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Covid: Have local lockdowns worked? Local lockdown UK: Do city-wide curbs work? It's not clear
(14 days later)
After a summer of gradual relaxation, the UK faces the prospect of further nationwide restrictions. But about a fifth of the population already know what it's like to go back into some form of lockdown. In many areas under local lockdown, cases and hospital admissions have continued to soar. Does that mean restrictions don't work?
So are these local lockdowns effective, and what can we learn from them? Consider the national lockdown in the spring. While it feels like it was one single policy, it was in fact a package of different measures. Schools, universities and offices shut. Pubs, restaurants and non-essential shops closed. No-one could mix with people from outside their household. People were advised not to use public transport and to limit the number of times they visited essential shops.
Not all lockdowns are created equal Together these had a dramatic impact on cases, and the number of coronavirus patients in hospital plummeted from 20,000 to about 800.
Since July, more than 10 million people have come under some form of new curbs to their freedom, from pub closures to a complete ban on mixing with other households. How much each part of that lockdown contributed is hard to say.
Restrictions were brought in at different points in local outbreaks. The rules were relaxed but then, at the end of June, Leicester became the first place to go into a local lockdown. Other cities, and whole regions, have followed. But so far, Leicester's lockdown is the only one to have come close to the strictness of the national policy. Shops and pubs were stopped from opening. Households were barred from mixing indoors. And new cases of the virus dropped by 60% during July. People in hospital beds with coronavirus fell from 88 to 18.
Given that many local restrictions have been implemented so recently, it is difficult to assess how effective they've been. Since Leicester, local lockdowns have multiplied. More than 15 million people - very roughly, a quarter of the UK population - have come under new curbs, in some form.
However, data from Leicester, Leicestershire and Greater Manchester, which have been subject to restrictions for longer periods, provide some insight. And it's become harder to see whether they are working or not.
In Leicester, action was taken fairly late, once cases had surpassed 140 per 100,000 people. Take Bolton, in Greater Manchester…
But once they were brought in, the measures were stringent, preventing shops and pubs from opening, and households from gathering indoors. After the first changes, cases continued to rise, throughout August. Then, after pub and restaurant closures, case rates dropped sharply. It is, however, too soon to say for sure that the stricter measures led directly to the decline.
And that lockdown had a visible impact on cases. In the rest of Greater Manchester, gatherings with other households were banned but shops, pubs and restaurants remained open. Cases have mostly kept climbing throughout these local restrictions.
Allowing for the fact that some people might change their behaviour a little before or after a formal lockdown is announced, the rise and fall in case numbers tracks very closely with measures being implemented, and then eased again. However, the latest week's data will be welcome news - suggesting the sharp increases might be levelling off. The rise in cases in many areas under local lockdown appears to be slowing, in line with the national picture.
Pubs, restaurants, gyms and beauty salons were gradually allowed to reopen from the beginning of August to the start of September. There are still limits on gatherings across the city. This may be a sign that the England-wide "rule of six" is working.
In Greater Manchester, a slightly different approach was taken. A large national study, published last week, confirmed the growth in cases was slowing across England, although overall levels remained high. But restrictions on households meeting - which have been seen at a local level - don't always lead to a slowing case rate. And this change in impact highlights the many factors involved which make it difficult to isolate the precise effect of local lockdowns.
Measures were brought in sooner than in Leicester - when cases hit about 80 per 100,000 people - but initially they were softer. People don't necessarily change their behaviour exactly in line with rule changes.
Gatherings with other households were banned, but shops, pubs and restaurants remained open. When concerns about cases rising begin to be reported, some people alter their behaviour before any law change. Other people, even when the rules come into place, don't obey them.
And the pattern when it comes to cases is less clear. So it may be a question of timing: are people more ready to restrict their movements now than they were in August?
Although Oldham saw a large weekly drop immediately after the restrictions were added, the trend has generally been upwards. To complicate the figures further, other things have been going on at the same time as local lockdowns were being introduced, including summer holiday season and schools reopening.
'Confirmed' cases In Leicester, cases fell when restrictions were introduced. When they were progressively eased in August and September, cases started to rise. But this rise coincided with more people travelling abroad. And with children going back to school.
When we talk about cases, what we're really seeing is how many cases are being confirmed through testing - and this can vary wildly depending on how much testing you do. In Greater Manchester, cases also rose over those months despite the area being in lockdown - albeit a looser version than Leicester's had been.
Testing has been troubled in recent weeks, but earlier in the summer huge resources were focused on areas with outbreaks, including testers going door-to-door to swab people, regardless of whether they had symptoms. Unpicking these different factors is a big challenge.
The government doesn't publish a breakdown of testing by local authority, but Public Health England does publish regional positivity rates - the number of positive cases as a proportion of all tests carried out. Looking at "positivity rates" - the proportion of all tests that are positive, adjusting for different levels of testing - shows there have been increases in cases across England, with particularly sharp spikes in the North West and North East between the end of August and the end of September. Restrictions in those regions were only introduced between the middle of September and the beginning of October, making it too soon to see the impact of these rules.
This makes earlier increases in cases look a little less steep than they do from confirmed cases alone. But in Blackburn, which has been in lockdown long enough for an effect to be seen, there was also a rise in cases - though this has come back down in recent weeks.
But it shows that recent rises in case numbers have been genuine, and not just a result of more testing. Recent increases in hospitalisations from coronavirus have highlighted the extent of the challenge facing the north of England. Though without up-to-date localised data, it is difficult to judge whether the impact on a local level - such as those in Blackburn - have helped prevent serious cases.
Hospital admissions There's no doubt the national lockdown had a considerable impact on cases.
While case numbers are skewed by how many tests are being done, hospital admissions are a more consistent measure. Fundamentally, the virus needs people to be in close contact and mixing between circles to spread through the population. How tight the restrictions are makes a difference - look at the experience of Leicester, compared with Oldham or Blackburn.
Looking at both hospital admissions and deaths in Leicester brings home how much impact its second lockdown had. But so do the crucial issues of timing and compliance. A lockdown only works if people stick to it.
A rise in hospital admissions was stopped in its tracks and reduced - only to come back up again in recent weeks, as restrictions have eased. The data also indicates that any impact lockdowns do have is far from permanent - relax the restrictions and allow more contact, and the virus will quickly start to spread again.
Coronavirus deaths in the city also saw a sustained decrease, with Leicester recording fewer than five deaths a week in the month to 7 September.
In Greater Manchester, again the picture is less dramatic but hospital admissions do appear to have been kept at a low level following the introduction of restrictions.
It is possible the measures did something to protect the most vulnerable, even if they didn't have as noticeable an impact on overall cases.
And, perhaps because some restrictions were brought in at an earlier stage, the rise in cases doesn't appear to have led to higher death rates.
But local hospitalisation data has only been published up to 2 September. National data shows hospital admissions for Covid have been creeping up since then.
In fact, since 2 September the number of people in hospital with coronavirus in the north-west has tripled to 393 - the highest since 6 July.
That hasn't yet translated to an increase in the number of people dying, but that will be the fear.
The data confirms that curbs in local areas can have a considerable impact, and the tighter they are, the bigger the impact on cases.
Fundamentally, the virus needs people to be in close contact and mixing between circles to spread through the population.
But it also indicates that the impact is far from permanent - relax the restrictions and allow more contact, and the virus will quickly start to spread again.
Unless and until a viable vaccine becomes available, government will be faced with the same choice: shut down large chunks of society or allow the virus to tear through communities, with little idea of the true toll that either will exact.Unless and until a viable vaccine becomes available, government will be faced with the same choice: shut down large chunks of society or allow the virus to tear through communities, with little idea of the true toll that either will exact.
In many areas under local lockdown, cases and hospital admissions have continued to soar.