Coronavirus: Why aren’t local restrictions working across the UK?

Such measures have proven largely ineffective in reducing transmission. Recent analysis found infection rates have risen in 19 of the 20 areas where restrictions have been in place for two months

As infection rates continue to surge across the UK – with hospital admissions and deaths clearly on the rise – one vital question has emerged amid the confusion and panic: why aren’t local restrictions working?

These measures, which include bans on household mixing and the serving of alcohol indoors, have been enforced far and wide throughout Britain, affecting tens of millions of people and once again reshaping life as we know it.

Yet such rules have proven largely ineffective in reducing transmission. An analysis by Labour found infection rates have risen in 19 of the 20 areas where restrictions have been in place for two months.

Across the north and the Midlands, the weekly seven-day infection rate has soared. In Nottingham, it stands at 661 cases per 100,000; in Liverpool, this number has reached 562; while in Manchester the rate is at 507 – figures that surpass those seen in European hotspots such as Madrid and Paris. More worryingly, hospital admissions are also beginning to rise.

Alarm bells have naturally been rung. Earlier this week, the leaders of Leeds, Liverpool, Manchester and Newcastle city councils wrote to the government, arguing that its strategy is failing and that they should be put in control.

“The existing restrictions are not working, confusing for the public and some, like the 10pm rule, are counter-productive,” the Labour politicians said.

While countries in Asia have largely succeeded in suppressing the virus, the UK stands on the precipice of a second wave that, if estimates prove right, could kill thousands in the months to come. Against this ominous backdrop, public officials, health experts and politicians have sought to explain what is going on.

Much of the blame has been pointed in the direction of the government’s failing test and trace programme. “It doesn’t matter how good the lockdown arrangements are unless you’ve got an effective find-test-trace-isolate-support system in place,” Gabriel Scally, a visiting professor of public health at the University of Bristol, tells The Independent.

The latest figures show that, after more than two months of operations, Test and Trace remains anything but “world-beating”. Some 68.6 per cent of close contracts were reached up to 30 September – the worst week on record – while only two-thirds of positive cases were transferred to the system over the same time period.

“The government hasn’t taken the steps to actually do the really important job of finding the cases, testing and tracing in a timely manner and helping people to isolate,” adds Scally, who also serves as a member of Independent Sage. “We are fighting this virus with one hand tied behind our back.”

Others are convinced that that the restrictions currently in place are simply not stringent enough. John Edmunds, a member of the government’s Scientific Advisory Group for Emergencies, argues that the Leicester lockdown stands alone in actually managing to reduce transmission and cut cases.

He stresses that the localised measures which have followed elsewhere have simply not gone as far as the Leicester example.

“They were much much more stringent in Leicester than everywhere else,” Edmunds, a professor of mathematical modelling for infectious diseases at the London School of Hygiene & Tropical Medicine, tells The Independent. “So non-essential retail was closed, the schools were closed, the university was closed, places of worship were closed.

“It was a proper lockdown and something very much akin to what we were doing nationally beforehand. There’s been not much evidence that subsequent local restrictions – and I’m not using the word lockdown – have done much.”

Edmunds adds that Leicester was also unique in the sense it implemented a mass testing campaign which hasn’t been replicated on the same scale since.

“They tried to test the whole city, or at least parts of it – the highest risk areas,” he says. “They brought mobile testing labs in and tried to encourage people, whether they had symptoms or not, to get tested to find cases and then isolate them. It was a significant step up from what we normally do for Test and Trace.”

He admits that there’s “an awful lot of confusion” surrounding the localised restrictions, making it hard for people to know what they can and cannot do. “I couldn’t tell you what the restrictions were in Blackburn with Darwen or in Newcastle, and neither could most politicians, as was proven,” he says.

To combat this, the government is intending to roll out a simplified three-tier lockdown system that would be applied nationally – but even then, Edmunds isn’t convinced this will be enough to reverse the rising trends that are being recorded. “I genuinely think we need national restrictions to be put back in place, because although the cases are much higher in big northern cities, the rates are increasing everywhere.”

Amid all the questions, theorisations and protestations of what will or won’t work, the role of the public cannot be overlooked. Compliance with the local restrictions, regardless of how tame they may be, can and does make a difference, argues Dr Julian Tang, a professor in respiratory sciences at the University of Leicester.

He points to a September report from Sage which found that less than 20 per cent of people in England fully self-isolate when asked to do so, rendering mass testing as practically irrelevant. Given the incubation period of SARS-CoV-2 – on average, it takes seven days to surface in the body – and the high percentage of asymptomatic cases, any small lapses in behaviour can allow the virus to fly “under the radar”.

“If compliance with the guidance is not strict, it might seem trivial but that’s feeding the epidemic as time goes on,” Tang tells The Independent. People who don’t quarantine, who don’t keep their distance, who “go to the shops after the 10pm curfew and mix in different households” are presenting the pathogen with the opportunity to continue spreading at an exponential rate, he adds.

“If you look at a number of Asian countries, like Taiwan and Hong Kong, their numbers are tiny. People say it must be due to test and trace or masking, but these populations are also very compliant. They don’t argue that they've lost their civil liberties. If the whole population complies, then the effect is very big.”

He says that one of the factors which sets apart these nations is that people who have been infected with the virus, or exposed to it, are admitted to an official quarantine facility where “they can’t just pop out for a cigarette or go to the supermarket like here”. This policy, although alien to many, has proven effective in blocking the stealth-like chain of transmission.

In the absence of such options, Tang adds, the UK is limited to imposing stricter nationwide measures that will prevent people from cutting corners – though he acknowledges there’s a “strong political will” against a return to another lockdown.

“All this adds up together,” he says. “If you don’t comply with these isolation measures, social distancing, masking precautions – any slight lapse is like a butterfly that will cause a hurricane on the other side of the plant.

“This is the chance to do something about this now, and if you miss this window of opportunity, you’re going to be faced with a much longer, larger second wave. We have to act fast and hit the virus hard.”