- There has been a significant reliance on testing for the presence of COVID-19, and the implications of negative test results in particular, in the UK Government’s policy response to COVID-19. However, this has been without a clear idea of the purpose of testing and of the level of confidence one can have in a negative result, and the policy implications of that level of confidence.
We need scientifically consistent guidance and clear advice that COVID-19 symptoms are also an indication to self-isolate for seven days, regardless of test results. We, therefore, welcome the recent changes to the national guidance in response to this concern.
- We support the statements by the Association of Directors of Public Health, the Faculty of Public Health, the British Dental Association and the BMA on the risks of easing lockdown too soon. We share the concerns raised by the ADPH that the UK Government is “lifting too many restrictions, too quickly” ahead of all the Government’s own five tests being met.
- We echo the important message about the role of directors of public health in developing and implementing local outbreak plans in partnership with other stakeholders, including national and local government, health services and public health agencies and others.
We also highlight the need for support and engagement by the UK Government with several pressing issues such as:
- workforce capacity
- timely access to relevant data
- the unequal impact of COVID-19 on Britain’s communities.
- Furthermore, we urge the UK Government to commit to a renewed drive to promote the importance of handwashing, social distancing and self-isolation of individuals and their households if symptomatic.
- We recognise that the app has a role to play as a possible means of helping with the concerns around workforce and system capacity. We note that it requires high take-up and a national public information campaign to be fully effective. There are also potential health inequalities issues arising from its use that should be considered.
- With all that in mind, it is not yet appropriate to implement all phase 2 measures. The number of new cases and of deaths is still too high meaning that the NHS test and trace service as it stands is not capable of following up the contacts of all new cases either because of workforce capacity limitations or because the app is not yet fully functional.
This statement was written by Peter English, chair of the PHMC and Maggie Rae, president of the Faculty of Public Health.
Read more about the public health medicine consultative committee.
Moving to the next phase
As the UK exits phase one of the Government’s response, where the Government has sought to contain, delay, research and mitigate, it will move through two further phases.
On 16 April the Government presented five tests for easing measures.
- Protect the NHS’s ability to cope. We must be confident that we are able to provide sufficient critical care and specialist treatment right across the UK.
- See a sustained and consistent fall in the daily death rates from COVID-19 so we are confident that we have moved beyond the peak.
- Reliable data from SAGE showing that the rate of infection is decreasing to manageable levels across the board.
- Be confident that the range of operational challenges, including testing capacity and PPE, are in hand, with supply able to meet future demand.
- Be confident that any adjustments to the current measures will not risk a second peak of infections that overwhelms the NHS.
Until the UK can reach phase three, the Government will gradually replace the existing social restrictions with smarter measures that balance its aims as effectively as possible.
The Government will enact measures that have the largest effect on controlling the epidemic but the lowest health, economic and social costs.
These will be developed and announced in periodic ‘steps’ over the coming weeks and months, seeking to maximise the pace at which restrictions are lifted, but with strict conditions to move from each step to the next. The Government will maintain options to react to a rise in transmissions, including by reimposing restrictions if required.
Over time, the Government will improve the effectiveness of these measures and introduce more reactive or localised measures through widespread, accurate monitoring of the disease.
That will enable the lifting of more measures for more people, at a faster pace. Meanwhile, the Government will continue to increase NHS and social care capacity to ensure care for all COVID-19 patients while restoring ‘normal’ healthcare provision.