Has England learned any lessons from the first wave of coronavirus? | Philip Ball | Opinion

No one knows what the next months hold, but suggestions that Britain will be back to normal by Christmas seem unlikely. Already, Leicester, Greater Manchester and Preston have enforced local lockdowns after registering rises in Covid-19 cases, while increases in Spain and Germany are an alarming reminder of the difficulty of controlling this virus. Cold weather could potentially boost the spread of coronavirus and make social distancing outdoors more difficult. The dangers are clear – so is England ready?

“We’ve got to up our game for the autumn,” says Ewan Birney, deputy director of the European Molecular Biology Laboratory. “We’ll be inside more. Universities and schools will be running. There will be a whole bunch of contacts we don’t have now.” England has made significant progress over the summer on some of the problems that made the first wave of coronavirus so disastrous. But this still may not be enough, and outcomes depend on factors that are hard to predict.

“We can anticipate a lot more infections over the next few months,” says virologist Jonathan Ball of the University of Nottingham. The government has pledged £3bn of extra funding for the NHS, but more support and preparation may be needed urgently to cope with the challenges of this winter.

The nightmare scenario for the NHS, according to Chris Hopson, chief executive of NHS Providers, is a combination of events all arriving at once. A second surge of Covid-19, combined with a difficult outbreak of flu and the usual pressures that winter puts on health services, could occur at the same time that the NHS is trying to restart services that were suspended during the crisis – all faced by an exhausted staff. “We struggle with winter pressures at the best of times, with insufficient bed and community care capacity to deal with levels of demand,” Hopson says.

It’s not all gloom, though. The situation with personal protective equipment has improved, as has the availability of ventilators. What matters most, however, is the capacity for testing. England’s response was crippled by its lack of testing capacity during the first wave, when scientists and public health authorities were flying blind, not knowing how widespread the virus was or where it was concentrated, and care homes were left fatally exposed.

It’s different now. The UK is conducting tests as widely and as fast as most European countries: around 200,000 each day. Most of these are analysed in the Lighthouse labs established for the purpose but repurposed academic labs are also helping. “We’re in a much better position than we were at the start of the pandemic,” says molecular geneticist Andrew Beggs, who leads testing efforts at the University of Birmingham. “The government has massively increased capacity in a short space of time, and I’m more confident than I was two months ago.”

What’s needed, says Ball, is “sentinel surveillance”, focused testing to actively discover levels of infection, particularly in high-risk locations such as hospitals and care homes, as well as schools and universities. The Office for National Statistics is heading a pilot survey to test a representative sample of households in the general population – up to 150,000 people a fortnight by October – to gauge the extent of infection. Such monitoring can alert public health services and epidemiologists to hotspots, so that they can be contained locally. This lets hospital staff know which patients can be safely kept on general wards, and whether they themselves are safe to be at work. Regular testing will be essential for frontline workers such as public transport staff.

Tests are nearly always returned now within 48 hours (much longer and they are of little value), and often within a day. New tests developed by British companies such as Oxford Nanopore and DNANudge could hypothetically reduce the waiting time to a few hours or less – allowing for tests to be portable and conducted on site, in places such as airport check-ins, commercial centres and factories. These options are still a long way off – and they depend on whether the promising initial results from the new methods stand up, as well as the companies’ unproven ability to scale up production. But “even if one technology doesn’t work out for rapid onsite screening, we have others in the pipeline”, says Beggs.

Both the number of tests and their speed still need to increase, though: Hopson thinks we’ll need about 1m tests a day by the end of December. “That’s a very tall order,” he says. And the system needs to be joined up: a test result must go at once into a patient’s health records so it can be accessed by local GPs.

It’s vital too that positive results are followed up with good contact tracing, which is still the weak link in the government’s Covid response. The number of people being contacted is far lower in the UK than in other countries, such as Germany, and it’s not clear how much they are actually self-isolating. “There has been no data published on it and we know it’s not happening”, says Susan Michie, professor of health psychology at University College London. People who are financially unable to self-isolate for 14 days need to be supported, with lost earnings covered by the government.

And then there is the question of schools. While there’s general agreement that getting pupils back in must be a priority, this will inevitably cause the virus to spread. There’s evidence that secondary-school pupils can do that as much as adults, and primary-school children can do so even if they display only mild symptoms (probably about 15-20% of children infected have no symptoms at all). But there are encouraging signs that schools might not be as big spreaders as initially thought. Sweden left schools open and didn’t see lots of outbreaks or transmission, says Sanjay Patel, consultant in paediatric infectious diseases at Southampton Children’s Hospital, and teachers had lower rates of infection than taxi drivers or supermarket workers.

Patel predicts that schooling “will be hugely disrupted – there will be closures and outbreaks, and lots of children will be in and out of school”. Children who get the usual winter sniffles “will have to be excluded at once until they get a test result, and their parents will have to isolate for that period too”. There’s no zero-risk option, but “the best way of protecting against outbreaks in school is to minimise infection in the community”, Patel says. This means compensating for school openings with restrictions elsewhere. “Do we prioritise our ability to have a drink in the pub, or the future education of our children?”

So are we ready? No – that would be nigh-on impossible even with a functioning and competent government. But we’re not as woefully vulnerable as we were in March. “We have some really good plans in place for this winter”, Patel adds. “We’ve learnt a lot from the first surge, and there’s absolutely no feeling of panic.”

Philip Ball is a science writer

Source: The Guardian

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