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December 2020

Tier 1 ‘didn’t work’ and tier allocation ‘too slow’

Apart from colleagues in a handful of areas, many general practice nurses are probably feeling pretty cheesed off about their current tier of COVID-19 restrictions.

But new research from the University of East Anglia shows that Tier 1 restrictions had little impact on COVID-19 transmission before the second lockdown came into effect. Tier 2 restrictions were also ineffective in around half of local authority areas. Tier 3 restrictions seemed to be effective in most areas, researchers said – but the real problem was that regions were not allocated to the most appropriate tier quickly enough.

They analysed the impact of restrictions between 14 October when the three tier system was introduced, until 5 November when the second lockdown was imposed.

They estimated the R number at different time points in each English local authority and found that there was little difference between authorities in the rate of infection when the tier system came into force, but by day 14 the R value in Tier 3 authorities had fallen to about 0.9, in Tier 2 to about 1.0 and in Tier 1 the R value was about 1.5.

Lead researcher Professor Paul Hunter said: ‘Based on this analysis, almost all of the regions in Tier 1 should have been in Tier 2. And about half of Tier 2 should have been in Tier 3.’

The team hopes that their findings will help to make the tier system more effective now that lockdown has lifted.

Practice Nurse 2020;50(10):6