Empowering local services is key to fighting virus, says public health expert

A leading public health expert has urged the government to drop its top-down “command-and-control” response to coronavirus (Covid-19) to give the UK the best chance to fight future spikes in infections.

Andrew Lee said empowering local services is the key to tackling the further outbreaks he expects as the country learns to live with Covid-19, but said these surges will be geographically specific.

Dr Lee, who is reader in global public health at Sheffield University, said the key to controlling these outbreaks is speed of response and the current centralised system is too slow to react.

He said: “We just have to be really quick. Go with ‘good enough’ and hit the virus hard. Respond really, really quickly.

“The reason why this is important is that, in the next year, I’m anticipating more outbreaks. And these outbreaks will be localised.

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“They might happen in this city or that city or this district or that district. And the response when those outbreaks appear locally, we have got to respond really, really quickly to that.

“We cannot be waiting for national instructions to respond to local outbreaks. We’ve got to be quick. And that’s kind of worrying.

“We’ve got to almost empower the front line to respond quickly.”

Dr Lee, who is editor of the journal Public Health and also a practising GP in Sheffield, said: “Thus far we’ve adopted very much a one-size-fits-all approach – a very top-down, command-and-control government-led solution.”

He said: “I don’t think a one-size-fits-all national diktat works well for that. It just slows the response down and it means that solutions are not tailored to the local setting.”

Dr Lee said directors of public health around the country were “clamouring” for the autonomy to act locally with a range of interventions, including the control of contact tracing.

He said further spikes were likely if the government’s strategy is to find a way of re-opening society while “living with the virus”, rather than an elimination approach, as in New Zealand and South Korea.

But Dr Lee said the government’s public messaging over the last 24 hours had left him unclear about the “end goal”.

“Are we looking just purely at keeping the level of infection down and flattening the curve so that the NHS can cope with the growing levels of infection that happens out in the community? Or, are we looking to go for full-out elimination of the virus which requires much more stringent lockdown and containment?” he said

“Those are two very different goals. To me, I’m not clear which the Government is trying to get at, really.”

On Monday, prime minister Boris Johnson said it was “entirely right” that devolved authorities in the UK have different approaches to dealing with the coronavirus pandemic.

The PM told the Downing Street press conference: “You’ve got to respect local issues, local flare-ups, local problems and part of the solution is responding in a particular part of the country, which we detect with our Covid Alert system, then we will be firefighting, doing whack-a-mole as that issue arises.

“Having a local, regional, national approach makes sense, but it also makes sense to have a strong UK approach as well.”