The UK is at a “tipping point” in the Covid-19 crisis and must act swiftly to avoid history “repeating itself”, the deputy chief medical officer, Jonathan Van-Tam, has said.
In a stark warning highlighting the worst is yet to come if we do not “all act now”, Van-Tam said the country was “at a tipping point similar to where we were in March”, and that the approach of winter made the situation even more grave.
“Winter in the NHS is always a difficult period, and that is why in the first wave our strategy was ‘contain, delay, research and mitigate’ to push the first wave into spring,” he said. “This time it is different as we are now are going into the colder, darker winter months. We are in the middle of a severe pandemic and the seasons are against us. Basically, we are running into a headwind.”
An estimated 224,000 people have contracted the virus this week in the UK, up from 116,000 a week ago, according to the Office for National Statistics. In his statement, Van-Tam asked people to stick to the rules to suppress the resurgence of the virus by washing their hands regularly, wearing face coverings in confined spaces, practising social distancing and self-isolating after testing positive.
“I would say, actually, we are beyond the tipping point. To be perfectly honest, I think it’s perhaps being a little bit optimistic. We are clearly on the path of exponential growth,” said Martin McKee, the professor of European public health at the London School of Hygiene and Tropical Medicine.
In a paper last month, the Scientific Advisory Group for Emergencies (Sage) told ministers that most people in the UK who had Covid-19 or who had been exposed to somebody who had tested positive fail to fully self-isolate.
A lack of financial support and the erosion of public trust had contributed to these findings, scientists interviewed by the Guardian said.
It was becoming clear that Covid-19 was a disease of poverty and vulnerability, Prof Mckee said, adding that years of austerity had taken their toll on the UK’s ability to absorb shocks in comparison with Nordic countries.
“If we don’t provide [people] with the support that they need, we won’t get the degree of isolation that is required,” he said. “That’s one of the reasons why we’re doing much worse than the Nordic countries.”
But perhaps most crucially, there is an erosion of public trust following the Dominic Cummings episode, when Boris Johnson’s chief adviser breached health protection regulations in late March. Other key figures, including the former Labour leader Jeremy Corbyn and the prime minister’s father, Stanley Johnson, were also caught breaking the rules.
In April, Catherine Calderwood, then Scotland’s chief medical officer, quit after intense criticism of her violations of Covid-19 regulations.
“Ever since that notorious Cummings trip — and I think we could keep going on about that — because actually it is really important that it did so much damage to trust in the in England in a way that didn’t come to Scotland. There’s still high levels of trust there,” Mckee said.
Hospital and intensive care admissions are on the rise, and although the spread initially was limited to younger adults, signs that it was making its way to the elderly in worst affected areas was apparent, Van-Tam said.
“Sadly, just as night follows day, increases in deaths will now follow on in the next few weeks,” he said.
The call to arms comes as Boris Johnson gears up to unveil a three-tier lockdown system for England – designed to streamline the current patchwork of localised restrictions that apply to about a quarter of the UK – with an all-encompassing set of potentially harsher restrictions including the closure of pubs and a ban on all social contact outside of household groups.
Paul Hunter, a professor in medicine at the University of East Anglia,said the framework of localised restrictions had confused people
“The confusing messaging throughout this epidemic … that is one of the biggest failures in our approach,” he said. “Hopefully, this traffic light (three-tier) system will be clearer.”
Even if all transmission was stopped today, deaths would continue to rise at least for the next two to three weeks, he added, “because, typically, it takes three to four weeks after an infection before somebody dies”.
The R number for the UK is between 1.2 and 1.5 , with every NHS region of England with an R well above 1, suggesting widespread increases in transmission continues across the country, not just in the north of England, Van-Tam said.
R, or the ‘effective reproduction number’, is a way of rating a disease’s ability to spread. It’s the average number of people on to whom one infected person will pass the virus. For an R of anything above 1, an epidemic will grow exponentially. Anything below 1 and an outbreak will fizzle out – eventually.
At the start of the coronavirus pandemic, the estimated R for coronavirus was between 2 and 3 – higher than the value for seasonal flu, but lower than for measles. That means each person would pass it on to between two and three people on average, before either recovering or dying, and each of those people would pass it on to a further two to three others, causing the total number of cases to snowball over time.
The reproduction number is not fixed, though. It depends on the biology of the virus; people’s behaviour, such as social distancing; and a population’s immunity. A country may see regional variations in its R number, depending on local factors like population density and transport patterns.
Hannah Devlin Science correspondent
Scientists have estimated that the doubling time for new infections is between eight and 16 days, and even faster in some areas of the country.
People need to be “realistic” and help the NHS help them, Van-Tam stressed.. “Earlier in the year, we were fighting a semi-invisible disease, about which we had little knowledge, and it seeded in the community at great speed. Now we know where it is and how to tackle it – let’s grasp this opportunity and prevent history from repeating itself.”
One of the other key ways to stem the growing tide of infections is to fix the centralised test, trace and isolate system, which is working by finding infected people and asking them to tell their contacts to quarantine, Mckee added.
“It’s increasingly clear that the centralised system is quite dysfunctional,” he said.
“Whereas in Germany, Korea and elsewhere, what they’re doing is backward tracing, which is you identify a case, and then you go back until you find the source, and then you act on that. If we were able to identify where the sources of infection were we can act against them. We need intelligent responses, which we don’t have.”