September 22, 2020

expert reaction to latest daily COVID-19 case numbers

The government have confirmed that there were 4,926 new confirmed cases of COVID-19 om Tuesday 22nd September 2020. 

Prof James Naismith FRS FRSE FMedSci, Director of the Rosalind Franklin Institute, and University of Oxford, said:

“The increase in today’s numbers of positive tests (4368 to 4926) and the Prime Minister’s announcements brings in to focus the challenges ahead.

“The first wave of covid19 may well have cost over 60,000 lives, based on excess deaths, the most useful measure.  Government statistics record around 42,000 deaths from covid.  These are tragedies.  As a point of comparison, Germany has had less than 10,000 deaths directly from covid.

“We had no choice but to lock down in March; were the hospitals to have overflowed, the death rate would have risen steeply due to triaging –  rationing healthcare to those judged most likely or most important to survive.  In the whole population, the virus kills around 0.3% to 0.4% of those infected.  However, the risk of death climbs steeply with age such that the elderly and those with other health problems are much more at risk.

“Lockdowns work because they break the transmission mechanism.  They are a blunt instrument, there is no doubt they have serious adverse outcomes.  It is to be regretted that we once again face further restrictions on our lives.

“The whole point of the track, trace and isolate system was to avoid a lock down.  I and many others consistently cautioned that building an effective system in the UK in such a short time, was a tall order.  We warned that it needed clear focus, experienced management and expert logistics.

“The 20% compliance with self isolation amongst symptomatic individuals, never mind the asymptomatic, renders the system useful for data gathering but less helpful in preventing transmission.  The importance of isolation of positive cases has been stressed by scientists for months.

“I believe the UK today is entering a second wave, our actions today matter.  We will see fewer deaths because medicine and science have provided effective treatments, but lowering the death toll is also a matter of public support and government action.

“We have to realistic in what we can do now that will make a difference between today and mid 2021 when a vaccine has been deployed.

“We could simply roll the dice, trust in ‘common sense’, ‘shield the vulnerable’, hope there is enough cross reactive T-cell immunity in the community and guess that the most efficient spreaders were infected in the first wave (limited herd immunity effect).  But what is ‘common sense’ in the pandemic changes, is hotly debated and ill defined.  In the first wave we did not ‘shield the vulnerable’ despite good intentions – we might do better next time.  There is no strong evidence for the immunity theories, that is not to say they are wrong.  Certainly given the much higher prevalence of covid19 in the UK’s first wave, if any country has reached a degree of herd immunity the UK is the prime candidate but there is no experimental evidence for such a hope.  Given the rise in cases we are seeing, there is evidence against it.  However, those who advocate ‘getting on with it’ should clearly outline the consequences and who faces them if they are wrong.  A strong second wave that overwhelms the NHS will kill thousands of mainly older people (since triage most likely will prioritise the young and otherwise healthy people with longer more economically productive lives ahead).  Of course if they are right and ‘getting on with it’ works, normal life can resume almost at once.

“However, there is evidence that the virus has not changed, less than 20 % have been infected (thus 80 % could potentially be infected), re-infection is possible (decreasing the potential for herd immunity), and that historically respiratory infections tend to come in waves.  Since shutting the entire country down for the winter is impossible (and undesirable), it is my view that more likely than not there will a second wave with deaths this winter.  We can and must reduce the toll, by doing our bit.  First and foremost, if we get sick or test positive, immediately fully self isolate.  If we live with someone with covid19, isolate ourselves.  Wash hands regularly, wear a mask to protect others, socially distance as much as possible, be outside where possible if we interact with others and ventilate with fresh air inside.

“For the government, supporting isolation is vital – if we don’t fix the 20% then everything else is much harder.  We have to test people with symptoms as quickly as possible and if not infected allow them to end isolation as soon as they are symptom free.  For positive cases, support whole household isolation, we know that inside the house is where most transmission occurs.  Obviously, simple easy to use tests would enormously help.  If you believe there will a second wave (as I do), since track, trace and isolate has not prevented the rise in case we now have to balance serious illness and deaths of some against everyone’s liberty / prosperity / well being.  It is right that this is for elected politicians to make these judgement, not scientists.  Data indicate some activities spread the virus more efficiently than others, the most effective curbs will be those that target these.  If right, the restrictions will have a real cost (socially, economically and in quality of life) over this winter, but we will have saved thousands of heartbreaks.  If this is all wrong, these restrictions will disrupt family life, limit the chances of young people and further damage the economy (which in turn will damage health) for no gain.

“I unequivocally support the right and duty of scientists to speak publicly to identify error or suggest a new course during this pandemic.  In doing so it is important for scientists to be clear about what is actually known as opposed what is possible or predicted, giving the evidence.  It is disheartening to read articles from scientists full of certainty that ‘there is one simple thing we need to do’.  Such articles often fail to communicate the complexity of the issue nor do they allow for the possibility of their own error and outline the consequences of any such error.  The stakes are very high and the public deserve our best efforts.

“We all need to trust that whatever government politicians decide to do or opposition politicians advocate for, has been done in good faith, is based on evidence and is clear about the consequences.  This has to mean more openness about what is not working and being upfront about trade offs and risks.”

https://coronavirus.data.gov.uk/

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