April 7th 2020
 
We write as a group of public health scientists and practitioners.
 
While implementation of stringent ‘lockdown’ measures was needed to curtail the rapid spread of COVID19, such measures will not be sustainable or tolerable for long. To strike the optimal balance between minimising COVID19 infections and minimising the harms of lockdown, the government must urgently incorporate new approaches into its strategy.
 
The first is to recognise the spatial dimension of this epidemic, driven by area-specific socio-cultural, demographic, economic and geographic factors that influence both the pattern of transmission and the differential vulnerability of households and communities to lockdown. This calls for a more decentralised approach to COVID19 control with explicit regional leadership and local area-based plans. Such an approach will also strengthen coordination across the NHS, social care services, and the community and voluntary sector.
 
The second, supported by widespread community testing, is to restore individual case detection, contact tracing and appropriate isolation as a core control measure. When combined with other measures including physical distancing, improved hygiene (including the use of facemasks) and some travel restrictions, this will enable a relaxation of lockdown measures. Extensive testing and tracing, coordinated by local area teams, will also provide a clearer real world picture of each local epidemic and enhance control measures even further.

Finally, we may need a bold plan for population-wide testing at regular intervals. This can be done if patents and regulations on both test manufacture and lab safety are set aside as part of a wider national mobilisation of scientists, technicians and biotech firms.

Yours sincerely,
 
David McCoy, Professor of Global Public Health, Queen Mary University of London
Paul Roderick, Professor of Public Health, University of Southampton
Julian Peto, Professor of Epidemiology, London School of Hygiene and Tropical Medicine
Guiqing Lily Yao, Prof of Health Economics, University of Leicester
Trish Greenhalgh, Professor of Primary Care Health Sciences, University of Oxford
Elio Riboli, Chair in Cancer Epidemiology and Prevention, School of Public Health, Imperial College London
David Hunter, Richard Doll Professor of Epidemiology and Medicine, Nuffield Department of Population Health, University of Oxford
Helen Ward, Professor of Public Health, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
Allyson Pollock, Professor of Public Health, University of Newcastle
Paul Elliott, Chair in Epidemiology and Public Health, School of Public Health, Imperial College London
Devi Sridhar, Professor of Global Public Health, University of Edinburgh
Mark S Gilthorpe, Professor of Statistical Epidemiology, University of Leeds
Keith Godfrey, Professor of Epidemiology and Human Development, University of Southampton
Anthony Costello, Professor of Global Health and Sustainable Development, University College London
Ruth Jepson, Professor of Public Health in Social Science, University of Edinburgh
Nisreen A Alwan, Associate Professor in Public Health, University of Southampton
Nicola Low, Professor of Epidemiology and Public Health, University of Bern
Rochelle A. Burgess, Deputy Director, UCL Centre for Global Non-Communicable Diseases; Lecturer in Global Health, UCL Institute for Global Health
Tim Colbourn, Associate Professor of Global Health Epidemiology and Evaluation, Institute for Global Health, University College London
Miriam Orcutt, Senior Research Fellow, Institute for Global Health, University College London
Adrian Martineau, Professor of Respiratory Infection and Immunity, Institute of Population Health Sciences, Queen Mary University of London
Anne Wilson, Lecturer in Epidemiology, Liverpool School of Tropical Medicine
Lefkos T Middleton, Professor of Neurology, Imperial College London
Luis E Cuevas, Professor of International Health and Epidemiology, Liverpool School of Tropical Medicine
Hynek Pikhart, Professor of Epidemiology and Medical Statistics, University College London
Steph Taylor, Professor of Primary Care and Public Health, Queen Mary University London

**If you are a public health specialist, epidemiologist, scientist in a relevant field or healthcare professional and would like to publicly support this letter, please add your name, specialty and affiliation below**

Full list of signatories will be available to view here: https://docs.google.com/spreadsheets/d/19cM4BjKUDy9Hv0XNNqwqs_DbAm-2ca_cBc0Zo8SRHmY/edit#gid=1356684786