Let’s use lockdown to break old habits and start afresh with healthier new ones

The Covid-19 pandemic has the potential to overwhelm every health care system in the world. To cope with such demand on its acute and critical care services, the NHS is buying ventilators, opening wards, creating hospitals, building labs, and vastly expanding its workforce.

At the same time, lockdown creates a natural pivot point in our lives to break old habits and start afresh with new and healthier ones. It also provides an important opportunity for the Government to implement a range of simple public health measures that could both free up NHS capacity in the short term and improve population health.

More than 10,000 people have now died from Covid-19 in the UK, with numbers of cases and deaths expected to increase dramatically in the coming weeks. Alongside this, the common problems that require hospital admission haven’t gone away: there is still a need to treat people for cancer, heart attacks, strokes, pneumonia, trauma, and much else.

But many of these non-Covid admissions are avoidable. In the year following the 2006 introduction of smoke free legislation in Scotland there was a 17 per cent fall in admissions for heart attacks, and reducing the US national maximum speed limit to 55 miles per hour in 1974 led to a 16 per cent fall in road deaths that same year.

As the roads empty following the lockdown the police are reporting increased numbers of speeding cars, including a driver caught travelling at 134mph in a 40mph zone on the A10. Over 50,000 admissions a year in England are due to collisions on the roads, but these are largely preventable.

The lower the speed the less likely a driver is to crash in the first place, and the less serious the resulting injuries. One’s chances of dying as a pedestrian if hit at 50 miles per hour are around 70 per cent. Reduce that speed to 40 miles per hour and the fatality rate drops to 30 per cent, at 30 miles per hour it’s seven per cent, and at 20 miles per hour the risk is just one to two per cent.

The Isle of Man has just introduced a maximum speed of 40 miles per hour across the island (there was no previous national speed limit) alongside lower limits in urban areas, explicitly to reduce the burden of injuries on health services. Both Bogotá and Berlin have expanded cycle lanes to support people commuting by bike.

Similar measures could be introduced overnight in the UK. Reducing all speed limits by 10 miles per hour – urban areas to 20 miles per hour, rural roads to 40 or 50, and motorways to 60 - alongside supporting information campaigns, enforcement, and increased speeding penalties could lead to significant reductions in the numbers admitted to hospital every day, particularly when lockdown measures are finally lifted.

Another key policy area is tobacco consumption. It’s well known that the short term effects of stopping smoking just four to eight weeks before a general anaesthetic can dramatically reduce the risk of breathing complications. Alongside the fact that smoking causes heart attacks, strokes, lung disease, and cancer, emerging data suggest that people who smoke are 14 times more likely to die from Covid-19 than non-smokers.

Smokers could be supported to quit through making nicotine replacement therapy free on request from pharmacies and supermarkets. And implementing the advice of the UK All Party Parliamentary Group on Smoking and Health to raise the legal age for buying tobacco to 21 could also help reduce smoking rates alongside supporting the UK’s ambition to be smoke free by 2030. These measures would not only increase the numbers of people surviving Covid-19, they would also benefit children and others sharing homes with smokers during the lockdown.

Alcohol availability presents a third major challenge. Alcohol was a contributing factor to nearly 1.3 million hospital admissions in England in 2018/19, including over 80,000 unintentional injuries. There are also increasing concerns that social isolation policies are fuelling domestic violence. Alcohol may be a contributing factor to intimate partner violence, and sales in Greenland have been banned following a rise in domestic violence there after schools were closed.

Whilst an absolute ban on alcohol sales during lockdown may not be socially or politically acceptable (although listing off-licenses as a key business does seem particularly inconsistent with broader government public health policy), it would be relatively straightforward to restrict alcohol sales per-transaction to match those imposed by supermarkets to avoid stockpiling of other products. Minimum unit pricing, in place in Scotland and Wales, should also be expedited given the 8 per cent fall in purchases seen in Scotland after the first year alone.

Policies targeting alcohol and smoking would likely narrow health inequalities and improve mental health. Policies to reduce speeding and increase cycling will reduce air pollution and create a safer and more appealing environment for the increasing numbers of key workers – including NHS staff – travelling to work by bike or on foot.

These are just some of the potential interventions, and some potential benefits. More detailed work to model the population effects of possible public health interventions, and how they might support the NHS to respond to Covid-19, is underway.

The changes we have all experienced in response to Covid-19 are highly disruptive. Rapidly implemented, targeted public health interventions should be a key part of a whole-government response to Covid-19. Interventions that can help people to stay healthy as well as support the NHS in its essential work to tackle this pandemic, allowing us all get back to normal as soon as possible.

• Adam Briggs is Associate Clinical Professor of Health Systems at the University of Warwick

• This article was co-written by Harry Rutter, Professor of Global Public Health at the University of Bath

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