COVID-19 Healthcare Challenge - a localised Leicester lockdown

On the 30th July 2020, the UK Health Secretary, Matt Hancock, announced that police have been given localised powers to enforce two further weeks of lockdown extensions in Leicester, as part of the first city-wide coronavirus response to a regional spike in cases, contrasting the usual top-down centralised government response in the UK.

Why has Leicester been ordered back into stricter lockdown restrictions?

As the rest of the UK has and continues to see the easing of lockdown measures in response to lower coronavirus deaths and cases per capita, Leicester has been performing "very significantly worse" than other cities according to Matt Hancock. These comments were made after comparisons between Leicester and other north-west and Yorkshire cities with similar demographics showed the hallmarks of a second localised spike in cases in Leicester, together with a steady rise in deaths, which has not been the case generally across the UK.

Grim milestones

Total coronavirus cases in Leicester have steadily increased since 14th March 2020, showing no sign of a reduction unlike nationwide cumulative totals in the UK. On 26th June 2020, Leicester passed 1,000 new cases and a seven-day infection rate of 135 cases per 100,000, a grim milestone not in keeping with the general downwards trend in other similar cities in the UK or indeed the majority of Europe.

Put into context, this is almost exactly one third of total cases since the beginning of the pandemic, with 2987 positive coronavirus tests confirmed in Leicester since then. 

Socioeconomic factors

Language barriers, high levels of diabetes and poverty could also be factors that are affecting the localised spike in Leicester. Children in Leicester have also been increasing among coronavirus carriers with unusually high incidence - whilst the evidence shows children do not suffer from severe illness requiring hospitalisation and they are far less likely to die than adults in every age group,  their role as potential carriers affecting vulnerable adults has lead to schools being once again closed as of Thursday 2nd July in Leicester.

The government's response to the increase in COVID-19 deaths and cases in Leicester has been clear; a local lockdown needs to come into force without further delay in exploring the reasons why Leicester is falling behind cities with similar demographics in its recovery from COVID-19. 

What restriction will be reinforced in Leicester's local lockdown?

Leicester residents will find that since the first easing of lockdown two weeks ago, a number of reversals will be made this week, including:

• all non-essential shops will be closed from 4th July
• all schools will be closed from 2nd July
• nationwide easing of restrictions from 4th July will be extended in Leicester to 18th July at the earliest
• all stores apart from supermarkets and pharmacies will be closed for two weeks
• no new ban on cars and trains in the city for now
• ease of shielding restrictions for the most vulnerable will not take place on 6th July in Leicester.

Public Health England image of Leicester areas affected by new localised lockdown

Source: Public Health England (PHE) press release 30th June 2020

Why could keeping responses localised be more effective at fighting spread?

The UK's city of Leicester is not the only major high-COVID-19 case country enforcing lockdowns at a local level, though it was perhaps inevitable that the country with the third highest cumulative coronavirus deaths, by number of days since 20th death, would experience a second spike in cases. The USA, with the highest recorded number of cases and deaths of any country in the world, has seen recent steady increases in the number of confirmed coronavirus cases in 36 of its 50 states as of 28th June 2020, including Texas and Florida.

Former Centre for Disease Control (CDC) Director Tom Frieden has warned that the local increases are "real increases", caused by new spread and not the result of anomalies due to higher number of tests being undertaken. He has blamed the rising numbers on "hasty re-openings" and predicts the increases will go on for weeks, meaning second lockdowns on a local level may be inevitable for large pockets of the USA.

In context, the USA has confirmed 2.54 million cases and 125,747 deaths according to John Hopkins University (correct at the time of writing on 30th July 2020). Governments at a local level have to balance the socioeconomic impact of re-imposing lockdown restrictions with the vast numbers of cases, deaths and daily coronavirus records seen in these localised pockets.

We have seen that case-fatality rates fluctuate within countries, so it seems reasonable that government and health authority response to local spikes should be focused on concentrating mobilise a swift shore up local ICU capacity for patients requiring ventilators and enforcing different lockdown restrictions dependent on why one area is affected more than another within the same country, to minimise local spread.

Once anomalies and other noise factors are dismissed when observing local trends, identification of potential spikes at a local level can enable a more rapid response to minimise the affect on local and national communities. If we can ensure fast, effective response to local spikes, we have a better chance of eliminating a spread throughout an entire country and beyond - it seems more governments are taking this approach and the data will allow us to determine how successful it has been.