I am publishing below the full text of the statement by the President of the Association of Public Health Directors on the proposed lifting of restrictions.
LINK
COVID-19 has already taken a huge social and economic toll on our
nation – and the reality is that it will continue to do so for some
time.
We are at a critical moment. We need to weigh up the balance of risks
between easing restrictions, to enable more pupils to return to school,
more businesses to open and more social connections to happen, with the
risk of causing a resurgence of infections.
Directors of Public Health are increasingly concerned that the
Government is misjudging this balancing act and lifting too many
restrictions, too quickly.
This is a new disease; evidence is still emerging and there is much
uncertainty. However, based on what is currently known, several leading
scientists and public health experts have spoken out about a string of
recent national policy announcements affecting England which project a
degree of confidence that many – including ADPH members – do not think
is supported by the science.
Over the weekend we have seen signs that the public is no longer
keeping as strictly to social distancing as it was – along with this, we
are concerned that the resolve on personal hygiene measures, and the
need to immediately self-isolate, if symptomatic, is waning. A
relentless effort to regain and rebuild public confidence and trust
following recent events is essential.
At a local level, Directors of Public Health (DsPH) consider that
honest and open dialogue with their communities is integral to
effectively containing COVID-19 and managing outbreaks. That focus must
be echoed at the very top of Government.
The Government has set five tests, each of which must be regularly
reviewed as restrictions are adjusted and eased. Here is our current
assessment:
Firstly, the pressure on the NHS – and those that tirelessly and
expertly work within it – has been significant but it has been able to
cope with those who unfortunately need hospital treatment for the
effects of COVID-19. The number of people in hospitals with COVID-19 is
falling, and beds are available for those that require them.
Secondly, there must be a sustained and consistent fall in the daily
death rate. While the first peak in deaths has passed, the downward
trend is slow – particularly in care settings. Deaths are a measure of
what happened roughly two weeks before – the effect of easing measures
now will only become evident in two weeks.
The critical debate is about the third test – ensuring the rate of
transmission of the infection continues decreasing to manageable levels
(taken to mean R being well below 1). The rapid and multiple ways in
which measures are being eased is likely to make it difficult to judge
the cumulative impact on R.
As we saw in March, R can go above 1 in a
very short space of time – and once it does it can take many months to
bring it back down. The room for manoeuvre is tight.
The fourth aspect, ensuring supply of tests and PPE is able meet
future demand, remains an enormous challenge. PPE manufacturing and
supply chains are stronger, but shortages are still being reported and
it is not clear that supply can meet new demand as different parts of
society, public services and the economy open. While testing capacity
has undoubtedly increased, we are not yet confident that the current
testing regime is sufficiently effective in getting the priority tests
done and the results to where they are needed to enable swift action.
Finally, the fifth test. A second peak cannot be ruled out – whether
it will overwhelm the NHS is an important question to ask. But perhaps
the even bigger one is, do we really want the same number of deaths
again? The scale to date represents an unimaginable tragedy and we must
do everything possible to limit further loss of life.
The ADPH has argued that an effective contact tracing system is vital to keep R consistently below one. We set out a
‘Statement of Principles’
to outline what needs to be in place to make this work. A huge effort
is underway to establish such a system. We would pay tribute to valued
colleagues at Public Health England, who have built on the contact
tracing work they conducted at the start of the pandemic – and Dido
Harding and Tom Riordan who have shown great energy and leadership in
recent days. We also welcome the new Joint Biosecurity Centre to support
action based on intelligence and there are welcome signs that local
knowledge, insight and capabilities are more widely understood and
recognised by the Government.
As ever, the ADPH will continue to be as constructive as possible and as challenging as necessary.
But, let’s be clear, the NHS ‘Test and Trace’ programme is currently
far from being the robust operation that is now urgently required as a
safeguard to easing restrictions. Directors of Public Health are working
at extraordinary pace to develop Local Outbreak Plans. The ADPH will
shortly be publishing a briefing paper setting out the guiding
principles needed to shape – and implement – them. It is important to
recognise that these plans will largely build on the health protection
duties that DsPH already have. The work that has been going on
throughout this pandemic, including managing outbreaks in settings such
as schools and care homes and support for vulnerable people, continues
day in and day out.
DsPH have proved themselves capable and ready to take on this
leadership role and will develop and deliver local plans with the
support and collaboration of local government colleagues and PHE
regional teams, as well as the NHS, third sector and business.
Now is the time for steady leadership, careful preparation and measured steps.
The ADPH is calling for full implementation of all Phase 2 measures
to be delayed until further consideration of the ongoing trends in
infection rates and the R level gives more confidence about what the
impact of these will be. There also must be a renewed drive to promote
the importance of handwashing, social distancing and self-isolating if
symptomatic, positive for COVID, or a contact of someone who is. And,
additional assurance is required that the NHS Test and Trace System will
be able to cope with the scale of the task.
The risk of a spike in cases and deaths – and of the social and
economic impact if we have to return to stricter lockdown measures –
cannot be overstated; this needs to be understood not only by the public
but also by the Government.
