This week, the preliminary results for the Oxford University coronavirus vaccine yielded an “extremely positive” immune response in its human trial subjects. This hopeful news came as lockdown restrictions loosened in the UK, with restaurants and pubs reopening, and the government’s work from home advice brought to an end. Boris Johnson has spoken of a “significant return to normality” by Christmas, but this promise may be dangerously optimistic. Experts warn that a second wave of coronavirus transmissions could be just around the corner.
In what was dubbed the “reasonable worst-case scenario”, a recent report from the Academy of Medical Sciences said that up to 120,000 people could die during a second peak of the virus in the UK this winter. This would place an unprecedented amount of pressure on the NHS, which already deals with a surge of patients during the colder months.
So, should we all be terrified? I put this figure to Professor Neil Ferguson, epidemiologist and former government advisor.
“The risk of another 120,000 deaths is low, so long as the government sticks to its stated policy of not allowing a resurgence of transmission,” he tells me over email. “A second wave is not a random event, but would happen as a result of human action or inaction. Namely, if risky contacts between people go up too much, the transmission will start increasing again, resulting in more cases and more deaths.”
We have already seen U-turns from countries who loosened social distancing measures, only to experience a rise in cases. Melbourne was forced to reimpose its lockdown earlier this month, and both Portugal and Germany have instigated localised lockdown measures following new outbreaks of the virus. Ferguson is sceptical about the need for another lockdown in the UK, but he does warn of the likelihood of increased infection rates as we head into winter. “Transmission is likely to increase in the autumn as high schools reopen, it becomes less feasible for people to meet outside and the climatic conditions become more favourable for transmission of a respiratory virus,” he says.
The government at least appears to be making some preparations for a possible second wave. Last week, Boris Johnson announced an extra £3 billion of funding for the NHS. But money alone won’t be enough to battle another surge of the virus. We need to learn from the mistakes we made the first time round, too.
“One thing we haven’t even come to grips with from the first wave that will be amplified in the second wave is unintended consequences,” Dr. Tolullah Oni, epidemiologist and member of Independent SAGE, tells me over Zoom. “So many diseases are not being seen. The heart attacks and strokes are not going away despite the 20 to 30 percent decrease in presentation. People just didn’t go to hospital [during the height of the pandemic in April and March].”
Not overwhelming the NHS has been central to the government’s response to the pandemic, which is why the lockdown came into place in late March. “The idea of lockdown as a very blunt instrument is to flatten the curve, which was about lowering the absolute numbers to ensure they didn't exceed healthcare capacity,” Oni says. “It buys time to equip and increase healthcare capacity.”
But lockdown shouldn’t be the only instrument we use in the fight against coronavirus. Epidemiologists agree that one of the most effective tools against a pandemic is a robust test and trace system, capable of identifying patients with the virus and preventing them from spreading it further.
“Stopping a second wave requires us to know where transmission is happening through large-scale testing and contact tracing, and then to respond to new clusters of cases as quickly as possible,” Ferguson says. “If local outbreaks get too large for such targeted measures to work, more local lockdowns like Leicester may be needed.”
Last month, Leicester was placed under the UK’s first full “local lockdown” after reporting 10 percent of all coronavirus cases in the country that week. But Oni points out that local authorities in the city did not have the information that would have helped them trace the spread of the virus. “One of the things we learned from the Leicester situation is that the local government and public health services on the ground didn't have access to data at the postcode level,” she explains. “They were not well placed to mount an effective response.”
Coronavirus cases are continuing to fall in the UK, but clustered outbreaks like those seen in Leicester could place pressure on local hospitals. However Ferguson says that he “doesn’t anticipate the same very high national level of demand for hospital beds we saw in March and April – so long as we keep on top of those local outbreaks.”
Along with the NHS, a second wave of coronavirus would be another huge blow to marginalised groups in the UK. Research conducted during the peak of the pandemic found that the coronavirus death rate of people from African and Caribbean backgrounds was up to three times higher than white Britons, and those of Bangladeshi heritage die at twice the rate of their white counterparts. This is partly due to factors such as overcrowding in housing, social deprivation and the high number of Black and minority ethnic people in public-facing and frontline work. Ferguson warns that we may see a similarly worrying divide during a second wave.
“This epidemic has affected those in society who have the least financial ability to isolate themselves the most,” Ferguson says. “Namely, those in key worker, often fairly low paid jobs. I am not overly optimistic about the likelihood that this will change in the short-term, which is another reason for everyone to try and keep infection levels low overall.”
The government help with this by providing practical support to those most at risk. “If we're asking people to quarantine, that should quickly be followed by, ‘Can you do that and what support would be needed?’ That is something very tangible,” Oni says. She adds that Black, Asian and minority ethnic groups are overrepresented in jobs such as transport, factories and health and social care. “There needs to be a strong risk assessment strategy because the reality is, people are not in a position to reject work,” she says.
There is still time to fortify the healthcare system and educate the public to ensure that we avoid a second coronavirus wave. But this also rests on the implementation of an effective test and trace system, as well as increased health and employment protection for the most vulnerable in our society.
“The bedrock of any disease control is an effective ‘find, test, trace and isolate’ system,” says Oni. “Without that, it becomes a lot more challenging. We also have to confront the realities of who is more vulnerable and how we are supporting them with tracing and isolation.”
On an individual level, the advice remains largely the same as it did back at the start of the pandemic. Wash your hands regularly, wear a face mask and isolate if you have coronavirus symptoms. And if there is a round two, we can't say that we weren't warned.