Parts of Kent, London, north Wales and Scotland are still battling significant Covid-19 outbreaks, sparking fears from scientists and public health directors that Leicester’s return to lockdown is set to be repeated.
Bars and restaurants are preparing to reopen on Saturday in what the prime minister, Boris Johnson, has dubbed “Independence Day”.
But infections have risen in the Medway, the boroughs of Hammersmith and Fulham and Ealing in London and Lanarkshire and Dumfries and Galloway in Scotland, according to publicly available figures relating to tests by NHS and Public Health England laboratories. All areas have seen increases of 10 or more weekly infections between 18 and 25 June.
“I am expecting there to be a number of Leicesters,” said Prof Deenan Pillay, a virologist at UCL and member of Independent Sage, the shadow government scientific advisory group. “The base level of infections going on in the UK is still much higher than it was in other countries in Europe when they started to release their lockdowns.”
“We need to be cautious on easing lockdown because we are not out of the woods yet,” said Jeanelle de Gruchy, president of the Association of Directors of Public Health. “Leicester is a sobering example of that. It should make us cautious about being too gung-ho in easing different measures.”
In his speech on Tuesday, Boris Johnson acknowledged the potential dangers ahead. “As we approach July 4, I am afraid that the dangers – as we can see in Leicester – have not gone away. The virus is out there, still circling like a shark in the water, and it will take all our collective discipline and resolve to keep that virus at bay.”
The warnings come amid concern that some local public health officials are not receiving enough information about exactly who has tested positive for the virus and where they live to enable new outbreaks to be quashed.
Epidemics of infectious diseases behave in different ways but the 1918 influenza pandemic that killed more than 50 million people is regarded as a key example of a pandemic that occurred in multiple waves, with the latter more severe than the first. It has been replicated – albeit more mildly – in subsequent flu pandemics.
How and why multiple-wave outbreaks occur, and how subsequent waves of infection can be prevented, has become a staple of epidemiological modelling studies and pandemic preparation, which have looked at everything from social behaviour and health policy to vaccination and the buildup of community immunity, also known as herd immunity.
Is there evidence of coronavirus coming back in a second wave?
This is being watched very carefully. Without a vaccine, and with no widespread immunity to the new disease, one alarm is being sounded by the experience of Singapore, which has seen a sudden resurgence in infections despite being lauded for its early handling of the outbreak.
Although Singapore instituted a strong contact tracing system for its general population, the disease re-emerged in cramped dormitory accommodation used by thousands of foreign workers with inadequate hygiene facilities and shared canteens.
Singapore’s experience, although very specific, has demonstrated the ability of the disease to come back strongly in places where people are in close proximity and its ability to exploit any weakness in public health regimes set up to counter it.
In June 2020, Beijing suffered from a new cluster of coronavirus cases which caused authorities to re-implement restrictions that CHina had previously been able to lift.
What are experts worried about?
Conventional wisdom among scientists suggests second waves of resistant infections occur after the capacity for treatment and isolation becomes exhausted. In this case the concern is that the social and political consensus supporting lockdowns is being overtaken by public frustration and the urgent need to reopen economies.
The threat declines when susceptibility of the population to the disease falls below a certain threshold or when widespread vaccination becomes available.
In general terms the ratio of susceptible and immune individuals in a population at the end of one wave determines the potential magnitude of a subsequent wave. The worry right now is that with a vaccine still many months away, and the real rate of infection only being guessed at, populations worldwide remain highly vulnerable to both resurgence and subsequent waves.
One senior director of public health told the Guardian that data from central government was “patchy” and made dealing with outbreaks like “playing a game of battleships” because postcode data was not always supplied.
Only since 24 June has detailed local positive test data been provided to directors of public health in local authority areas.
“There are public health people in Leicester who are still unclear about precisely where the cases are,” said Pillay. “The data problem has probably spawned a whole load of other infections, which could of course lead to deaths.”
A spokesperson for the Department of Health and Social Care said: “We have been working closely with our local partners, providing them with the resources and tools so that they can take swift action to deal with any new local spikes in infection.”
The extent of local infection rates remains unclear because while the government publishes data for tests that relate to hospitals and public health laboratories, it doesn’t publish the results of community testing for local areas.
According to the test results from hospitals and public health laboratories that are available, Bedford, Barnsley, Flintshire and Hammersmith and Fulham were among the areas that recorded higher rates of coronavirus infection in the week up to 25 June than Leicester. However, because the data published by the government is only partial, that does not necessarily mean their outbreaks are worse.
When the health secretary, Matt Hancock, announced the Leicester lockdown on Monday night, he used additional data from wider testing in the community. This showed that, once results from home tests and mobile units were added in, the seven-day infection rate was 135 cases per 100,000 people, three times higher than the next highest city.
Hancock said Leicester accounts for around 10% of all positive cases in the country over the past week and that admissions to hospital in the east Midlands city are running at between six and 10 a day rather than around one a day at other trusts.
The north Wales island of Anglesey is another of the worst affected areas, with 216 cases now reported in relation to the outbreak at the 2 Sisters poultry processing plant in Llangefni.
On Tuesday, Public Health Wales reported 17 new cases at Rowan Foods in Wrexham, bringing to 237 the number of people found to have been infected in the workforce, and 101 cases were found at a third food plant in Merthyr Tydfil.
Dr Giri Shankar, incident director for the Covid-19 response at Public Health Wales, said the 2 Sisters outbreak has been controlled and “there is no evidence to suggest that the outbreak at the plant has led to significant community transmission”. He said there were no plans for any school or workplace closures.
The publicly available data for Gwynedd in north Wales showing 83 cases per 100,000 people in June, and for Barnsley, which recorded 45 per 100,000 in the month, showed that other areas have also been tackling significant levels of infection. The figures compare with Leicester’s rate of 41 per 100,000 over the month but again the figures do not include the community test that the government used to inform its decision to reimpose lockdown in Leicester.
Doncaster went from nine new infections in the week ending 18 June to 31 the following week, but that does not account for community testing. Once community testing is included, the rate of infection has been falling gradually to around 21 infections per 100,000 people, according to officials at the Yorkshire borough.
The lack of public community testing data makes trying to understand the pandemic like “flying blind”, said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. “It is clear that there are some parts of the country where the epidemic is still progressing,” he said. “This means there is a need for a much more granular and localised assessment of when areas can open up.”
While London was initially one of the worst hit by the virus, cases there are now dramatically reduced and every English region apart from the north-east and south-west saw more cases than the capital in June.
London has recorded just 2% of its cases in June – the lowest proportion in England – compared with the east Midlands, where 7% of its cases were recorded this month alone. Yorkshire and the Humber, the east of England and the north-west have also seen over 5% of their cases in June.
