Okay, it was almost unanimous! You want more on Covid-19… Oh well clearly no one listened to my plea for “no more”. So you asked for it and here it is, more on Covid-19…grrrrrrr….
Has anyone noticed we are not all in a spiral of panic and the country has not gone into national lockdown, even though the numbers should be alarming us!? Why?! What numbers are alarming?! Well the media likes death rates, and these are doing really well in comparison to earlier in the year. The healthcare system is now understanding the disease and treating the disease far better than when it was an “unknown” entity and I think we should all pat ourselves on the back for that. We are saving more people and a low death rate makes us feel less alarmed (graph below).
Click for larger image
However, cases are another picture entirely. The graph (below) shows the number of cases diagnosed everyday in the UK with a trend line. It is very clear that we are having many, many more cases of Covid-19 everyday now than when we were during the “really bad” phase earlier in the year. OK so this might be because we are now testing lots more people, which is true we are doing more tests (even on those without symptoms which may just give us a lot of false positives!), but let’s look past that for now, the graph still shows 4x more cases everyday now (20,000) than we had before (5,000) when there was mass-media hysteria and national lockdown. How and why has this happened? What went wrong as we came out of lockdown?
Click for larger image
Well, in order to understand the problems, it is worth looking in more detail at how we got into lockdown in the first place.
Getting into lockdown
Back in February of this year health professionals around the World were looking at what was happening in China, Italy and Spain with thousands of cases of a new virus which was overwhelming their healthcare facilities. Finally, we all woke up and realised that if we didn’t do something, we would be next.
So back on the 2nd February Public Health England (as they were then!) started a public health campaign to inform the public about the virus. Diagnostic testing was rolled out on the 7th February and new surveillance systems were launched on the 26th February. On the 12th March people who tested positive were told to isolate themselves at home for 7 days.
By the 16th March anyone who came into contact with an infected person or who felt unwell was told to self-isolate at home for 14 days. We were told to avoid unnecessary travel, pubs, clubs and gyms and not to take part in mass gatherings. The Foreign Office stopped us doing non-essential foreign travel (that’s when all our holidays got cancelled!) and schools were closed on the 20th March along with entertainment, hospitality and leisure facilities (…so that’s where all the fun went?!)
We eventually entered lockdown on the 23rd March 2020.
As we entered lockdown we were seeing about 900-1,000 new cases of Covid-19 a day, but numbers were increasing rapidly. Over the next nearly 7 weeks cases increased to about 4,000-6,000 cases per day, plateaued around the second week of April and then started to fall during the second week of May. Everyone sighed with relief as we all started to peek out our front doors again and the Government started to look at bringing us all out of lockdown.
Coming out of lockdown – timing is everything
I have blogged about coming out of lockdown before back in April; part 1 and part 2. I proposed then that we should come out of lockdown in stages similar to what the Government has done, BUT there was one overwhelming caveat that I made and that was “we needed to take our time and monitor the results”. In fact, I made it clear we needed to wait 4 weeks after each decision in order to see what effect it had.
So, what did the Government do? Did they leave 4 weeks between changes… no they didn’t… but no one listens to me, that’s why we are all reading another Covid-19 blog!
Looking at the timeline above showing the cases of Covid-19 in the UK; we didn’t really see an impact of the lockdown until the second week of April when the number of cases started to stabilise (3 weeks into lockdown). Whilst the number of new cases stabilised in April the number of new cases didn’t actually reduce until the first week of May (6 weeks into lockdown). Note: odd spikes may indicate Easter 10-13th April and May bank holiday 8th May. The data confirms that the effects of any changes made in how we managed Covid-19 were not be seen for at least 4 weeks, and in fact 6 weeks probably gives a more accurate timeline for case numbers to be seen to reduce.
So what were the consequences? Read on to see what the effect was…
Easing lockdown the UK way
I have been through the UK guidance on easing lockdown using this website and I’ve added these measures to the case number timeline below.
Getting into lockdown
Back in February of this year health professionals around the World were looking at what was happening in China, Italy and Spain with thousands of cases of a new virus which was overwhelming their healthcare facilities. Finally, we all woke up and realised that if we didn’t do something, we would be next.
So back on the 2nd February Public Health England (as they were then!) started a public health campaign to inform the public about the virus. Diagnostic testing was rolled out on the 7th February and new surveillance systems were launched on the 26th February. On the 12th March people who tested positive were told to isolate themselves at home for 7 days.
By the 16th March anyone who came into contact with an infected person or who felt unwell was told to self-isolate at home for 14 days. We were told to avoid unnecessary travel, pubs, clubs and gyms and not to take part in mass gatherings. The Foreign Office stopped us doing non-essential foreign travel (that’s when all our holidays got cancelled!) and schools were closed on the 20th March along with entertainment, hospitality and leisure facilities (…so that’s where all the fun went?!)
We eventually entered lockdown on the 23rd March 2020.
As we entered lockdown we were seeing about 900-1,000 new cases of Covid-19 a day, but numbers were increasing rapidly. Over the next nearly 7 weeks cases increased to about 4,000-6,000 cases per day, plateaued around the second week of April and then started to fall during the second week of May. Everyone sighed with relief as we all started to peek out our front doors again and the Government started to look at bringing us all out of lockdown.
Coming out of lockdown – timing is everything
I have blogged about coming out of lockdown before back in April; part 1 and part 2. I proposed then that we should come out of lockdown in stages similar to what the Government has done, BUT there was one overwhelming caveat that I made and that was “we needed to take our time and monitor the results”. In fact, I made it clear we needed to wait 4 weeks after each decision in order to see what effect it had.
So, what did the Government do? Did they leave 4 weeks between changes… no they didn’t… but no one listens to me, that’s why we are all reading another Covid-19 blog!
Looking at the timeline above showing the cases of Covid-19 in the UK; we didn’t really see an impact of the lockdown until the second week of April when the number of cases started to stabilise (3 weeks into lockdown). Whilst the number of new cases stabilised in April the number of new cases didn’t actually reduce until the first week of May (6 weeks into lockdown). Note: odd spikes may indicate Easter 10-13th April and May bank holiday 8th May. The data confirms that the effects of any changes made in how we managed Covid-19 were not be seen for at least 4 weeks, and in fact 6 weeks probably gives a more accurate timeline for case numbers to be seen to reduce.
So what were the consequences? Read on to see what the effect was…
Easing lockdown the UK way
I have been through the UK guidance on easing lockdown using this website and I’ve added these measures to the case number timeline below.
Click for larger image
In summary there were 6 key changes:
So on average we eased lockdown precautions every 2-3 weeks; this in my opinion was too fast and there was a lack of monitoring of the changes. The fact we did not systematically ease restrictions and stick to one type of re-opening at a time but rather added together various variables e.g. international travel and tattoo parlours, or schools back and all shops reopen etc. all adds to the problem of determining what easing measure caused the increased transmission. We now do not know what we can get away with opening next time we come out of lockdown and what the “risk factors” for causing transmission are.
What has happened since we started easing lockdown?
So initially it all looked good. Cases of Covid-19 continued to decrease over June and July down to about 400-500 cases per day… but then they stopped going down. By the second week of August cases were back up to 1,000 cases per day and they haven’t slowed down since, and now we are up at over 20,000 cases a day!
So, let’s stop a moment and see why cases might have gone up again.
Everyone is looking at the rising cases and concentrating on what are we doing NOW, but that’s the wrong approach. The correct question is “what were we doing 4-6 weeks before the case numbers started going up?” So, we have to go back to the beginning of July to look for the decisions that might have caused cases to go up in the second week of August. Or mid-September, to see what might have caused cases to go up now.
The main decision made at the beginning of July was to reopen restaurants, pubs, cafes, holiday accommodation, tourist attractions, places of worship and weddings (with 30 guests) plus 2 households were allow to mix irrespective of numbers. “Gosh that was quite some ‘uncontrolled’ easing, Boris!” It is reasonable to assume that one or all of these “new freedoms” resulted in cases going up. As for mid-September affecting the “now”, well schools and universities returning are the most obvious activities at this time of year. The rule of 6 came into force on 10th September, on the 18th September Health Secretary Matt Hancock notes the “concerning rise in Covid-19” followed by 29th September remark “if everybody follows the rules we can avoid further national lockdowns”. SAGE advised the Government to commit to a short “circuit break” lockdown on the 21st September.
Since then we have just continued to relax the lockdown decisions and increase the ability of people to mix and therefore the virus to spread. Oops! Looks like we all misbehaved :-) and unsurprisingly then case numbers have steadily climbed, and we are now in the position of having many more cases than we had before. In fact if you “copy” the case number graph from the beginning of the outbreak in March (before or around lockdown) and superimpose it onto the rise in cases from the 1st September it’s an almost identical match… perhaps the huge rise we are seeing now is what we would have seen back in April and May if we hadn’t actually gone into full lockdown, aborting the original outbreak. It’s a sobering thought and perhaps justifies the harsh decisions made at that time… and the SAGE advice given to the Government in September!?
- 13th May (7 weeks into lockdown) - allowed to travel to work if you must, avoid public transport, consider wearing face coverings in enclosed spaces, outside contact with one other person not from your own home and maintain social distancing
- 1st June – (19 days later) go to work if open, shops can start to reopen, schools years 1 and 6 as well as 0-5 year olds can return, allowed to mix outdoors with 6 people from different households as long as socially distance, those shielding can start to go outdoors and maintain social distancing
- 15th June (14 days later) facemasks made mandatory on public transport and in the NHS, all shops can reopen, secondary schools return and maintain social distancing
- 4th July (19 days later) Restaurants, pubs, cafes can open, tourist accommodation and attractions open, places of worship and weddings (with 30 guests) can take place, 2 households now allowed to mix irrespective of numbers and maintain social distancing
- 10th July to 13th July (6 to 9 days later) international travel corridors introduced, outdoor performing arts restart, beauty salons, nail bars, tattoo parlours, massage facilities and spas reopen
- 24th July (11 days later) gyms, pools and leisure centres reopen and facemasks were made mandatory in shops
So on average we eased lockdown precautions every 2-3 weeks; this in my opinion was too fast and there was a lack of monitoring of the changes. The fact we did not systematically ease restrictions and stick to one type of re-opening at a time but rather added together various variables e.g. international travel and tattoo parlours, or schools back and all shops reopen etc. all adds to the problem of determining what easing measure caused the increased transmission. We now do not know what we can get away with opening next time we come out of lockdown and what the “risk factors” for causing transmission are.
What has happened since we started easing lockdown?
So initially it all looked good. Cases of Covid-19 continued to decrease over June and July down to about 400-500 cases per day… but then they stopped going down. By the second week of August cases were back up to 1,000 cases per day and they haven’t slowed down since, and now we are up at over 20,000 cases a day!
So, let’s stop a moment and see why cases might have gone up again.
Everyone is looking at the rising cases and concentrating on what are we doing NOW, but that’s the wrong approach. The correct question is “what were we doing 4-6 weeks before the case numbers started going up?” So, we have to go back to the beginning of July to look for the decisions that might have caused cases to go up in the second week of August. Or mid-September, to see what might have caused cases to go up now.
The main decision made at the beginning of July was to reopen restaurants, pubs, cafes, holiday accommodation, tourist attractions, places of worship and weddings (with 30 guests) plus 2 households were allow to mix irrespective of numbers. “Gosh that was quite some ‘uncontrolled’ easing, Boris!” It is reasonable to assume that one or all of these “new freedoms” resulted in cases going up. As for mid-September affecting the “now”, well schools and universities returning are the most obvious activities at this time of year. The rule of 6 came into force on 10th September, on the 18th September Health Secretary Matt Hancock notes the “concerning rise in Covid-19” followed by 29th September remark “if everybody follows the rules we can avoid further national lockdowns”. SAGE advised the Government to commit to a short “circuit break” lockdown on the 21st September.
Since then we have just continued to relax the lockdown decisions and increase the ability of people to mix and therefore the virus to spread. Oops! Looks like we all misbehaved :-) and unsurprisingly then case numbers have steadily climbed, and we are now in the position of having many more cases than we had before. In fact if you “copy” the case number graph from the beginning of the outbreak in March (before or around lockdown) and superimpose it onto the rise in cases from the 1st September it’s an almost identical match… perhaps the huge rise we are seeing now is what we would have seen back in April and May if we hadn’t actually gone into full lockdown, aborting the original outbreak. It’s a sobering thought and perhaps justifies the harsh decisions made at that time… and the SAGE advice given to the Government in September!?
Click for larger image
What would I have done differently?
OK so hindsight is 100% accurate but at the risk of repeating myself many times I would have done things much slower. I would also have been willing to stop and take a backward step along the easing pathway, perhaps restricting the bars and clubs etc. much sooner than has been done. I do wonder if the reason we didn’t step back sooner was more of a political decision than a public health decision but I’m just a Clinical Microbiologist and not part of Government decision making….
If we had been more careful in monitoring, we should and could have been willing to undo decisions if they were shown to be too early. But it doesn’t seem we were actually monitoring any easing decisions! In fact it felt that every other day there was another set of easing rules, which left many of us, including myself, muddled, confused and totally fed up. The result…more people just gave up trying to conform as they didn’t know whether they were coming or going.
Spare a thought for those living on or close to a devolved border, who have all sorts of added complications and differences to contend with. For example, in the town of Llanymynech the Wales/England National border is the main road; on the English side there are two pubs and a fish and chip shop which can open as normal but not to Welsh residents, whereas on the Welsh side there is the post office and a shop, which are open only for essential items and off limits to the English who face a travel ban into Wales! Crazy!
I pity the Government though, who didn’t want to appear to be making another u-turn and admit that their easing steps 4 to 6 in July were just too soon; the media and other political parties would have exploited that kind of “strong/weak” decision even though it would perhaps have been the most responsible thing to do. But as I say, I’m no politician!
We are not the only country seeing cases rise. All countries relaxing their lockdowns are seeing cases rise again.
So, what happens now?
Cases are now very high and so far there is no evidence that they are slowing down again. The Government has just started putting high incidence areas back into more stringent control measures (Tier 3) and if the past is anything to go by then we won’t see the effects of these until 4-6 weeks’ time… essentially that’s the beginning of December! At that stage cases should plateau but they still won’t be going down, that will take another 4-6 weeks!
So taking action now might bring case numbers down in 2-3 months’ time… that’s the beginning of January.
What was it Boris Johnson, the Prime Minister of the UK, said last week? We need to prepare for a “Digital Christmas”. Looks like he is getting us all prepared for the disappointment of the “lockdown Christmas”. I think our current actions have been too little too late to avoid it!
[PANIC ALERT: ECIC (aka my wife) has already ordered the turkey, made room for it in the freezer and is picking it up on Monday!] Bah Humbug…I’ll probably be working this Christmas!!!
OK so hindsight is 100% accurate but at the risk of repeating myself many times I would have done things much slower. I would also have been willing to stop and take a backward step along the easing pathway, perhaps restricting the bars and clubs etc. much sooner than has been done. I do wonder if the reason we didn’t step back sooner was more of a political decision than a public health decision but I’m just a Clinical Microbiologist and not part of Government decision making….
If we had been more careful in monitoring, we should and could have been willing to undo decisions if they were shown to be too early. But it doesn’t seem we were actually monitoring any easing decisions! In fact it felt that every other day there was another set of easing rules, which left many of us, including myself, muddled, confused and totally fed up. The result…more people just gave up trying to conform as they didn’t know whether they were coming or going.
Spare a thought for those living on or close to a devolved border, who have all sorts of added complications and differences to contend with. For example, in the town of Llanymynech the Wales/England National border is the main road; on the English side there are two pubs and a fish and chip shop which can open as normal but not to Welsh residents, whereas on the Welsh side there is the post office and a shop, which are open only for essential items and off limits to the English who face a travel ban into Wales! Crazy!
I pity the Government though, who didn’t want to appear to be making another u-turn and admit that their easing steps 4 to 6 in July were just too soon; the media and other political parties would have exploited that kind of “strong/weak” decision even though it would perhaps have been the most responsible thing to do. But as I say, I’m no politician!
We are not the only country seeing cases rise. All countries relaxing their lockdowns are seeing cases rise again.
So, what happens now?
Cases are now very high and so far there is no evidence that they are slowing down again. The Government has just started putting high incidence areas back into more stringent control measures (Tier 3) and if the past is anything to go by then we won’t see the effects of these until 4-6 weeks’ time… essentially that’s the beginning of December! At that stage cases should plateau but they still won’t be going down, that will take another 4-6 weeks!
So taking action now might bring case numbers down in 2-3 months’ time… that’s the beginning of January.
What was it Boris Johnson, the Prime Minister of the UK, said last week? We need to prepare for a “Digital Christmas”. Looks like he is getting us all prepared for the disappointment of the “lockdown Christmas”. I think our current actions have been too little too late to avoid it!
[PANIC ALERT: ECIC (aka my wife) has already ordered the turkey, made room for it in the freezer and is picking it up on Monday!] Bah Humbug…I’ll probably be working this Christmas!!!
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