AbstractBackgroundAs countries begin to ease the lockdown measures instituted to control the COVID-19 pandemic, there is a risk of a resurgence of the pandemic. The UK started easing lockdown in England when levels of community transmission remained high, which could have a major impact on case numbers and deaths. Using a Bayesian model we assessed the potential impacts of successive lockdown easing measures in England, focussing on scenarios where the reproductive number (R) remains ≤1 in line with the UK government’s stated aim.MethodsWe developed a Bayesian model to infer incident cases and R in England, from incident death data from the Office of National Statistics. We then used this to forecast excess cases and deaths in multiple plausible scenarios in which R increases at one or more time points, compared to a baseline scenario where R remains unchanged by the easing of lockdown.FindingsThe model inferred an R of 0.81 on the 13th May when England first started easing lockdown. In the most conservative scenario where R increases to 0.85 as lockdown was eased further on 1st June and then remained constant, the model predicts an excess 400 (95% CI 34-1988) deaths and 56,019 (95% CI 4768-278,083) cumulative cases over 90 days. In the scenario with maximal increases in R (but staying ≤1) with successive easing of lockdown, the model predicts 1,946 (95% CI 165-9,667) excess cumulative deaths and 351,460 (95% CI 29,894-1,747,026) excess cases.InterpretationWhen levels of transmission are high, even small changes in R with easing of lockdown can have significant impacts on expected cases and deaths, even if R remains ≤1. This will have a major impact on tracing systems and health care services in England. This model can be updated with incoming death data to refine predictions over time.FundingNone.Research in contextEvidence before this studyThe impact of social distancing and lockdown measures on controlling the COVID-19 pandemic has been studied extensively over the last few months. However there has been little examination of the likely impact of easing lockdown measures in a staged manner as is being currently carried out in England, UK. We searched PubMed, medRxiv, bioRxiv, arXiv, and Wellcome Open Research for peer-reviewed articles, preprints, and research reports using the terms “COVID-19”, “United Kingdom” and “lockdown” for research examining these impacts, but found no relevant research that could inform the impact of phased easing of lockdown within England, UK.Added value of this studyDecisions around timing of easing lockdown need to be informed by current scientific evidence. In this context, this study provides urgently needed information about the potential impact of lockdown easing at this point within the COVID-19 pandemic in England. Using an epidemiological approach with Bayesian inference, we specifically assess several plausible scenarios of increase in R from baseline as a result of easing lockdown measures at levels of current community transmission, even when the R is maintained ≤1, which is the stated aim of the UK government. We provide a comparison of these scenarios, with a baseline scenario where R remains constant, as well as against elimination strategies, where transmission is aggressively suppressed to the lowest level possible. As our code is publicly available, these methods can be easily applied to accruing data, and to any number of scenarios to better understand the implications for public health policy.Implications of all the available evidenceEasing lockdown at a point of relatively high community transmission within the UK would lead to substantial excesses of deaths, and cases, even if R is maintained at ≤1. As expected, these increases are more marked, when R rises above 1, which is a distinct possibility, given recent estimates of R by a UK government advisory group.1 Our findings suggest that an elimination strategy would be more appropriate at this point, to allow suppression of community transmission to a point where easing of lockdown would not have the same impact, as with current transmission, and would likely not overwhelm systems of test, trace and isolate, and health services within England.
Gambling in COVID-19 Lockdown in the UK: Depression, Stress, and Anxiety
