HOW TIERS CAUSED SECOND WAVE
JUST WHAT CAUSED THE SECOND WAVE?
FEW could have predicted the sheer force of the Covid pandemic when it first hit. While the Government has faced criticism for its handling of the situation in those early days, as experts have pointed out, this is with the luxury of hindsight.
But by the same measure, it would be difficult to argue the second wave wasn’t foreseen. Was enough done to prevent it from happening? At the end of August last year, after a relatively uneventful few months following the surge in March and April, Covid cases began to climb again – and Ministers warned of the ‘serious threat’ of a winter spike.
Initially, there was no corresponding increase in hospitalisations or deaths – with more dying from causes other than Covid throughout autumn. But any hope was short-lived. The initial rise in cases was in younger age groups, who are significantly less likely to suffer severe illness. A third of new Covid infections at the start of September were in people aged 20 to 29.
This phenomenon was not limited to Britain: World Health Organisation global data show people aged 15 to 24 represented just under five per cent of Covid cases in late February, compared with 15 per cent by mid-July.
But slowly, week by week, the virus crept ever more rapidly to the older and more vulnerable age brackets.
In October, SAGE published its‘ reasonable worst-c as escenario’: 85,000 secon d-wave deaths, with the surge ending at the end of March this year.
It was accused of scaremongering. But those numbers now appear frighteningly prescient.
There have been roughly 60,000 deaths attributed to Covid in Britain since September 1, compared to 58,000 up to that point – cumulatively, more people have died already during this second wave, according to Office for National Statistics figures.
On Wednesday, Prof Whitty confirmed the UK had passed the peak of the second wave. But last week alone, despite being in lockdown since January 4, there were still 7,956 Covid deaths.
Yet in September, when the signs were all there, Matt Hancock was still hopeful that a winter surge was ‘avoidable’.
So was it? Or by then, were the seeds already sown?
On paper, at least, the plan at the end of the first lockdown in May seemed measured: a phased reopening of the retail, hospitality and leisure sectors.
By August the Prime Minister was urging the public to have ‘confidence’ to go back into offices and workplaces, and there was a new catchphrase – ‘Hands, Face, Space’ – designed to hammer home the importance of social distanci ng, mask wearing and social responsibility in l i miting t he spread of the virus.
Some experts say Britain, and almost every other European country now seeing a second wave, ‘rushed to reopen’ – and in doing so l aid the groundwork for a second crisis.
For instance, The Eat Out to Help Out scheme, which incentivised pubs and restaurants to offer heavily discounted meals in August, was blamed for a rise in infections in late summer.
One University of Warwick analysis found an increase in Covid infection clusters a week after the scheme opened in areas where it was most popular.
However, the authors noted it was difficult to disentangle the impact of a single policy, as many restrictions, such as the stay at home order, were lifted at the same time.
Overall, the problems are more nuanced. Initially, the Government’s strategy involved shutting down areas when surges in cases were spotted.
These local lockdowns – the socalled ‘whack-a-mole’ approach – were replaced by the tier system in October.
There were, at first, three tiers, corresponding to varying restrictions and l i mits on permitted social mixing. Despite these attempts to suppress the virus, cases continued to rise. How much was the public itself to blame? Data from the University College London’s Covid19 Social Study shows that compliance with measures declined over the summer. Overall, fewer than half of Britons followed the rules to the letter, with that figure dropping to around one in five of those under 30.
There was also widespread confusion over the guidance.
‘During the national lockdown, 90 per cent of people said they fully understood the guidance.
‘But this dropped to 13 per cent afterwards,’ says behavioural scientist Prof Linda Bauld. Some have also suggested, in certain areas of England, there were high levels of the virus still circulating even after the first lockdown.
Prof Gabriel Scally, a public health expert at the University of Bath, points to data on parts of Greater Manchester as evidence of this: ‘These were areas where there were high levels of deprivation and overcrowded housing.
‘The epidemic was still going on and easing restrictions simply fuelled it.’ Yet the overwhelming expert consensus is that the prime reason for the second wave is that the tier system was flawed.
Initially, the majority of the country – aside from a handful of Northern counties, which had high case rates – was placed in tier 1.
Here, schools and universities were open, alongside hairdressers, shops, gyms, and entertainment venues. Travel around the country was allowed with overnight stays. Bars and restaurants were ‘table service only’ and subject to a 10pm curfew.
The only major curb, aside from continued mask-wearing and social distancing, was ‘the rule of six’, prohibiting gatherings of more than six people either in or outdoors. The impact of each individual part, in terms of encouraging spread of the virus, continues to be studied – of note, the role schools have played, which will be key if they are to reopen safely.
But overall, argues London School of Hygiene & Tropical Medicine epidemiologist Prof Graham Medley, the tier system was not sufficient to control the spread of the virus. Prof Medley, who is chairman of the Scientific Pandemic Influenza Group on Modelling (SPI-M), a body that has been advising SAGE during the pandemic, says: ‘The way the tier system was organised, we saw an inevitable upward drift in prevalence of the virus.
‘Everywhere in tier 1 eventually ended up in tier 2, as cases rose. And tier 2 [almost the same as tier 1, but prohibiting mixing with other households indoors] wasn’t enough, in some cases, to stop the prevalence continuing to rise.
‘So these places ended up in tier 3. And by the time you got to tier 3, the prevalence was so high, nothing could contain the spread except for full lockdown.’
On the same week the tier system was announced it emerged that SAGE had, in mid-September, recommended an immediate ‘circuit breaker’: a short period of full national lockdown, in order to bring case numbers down.
The body had warned that ‘not acting now’ would result in a ‘very large epidemic with catastrophic consequences’. But the tier system remained in place until November 5, when a four-week full national lockdown was finally imposed, ending on December 2.
The initial plan had been to restore the tier system, with a significant easing of restrictions during the week of Christmas to allow three families to mix.
This was reversed on December 19, chiefly due to concerns about the emergence of a new, more transmissible variant.
Much of the country was placed into the new tier 4 – prior to the current lockdown, which began on January 4. Prof Medley explains the timing of such measures is critical. ‘The logic behind suggesting a circuit break was to avoid the prevalence of the virus getting high – to act before you absolutely have to.’
The November lockdown did lead to a 22 per cent drop in the infection rate, according to a recent paper. But this was not sustained –with prevalence already alarmingly high, the rate rapidly increased when it was lifted.
The second wave was, by then, already inevitable. ‘Lockdowns are harmful, and painful,’ concedes Prof Medley. ‘They also work – but for them to work, people must agree to them. And for people to agree to them, they must seem justified. That’s why the Government is in a difficult position, trying to persuade the public into a precautionary break, before it seems needed.’
Eat Out To Help Out scheme was blamed for a rise in infections
DID CHRISTMAS LEAD TO A SPIKE IN CASES?
IN late November, the Government announced its ‘Christmas bubble’ plan. Up to three households, of an unlimited number of people, would be allowed to mix for five days, over the Christmas holiday. The move was criticised by commentators, who accused Ministers of pandering to populism, and many in the science community.
As Prof Lawrence Young, an expert in viral infections at Warwick Medical School, said at the time: ‘The virus doesn’t know that it’s Christmas and it is inevitable that these relaxed restrictions will result in a surge in infections.’
Yet it appears the Government was following guidance issued in late October by the Scientific Pandemic Influenza Group on Behaviours (SPI-B), which advises SAGE. It warned that stopping ‘valued’ events could ‘spark disorder’, and cause even riskier behaviour such as increased social mixing.
Mark Drakeford, the First Minister of Wales, said UK leaders agreed to the Christmas bubble strategy as a direct result of this.
On December 19, the plans were scrapped. Citing concerns about the rapid spread of the more transmissible Kent variant, much of the South East of England was put under new tier 4 restrictions, akin to a full lockdown but with schools staying open. Instead of three families being allowed to mix, only meeting one person from another household, outside, was permitted.
Elsewhere, families were allowed to meet but on Christmas Day only. Even members of SPI-B seemed to support this drastic change of approach. One, Prof Susan Michie, a public health expert at University College London, said: ‘One has got to respond to the situation as it is, not the situation as we’d like it to be. If we really want to keep our loved ones safe, the best thing is not to see them.’
Nationally, after the November lockdown the number of new cases had risen two- fold in just two weeks, reaching the highest figure since the start of the pandemic. Hospitalisations had also doubled over a similar timeframe.
Cases, hospitalisations and deaths continued on an upward trend, with Prof Chris Whitty only cautiously announcing last week that he and his colleagues ‘thought’ we were now past the peak of the second wave.
So did people stick to the Christmas restrictions? It seems so. On January 14, results of a nationwide survey by the London School of Hygiene and Tropical Medicine found that, due to the closure of schools and workplaces over Christmas, social contact dropped to roughly the level it was during the November lockdown. A string of reports published days after Christmas linked festive gatherings to a sudden spike in cases on 27 and 28 December. However these infections are likely to have occurred prior to Christmas – it takes at least five days before symptoms become apparent.
Data suggests numbers of people visiting relatives in the week prior to testing positive doubled in the week after Christmas. But four times as many positive cases were linked to visiting shops.
Virologist Prof Lawrence Young says: ‘The pattern of increase in infections after Christmas was generally in line with the speed of growth before the holidays.’ Meanwhile, Prof John Edmunds, epidemiologist at the London School of Hygiene and Tropical Medicine and SAGE member, admitted that some additional cases were a result of Christmas mixing, but concluded: ‘The major spike that we saw [around Christmas] was most likely due to the new strain, not increases in contacts.’
WAS WINTER SURGE SIMPLY INEVITABLE?
REGARDLESS of failings in the tier system, some argue a second wave of virus may have been inevitable – as with other respiratory viruses, it does appear Covid is seasonal.
This wasn’t initially obvious, as countries with hot climates, such as India and Brazil, were hit with first waves of the pandemic.
But last week, scientists from the University of Illinois published data of cases, deaths and hospitalisations in 221 countries and found a strong association between pandemic severity and temperature.
In Australia, after a first wave in March and April, cases dropped away dramatically. But as their winter approached, in July, there was a second spike, larger than the first (admittedly, their daily death figures remained in the double digits, with a peak of 59 deaths on September 5). A similar pattern has been seen in Thailand during their coldest period. Scientists have drawn parallels with the Spanish flu epidemic in 1918, which occurred in distinct phases, accelerating over the winter months.
Paul Hunter, Professor of Medicine at the University of East Anglia, predicted a UK second wave, regardless of restrictions.
‘We know that all the other coronaviruses that have been circulating for hundreds of years virtually disappear in the summer and transmit more in the winter,’ he says.
In the UK, it’s not just because of temperature but also because of a change in behaviour between seasons, such as spending more time inside.
‘Other countries may have had outbreaks in their summers, but often this coincided with a monsoon season, which involves short periods of a drop in temperature that drives people indoors.
‘Without keeping everyone locked down and schools closed for the
Christmas mixing caused some cases but the new strain created the spike
entire year, it would have been near i mpossible to prevent a winter peak.’
That said, it needn’t have got quite so out of control. He says: ‘ Perhaps if we’d stayed locked down for an extra month or two, it would have given Test & Trace time to sort itself out, and stopped cases climbing quite so high.’
Experts say the continued high prevalence will have been directly responsible for the emergence of a new, more transmissible variant. While not thought to be more deadly, it is at least equally so. And as the evidence mapped out over these pages has shown, an increase in the spread and prevalence of the virus are equally worrying.
Last week, Baroness Dido Harding, responsible for masterminding NHS Test and Trace, said the Kent variant was ‘something that none of us were able to predict’.
But scientists disagree. ‘It’s no surprise that new mutations arose in Britain, South Africa and Brazil, which are areas where infections are very high,’ says Prof Hunter.
‘With roughly every 10,000 infections, you’ll get a mutation – they occur randomly, due to errors i n the virus’ genetic code as it replicates.
‘If you have 100,000 infections circulating, the risk of mutations increases ten-fold.’
Last week, 162,000 Britons were actively infected with Covid-19. Prof Hunter says: ‘ If we didn’t encourage people to crowd into restaurants in the summer, or failed to help people isolate properly, the variant may not have arisen at all in the UK. It’s nonsense to say we couldn’t have predicted it – in fact, we did.’