The impact of social and physical distancing measures on COVID-19 activity in England: Findings from a multi-tiered surveillance system

James Lopez Bernal, Mary Sinnathamby, Suzanne Elgohari, Hongxin Zhao, Chinelo Obi, Laura Coughlan, Vasileios Lampos, Ruth Simmons, Elise Tessier, Helen Campbell, Suzanna McDonald, Joanna Ellis, Helen Hughes, Gillian Smith, Mark Joy, Manasa Tripathy, Rachel Byford, Filipa Ferreira, Simon de Lusignan, Maria ZambonGavin Dabrera, Kevin Brown, Vanessa Saliba, Nicholas Andrews, Gayatri Amirthalingam, Sema Mandal, Michael Edelstein, Alex J. Elliot, Mary Ramsay

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


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

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


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