Physical distancing restrictions are not simply a matter of preserving NHS capacity, they are about saving lives, says Red Elmahdi

Dressed up in a false narrative of liberation from restrictions on individual liberty and personal freedoms, and punctuated by references to ‘R’ and other confusing and similarly uninformative statements, Boris Johnson has announced that he would no longer be asking people to stay at home but rather to ‘Stay Alert’, which as a doctor and researcher, concerns me a great deal. The ‘Stay at Home’ message is not just about protecting the NHS but it’s also about saving people’s lives. I have been consistently puzzled and infuriated by the government’s management of this outbreak. Considering the contempt shown by successive Tory governments for the NHS, working classes and ethnic minority groups (those now worst affected by the virus) this should not have come as a big surprise to any of us however the bare-faced lies, often dressed up as ‘expert recommendation’ that have emanated from the Downing Street PR machine have been overwhelming, even for this government.

Most experts now agree that physical distancing measures were initiated far too late in the UK, despite voices from across the UK’s public health community urging restrictions to be put into place from as early as early March. We had heard and witnessed the tragically high death toll seen in Italy and Spain who were caught off guard and realised that the trajectory of the UK would be similar if we did not act to stop transmission immediately by restricting physical contact and these measures have been effective. Projections from the now infamous Imperial College London model of up to 500,000 deaths before the summer did not occur (although how this worst-case scenario in the context of complete inaction could ever be considered as a benchmark for any government is baffling), ventilator capacity and hospital bed occupancy was not overwhelmed either. So, what has changed for this government to consider easing these restrictions now?

The answer is, not very much. Although it’s true that we have seen a decrease in the number of daily positive tests for SARS-CoV-2 (the virus causing COVID-19 disease) and that we have reached the ‘peak’ in hospital admissions, ITU bed occupancy and deaths, there continues to be an ongoing transmission. There has been an average of approximately 4,000 new positive tests/day and an average of 554 daily deaths since that point. That’s an average of over 500 recorded deaths a day due to this disease, even after 6 weeks of lockdown. The government should not be rushing to lift these measures but rather putting into place additional public health measures to reduce transmission, including rolling out testing at the community level, contact tracing and case isolation.

Further measures are particularly important now as there has been little to no serious enforcement of the lockdown in many places. We’ve all been witness to a creeping increase in the number of people out on the streets. On my commute to the hospital over the last 2 weeks, I’ve been sharing train carriages with more and more people with 2-meter distancing becoming impossible in the last few days. This concerns me, as I am travelling in to and out of a COVID-19 ward where, even with appropriate PPE available, I cannot guarantee I have not been exposed and therefore at risk of transmitting this coronavirus. I take the necessary precautions, including hand-washing and avoidance of contact with the high-touch surface but should my seasonal hay fever symptoms result in my sneezing in those carriages, I could potentially spread this disease and I am only one of an estimated 7.1 million key workers across the country. It doesn’t take an epidemiology degree to see that multiplying that exposure by increasing the numbers of commuters on public transport and other shared public spaces again, poses considerable risk of transmission. How do you propose that those who are working in construction and manufacturing, often the most poorly paid people in this country, avoid public transport? There is no answer given for this key question with the implication being that this government is willing to ask the millions of people who work in construction and manufacturing in this country to take this unnecessary risk. This is not, as the right-wing conservatives would have you believe, simply a matter of the personal freedom to return to work. The lifting of this restriction is likely to result in low-paid workers on precarious contracts being forced to return to work in the context of an ongoing pandemic and thereby putting themselves, their loved ones, and many other vulnerable people at risk.

The stark fact of the appearance of novel pandemic disease is that not all those who are infected can be saved. Even with increased ventilatory capacity, oxygen therapy and other supportive treatments (which, let’s not forget were not always guaranteed during this outbreak) may be insufficient to save those who are very, frail, or have comorbidities that increase their risk of death. This has been brutally illustrated to us all by the havoc this disease has wreaked in care homes up and down the country, where thousands of our loved ones have died, isolated from their families and alone apart from the social care workers who struggle to support them in their final hours. Those of us working on the frontline know that in the absence of effective treatment and vaccination (both of which are still many months off, even by the best estimates) we cannot hope to save everyone and that we must reduce transmission in order to save lives. It is perplexing to many of us how we can have the highest death count due to this virus in Europe and the government response is to force millions of people into situations that put them at risk of infection by easing physical distancing measures.

The great irony of this situation is that, had this government responded rapidly to put physical distancing restrictions into effect early in this epidemic, alongside the public health measures for reducing transmission that every country that has successfully controlled this first wave have used, we could have been seriously considering easing of physical distancing restrictions long before now, however, this did not happen. Wilfully forcing millions of precariously employed people back to work at this time but taking away their primary legal protection is positively dangerous. When Boris Johnson says that he is happy to ease lockdown measures what he is telling us is that he is happy for many more people to die.