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The handling of first two cases of Covid in the UK a year ago this week provided an ominous foretaste of the country’s response to the pandemic, according to those caught up in the incident.
On 30 January last year the official threat level from coronavirus was moved from “low” to “moderate”, as rescue flights were organised for 273 people stranded in Wuhan in China’s Hubei province, where the outbreak began.
It was also the day that the first two people already in the UK, tested positive for the virus. Although this first outbreak was successfully contained, the incident did expose some now familiar flaws in the UK’s approach to the virus.
The pair involved, a 23-year-old Chinese national studying at York university and his 50-year-old mother, were among more than 18 million people who travelled to the UK in the first three months of 2020. Unlike the rescue flight evacuees these travellers were not made to quarantine on arrival.
The son had travelled from Hubei to the UK on 6 January. His parents flew to the UK from Hubei to visit him on 23 January. A day later they checked into the Staycity apartment hotel in York with their son. The mother began feeling queasy on 26 January and when her son also fell ill, he called NHS 111 to complain they were both suffering with a dry cough and a fever.
Just before 8pm on 29 January all three guests were ushered to an ambulance by paramedics in hazmats suits. They were initially taken to hospital in Hull, where they were tested. According to an article in the Journal of Infection by the doctors who treated them “they were managed in separate negative pressure cubicles with anterooms”.
One of the authors, Dr Patrick Lillie, said: “At the time, there were less than 10,000 reported cases of coronavirus in the world. Therefore we had very little understanding of what this was, how infectious it was, what the spectrum of the disease was and what we were dealing with.”
The patients’ test samples were analysed at Public Health England’s (PHE) lab in Colindale, north-west London. On 30 January both mother and son tested positive. As Lille and his colleagues noted “interestingly” the father “remained asymptomatic throughout and had negative tests”.
On Friday 31 January the family were transferred to a high-level isolation unit in Newcastle.
There was intense media interest amid growing public concern in York after the guests were seen being removed by paramedics in hazmat suits on 29 January. But the positive results were not announced until the afternoon of Friday 31 January. Until then journalists were give the “runaround” by all the organisations involved. PHE, NHS England, the Department of Health, and Newcastle hospital, all refused to discuss the incident.
Staycity hotel was also staying quiet about the incident to its increasing anxious guests. On at least one occasion a staff member told guests that reports of a suspected coronavirus case were “all lies”. Staycity now insists this was unauthorised comment and that it followed PHE guidance throughout.
Sami, not his real name, was one of at least six members of the hotel to have come into contact with the infectious guest, when he checked them in. Contract tracers from PHE got in touch with him to ask how long he had spent with the family.
Speaking to the Guardian he said: “When I checked the CCTV it showed I was with them for three minutes and you could tell they were not 100% well.”
He added: “They [PHE] said there was no risk. I asked if I could get a test because I was worried, but they told me I didn’t need to. They said I could carry on working and to call 111 if I had any symptoms. I was surprised, because we were getting customers calling asking: ‘How are you still open?’; they kept swearing, saying: ‘Have you not seen the news? Just close the bloody hotel.’ We were refunding customers non-stop.”
That weekend Staycity had 388 cancelled bookings at a cost of £51,000.
The hotel gave PHE the names of six individuals who had come into contact with the infected guests. They included an engineer who had fixed a washing machine in their room and a cleaner who was advised to self isolate for two weeks. The room was later decontaminated with a hydrogen peroxide-based product developed in the US to tackle an anthrax attack.
In total PHE contacted 52 individuals who had close contact with the family, according to a paper in Epidemiology and Infection, that was co-written by some of the PHE staff involved. They included taxi drivers, hotel staff, and 45 healthcare workers.
It revealed there was particular concern about the risk to cleaners. “A small number of contacts had exposures with potentially higher risks such as those cleaning environments, which were potentially contaminated. These groups were placed under active follow-up but did not develop Covid.”
Another cleaner was also exposed to potential contamination because of the scarcity of information shared by PHE, according to York Central’s Labour MP, Rachael Maskell.
This also hampered efforts to reassure the public, she said. “People were very frightened right from the beginning, and that fear fell first in York. Institutions were frustrated that they weren’t being informed, even the local authority were not being kept informed of what PHE were unveiling.”
On 1 February the York University issued a statement confirming that one of its students had tested positive but had had no contact with the university while infectious. But on 4 February PHE revealed that the student had spent a night at privately provided student room days before he tested positive.
Maskell says this clarification came too late to prevent a cleaner entering that room unprotected. “PHE should have been talking earlier to the university to a highlight a potential risk to students and cleaning staff,” she said.
Prof Charlie Jeffery, York university’s vice-chancellor, said: “Clearly it wasn’t helpful that we didn’t have the full information at first. But I don’t think they [PHE] had got the full story from the family at that time.”
Sharon Stoltz, York city council’s director of public health, is less forgiving. She said: “Data sharing was a constant battle. We weren’t give the right information at the start. People were highly anxious and afraid of being exposed to the virus, so it was vital that we gave accurate information and that was difficult.”
Fear in the city was becoming ugly, with some incidents of racist abuse against people with an east Asian appearance. Stoltz said: “There were exaggerated fears about overseas students in the city. We were very concerned about potential civil disorder and community safety.”
And fears were stoked as other people were taken away by paramedics in hazmat suits. Stoltz wanted to confirm that these turned out to be negative tests to reassure the public. But she was advised against citing specific areas or streets by the Department of Health and PHE for fear it could undermine patient confidentiality.
After some “lively discussions” Stolz decided to ignore the central diktat to issue only generic messages. “We couldn’t depend on PHE getting information out to us quickly enough and that the tone needed to be personalised to York,” she said.
In the paper they co-wrote, PHE staff said: “Contact tracing was complex and fast-moving. Additional challenges were encountered through media and national interest and having to rapidly review the available evidence and develop scientific consensus to inform actions. Despite these challenges, no confirmed links [to these patients] were identified.”
Dr Mike Gent, PHE’s deputy director, said: “PHE had robust plans in place to detect and respond to the first case of Covid-19 in the UK. We shared necessary information promptly with stakeholders as the incident evolved, working closely with NHS partners, City of York council and the University of York, to trace close contacts of the cases and successfully prevent any further cases of infection linked to the initial cases.”
Despite the communication problems, Maskell said the incident showed that contact tracing worked. But she questioned why the government initially moved away from trying to trace contacts as cases increased. “At the beginning it was a central tool for being able to manage the pandemic, so why was there a decision to change that?”
The identity of the student and his family have never been revealed. Prof Jeffery said: “I have never known the identity of the student because I didn’t need to. Some of my colleagues did and I was told there was real appreciation for the efforts we took to maintain their anonymity.”
On 17 February they were released from hospital in Newcastle after twice testing negative.
Source: The Guardian
Keyword: Covid in the UK: how first cases exposed flaws in response | World news