COVID-19: scientists question UK government plans

  • Tim Locke
  • Medscape UK
  • 15 Mar 2020

  • UK Medical News
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The Government says its plans for the delay phase of the coronavirus operation are driven by science but open letters from more than 300 UK and international scientists question the approach and call for stronger measures.

The publication of the letters follows significant developments over the weekend, including the deaths of 24 more people with COVID-19, and reports of a newborn testing positive for coronavirus.

This morning, the Health and Social Secretary for England, Matt Hancock told Sky News that over-70s will eventually be asked to self-isolate, possibly for up to 4 months: "That is in the action plan, yes, and we will be setting it out in more detail when that's the right time to do so, because we appreciate it is a very big ask of the elderly and vulnerable, and it's for their own self-protection."

The plan also includes working now with manufacturers to obtain more ventilators for hospitals. "We cannot make too many." Mr Hancock wrote in the Sunday Telegraph

Reports also said the private sector was being asked to help with extra capacity for the NHS.

Rising Death Toll

Saturday saw the number of deaths of patients with coronavirus in the UK rising from 11 to 21. Deaths have tended to be older patients with underlying medical conditions.

On Sunday, the number of deaths rose to 35. As of 9 am on 15th March, a total of 40,279 people have been tested with 1372 positive results.

Dr Stephen Griffin, associate professor, Leeds Institute of Medical Research, University of Leeds, was one of a number of experts commenting on developments via the Science Media Centre. He said: "The upsurge in daily cases this week could indicate that we're at the beginning of the exponential phase of the UK epidemic. Unfortunately, I suspect we can expect to see further daily increases in both diagnostics and mortality over the coming weeks."

In the new phase of action against coronavirus, testing priorities are being changed to give precedence to at-risk patients, including those in hospital with pneumonia or acute respiratory illness.

Public Health England said: "People who are in the community with a fever or cough do not usually need testing."

Azra Ghani, professor of infectious disease epidemiology, Imperial College London, commented: "Interpreting daily reports of both cases and deaths as the epidemic unfolds requires a good understanding of where testing is taking place."

Prof Ghani continued: "Testing has focused on patients in critical care – ie, intensive care units and high-dependency units. As these patients have a range of underlying health conditions – and some may have been admitted for other reasons – we need to interpret these new numbers with this in mind."

Baby Tests Positive

Reports said doctors are testing to see if a baby that tested positive was infected in the womb or during birth.

Prof Richard Tedder, visiting professor in medical virology, Imperial College London, commented: "The description of the apparent detection of COVID-19 infection in a newly born child of a mother with COVID-19 infection herself raises concerns about the potential ways in which this transmission may have occurred. It is important to say at this point in time that the detection of COVID-19 nucleic acid on the sample from the child does not necessarily mean that the child was infected.

"It could well have come from the mother at the time of delivery, further follow-up of the infant will clarify whether or not the infant is infected. Previous data from colleagues in China, published in the journal The Lancet, albeit on a small number of mother and infant pairs, did not show infection in any of the infants at the time of birth. Neither did sampling of breastmilk immediately after birth contain detectable virus. Thus, the UK observation of a possible neonatal transmission is unexpected and needs further confirmation.

"The question of risk to a newly born child being nursed by a mother who is known to be infected is a matter that will need careful consideration. The absence of detectable virus in breast milk would appear to reduce the risk of breastfeeding however the close, intimate and entirely understandable contact between a mother and her baby will raise questions about how best to care for them. Compounding this too is the lack of knowledge of the clinical outcome of neonatal infection, should this actually occur."

Tactics Questioned

The UK Government has stopped short of closing schools and banning large events, although many sports' own governing bodies have suspended fixtures, including the Premier League and London Marathon.

One open letter from scientists, including some PhD students, said: "We believe that additional and more restrictive measures should be taken immediately, as it is already happening in other countries across the world."

The signatories include professors, lecturers and researchers in immunology, biology and medicine, including those from Oxford and Cambridge Universities, Imperial College London, and the London School of Hygiene & Tropical Medicine.

The letter says: "In particular, we are deeply preoccupied by the timeline of the proposed plan, which aims at delaying social distancing measures even further. The current data about the number of infections in the UK is in line with the growth curves already observed in other countries, including Italy, Spain, France, and Germany. The same data suggests that the number of infected will be in the order of dozens of thousands within a few days."

It also questions reliance on an increase of cases leading to herd immunity: "Going for ‘herd immunity’ at this point does not seem a viable option, as this will put the NHS at an even stronger level of stress, risking many more lives than necessary."

Mr Hancock wrote: "We have a plan, based on the expertise of world-leading scientists. Herd immunity is not a part of it. That is a scientific concept, not a goal or a strategy. Our goal is to protect life from this virus, our strategy is to protect the most vulnerable and protect the NHS through contain, delay, research and mitigate."

In a statement before the publication of the letter, and after the latest meeting of the Scientific Advisory Group for Emergencies (SAGE), the Department of Health and Social Care said: "SAGE advised the next planned effective interventions (shielding the vulnerable and household isolation) will need to be instituted soon.

"SAGE is examining models of further interventions. SAGE also agreed that in line with good scientific practice the modelling and data considered by SAGE in future will be published."

Chief Scientific Adviser Sir Patrick Vallance and Government Medical Adviser Prof Chris Whitty said: "We are dealing with a very fast-moving epidemic with emerging data from many disciplines and many complex decisions.

"Scientists across the world are helping each other, governments and society to deal with this international emergency."

Adapted from Medscape UK.