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England risks following the route of several US states which have seen a sharp rise in coronavirus cases after lifting lockdown too early, a leading epidemiologist has warned.
Professor Gabriel Scally, a member of the Independent Sage group of experts, said that the country was in a “difficult and dangerous situation” after Boris Johnson’s decision to ease restrictions while daily infections are still running well into four figures, the NHS Test and Trace system has yet to prove its effectiveness and the promised smartphone app has been shown to be a “dead duck”.
He was speaking to The Independent after a joint plea was issued by eminent doctors, including presidents of 11 medical royal colleges, for Mr Johnson’s administration to make preparations for a probable second wave of Covid-19.
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The prime minister on Wednesday told MPs there was there was an “effective cluster-busting operation” in place to nip Covid flare-ups in the bud before they have a chance to spread, as has happened at a hospital in Weston-super-Mare and GP surgeries in north London.
But Labour leader Keir Starmer questioned whether the test and trace service was identifying and contacting enough infected people to prevent further spread.
Pointing out that just 10,000 of the estimated 33,000 thought to have coronavirus in England have been referred to the system, he warned: “The prime minister risks making the mistakes he made at the beginning of the pandemic, brushing aside challenge, dashing forward, not estimating properly the risks.”
And medical experts warned that the simultaneous relaxation of lockdown restrictions in pubs, restaurants and hotels on 4 July creates a “serious risk” of rate of reproduction – known as R – rising from its current level in England of 0.7-0.9 to above 1, the point at which the disease could start surging again.
Warwick University epidemiology assistant professor Louise Dyson said: “Until now the relaxations made to lockdown primarily allowed more interactions outdoors.
“The proposed releasing of so many lockdown restrictions simultaneously, including allowing more contact indoors, without an effective test and trace scheme, represents a serious risk of the R number rising above one.”
And Dr Ed Hill, who is modelling the spread of disease at Warwick, added: “Whilst it is not possible to predict with certainty the future course of the pandemic, a second wave of infection remains a real risk. Concurrently relaxing multiple measures, including allowing more contact indoors, poses a serious chance of increased transmission and of the R number rising above one.”
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The Royal Colleges’ letter called for an urgent review to ensure the UK is ready for a second wave of coronavirus, in the absence of any proven vaccine or failsafe treatment for the novel illness.
One of the signatories, Royal College of GPs president Martin Marshall, told The Independent: “I don’t think anybody knows whether the Covid virus will have a second wave, but on the basis of epidemiological history it is likely. Historically, second waves have often been worse than first waves, so that is why we have to take it seriously.
“If we unprepared, it would be unforgivable.”
Key measures which must be taken include better coordination of different parts of the healthcare effort, robust supply chains for protective equipment (PPE) and testing kits, greater involvement of local NHS and public health professionals in commercially-run test-and-trace operations and protection for vulnerable people including Bame communities, he said.
“And we have to learn from other countries,” said Prof Marshall. “We can’t pretend to have done as well as we would have liked in the first wave. If you compare us with Germany or Australia or Singapore and South Korea, we could have done a whole lot better.
“In other countries they tested early, traced rigorously and isolated robustly and stopped the spread. The only alternative is to hope there’s enough immunity in the community to stop spread happening, and of course there isn’t.”
US states like Arizona, Florida and Oklahoma – where Donald Trump held a controversial rally last weekend – have recorded sharp rises in coronavirus cases after reopening shops and bars while the disease was still circulating widely in communities.
Prof Scally, public health professor at Bristol University, said he was “very alarmed” to hear chief medical officer Chris Whitty acknowledge at Tuesday’s Downing Street briefing that he expected Covid to remain at “significant” levels in England through to the spring of 2021.
“I find it quite terrifying to think that is the level of their ambition,” he told The Independent. “As I see it developing, there will be a whole series of outbreaks. That’s almost inevitable.
“If the estimates of 3,000-5,000 new cases every day are right, if we are still getting deaths in three figures, as we are, and if that is going to go on to the spring, the fear will be that there will be a lot of outbreaks in due course and these will coalesce and become uncontrollable and form a second wave.”
Independent Sage earlier this month released proposals for a more locally-oriented test and trace system, drawing on the expertise of public health officials, GPs and health visitors, and crucially offering financial incentives for those identified as contacts of infected people to self-isolate.
He urged ministers to put resources into beefing up the system and to urge the public to maintain social distancing even as lockdown is being relaxed.
“You just need to look at the states in the US who have lifted their lockdown restrictions and they are, lots of them, having very substantial increases in new cases,” he said. “Absolutely we are in danger of following that route.”
Ironically, Prof Scally said that the lack of public trust in the government may help England avoid a second wave, as many people will decide not to take Mr Johnson’s advice that it is now safe to visit pubs, restaurants and non-essential shops.
But he said it was an “abdication of responsibility” for the government to rely on the common sense of the public to avert a fresh outbreak.
Speaking at prime minister’s questions in the House of Commons, Mr Johnson insisted: “What NHS Test and Trace is doing is contacting the vast majority of those who test positive and their own contacts and getting them to self-isolate, and it is a formidable achievement.”
And the PM’s official spokesman told reporters that Nightingale hospitals in London, Manchester, Bristol, Harrogate, Sunderland and Birmingham remain on stand-by, and another in Exeter is being completed, in order to be ready to deal with a fresh upsurge of Covid.
Meanwhile, some 21, 200 mechanical ventilators and 11,000 non-invasive ventilators remain available – well above the 18,000 said to be needed at the height of the first wave of infections.
The spokesman said: “We have taken unprecedented action to support the NHS and thanks to the hard work of NHS staff, hospitals were not overwhelmed.
“We will continue to ensure our health and care services have the resources they need and are working closely with the NHS to prepare for the winter.”
But former health secretary Jeremy Hunt backed the royal colleges’ warnings of a second wave.
Speaking to Emma Barnett on BBC Radio 5 Live, Mr Hunt, who is chair of the House of Commons health committee, said: “The point they’re making about a second wave is absolutely right. You just have to look at Germany which has had one of the best responses and they’ve got this big issue in a meat processing plant, thousands of people infected. Look at South Korea which had to trace the contacts of 1,700 people after a nightclub incident.
“So even in the places that are the best in the world, they’re dealing with these spikes and we have to recognise there’s a very real risk of that happening here too.”
Acting leader of the Liberal Democrats Ed Davey backed the doctors’s call for a review on lifting lockdown.
“Yesterday Boris Johnson announced a dramatic shift away from lockdown, despite the fact that we still lack an effective system to test, trace and isolate that is essential to keep people safe,” said Sir Ed.
“With no cure and no vaccine for Covid-19, the risk of a second wave is very real. Given that the Conservative government failed to secure adequate protective equipment or ramp up testing capacity at the start of this crisis, ministers must act now to guarantee that we are ready to meet new surges.”
