UK COVID-19 Update: '6 month problem', 50,000 cases a day 'by mid October'

  • Tim Locke, Medscape.com

  • UK Medical News
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These are the latest UK coronavirus stories you need to know.

Downing Street Briefing

The Government's chief medical and scientific advisers set out the scale of the COVID-19 problem facing the UK in a Downing Street briefing. There were no ministers alongside them, they sat at a desk rather than lecterns, and they didn’t take questions.

"We should see this as a 6 month problem that we have to deal with collectively, it's not indefinite," Professor Chris Whitty said. 

Sir Patrick Vallance said that with cases doubling every 7 days, "Let's say, there were 5000 today it would be 10,000 next week, 20,000 the week after, 40,000 the week after…if that continued, you would end up with something like 50,000 cases in the middle of October, per day." 

 

A month later, he said, there could be 200 plus deaths a day. The experts pointed to warning signs from Spain and France.

Positivity

Some people have suggested rising cases are due to testing being ramped up. "Could that increase be due to increased testing? The answer is no. We see an increase in positivity of the test done so we see the proportion of people testing positive has increased, even if testing stays flat."

Sir Patrick continued: "Of course the challenge therefore, is to make sure that the doubling time does not stay at 7 days."

That, he said, "requires speed, it requires action, and it requires enough in order to be able to bring that down".

This virus is starting to impact hospitals again, he said: "Cases are increasing, hospitalisations are following, deaths, unfortunately, will follow that. And there is the potential for this to move very fast."

Any hopes of widespread herd immunity have not been realised: "So about 8%, so three million or so people may have been infected and have antibodies. It means that the vast majority of us are not protected in any way, and are susceptible to this disease."

Professor Chris Whitty said:  "Firstly we saw very small outbreaks, might be associated with the workplace or another environment, then we've seen more localised outbreaks, which have got larger over time, particularly in the cities. And now what we're seeing is a rate of increase across the great majority of the country. It's going at different rates but it is now increasing. And what we found is that as we go through in time, anywhere which was falling is now moving over to beginning to rise. And then the rate of rise continues in an upward direction. So, this is not someone else's problem, this is all of our problem."

With rising cases, "we have in a bad sense, literally turned a corner, although only relatively recently," he said. "And I think everybody will realise that at this point the seasons are against us."

Prof Whitty continued: "So we should see this as a 6-month problem that we have to deal with collectively. It's not indefinite...science will in due course ride to our rescue but in this period of the next 6 months, I think we have to realise that we have to take this collectively very seriously."

He said there's no evidence the virus is any milder now than it was in April.

"Treatment is better. There's no doubt about that. Doctors, nurses, have learned to treat this much more effectively. And we have new drugs, such as dexamethasone, and these will reduce the mortality rate, but they will definitely not eliminate or take it right down to trivial levels."

'Difficult Balance', Vaccines

As well as deaths from COVID-19 itself, Professor Chris Whitty warned of indirect deaths if the NHS has to spend a “large proportion” of its effort tackling COVID. He said, "it will lead to a reduction in treatment for other areas, in early diagnosis of disease, and in prevention programmes".

He admitted governments have tough choices to make: "We also know that some of the things we've had to do are going to cause significant problems in the economy, big social impacts, impacts on mental health, and therefore ministers making decisions, and all of society, have to walk this very difficult balance. If we do too little, this virus will go out of control, and we will get significant numbers of increased direct and indirect deaths. But if we go too far the other way, then we can cause damage to the economy, which can feed through to unemployment, to poverty, to deprivation, all of which have long-term health effects."

However, he said: "We have to break unnecessary links between households, because that is the way in which this virus is transmitted." Overall he warned: "If we do not change course, then we're going to find ourselves in a very difficult problem."

Sir Patrick said: "We will be living with this virus. This is now circulating amongst the population worldwide. It will continue to do so. We will be learning how to live with it."

He pointed to the deals the UK has done to secure various vaccines when they are ready. "It’s possible that some vaccine could be available before the end of the year in small amounts, for certain groups. Much more likely that we'll see vaccines becoming available over the first half of next year. Again not certain. But pointed in the right direction, which then of course gives the possibility of a different approach to this virus."

In the meantime, he concluded, we have to "make sure that we can live with it in a way that's sustainable and protects health and society overall".

Expert Reaction

Professor Andrew Goddard, president of the Royal College of Physicians said: "The chief medical officer has given us a clear message. All of us need to make sure the NHS doesn’t become overwhelmed with COVID-19 cases. If it does, waiting lists for treatment will grow, non-COVID illnesses won’t be discovered and treated early enough, and programmes to prevent people from contracting illnesses will stall."

Professor Angela Thomas, acting president of the Royal College of Physicians of Edinburgh commented: "This is a time for cool heads and responsible decision making," adding: "We must also have clear, concise and consistent public health messaging from government and public health agencies."

Other experts commented via the Science Media Centre.

Dr Simon Clarke, associate professor of cellular microbiology at the University of Reading, said the briefing "provided a stark reminder of where we currently stand in terms of the accelerating transmission of COVID-19 in the UK".

Prof Jackie Cassell, deputy dean, Brighton and Sussex Medical School, described the briefing as "sober and accurate, adding: "This statement will I think be welcomed and trusted by the public. It gives clear advice on the importance of compliance with a wide range of basic measures such as COVID-secure workplaces.   There was none of the bombast about future world-leading technical solutions that have undermined trust and distracted from the basics in recent weeks and months."

Dr Michael Head, senior research fellow in global health, University of Southampton, was disappointed long COVID wasn't mentioned but said the experts stressed the importance of the antibody data: "Therefore, the herd immunity idea is fanciful and not something that can be part of any public health strategy."

More Local Lockdowns

The Prime Minister will make a Commons statement tomorrow after a meeting of the COBRA emergency committee and is reported to be planning a TV address later this week to set out possible new lockdown plans.

On Monday, he spoke to the leaders of Scotland, Wales, and Northern Ireland.

The Welsh Government announced restrictions for four more areas from 6pm tomorrow: Blaenau Gwent, Bridgend, Merthyr Tydfil, and Newport. 

Restrictions on most gatherings indoors with other households will apply across all of Northern Ireland from 6 pm tomorrow.

Scotland's First Minister Nicola Sturgeon said additional lockdown restrictions for Scotland will "almost certainly" be put in place this week.

There were 4368 new UK cases announced on Monday.

Cancer Task Force

NHS England's 'cancer taskforce' meets this week to kick-start services, the BBC reported.

Three million people have missed cancer screenings since March, according to Cancer Research UK.

The Guardian reported that some hospitals will remain designated as COVID-free to help keep more services open during the second wave.

Meanwhile, a Patients Association survey of nearly 1000 people across the UK found 59% had problems accessing at least one healthcare service during the pandemic. This included GPs, dentistry, and diagnostics. 

The charity's Chief Executive Rachel Power commented: "We are certainly worried about what the coming winter might hold for patients and the NHS needs to be responsive to what patients have told us about their needs in this survey. When the time comes to rebuild, using this emergency period as a long-term basis for services should be unthinkable."

On Sunday, NHS England announced a £28m fund to help recruit international nurses and midwives. The money will help NHS organisations pay for additional COVID-19-related costs, including accommodation, flights, and quarantine.

Lockdown Breach Fines

Self-isolation for those at risk of passing on the virus becomes law in England from next Monday with fines starting at £1000 for breaches. Test and Trace call handlers will be checking compliance and will escalate suspected non-compliance to local authorities and the police.

On Monday, MPs on the Commons Joint Committee on Human Rights raised concerns over fines where rules may be unclear.

Committee Chair Harriet Harman commented: "As we approach the Coronavirus Act’s 6-month review, there are a number of concerns that the Government must urgently address. Confusion over what is law and what is merely guidance has left citizens open to disproportionate and unequal levels of punishment for breaking the rules, and unfortunately, it seems that once again, this is overtly affecting BAME individuals. The Government must learn from these mistakes to ensure that any additional lockdowns do not unfairly impact specific groups."

Stoptober

One positive outcome of the lockdown appears to be a rise in people quitting, and attempting to quit, smoking.

UCL data released as part of the annual Stoptober campaign show 22% more quit attempts compared to last year and the highest quitting success rate in over a decade at 23%.

Adapted from Medscape UK.