Directors of public health across the UK have been thinking deeply about how our communities can live with Covid-19 in the months ahead. Although people have shown remarkable commitment to looking out for one another during this past year, we can’t afford to endure an endless cycle of lockdowns forever. The social, physical, mental and economic costs are simply too high. But neither can we accept high levels of Covid-19. Increased transmission results in a greater risk of new variants emerging and leads to severe illness and death.
So as the government prepares to issue its forthcoming “roadmap” for easing restrictions, what should this look like? There are four principles that should guide the government’s approach to lifting the lockdown.
Our first collective aim should be reducing transmission to as low a level as possible – and keeping it low. To do this, we’ll need to continue with interventions such as social distancing and remote working. There will be no quick transition back to normal. It’s likely that some restrictions will still be needed in months to come, but these should be dynamic and flexible, responding to different risks as they arise.
Restrictions should only be lifted in a phased, cautious way and only when levels of transmission are judged low enough to do so. People have already grown used to washing their hands regularly, wearing face coverings and maintaining social distance from others. As lockdown restrictions are eased, keeping these behaviours in place will help protect ourselves and others against Covid-19.
Secondly, it will be crucial that we continue to monitor transmission and quickly identify any new variants. Public Health England deserves enormous credit for its work in providing and developing an early warning system capable of swiftly identifying variants and increases in transmission rates. Likewise, the Covid-19 Genomics UK consortium has played a vital role in sequencing and identifying new variants of the virus. As we’ve learned over the past year, hesitation leads to hospitalisation and deaths. When restrictions are eased, we will have to be prepared to act fast, both locally and nationally, to get ahead of the virus.
The third important aspect of this roadmap should be a highly effective test, trace, isolate and support system. As cases fall and people begin to mix again, keeping the virus under control will depend upon the effectiveness of this system. Financial and practical support must be available to people who are asked to isolate, and the NHS test and trace system should be localised, with resources passed down from Whitehall to regional and local health authorities.
Finally, although the vaccination programme has been a success story, it’s vital that we support as many people as possible to receive the jab. Councils and communities must work together to ensure those who are least likely to take up the offer of a vaccination are engaged and supported, whether through targeted, culturally aware communication campaigns or enlisting community representatives to encourage uptake. Local community leaders, businesses, faith groups, libraries, schools, sports clubs and local media will all be central to these efforts.
Of course, the success of all of these measures will rely on a contract with the public. We don’t just need a plan, but a campaign to build trust. There are no magic bullets to solve this pandemic, and our focus must be on designing and funding the tools we have so they work to maximum effect.
A full recovery from Covid-19 won’t be possible unless we address the underlying structural inequalities that help the infection to persist. We owe it to the diverse and disadvantaged communities who have paid the highest price for the virus to plot a recovery that addresses our nation’s health inequalities. This will mean improving and investing in the social determinants of health, such as housing, air quality, education, income and food. All of these underlying factors overwhelmingly shape how long each of us lives in good health.
It seems likely that we’ll be living with Covid-19 for some time to come. But with these measures in place, we should be optimistic that we can do so safely, while moving towards brighter days.