NEWS BMJ: first published as 10.1136/bmj.m3959 on 13 October 2020. Downloaded from London Cite this as: BMJ 2020;371:m3959 Covid-19: Leading doctors argue against local lockdowns http://dx.doi.org/10.1136/bmj.m3959 Jacqui Wise Published: 13 October 2020 The UK government’s own scientific advisers and “It’s too late for test and trace to stop it. Things will other leading experts argued against a policy of just get worse.” increased restrictions in local areas to control the He wrote that local restrictions (rather than a full covid-19 pandemic, instead calling for a national national lockdown) risked increasing numbers of short period of lockdown or “circuit breaker,” cases and deaths, with possible exponential spread. documents show. “It also means we shall reach a new state of The newly released documents reveal that the ‘endemicity’ with repeated surges and falls until such Scientific Advisory Group for Emergencies times as the virus has eaten its way through all recommended on 21 September that such an exposed and vulnerable people.” immediate circuit breaker was the best way to control He said a circuit breaker should stop transmission of cases.1 infection within and between communities and might Rumours about SAGE’s advice had been circulating also break the oscillation of surges and falls in for some weeks,2 but the minutes were officially infections. However, delaying a circuit breaker risked released only after the prime minister announced a an exponential increase in cases like that in March. new three tier system for England, with Liverpool “Without major reform of Find, Test, Trace, Isolate, facing the most stringent restrictions.3 Support (FTTIS) the UK will be back in trouble in two to three months,” he predicted. The SAGE documents also suggested: Costello said that the current test and trace system • Advising people to work from home if they can programme, “based on centralised, privatised and • Banning all contact within the home with members ineffective companies,” had “failed miserably.” He of other households called for Dido Harding, the current head of NHS Test and Trace, and England’s health secretary, Matt • Closure of all bars, restaurants, cafes, indoor Hancock, to be removed and an experienced minister gyms, and personal services, and such as Greg Clark or Jeremy Hunt and a strong public All university and college teaching to be online. health leader and independent public health team • http://www.bmj.com/ put in place to lead a test and trace programme. Of all the measures SAGE proposed, only one—advising people to work from home—was He called on the government to fund local test and implemented by the government at the time. trace systems, to be run through local district outbreak management teams that included local SAGE said, “The more rapidly interventions are put public health, virology, primary care, and local in place, and the more stringent they are, the faster authority leaders, backed by volunteers if necessary. the reduction in incidence and prevalence, and the The government must cover salaries in full of people greater the reduction in covid-related deaths (high asked to isolate, he said, and compliance with on 23 September 2021 by guest. Protected copyright. confidence). Both local and national measures are isolation should be monitored through calls, home needed; measures should not be applied in too visits, or an app, as in South Korea. specific a geographical area.” 1 Scientific Advisory Group for Emergencies. SAGE 58 minutes: Coronavirus David Nabarro, World Health Organization special (COVID-19) response, 21 September 2020. 12 Oct 2020. envoy for covid-19, has separately appealed to https://www.gov.uk/government/publications/fifty-eighth-sage-meeting- on-covid-19-21-september-2020. government leaders: “Stop using lockdowns as a 2 Iacobucci G. Sixty seconds on . . . circuit break. BMJ 2020;370:m3686. primary means of controlling the virus. Develop better doi: 10.1136/bmj.m3686 pmid: 32958462 systems for doing it.” Speaking in an interview with 3 Iacobucci G. Covid-19: Three tier alert system takes effect across England. Spectator magazine he said, “The only way that BMJ 2020;371:m3961. lockdowns are justified is to buy you time to 4 Costello A. Twitter 11 Oct 2020. https://twitter.com/globalhlthtwit/sta- reorganise, regroup, rebalance your resources and tus/1315336234382827522. protect your healthcare workers.”4 5 Turner-Cohen A. Coronavirus: WHO backflips on virus stance by condemning lockdowns. 12 Oct 2020. https://www.news.com.au/world/coronavirus/glob- On 11 October Anthony Costello, professor of global al/coronavirus-who-backflips-on-virus-stance-by-condemning-lock- health and sustainable development at University downs/news-story/f2188f2aebff1b7b291b297731c3da74. College London and a member of the Independent SAGE group, wrote a long thread on Twitter arguing This article is made freely available for use in accordance with BMJ's website against local lockdowns and calling for a national terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, circuit breaker together with immediate reform of the non-commercial purpose (including text and data mining) provided that all 5 test and trace system. copyright notices and trade marks are retained. “We’re in a mess. Cases, hospitalisations and deaths are rising,” wrote Costello, a former WHO director.

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