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The Green Party’s Community Shield

This morning the Green Party announced their vision of a novel coronavirus “Community shield” via a press release on the web site of Caroline Lucas:

I have called on the Government to adopt the advice of the World Health Organisation on community-based testing and contact-tracing to prevent the further spread of Covid-19 and as a precondition for any relaxation of the lockdown. 

The First Minister of State, Dominic Raab, has set out five conditions for the lifting of the lockdown but they do not include the clear WHO advice that health systems must have the capacity to “detect, test, isolate and treat every case and trace every contact”.

A Green Party report, published on Tuesday and put together by the party’s health team with input from other experts, makes the case that we will prevent further Covid-19 outbreaks and new lockdowns only if there is a network of community-based protection schemes, or “community shields”, which can respond quickly to any re-emergence of Covid-19 once the current lockdown is lifted. 

These “shields”, co-ordinated by Public Health England’s regional Outbreak Management Teams, would be created by bringing together and building on existing systems including the NHS 111 phone service, GP surgeries and local authority public health teams to identify those with symptoms, arrange for their testing and then, crucially, trace all their contacts in order to stamp out outbreaks of the virus in the communities where it’s happening. 

It seems as though the Green Party have been considering an idea we have been putting considerable thought into over recent weeks as well! It further seems as though the concept will be brought before the UK’s “virtual” parliament this afternoon:

If attempts to lift the lockdown are made before this infrastructure is in place, we’re likely to see a repeating cycle of national lockdowns as surges of new cases of the virus occur. 

I plan to table an Early Day Motion on Tuesday when Parliament re-opens calling for community-based protection schemes to be put in place.

It will be very interesting to see if the issue does get debated, and whether anything changes as a result! As Caroline Lucas puts it:

The Government record on testing in this crisis has been poor, with a change in strategy which squandered vital time, and mixed signals coming from ministers and scientific advisers who have even suggested that WHO advice doesn’t somehow apply to Britain. It would be criminally negligent if it compounded this error by failing to listen to the WHO’s advice on the criteria which need to be in place before lifting the lockdown.  It is profoundly worrying that the “Five Conditions for Exit” announced by First Minister Dominic Raab last week made no mention of this advice.

A community shield approach wouldn’t only help trace outbreaks of the virus where they occur and allow a swift response, it would also provide support to Covid-19 patients by monitoring their condition by phone and app, leaving them safely at home but not isolated.  This would give people the reassurance they need to exit lockdown with confidence when the time is right.

Preparations need to be made now to allow these “shields” to be in place for the ending of lockdown once the upward curve of infections has been brought down.  The system could be activated immediately in communities where the infection rate is low, and rolled out more widely as the number of cases declines.

People need the reassurance that lifting the lockdown won’t result in further out-of-control outbreaks and this would help give it to them – and build on the amazing community solidarity we have seen in the past few weeks.

The full report is available on this link – Building a Community Shield to Suppress the Coronavirus April 2020.pdf

How will the UK Government “build on the amazing community solidarity we have seen in the past few weeks” and reassure the citizens of the nation “that lifting the lockdown won’t result in further out-of-control outbreaks”?

Watch this space!

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Wearing face masks in the community

Hopefully we’ve made our own views on this topic clear by now, but what does the science say about the pros and cons of “the average person in the street” wearing a mask in public? Here’s an extract from a new paper in The Lancet entitled “Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity“:

The WHO ha[s] not yet recommended mass use of masks for healthy individuals in the community (mass masking) as a way to prevent infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in its interim guidance of April 6, Public Health England (PHE) has made a similar recommendation.

By contrast, the US Centers for Disease Control and Prevention (CDC) now advises the wearing of cloth masks in public and many countries, such as Canada, South Korea, and the Czech Republic, require or advise their citizens to wear masks in public places.

An evidence review and analysis have supported mass masking in this pandemic. There are suggestions that WHO and PHE are revisiting the question.

People often wear masks to protect themselves, but we suggest a stronger public health rationale is source control to protect others from respiratory droplets. This approach is important because of possible asymptomatic transmissions of SARS-CoV-2.

Authorities such as WHO and PHE have hitherto not recommended mass masking because they suggest there is no evidence that this approach prevents infection with respiratory viruses including SARS-CoV-2. Previous research on the use of masks in non-health-care settings had predominantly focused on the protection of the wearers and was related to influenza or influenza-like illness. These studies were not designed to evaluate mass masking in whole communities.

The authors go on to address that failing of previous studies:

Absence of evidence of effectiveness from clinical trials on mass masking should not be equated with evidence of ineffectiveness. There are mechanistic reasons for covering the mouth to reduce respiratory droplet transmission and, indeed, cough etiquette is based on these considerations and not on evidence from clinical trials. Evidence on non-pharmaceutical public health measures including use of masks to mitigate the risk and impact of pandemic influenza was reviewed by a workshop convened by WHO in 2019; the workshop concluded that although there was no evidence from trials of effectiveness in reducing transmission, “there is mechanistic plausibility for the potential effectiveness of this measure”, and it recommended that in a severe influenza pandemic use of masks in public should be considered. Dismissing a low-cost intervention such as mass masking as ineffective because there is no evidence of effectiveness in clinical trials is in our view potentially harmful.

Mass masking is underpinned by basic public health principles that might not have been adequately appreciated by authorities or the public. First, controlling harms at source (masking) is at least as important as mitigation (handwashing). The population benefits of mass masking can also be conceptualised as a so-called prevention paradox—ie, interventions that bring moderate benefits to individuals but have large population benefits. Seatbelt wearing is one such example. Additionally, use of masks in the community will only bring meaningful reduction of the effective reproduction number if masks are worn by most people—akin to herd immunity after vaccination. Finally, masking can be compared to safe driving: other road users and pedestrians benefit from safe driving and if all drive carefully, the risk of road traffic crashes is reduced.

So there you have it. Mask up if you’re out and about in public. You know it makes sense!