I studied epidemiology many years ago; my undergraduate dissertation was on the epidemiology of HIV/AIDS, at a time when little was really known about it (1990). I wouldn’t claim to be an expert and be anywhere near as knowledgeable as the epidemiologists at Imperial College, Oxford or LSHTM. But. When I undertook the study for the dissertation, I was dogged by issues of data quality and quantity, much like we’ve seen with Covid-19. I also recall testing being thin on the ground with HIV at the time. Covid-19 is of course a completely different virus to HIV, but it would seem that many of the challenges, from an epidemiological perspective, are similar.
With that in mind, here are the questions I would be asking of the Welsh Government as it contemplates relaxation of the lockdown. None relates to the economy – yet.
Q1a: We have seen issues with data quality and quantity across the UK, so what measures is the Welsh Government taking to ensure that we have the best data and evidence base to support decision making?
Q1b: What does data show us to date about the extent to which lockdown has had regional socio-economic impact across Wales, and how is that informing decision making?
Point 2: Much is spoken about tracing, but the apps to support it are likely to have no benefit whatsoever unless they’re supported by significant testing; they’re reactive, not proactive. The apps also present significant data privacy issues as articles have noted.
Q2a: The Welsh Government has sought to encourage downloads of its app. To what extent have inferences been made from it to date and what evidence is there to show that they’ve been beneficial?
Q2b: How is the Welsh Government looking to accelerate the rate at which tests can be performed, particularly since a second, and possible equally concerning, wave of Covid-19 (which may well occur as a result of over-relaxation of lockdown constraints) will occur?
Point 3: Any relaxation of lockdown may result in travel to/from England (and other countries via Wales’ ports). In particular, the porous border with Wales in the SE and NE corners of Wales may see significant traffic.
Q3: How is cross-border tracing going to work, given that England – our nearest neighbour – may take a different approach?
Point 4: Much is made of R0 and yet it can be an aggregate number that takes no account of varying population density across a geography [1]. Infection transmission risk may be much greater where contact is likely to be a lot greater – areas with either a high static or transient population density.
Q4a: How is regional / local monitoring going to be performed, and in particular, how is it being incorporated into decision making regarding any re-tightening of conditions?
Q4b: What are the implications of this heterogeneity for lockdown relaxation / retightening at a local level, particularly with regards to school opening / closure?
Point 5: Finally, the risk is multiplicative with age, so older people are at significantly higher risk than younger ones. The percentage of people over-65 is greater in Wales than in the UK as a whole.
Q5a: How will that impact the relaxation of the lockdown?
Q5b: What moves are there for this group, particularly given the additional risk that an extended lockdown would present for them (eg aggravation of comorbidities)?
I must add that there is no easy answer to any of these questions, nor would any answer remain static as evidence emerges. However, we have a public health emergency with Covid-19, a virus for which there is, as yet, no known vaccine or treatment of note. It is therefore imperative the population of Wales – including businesses – have a clear idea of Welsh Government policy so they can themselves make informed choices about the risks they take.