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Discussing the effects of a third wave in Europe, the Prime Minister told reporters that “…previous experience has taught us that when a wave hits our friends, it washes up on our shores as well. I expect that we will feel those effects in due course.”
Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, University of Leicester, said:
“The main issue to keep in mind is that the majority of people in Europe are not yet vaccinated against COVID-19, which may underlie the development of a current 3rd (or 4th) wave. So ongoing viral replication will always have the potential to produce new variants.
“Although the UK has vaccinated almost 30 million people, with perhaps about 5-10 million people with natural immunity, almost half of the remaining population are not yet immune, which is still plenty of people in whom the virus can spread exponentially.
“Also, if the source of immunity is the AstraZeneca vaccine, various studies have shown that it is much less effective against the South African variant than the Pfizer vaccine (see e.g. https://www.nejm.org/doi/full/10.1056/NEJMoa2102214) – so the immunity in the UK population may not be that secure – and other such vaccine-escape variants may spontaneously arise from outside or within the UK.
“So some degree of social distancing and masking when indoors with other people may still be wise – until all adults are vaccinated to reduce the overall viral replication in the population which will reduce the chances of such variants arising.
“In addition, if international travel does open up, then those vaccinated may be protected against some viral strains (like the UK Kent variant) more than others (like the South African and possibly the Brazilian P1 variant). But if they encounter any viral variants that may cause symptomatic, or more likely, asymptomatic infection and bring these back to the UK, then this could seed vaccine escape variants in the UK population.
“Hopefully now, any next COVID-19 wave in the UK will not see such dramatic death and hospitalisation rates for severe COVID-19, as the elderly and vulnerable are now mostly protected from severe disease and death by vaccination.
“The healthcare burden will then likely shift to the younger unvaccinated 19-50 year old working adults, most of whom may not be sick enough to need hospitalisation, but who may visit their GPs – so shifting the burden to community/primary healthcare services.
“Yet we also know that a proportion of this age group, however, will still develop severe acute COVID-19, as well as longer COVID-19 symptoms that may last several months.
“We will just have to monitor carefully what happens and try respond quickly, appropriately and decisively, accordingly – and now after a year of experience, we should not make the mistake of under-estimating this virus anymore.”
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“The admission from the Prime Minister that the growing wave of European infections will likely affect the UK in due course seems is deeply troubling, and entirely at odds with the mantra of data rather than dates. Merely carrying on with the UK roadmap unchanged in light of these events is reminiscent of the blinkered attitudes from last summer that ultimately led to the resurgence in the autumn and repeated lockdowns. Prevention is better than cure.
“As we see cases plateauing and the persistence of relatively high levels of infection in certain areas of the UK, the idea that importing further cases from abroad cannot be avoided is even more of a concern. Whilst vaccination is going well, this must be safeguarded by ensuring that infections do not rise again before sufficient coverage is achieved, and by minimising the importation of SARS-CoV2 variants that might conceivably undermine the future of the vaccination programme.
“Whilst R0 is currently below 1, an influx of cases from Europe could reverse this and potentially allow exponential increases of infections, including variants of concern. Tighter restrictions on foreign travel across the board would mitigate this possibility, and keep the ideal endgame of UK vaccine-driven population immunity in sight.”
Prof Lawrence Young, Professor of Molecular Oncology, Warwick Medical School, said:
“A third wave is not inevitable if we can keep up the pace of vaccinations, ensure strict border control and continue to operate an effective test, trace and isolate system. The importation of virus infections from Europe fuelled the previous waves of infection in the UK. The rise of variants, particularly the South African variant which is now responsible for up to 10% of cases in parts of Europe including France and Austria, is a real concern – this variant is more transmissible, partially resistant to vaccine protection and may be able to re-infect people who have previously recovered from COVID-19. Europe is now in the grip of a third wave of infection which is being driven by the UK variant (B.1.1.7) – accounting for well over 50% of cases in Denmark, Italy and Germany. We need to keep vigilant. We are in a very precarious situation with a significant proportion of the adult population unvaccinated (approximately 21 million in the 18-49 age group) and the continued threat of more threatening virus variants popping up in different parts of the country as well as being imported from overseas. If we do find ourselves in a situation with signs of a third wave starting in the UK we may need to revisit the timetable for easing out of lockdown.”
Dr Simon Clarke, Associate Professor in Cellular Microbiology at the University of Reading, said:
“The Prime Minister’s comments suggest the UK is highly likely to see a share of the waves of infection being seen in many neighbouring European countries. Sadly, the highly infectious nature of the virus means this is quite likely. It will be interesting to see what versions of the virus arrive on our shores, but if it is the ‘South African’ variant, its resistance to vaccine induced immunity could mean we are in for trouble. If it ends up being the ‘Kent’ or similar variants, then we’ll see just how well the vaccines actually work – in real life as opposed to in trials or lab studies. One thing that is likely to happen is the exposure of the claims of super high effectiveness of the vaccines – evidence suggests the peak of super high effectiveness at around 6 or 7 weeks after vaccination only lasts for a week or so anyway before falling (after one dose).”
Prof Paul Hunter, Professor in Medicine, The Norwich School of Medicine, University of East Anglia, said:
“As stated by Chris Whitty and Sir Ian Diamond in recent weeks a further wave of COVID in the UK is inevitable. Though whether this is in the next few months or later in autumn is not certain. How the current surge in cases across several European nations will impact on the UK is also not certain at present. As my group reported back in January in a pre-print https://www.medrxiv.org/content/10.1101/2021.01.16.21249946v1 vaccination alone is unlikely to bring R down to less than one. The same conclusions were also subsequently and independently reached by a group from Warwick https://www.medrxiv.org/content/10.1101/2020.12.27.20248896v2. But although none of the current vaccines can really prevent transmission, they certainly supress transmission and will go a long way towards reducing the impact of any future wave.
“How large the next UK wave will be and when it will occur will depend on several factors:
“But even though a further wave of COVID in the UK is almost inevitable, that does not mean that it will be as bad as the last few months or that we will need as severe restrictions as we have recently been living under.
“The fact that current vaccines do prevent at least a half of infections mean that the R value will be lower when a large proportion of the UK population have been immunized. That means that we will not need as severe restrictions as currently to bring R down to below 1, even though we may still need some restrictions. Also because current vaccines are effective at preventing severe illness and death even in those who still get infected by about a half, the pressure on the NHS will be rather lower for an equivalent number of cases in the community.
“But there remains significant uncertainty about when (but probably not if) new variants with escape mutations such as the South African variant spread within the UK. Current evidence suggests that current vaccines are still effective at reducing the risk of severe disease even when they are less effective at reducing infection and so transmission. So even with the new variants, future waves should be less devastating, especially if modified vaccines are being distributed sooner rather than later.
“If we manage to keep the new escape variants under control then we should be able to have a reasonably relaxed summer, but these mutations do seem to be spreading in Europe and so could be introduced into the UK when travel restrictions are relaxed.
“So at present it is really difficult to predict what life will be like in the next few months never mind next autumn and whether or not the current roadmap is still on track. However, I do believe we are through the worst of the current pandemic at least in the UK, providing that our immunization campaign remains on track.”
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Dr Stephen Griffin: “No conflicts.”
None others received.