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England’s tiered lockdown system, designed to simplify the rules and restrictions around coronavirus, appears to be causing even more confusion.

Since the tier system came into effect  it has been unclear what areas can do to move back down to lower tiers with fewer restrictions.

This has fuelled growing unease among members of the public and MPs alike.

Sir Graham Brady, chairman of the 1922 committee of Tory backbenchers, recently urged the government to “set a clear end date and a strategy for returning life to normal”.

While we don’t yet have any firm details of a clear end date, here’s what we know – however vague – about how areas can move back to lower tiers.

So, how can areas move down a tier?

Speaking at Prime Minister’s Questions (PMQs) on Wednesday, Boris Johnson confirmed the way for areas to get out of the higher tiered restrictions is to “get the R [rate] down to 1 or below”.

As well as following the rules of their specific tier, people should keep washing hands, wearing a face covering in enclosed spaces, and maintaining a sensible distance from others, he said.

However when pushed on the finer details of the tier exit strategy by Labour leader Keir Starmer, there was not a huge amount of clarity offered. 

“Obviously the R is one of the measures we look at,” Johnson said, “and we will take a decision based on a number of things including the R but also, of course, rates of infection, rates of admission to hospital and other data.”

Health minister Edward Argar was also asked about the criteria that impact whether or not a region can exit the tier it are in, and said the government will look at the area’s infection rates per 100,000 people, the impact on the NHS in terms of hospital capacity and hospitalisation rates, as well as relying on knowledge from local public health officials.

“Areas in tier 3 or tier 2 will remain in those areas as long as is necessary to protect the health of the local people and the NHS in that region,” he said.

The prime minister said when areas enter a new tier, they are “only in there for 28 days” before the government will review an area’s position within that tier.

“Areas that have gone into tier 3, I believe, are already making progress and areas where there are restrictions in place are already showing signs of progress,” he added.

Does the government have an exit strategy?

As it stands, UK Covid-19 cases are continuing to rise, alongside hospitalisations and deaths. This week, the UK recorded 241 Covid-related deaths in a single 24-hour period, the highest number since the start of June.

The lack of clarity surrounding how places like Greater Manchester might move back down a tier has left many wondering if and when they’ll be able to see loved ones again, and is causing a great deal of concern over how people will afford to live if they can’t work for months on end. 

“Tier 3 is a gateway to weeks and weeks, more likely months and months, of agony from which there’s no likely exit,” Starmer told the Commons. “Can the prime minister not see the problem if there isn’t a clear exit?”

The measures for Greater Manchester will be reviewed by November 11, HuffPost UK understands.

Data on the spread of the virus across local areas is being monitored and then used to provide advice and recommendations on areas of intervention to ministers. After consultation with local authorities and leaders, the government makes a final decision on the appropriate tier for each area.

In response to HuffPost UK’s request for comment on the matter, a government spokesperson said: “The Covid Alert Levels simplify and strengthen rules to help protect lives and reduce the transmission of the virus, whilst minimising the impact to livelihoods and the economy.

“Decisions are made in close consultation with local leaders and public health experts, informed by the latest evidence from the JBC and NHS Test and Trace, PHE and the Chief Medical Officer for England.

“We constantly review the evidence and discuss measures with local Directors of Public Health and local authorities, and do not wish for restrictions to be in place for longer than is necessary.”

Are there alternatives to the tier system?

Wales, Scotland and Northern Ireland have implemented a range of heavier, albeit temporary, lockdown measures to try and reduce infections – a method referred to as a ‘circuit breaker’. The aim is to try and reduce the R rate and prevent health services from being overwhelmed.

The option of a ‘circuit breaker’ lockdown in England hasn’t been ruled out, however there is a reluctance from the UK government to resort to this measure, because some areas have a much lower number of infections than others.

England’s deputy chief medical officer Jonathan Van-Tam acknowledged this week that infections are “heating up” across the country but said the virus was only “out of control” in some areas, mainly concentrated in the north, so a national circuit breaker lockdown wouldn’t be right.

There are some experts who believe the tiered system isn’t having much of an effect. Independent Sage points out that cases have continued to rise despite the introduction of tiers “and although cases are highest in the North of England, they are rising rapidly across the country”.

“We do not believe the current tiered system is sufficient to reverse the growth of the pandemic,” the independent panel of scientists said. 

Professor Deenan Pillay, an expert in virology at University College London and a member of Independent Sage, tells HuffPost UK he believes there should now be a national circuit breaker, along the lines of the two-week circuit breaker introduced in Wales.

Everyone in Wales is currently required to stay at home – this means working from home where possible, with the only exceptions being critical workers and jobs where working from home is not possible. All non-essential retail, leisure, hospitality and tourism businesses have also been forced to close.

Prof Pillay says: “The varying tiers [in England] are a blunt instrument for an infection which is rapidly spreading in all parts of the UK – albeit with varying numbers at present. It just makes no sense to wait until hospitals are starting to fill up, and deaths increase, to clamp down on the infection.” 

Instead, he says, we should be focusing on preventing that rise. 

Why test-and-trace matters just as much

Scientists have been calling for improvements to the test and trace system in England for some time now, arguing that it is one of the key ways to keep cases down. At the start of October, the service reported its worst ever figures for tracking down “close contacts” of people with Covid.

“The apparent dichotomy between protecting the economy on the one hand, and stopping virus spread on the other, is false,” says Prof Pillay. “Those countries which have implemented the most stringent lockdown, and have a fully functioning test and trace system, are those whose economies have fared the best.” 

Singapore, for example, has recorded fewer than 30 deaths despite almost 60,000 confirmed cases, which experts believe is down to its effective rapid test-and-trace programme.

Currently, there isn’t a single part of England that would be classed as “safe” from coronavirus using the government’s own threshold for quarantining overseas travellers.

When will the tier system end then? 

Ultimately, we just don’t know. Professor David Hunter, Richard Doll Professor of Epidemiology and Medicine at the University of Oxford, tells HuffPost UK that “from an epidemiological perspective it might appear to make sense to have a tiered system, but from a social and political perspective it does not seem to be working very well”.

Prof Hunter says it’s “impossible” to say how long the tier system will be in place “because the government has been conducting a series of U-turns at regular intervals for almost the whole of the epidemic”.

“If the question is whether the system of tiers is going to control the epidemic, my expectation is that we would all wind up in tier 3 eventually,” he says.

“It’s just a matter of time before tier 2 places become tier 3, and tier 1 places become tier 2, because the evidence is the epidemic is increasing across the country, it has just started with a higher baseline in the areas that are currently tier 3.”

He says a nationwide ‘circuit breaker’ would “make more sense at this point” and would potentially stop tier 1 areas moving up to tier 2, “so it would be a benefit to the whole country” – but he caveats that it wouldn’t be easy (due to the obvious economic and mental health implications) and that we’d almost certainly need another circuit breaker in the future.

We also need a fully functioning test, trace and isolate system that is “decentralised and effective”, he points out (not for the first time, either). 

For those wondering whether to make plans for the foreseeable future, Prof Hunter believes that realistically we won’t see an end to the restrictions and measures until well into 2021. “We won’t get to herd immunity without a vaccine, and I think no-one is ready to let the NHS be overwhelmed,” he says.

“So we are stuck with intermittent lockdowns or ‘circuit breakers’ until the weather gets better in the late spring or early summer and we can be outdoors again and that does seem to help limit transmission.”

Another way to return to normality is to have a vaccine widely available, he adds. But he estimates suggest that’ll be “Q2 or Q3 next year at best”.

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