By DOMINIC HARRISON, director of public health Blackburn with Darwen Council

LANCASHIRE is now into its second week of the 28-day 'Very High' Local Alert Level (tier three) agreement on its new Covid control measures with central government.

Rates across the county are still rising with Blackburn with Darwen now having the highest confirmed case rate in England followed by Rossendale (as at 27/10/2020).

The average time from infection to symptoms, if you do get them, is about five days. Add on a couple of days for testing and results and it will be another week at least before we can see whether the new measures are having any discernible effect. The first week's data can only tell us what was happening before the measures were in place.

Mersey City Region did go into tier three with broadly similar measures as Lancashire a week earlier. The picture there so far looks mixed. Liverpool city rates have declined, but Knowsley still has England’s third highest rate.

We simply cannot be sure, but it seems very likely on the evidence we have, that we will exit the tier three agreement on the November 10 with rates across Lancashire that are higher than those at which we entered it.

There are then two possible scenarios. The most likely in my view is that as the 'R' rate is now very high across the country in all regions, with many other local authority areas who had previously low rates catching up fast with Lancashire, the government will be forced into calling a national circuit breaker lockdown across much of the UK. This would need to last at least three weeks and would dampen down the transmission of the virus to the point that we might exit at the level of the current tier two (tier one if we are very lucky).

The second most likely scenario is that the government will seek to negotiate further control measures, for another period of 28 days in tier three areas whose rates have not fallen. Mersey City Region will face this discussion first with Lancashire following. By November 10, many more areas in the north of England will also be in tier three and areas such as London and the midland regions are likely to be facing a tier three discussion.

Sadly however, we are very likely to find out that tier three was the right medicine at the wrong dose. The dose will have not been enough to cure the condition and the patient will have to stay longer in treatment. This will be the worst of all possible outcomes for the north of England whose economy will be impacted for longer.

International evidence suggests that those countries who act early on high and rising rates with control measures that are harsh but effective, are in lockdown for less time. The impact on the economy is reduced and more jobs and lives are saved.

On September 21, SAGE urgently advised the Government to institute a nation-wide circuit breaker lockdown for two to three weeks. The north of England is now likely to pay a disproportionate price for that scientific advice not being taken. The government needs to make that decision now.