This site is intended for health professionals only


The UK has failed the first phase – we need to get the next phases right



In the last week, I have spoken to dozens of medic friends who were almost unanimously opposed to lifting the lockdown. All agree that the Government needs to focus on limiting the spread of Covid-19 among health and social care workers, and reassure them, as an absolute priority. To date, over 180 NHS staff are understood to have died.

The UK started its lockdown late, when even just a week earlier would have saved an estimated several thousand lives across the course of the pandemic. To avoid even more needless deaths, the Government now needs to look beyond short-term gains and produce a comprehensive strategy for the long haul.

The present lockdown is set to be lifted in part later this week. But if we come out of lockdown without proper considerations, it will be the jobless, elderly and vulnerable who will be left behind.

Current data indicate that the national lockdown is slowing down the transmission and most scientists agree that the real-time effective reproductive number – the so-called ‘R’, which shows how many people a Covid-19 sufferer can infect on average – has declined, indicating a flattening of the curve of the spread of the epidemic.

But is flattening the curve the right metric to measure the success of the UK’s coronavirus strategy? After all, merely flattening the curve will simply mean allowing huge numbers of people to die over a longer period.

The benefits of the lockdown, which were gained at huge economic and social cost, could easily be lost if the Government gets it wrong. Reopening without triggering a new acceleration depends on our ability to transition from population-wide mitigation – which is what social distancing does – to individual-level containment.

Mass testing will provide the reassurance that many need to resume normal activities

 And that means that ending the lockdown must be linked to an ability to conduct the World Health Organisation’s test-and-trace plan on a massive scale – allowing each infected individual to be quickly identified and their contacts rapidly traced, tested and where necessary isolated, breaking the chains of transmission and starting to containthe virus, not merely mitigate its spread.

In addition, one of the Government’s conditions for re-opening the country is a downward trend in infections. But we can’t know that the numbers are going down unless we have an accurate daily count, which can only be obtained through widespread testing.

Mass testing will also provide the reassurance that many need to resume normal activities. Having enough tests to regularly check employees, students and teachers would help provide confidence that we can resume work and school. It will also help in healthcare settings – we can separate Covid-19 positive patients from those with negative tests, and patients would not be so frightened to seek care for ongoing medical reasons such as cancer, pregnancy or heart disease. It will aso help us optimise the use of PPE that is in such short supply.

But we are very, very far from being in a position to take this essential step. Matt Hancock said last week that we have too many cases for test-and-trace to be realistic – a damning indictment of the Government’s performance and strategy so far – but we have to start from where we are, not where we should be. There is no other route out that will not cost huge numbers of lives.

In addition, the Government’s long-standing failure to provide enough PPE to health staff not only inspires no confidence in Government assurances that a test-and-trace scheme will be ready when the UK reviews its lock-down next month, but also leaves huge holes in the lockdown’s effects, allowing the virus to continue spreading more than it should.

Currently, the UK Government has no capacity, no credible strategy and neither the ability nor the willingness to implement the watertight ‘test, trace and isolate’ plan that is vital for a successfully-concluded lockdown.

Sadly, the Government has instead adopted a stop-gap strategy in place of a sustainable, robust public health strategy and this will cost us in the long run. It has already cost us.

The past two months were an opening gambit. Now the UK needs to handle the middle- and end-game well. The delays so far have made this task far larger than it needed to be.

But there is no alternative. Any attempt to lift the lockdown without such a system ready to go is doomed to failure – a failure that will kill people, will kill NHS workers. The responsibility for those deaths, like many of the lives already lost, will be at Government’s door.

Dr Kailash Chand OBE is a retired GP in Tameside