‘We need a strategy’: senior clinicians fear UK has no plan for second wave

Boris Johnson has rolled the dice. Last Monday, schools and some non-essential shops reopened. On 15 June more children will go back to class and many more shopkeepers will raise their shutters. The prime minister is gambling that easing the lockdown will not lead to another outbreak. Soon we will find out if he was right, if infections and deaths continue to fall, two weeks after the measures were lifted. But if he’s wrong, are we ready?

Senior clinicians, frontline NHS staff and public health experts agree that Britain needs a plan to deal with a potential second wave of Covid-19 infections. But the most senior leaders, who talk regularly to the government, are not convinced there is one.

“I think the criticism that we can’t see a strategy is a legitimate criticism,” said Prof Martin Marshall, chairman of the Royal College of GPs. “That isn’t a criticism at all of thoughtful people trying to do their best, but it is a criticism of the political agenda.”

In England, the relentless focus by Johnson and Matt Hancock, the health secretary, on meeting their self-imposed target of 100,000 then 200,000 daily tests has got in the way of practical matters, according to Marshall and some of his counterparts at the royal colleges. Developing a strategy is now a matter of urgency.

“We need a strategy for test and trace, for PPE, for the use of technology, for maintaining Covid services and opening up non-Covid services,” Marshall said. “Clinicians working on the ground find it tiresome and difficult to work in an environment where things are changing every day and there’s no sense of direction as to where we’re heading.”

The official death toll passed 40,000 last week but new infections have been dropping substantially. Is the latest figure, of 1,650 positive tests released on Friday, low enough? No, according to Prof Maggie Rae, president of the Faculty of Public Health.

“The number is falling, but it’s still high,” she said, saying the objective needs to be zero infections spread in the community. She is most concerned that the joint biosecurity centre, intended to be part of NHS test and trace and designed as an early warning system, will not be working for some time.

When Covid-19 first hit the UK, ministers were worried the NHS would be overwhelmed. “A promise to avoid a second peak implies we can accept another wave of around 50,000 deaths,” she said. “This promise is not reassuring.”

Niall Dickson, chief executive of the NHS Confederation, said that the numbers were going in the right direction. “So we certainly wouldn’t jump in and say this is too early, you’re not doing it right. On the other hand, I think we absolutely don’t want any more relaxation till we are confident that the test and trace system is working both at national and local level.”

A second wave may not arrive and some epidemiologists, such as Prof Sir Hugh Pennington, believe the Covid-19 will not come in waves as the Spanish flu did, but may be more like Sars, which disappeared after a public health campaign. Yet many believe there is a serious risk that Covid-19 will either remain endemic with local outbreaks, or come back harder as a second epidemic.

Even without any escalation in cases, the NHS faces many immediate pressures, and emergency departments are starting to fill up again.

“I don’t think the public understand that capacity in the NHS is dropping dramatically,” said Dr Katherine Henderson, the president of the Royal College of Emergency Medicine and a consultant at St Thomas’ hospital in London. The need for social distancing means far fewer people can stay in the waiting area.

“My urgent-care centre hits capacity at 16 patients now. In the past, we would have had 40 patients in there. People know they need to queue outside Tesco and M&S. Are they going to cope with the concept of queueing outside the emergency department?”

The backlog of cancelled appointments, with up to 8 million patients waiting for surgery by autumn, is also putting the NHS under strain. Prof Derek Alderson, the president of the Royal College of Surgeons of England, said patients needed to be confident they could go to hospital without becoming infected.

He wants backing for acute trusts trying to create Covid-light sites – a model used effectively by some cancer hospitals. “The model could work for other conditions, other types of surgery,” he said.

Retaining the NHS’s deal to use private hospitals is vital, Alderson added. “We need to keep this extra capacity, if we can, to deal with the backlog as well as the work that would normally be coming our way,” he said. The deal ends on 30 June, although there is a rolling one-month notice period.

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Many also believe that those doctors and nurses who came out of retirement to help need to be retained. Prof Ravi Mahajan, president of the Royal College of Anaesthetists, said there was also a need for doctors to be trained in other medical skills as a “reserve” force, so they could be redeployed in an emergency.

“We saw that if you shut down some NHS operations, staff become available,” he said. “But for example, they are not trained in intensive care. So we need to plan how we can get staff cross-skilled and trained so they can be redeployed.”

Yet these immediate pressures pale into insignificance compared with the nervousness clinicians have about winter. A combination of Covid-19 and winter flu could be devastating, they fear.

Alderson said the country “certainly can’t handle a second wave that takes us into the beginning of the winter months”, while Rae is concerned that if people are afraid to go to their GP, flu vaccine take-up may be lower.

“There need to be even more aggressive public health campaigns about flu,” Marshall said. “A good flu immunisation programme will make it easier to identify and treat Covid.”