London School of Hygiene & Tropical Medicine

In the UK, emergency measures were taken to reduce transmission in March. Asking people to stay at home meant that the networks through which the virus moves were broken. We know that there are four main activities and settings in which people meet: home, work, school and leisure. Leisure was closed completely, and school/work contacts reduced as much as possible.

It worked – transmission was greatly reduced and incidence of infection went from hundreds of thousands per day down to thousands per day. However, these measures were always unsustainable. We cannot live our lives in permanent “lockdown”. The negative impacts on well-being, including mental health and child/partner abuse, and damage to the economy are immense.

We have to find a way of being able to go back to living our lives without reconnecting all the networks. The virus is still here and has not changed – if re-opening goes wrong then we will be back to where we were in March and have to disconnect the whole network again.

Making the places that we meet, and the way that we meet, less likely to result in transmission is important – social distancing, mask-wearing, handwashing are critical. Contact tracing and making sure that people who are, or even might be, infected stay at home away from others is even more so. If these all work well, then we can remake a lot of the connections.

But what we are seeing in the UK at the moment, and across Europe, is that re-opening is resulting in transmission increasing. Hence the government decisions on tightening measures and the Chief Medical Officer highlighting that we are at the limit of what we can do at the moment. Keeping the prevalence of the virus low during the summer is vital given that the winter is likely to be even more difficult.

The government is going to have to make some very tough decisions: unfortunately, they are all lose-lose. Re-opening schools must be a priority. The wellbeing, development and education of children is vital for their and the UK’s future. But in order for this to happen, to ensure that we do not have to go back to more drastic, national “lockdown”, some sectors might have to close. Keeping the prevalence of the virus low is crucial.

Of the four areas, leisure is perhaps the least critical, but the leisure and hospitality industries are workplaces. Behind the bars and in gyms people earn a living for themselves and their families. Jobs and income will be lost if they are closed without additional support.

Nobody wants to see sectors closed. But we will very likely be in a far worse position if we have to lockdown a second or third time over the next twelve months. Targeted and scheduled closures will cause less damage.

We are learning how can we make living with COVID-19 sustainable, so that we can control the virus and continue to live our lives. But we know there are no easy answers. We also know that if we fragment as a society, the virus will survive much better and infect more of us, taking lives and livelihoods.

We must help each other through this, and where possible take these decisions together.