1. Preventing transmission
The section on PREVENTING TRANSMISSION includes information on key public health measures that aim to prevent the further spread of the disease. It details how countries are advising the general public and people who (might) have the disease to prevent further spread, as well as measures in place to test and identify cases, trace contacts, and monitor the scale of the outbreak.
1.1 Health communication
Update September 22nd 2020
The Covid alert level was upgraded from 3 to 4 on 22nd September 2020, as the number of cases, test positivity and the number of outbreaks increases. The Prime Minister addressed the public to announce new measures including restricted hours for pub and restaurant opening, a reminder about the so called rule of 6 (restricting inter household mixing to 6 people unless exempted by special circumstances) and to request that people start again to work from home, rather than go back to the office as previously requested. This address was followed by broadcasts by the First Ministers of Scotland and Wales and a joint broadcast by the First Minister and Deputy First Minister of Northern Ireland announcing a similar tightening of COVID-19 measures in the devolved nations (see more details in section 1.2: physical distancing).
Update 28th August 2020
The Covid alert level was downgraded from 4 to 3 on 19 June 2020, as the virus remains in general circulation with a risk of localised outbreaks.
Update 4th August 2020
The government has announced a new campaign with the slogan ‘Wash hands, cover face and make space’.
Update July 14th 2020
The Prime Minister announced that the daily press briefing to the UK public would cease on June 23rd 2020 and that these would be replaced with briefings when there were important announcements.
Update June 12th 2020
On June 6th, the Department of Health and Social Care developed an advert to encourage people with symptoms to get tested and to respond to the national NHS test and trace service, which started on May 28th. There has been some debate around the alert level, which remains at 4 and the estimate of R, which the government estimates to be between 0.7 and 1.0. Other groups have estimated that this is higher, between 0.9 and 1.0 (https://www.theguardian.com/world/2020/jun/05/covid-19-infections-fell-sharply-in-england-in-late-may-ons-finds), and the rationale for easing lockdown without communicating any meaningful change in R or any fall in the alert level have not been communicated; it is believed that the Chief Medical Officer has resisted pressure to drop the Alert Level.
Update 7th June 2020
On 2nd June, the Prime Minister’s spokesperson announced that daily media briefings on COVID-19 would be reduced to 5 times per week, with none held at the weekend due to declining viewing figures (https://news.sky.com/story/coronavirus-government-scraps-covid-19-briefings-at-weekends-due-to-low-viewing-figures-11999188). Going forward, the Prime Minister has committed to lead at least one briefing per week alongside scientific and medical advisors, with other briefings led by Secretaries of State.
Update 15th May 2020
Communications about easing lockdown restrictions were published in April in Wales, outlining 3 pillars to guide decision-making (https://gov.wales/sites/default/files/publications/2020-04/leading-wales-out-of-the-coronavirus-pandemic.pdf), and in Scotland (https://www.gov.scot/publications/coronavirus-covid-19-framework-decision-making/).
1) The first pillar describes the key metrics (e.g. sustained fall in transmission, evidence that the health system could cope in the event of an increase in transmission, availability of PPE and international engagement) that will be used judge readiness to move into recovery.
2) The second pillar addresses considerations for how to evaluate the impacts and consequences of any easing, including a risk benefit analysis for each measure and plans for reversing these measures where necessary.
3) The third pillar in Wales relates to the public health impacts, including the direct impacts of COVID-19 on health, the indirect impacts in the event that the NHS becomes overwhelmed, or from patients avoiding health services despite needing them as well as the societal and socioeconomic harms.
The response in Wales will be composed of 4 strands, including: surveillance, effective case identification and contact tracing, learning from international experience and public engagement.
The Scottish plan outlines the key strategies to prepare for transition; the frameworks guiding decision making; the potential options to ease or impose restrictions; and the considerations for responding and recovering from the COVID-19 pandemic. The approach is to be staged and will be based on suppressing the virus, providing healthcare for those who need it and supporting society, whilst adjusting to a new normal, protecting against future pandemics and renewing society and the country’s economy. The Scottish government published an estimate of the reproduction number (between 0.6 and 1.0) and like Wales, emphasised that restrictions would need to be reinforced in the event that the reproduction number increased again.
In the second week of May, the UK government announced a new slogan to ‘Stay alert, control the virus and save lives’. This slogan has been met with much criticism from the public and the media who feel that the clarity of the original messaging to stay home has now been watered down and leads the public to believe that it is safe to go out. At the same time, the government released their plans for strategically and carefully phasing out lockdown in a very gradual fashion.
Prime Minister Boris Johnson announced the government’s roadmap for transition out of lockdown on the 10th May (https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy?utm_source=b8dbfb04-d2ab-41ea-9a9c-b163f1108b8a&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate). He stressed that the plan was the product of consultations across government and the devolved nations but acknowledged the cross-regional variation from Wales and Scotland who have decidedly rejected the new slogan to ‘Stay Alert’. He reiterated that the plans were based on the 5 tests stated previously (See section 1.2 Physical distancing, transition measures):
1. Making sure the NHS can deal with the number of people needing treatment
2. Sustained and consistent fall in daily deaths
3. Reliable data that infection is decreasing
4. Ensuring there is enough PPE and testing capacity
5. No risk of a second peak of infections
He announced the creation of a new COVID-19 alert system based on a scale of 1 (disease no longer present) to 5 (most severe level), which would be based on both the current reproductive number and the number of cases. He outlined the intention to ‘reverse epidemics’ in care homes and in the NHS and to scale up a robust test, trace, isolate system.
The key measures he announced were that those who could work from home should continue to do so and that those who could not, should return to work with caution, observing the principles of social distancing. The new announcements also allowed people to sunbathe and to exercise as much as they wished outdoors (including outdoor sports at a distance) and also to see a single member from another household, provided it is outdoors and at a 2 metres distance. This is considered to be stage 1.
So long as the reproductive number does not increase with these measures, stage 2 will allow the opening of schools in June, starting initially with children in reception and those at key stages of development and some shops will open at the same time.
If this is successful then the intention is to move to stage 3, when bars and restaurants are proposed to open, around July. The Prime Minister also announced that all people coming in from other countries would be quarantined when the R number had fallen, although there is still little detail on how this will be instituted, and it is understood that these measures will not apply to France. These measures are all subject to transmission rates and case numbers and changes will be made in accordance with the COVID Alert stage at the time. Critically, it has been made clear that the transition from stage 1 to 4 is not a unidirectional one and that we are likely to have to reverse any easing measures quickly if transmission increases.
The announcements have resulted in some confusion and frustration from workplaces, schools and the general public for whom publicly available guidance was not available when the announcements were made. In the few days that followed, more than 20 guidance updates and announcements were published. Although this clarity has been welcome, many have expressed concern at the lack of forewarning that would allow people to prepare for these changes, as has been seen in other countries.
Communications on public transport have also been announced and are described further in 1.2 Physical Distancing, Transition Measures.
Information is communicated through official government websites and social media accounts and mass media (including the BBC and Channel 4 as public service broadcasters). From mid-March there have also been daily briefings from the Prime Minister alongside other relevant Ministers and selected medical and scientific experts, including the Chief Medical Officer and Chief Scientific Advisor.
Official advice on hand hygiene, respiratory etiquette and social distancing was issued fairly early in the COVID-19 outbreak (in January 2020) through multiple press briefings and Ministerial speeches. Health Protection teams (which are part of Public Health England) and frontline health professionals also offered general advice about COVID-19 to the general public and to individual cases and contacts. Advice was also published on the UK government website [https://www.gov.uk] which has a specific page for COVID-19 and included instructions on how to wash hands and when. No travel restrictions were put in place, but Port Health Authorities asked people arriving to the UK from high risk settings to report any symptoms, also disseminating leaflets, translated into several languages. On March 3rd, the government published an action plan to outline their proposed plans for managing Covid-19, in which they outlined three stages, including ‘containment’, ‘delay’, and ‘mitigation’ and described the roles and responsibilities of different stakeholders. From March 2020, people were advised against all but essential international travel and to avoid travelling on cruise ships following several cruise ship outbreaks. To support the implementation of stricter measures asking people to start physical distancing, the government launched a nationwide public health campaign with the motto: “stay home, protect the NHS, save lives” at the end of March. The widespread campaign has appeared across print, social and digital media channels (https://www.lbbonline.com/news/uk-government-campaign-urges-public-to-stay-home-protect-the-nhs-save-lives/). In early April, the Prime Minister wrote to each household individually appealing to them to abide by the government guidance.
In early May, the government published the evidence considered by the scientific pandemic influenza modelling (SPIM) group in February that contributed to their advice not to enforce mass school closures earlier and ceasing public gatherings and released consensus statements. In particular, they highlighted uncertainties about the role of children in transmission and the need to close schools for a considerable period of time (six weeks or longer) to achieve the desired impact, which they considered to be modest at best. Stopping public gatherings, such has football matches was also considered to be of modest value, particularly as it was deemed likely that people would replace attendance at football matches with more riskier activities, such as watching the football at the pub. SPIM also concluded that contacts are less likely to be intimate and are also shorter at public gatherings than in other settings such as contacts with family members and co-workers. At the same time, they also published the suggestions from the SPIM to consider in terms of the timing and options for easing restrictions and the methods to promote adherence to changing restrictions.
Planning assumptions based on the known differences between COVID-19 and influenza:
Mass school closures: