longer the government keeps current restrictions in place, the faster we will drive down case numbers and be able to lift restrictions. There is still much room for improvement in the current lockdown. According to polling by the Trades Union Congress, one in five employees are going into workplaces unnecessarily when they could be working from home. We still do not have a well-functioning test, trace and supported isolation system, and many of those who must self-isolate are offered no financial or practical assistance. Our borders are leaky: although those arriving from countries on a "red list" must quarantine in a managed hotel for 10 days, people are still arriving from countries where variants are unknown.
The question of when to lift restrictions isn’t just about what the science says. It involves value judgments about what kind of society we want to live in, who should influence decision-making and what areas we want to prioritise. The decision should therefore be based on both scientific advice and public engagement, and restrictions should be lifted at a pace to allow continual review and adjustment if needed. The consensus is that schools should be one of the first settings to have restrictions eased, but recent modelling suggests this will need to be done very carefully if the R value is not to be increased.
One way of doing this would be repurposing unused spaces to create "Nightingale" schools where children are able to learn in a safe and socially distant way, reducing crowding in existing classrooms, and calling on former teachers who have left the profession to help. In addition, we could use blended learning, combining classroom and at-home education to reduce the amount of social mixing in schools. This would require ensuring that everyone has internet connectivity and laptops or tablets.
The UK will need the capacity to undertake widespread testing, assimilated into a functioning test, trace and isolate system. This system should be based in local public health organisations and primary care, and coordinated by the NHS - which has had huge success in organising the vaccination programme. Doing this will mean diverting resources away from failed commercial contracts and towards local authorities and those with the expertise and trust to deliver a comprehensive system.
Meanwhile, as the vaccination programme is extended to the entire population, regular boosters will be needed to fight new variants, and skilled engagement with groups of people who may be hesitant about receiving the jab will be required.
In the longer term, we should establish "green zones" - areas where the virus has been judged to be under control, where there is no danger of infection and thus no need for restrictions. We’ll need a new system for accrediting Covid-safe environments, from workplaces to schools, shops, hospitality and transport, as we do with hygiene ratings for restaurants. This will require robust guidance, support, regulations and inspections to ensure that all public spaces meet agreed safety standards, with publicly displayed certificates and a hotline for reporting breaches.
Finally, as the UK slowly recovers from Covid-19, one of politicians’ chief priorities should be to address the inequalities that helped the virus to spread. During the pandemic, people in precarious and low-paid jobs, those in deprived communities, people from minority-ethnic backgrounds women and people in poor housing have suffered disproportionately. Fixing this is possible - but as with driving down Covid-19, it requires political will.
This article was originally published in The Guardian on 21 February 2021.