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Background: A multi-tiered surveillance system based on influenza surveillance was adopted in the United Kingdom in the early stages of the coronavirus disease (COVID-19) epidemic to monitor different stages of the disease. Mandatory social and physical distancing measures (SPDM) were introduced on 23 March 2020 to attempt to limit transmission. Aim: To describe the impact of SPDM on COVID-19 activity as detected through the different surveillance systems. Methods: Data from national population surveys, web-based indicators, syndromic surveillance, sentinel swabbing, respiratory outbreaks, secondary care admissions and mortality indicators from the start of the epidemic to week 18 2020 were used to identify the timing of peaks in surveillance indicators relative to the introduction of SPDM. This timing was compared with median time from symptom onset to different stages of illness and levels of care or interactions with healthcare services. Results: The impact of SPDM was detected within 1 week through population surveys, web search indicators and sentinel swabbing reported by onset date. There were detectable impacts on syndromic surveillance indicators for difficulty breathing, influenza-like illness and COVID-19 coding at 2, 7 and 12 days respectively, hospitalisations and critical care admissions (both 12 days), laboratory positivity (14 days), deaths (17 days) and nursing home outbreaks (4 weeks). Conclusion: The impact of SPDM on COVID-19 activity was detectable within 1 week through community surveillance indicators, highlighting their importance in early detection of changes in activity. Community swabbing surveillance may be increasingly important as a specific indicator, should circulation of seasonal respiratory viruses increase.

Original languageEnglish
Article number2001062
Pages (from-to)25-35
Number of pages11
Issue number11
Publication statusPublished - 18 Mar 2021

Bibliographical note

Funding Information:
We are grateful to the patients, members of the public, healthcare workers, GPs, NHS trusts and other providers participating in the surveillance schemes. NHS 111 and NHS digital providers supporting NHS 111; providers submitting data to the GP out of hours system; Accident and Emergency clinicians, NHS Trusts and NHS Digital supporting the EDSSS (Emergency Department Syndromic Surveillance System); participating primary care practices and University of Oxford supporting GP in hours; ambulance trusts and the Association of the Ambulance Chief Executives in syndromic surveillance schemes. We are also grateful to the PHE Surveillance Cell, Epidemiology Cell, Virology Cell and the wider PHE Incident Management Team, as well as Health Protection Teams, Field Service and Respiratory Virus Unit and the RCGP RSC.

Publisher Copyright:
© This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence and indicate if changes were made.


  • COVID-19
  • coronavirus
  • lockdown
  • non-pharmaceutical interventions
  • social distancing
  • surveillance


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