Latest evidence provides cautious grounds for optimism but no room for complacency. Over the last few days, we have had data published from three independent studies - the monthly REACT-1 study from Imperial, the weekly ONS infection survey and the daily Covid Symptom Study from Kings - all with broadly similar findings and containing both good and bad news.
First the bad news. All three studies have shown that infections did rise very quickly in September to levels not seen since May – confirming that the virus still has the potential to spread very quickly.
The REACT study showed that about 1 in 200 people have the virus now versus 1 in 1000 in August (and a low of 1 in 2500 in July), while the ONS study showed a similar trend but estimates that about 1 in 500 had the infection in the third week of September (up from about 1 in 2000 a month earlier).
Both studies also showed that levels of infection have also increased in all age groups, including the most vulnerable older age groups, and also in all regions, but with much larger increases in the North, Midlands and London.
These increased infections are not due to increased testing, or changes in the people being tested or higher numbers of false positives – both REACT-1 and ONS use random household surveys and the proportion that are testing positive each week/month has increased. The map below shows the most recent spread of the virus nationally:
There is also good agreement between REACT, which includes symptomatic and asymptomatic infections and the Covid Symptom Study, both of which estimates roughly 200,000 are symptomatic.
The number of infections from all these studies is much higher than that being picked up by NHS test & trace which means that many cases are still being missed – and shows we cannot rely on it alone to control the spread of the virus.
But there is also good news in all these studies.
They all show this is not a repeat of the first wave as infections are rising much more slowly, doubling roughly every 11 days now vs. three days then. And crucially, they also show that the rate of increase is slowing down significantly.
REACT 1 estimates that R has fallen from 1.7 at the beginning of September to around 1.1 now (albeit with a wide range of uncertainty 0.7 to 1.5) and the Covid Symptom Study has R falling from 1.4 to 1.2. Similarly, the ONS survey shows infections levelling-off after a sharp increase.
This is the first empirical evidence we have that it is possible to slow the spread of the virus without a national lockdown.
Going forward, I think the government’s current approach is broadly correct and is rightly focusing more on the balance of benefits and harms in order to produce the best overall outcome.
But all measures should have evidence that they are effective; there is confusion over not exempting younger children from the ‘rule of 6’ and the 10pm pub curfew, and does a mandatory approach have a clear benefit over a voluntary one?
Comprehensive cost-benefit analysis must be done, and the government should trust the public with this evidence and be honest about the uncertainties and the trade-offs.
During my time on the frontline in the first wave, I highlighted the non-Covid health harm that was being caused by our response, and called for restrictions to be lifted as it became clearer that they were causing more harm than benefit.
But it has also become clear that to save the most lives from all causes – and not just Covid - we need to keep Covid hospital admissions at a much lower level this time to make sure we keep all NHS services running and help our patients overcome their fear of coming to hospital.
The NHS urgently needs to provide individual ‘Covid risk calculators’ to help people understand their own risk (which is often overestimated) as well as enable more targeted, voluntary, shielding.
In conclusion, although it is too early to be certain, the current measures appear to be working and show that we can control the virus without a national lockdown - and while keeping schools open and the economy growing.
If we follow the current measures and persist with social distancing, self-isolation, etc., we can keep cases down and save lives from all causes - and livelihoods – and avoid a second lockdown with all its disastrous consequences.
Dr Raghib Ali is Senior Clinical Research Associate at the MRC Epidemiology Unit, University of Cambridge and an Honorary Consultant Physician in Acute Medicine at the Oxford University Hospitals NHS Trust. He writes in a personal capacity.