Last week, I put my neck on the line and make a prediction: that there would be no second wave in this pandemic. I wasn’t alone, and many other well-respected doctors and researchers have since echoed my sentiments.
But I’ll admit I gulped when, on Sunday, news began to filter through that Leicester was experiencing an alarming spike in Covid-19 cases.
By Tuesday, it became the first British city to be put back in lockdown – and its pubs, restaurants and hairdressers remain closed.
Meanwhile, across the Atlantic, entire American states are seeing surging numbers of infections – and the end-is-nigh doom-mongers online doubled down, in a ‘don’t say we didn’t warn you’ kind of way.
Had I been wrong? I don’t think so.
We are not seeing a second wave. In fact, lockdowns such as the one in Leicester, as painful as they’ll be, are the way we’re going to avoid one.
DR ELLIE CANNON: Lockdowns such as the one in Leicester, as painful as they’ll be, are the way we’re going to avoid a second wave (pictured, people wearing face masks in Leicester)
As I wrote last week, we will see bumps and ripples, and local resurgences – and that is what’s happening right now unfortunately.
Numerous other hotspots are emerging – residents of Bradford, Barnsley, Rochdale, Bedford and Oldham could all also soon be facing restrictions.
I don’t doubt there will be more. This is, as the Prime Minister puts it, the ‘whacka-mole’ approach: using effective testing and tracking to spot outbreaks as they emerge, and quickly and effectively tackling them with strict social-distancing measures.
As we saw with the cluster of more than 600 cases that emerged last month in Anglesey, North Wales, it seems to work.
There, swift action means the situation is now under control, with just one new case reported in the area over the past week.
At the start of the lockdown, Government health advisers warned that coming out of it would not be seamless. They suggested the restrictions ‘tap’ would need to be turned on and off as, when and where it was needed.
Freedoms would be given, and then suspended or shut down.
It’s a standard method of pandemic control in other countries – but, of course, it all still feels very peculiar to us.
So, although horrible for those affected, I’m not surprised or worried by these local rises. I was, however, very concerned by something else I discovered last week.
Throughout this pandemic, I’ve been unwavering in my support for senior medical colleagues in Government.
DR ELLIE CANNON: As I wrote last week, we will see bumps and ripples, and local resurgences – and that is what’s happening right now unfortunately (pictured, a woman has her temperature for entry to the zoo at Chessington World of Adventures in Surrey)
But over the past few days, I have had my patience tested.
We have been told repeatedly to stay alert. As the Government has reminded us on many occasions, to an extent, it’s up to us, the general public, to behave well and do our bit now in order to keep each other and ourselves safe, and get the country moving again. But this will only work if we’re first given a complete picture of what’s actually going on, and things are then communicated clearly.
And this has not been happening as well as it should be.
First, on Monday, when Matt Hancock, the Secretary of State for Health spoke in the Commons about the decision to lock down Leicester, he said children had been ‘particularly impacted’.
Obviously, listening to this, I was alarmed. My Twitter feed suggested scores of others felt the same: we have been repeatedly told, and studies seem to confirm, that children are not at risk from Covid-19.
What did he mean by ‘particularly impacted’? As I’ve said on national news channels, children are more likely to get struck by lightning that they are to suffer severely from the virus. This is why I have argued schools must reopen without delay.
The new rules on shops, weddings, work – and going to the pub
- Why do you have to wear a face mask in shops in Scotland, but not in England?
Last week, Scotland’s First Minister Nicola Sturgeon said the use of face masks or coverings in shops would become mandatory from July 10. But in England, this is not the case – face masks are only mandatory on public transport.
The Scottish and English governments are both being advised by scientific experts, and have access to similar information about how much impact face masks could have on the spread of infection.
But ultimately decisions about new rules around Covid-19 fall to politicians. Officials in England do, however, recommend masks are used whenever social distancing is not possible – for example, in confined spaces.
A cloth face covering, either a reusable one that you can buy online, or one fashioned out of a scarf or old T-shirt, will stop you passing the virus to others if you are unknowingly infected. So while it isn’t yet mandatory, it seems a good idea to wear one regardless.
- What are the rules for weddings and funerals?
In England, weddings and civil partnerships are now allowed in licensed venues, including places of worship. You can invite a maximum of 30 people to the ceremony, so long as strict social distancing rules are observed.
Traditional wedding receptions, including wedding breakfasts, are not allowed. The Government says couples can have what it calls a ‘wedding celebration’ in which a maximum of six people can gather outdoors, or two households can gather indoors.
Scotland has similar restrictions, stating that the number of attendees must be ‘minimal’. In Wales, only the immediate family is allowed to attend and the ceremony must be in a place or worship or in a register office. In Northern Ireland, eight people can attend, but ten are allowed if one partner is terminally ill.
As for funerals, there is currently no specific limit on the number of people attending in England. However, the Government states that, as well as minimal funeral staff, only members of the person’s household and close family members should attend.
If family and household members cannot attend, close friends can come. A celebrant of the bereaved family’s choice is also allowed.
In Scotland and Wales, funerals are by invitation only. The venue will decide how many attendees it can hold while adhering to social distancing rules, and tell the bereaved family how many invitations to send out.
In Northern Ireland, a maximum of 30 mourners can attend.
- Is it safe for everyone to go back in to work?
Despite the easing of the lockdown, the Government advises that those who can work from home continue to do so. The closure of offices played an integral part in rapidly reducing the rate of transmission.
Employers are required to carry out a risk assessment for employees to determine if it is viable for them to return to work safely, with social-distancing measures in place. This should be discussed by both parties before a decision is made.
The Government has issued specific guidance to businesses for protecting the workforce, which they are expected to adhere to. Anyone who is concerned that their employer is not promoting social distancing can report them to the Government’s Health and Safety Executive by visiting hse.gov.uk.
- Is there a risk of ‘superspreading’ now that pubs are open again?
Around the world, certain gatherings of people, such as birthday parties, have led to a significant number of Covid19 infections. In some instances, just a single infected person has transmitted the virus to dozens of others at these so-called ‘superspreading’ events.
The Government’s chief scientific adviser, Sir Patrick Vallance, warned on Friday that pubs are environments where ‘superspreading’ of the virus is more likely to occur.
Evidence shows coronavirus is transmitted more easily indoors, and when people are in close proximity. This makes a crowded pub an ideal place for the virus to spread. Pubs are being told to collect contact details of customers.
This is so that they can be easily contacted by the NHS test and trace service if, at a later date, they are thought to have come into contact with someone in the pub who has tested positive for Covid-19.
It is hoped this measure will prevent any local outbreaks of the virus.
On further investigation, speaking directly to the office of the Chief Medical Officer, it seems there’s actually little cause for alarm. It turns out that, as the hotspot in Leicester began, testing was ramped up, as per the protocol – when one person was found to have the virus, they began tracking and swabbing larger numbers of people they’d come into contact with.
It meant that many more families, including children who were not actually ill, tested positive. These included kids who hadn’t been at school, so they must have caught the virus from their parents. I wish this had been shared properly with the public.
Which leads me to my second gripe. As I said last week, the test-and-trace system is not perfect. Not every contact is traced, so not every single case is being picked up. Scientifically speaking, though, this is good enough to be effective.
However, Leicester has highlighted other flaws.
We have repeatedly been told we must stay alert if we’re to beat this virus. And I’m a big supporter of people being informed, and playing an active role in their health. So I like the philosophy behind the slogan.
But I was hugely dismayed to discover that, until last week, the figures for new infections being published by the Government were only giving part of the picture.
Our national Covid-19 testing programme is broken up into ‘pillars’. Pillar 1 is the testing done in hospitals – people who are sick enough to need in-patient care, and healthcare workers. Pillar 2 refers to the tests being done ‘in the community’ – so, when you feel sick, you drive off to one of these drive-through testing sites, or get a DIY test to do at home.
Pillar 3 and 4 are antibody tests and testing done for research, which aren’t relevant here.
At the start of the pandemic, pillar 1 figures were crucial, as so many people were very sick. It gave us a clear idea about how bad the illness was, and where the epicentres were. And, to be honest, in the earlier months, it was just about all we had. But as the total numbers have gone down, so have hospital cases.
It’s essential we now focus on the pillar 2 figures, which will let us know what’s going. In particular, we need to be able to see what the numbers are for our own local area.
Except, the Government, until Wednesday, was only publicly reporting detailed pillar 1 figures, and not pillar 2 figures. This meant that in Leicester, there were just 80 new cases of Covid-19 between June 13 and 26, according to the published figures at the time. In fact, it has transpired the real number was 944.
Apparently, the data was available to local public health officers under Data Protection Act laws, but not to the general public – or even GPs, like me, for that matter. This makes no sense.
It’s the community-specific information that lets us all tackle local problems – after all, how can we ‘stay alert’ when we don’t actually know what’s out there?
Leicester’s mayor, Sir Peter Soulsby, summed it up, suggesting they could have acted sooner if it’d been widely known earlier that they had a problem.
‘I would wish that they had shared that [data] with us right from the start,’ he said.
Seeing so few cases in London, I’ve started visiting patients at home, and have been calling more in for face-to-face consultations.
I reasoned it’d be highly unlikely anyone would actually have Covid-19. But when I read the figures I had been looking at were incomplete, I worried.
Had I been putting myself and others at risk? Since the lack of transparency was revealed by the Financial Times, the Government has made all the data available.
So I’ve been able to see the real numbers for my local area, and you can do the same: but I warn you, be prepared to be bamboozled. There are nice, easy-to-follow infographics on the gov.uk website detailing the weekly figures for larger region areas such as East Midlands or North East.
But you have to dig much deeper into the difficult-to-read spreadsheets on the website to see the intricate local figures.
Reassuringly, there have been only two new cases diagnosed in my borough, Camden, in North London, in the past week – which compared with 496 in Leicester, and 375 in Bradford, which are at present the two areas with the most infections.
So I’m going to carry on as I have been. But I hope, a few weeks back, my GP colleagues in Leicester weren’t looking at the misleading published numbers, being led into a false sense of security, and making decisions as I did.
Likewise, shielding patients urgently need this detailed level of information too, as they may need to be very careful again if local cases are rising.
Just a few days ago, in the run-up to yesterday’s grand reopening – so-called Super Saturday – the Prime Minister urged the public not to ‘overdo it’ and ‘undo the sacrifices you have made with reckless behaviour’.
But, really, as we have seen over the past two months, one-off events and mass gatherings seem to have a minimal impact on infection rates. Some outbreaks have been linked to workplaces – in Wales, cases were seen in meat factory workers.
But others, such as in Leicester, don’t have an obvious focal point. There, cases seem to be in working-age people, and mainly in deprived areas, where families live in more crowded conditions.
Although there is a spike in cases, thankfully there has been no rise in hospital admissions. These nuances are key to our approach now – what is right for one area of Leicester will be wrong for one area of another city or country.
In American states such as Texas, officials are now seeing about 6,000 new cases a day, and a similar number of hospital admissions.
Some people, including Governor Greg Abbott, blame the decision to reopen bars and restaurants back on April 30.
In the meantime, how will the further easing of our own restrictions affect things? I’m still optimistic. But I also urge the scientists in Whitehall to be honest with us, and communicate clearly.
Yes, we can carry on washing our hands and wearing face masks. We can stay a metre or more apart, queue diligently at the supermarket, and limit contact with extended family and friends. But we also need to know what is going on around us, so that we can, indeed, stay alert.
Lockdowns don’t need to come to every city. Stopping viral transmission, spotting clusters and immediately responding effectively will prevent a second wave, but only if we empower people to make decisions based on the facts.