Watching the second wave: Covid-19 wins yet again

It has been an uneasy summer, watching the numbers of cases of Covid-19 rising all around the world, wondering what our leaders are planning, to discover that they’ve only just noticed what’s been going on while they’ve been on holiday.

Here in England, we were doing great into early July. There were days when the total number of fresh cases was less than 500, which works out to less than 1 per hundred thousand. On the Isle of Wight, with a population of around 140,000, we went for over three weeks without a single case. There were some localised outbreaks on the mainland, and the figures steadily grew until by the middle of August there were more than a thousand fresh cases every day.

England

This seemed a crucial time: if growth in numbers were to be exponential, this would form the gentle start of the upward slope. By the beginning of September, it was clear that the only way was up, but no one in government seemed bothered. As days passed, numbers climbed further: 2,000 in the first few days of September, nearly 3,500 on 7th. It was to prove another week before anyone talked about doing something to stop the rise, and still, on 21 September, there has been a great deal of blamestorming but no real action.

Over the period since the middle of August, when the rise was first obvious, all schools have returned, businesses have been told that workers should stop working from home and return to their offices, etc., people have been financially encouraged to eat and drink indoors in restaurants and pubs, and there has been no sign of the cautions that we exerted back in May or even June.

Preston

Until recently, it was the densely populated urban areas in the Midlands and north of England which had been showing some of the highest rates of fresh cases. Preston, a city to the north-west of Manchester, is a good example which has had various levels of local ‘lockdown’ for some weeks now. The graph shows how its lowest rates during July soon came to an end, with higher numbers through August, and rapid growth from the start of September. Daily rates as low as one case have risen to 40 or more over that period.

Newcastle

Up in the north east, the city of Newcastle showed a similar pattern, with a minimum of cases through July, rising significantly by the middle of August, then accelerating rapidly in early September.

IsleOfWight

Here on the Island, as in much of the rest of the south of England, recent increases have been noticeable but much smaller, so far. For a period of more than three weeks, there were no fresh cases at all, since when there have been more, but sporadic cases, with only two days, in September, on which there have been more than two cases per day. It’s almost impossible with these low numbers to find any comparable way to fit any sort of curve through them without misrepresenting the data.

It has been more than a month since we on the Isle of Wight started trialling the completely new version 3 of the England Test and Trace smartphone app, for iOS and Android. Back in August I promised to provide more details about it, but I must admit to being underwhelmed.

iwapp301

The app we have been trialling offers only two features which aren’t already available on national websites: QR code scanning to record your entry into a pub, restaurant, or other location in which you could be exposed to a risk of infection, and standard Apple-Google decentralised ‘exposure notifications’. There are still hardly any businesses which appear to be displaying QR codes to scan, although our local pub (where we only sit outdoors and keep our distance) is the one place I have seen and regularly use them.

In the week that this app is due to be released for general use across England, I have seen a report that its exposure notification feature is being disabled, making it even less purposeful than the first version of the app which we trialled in early May. It seems that more than four months and many millions of pounds later, England still hasn’t found a way to improve reporting, testing and contact tracing using smartphones.

Although the UK has greatly increased its Covid-19 testing capacity, that failed to meet demand in early September, with those suspected of being infected sent long distances to try to get tested. There appears to be a multiplicity of problems, not least of which was the candid admission that the Test and Trace service hadn’t been expecting a rise in demand when schools returned – a staggering lack of foresight.

Inevitably, no one knows whether the shortage of tests has had any significant influence on figures, nor even how many people who were suffering from Covid-19 have been unable to get tested at all.

The other half of the Test and Trace service has had a stormy period despite the fine summer here. Initially set up as a national service run from call centres, it proved inferior to the local public health services spread across the country, which were far more successful at tracing contacts of those freshly diagnosed with Covid-19. Much of the central service has since been disestablished to support local work.

It’s hard to know with Boris Johnson whether what he says is meaningful, or primarily intended to manipulate search engines to his advantage. A few weeks ago, just before the UK ran out of testing capacity, he spoke about plans to test “millions” each day in the New Year. In a risible confusion between diagnostic and surveillance testing, the Prime Minister of the UK failed to provide any rational account of that plan. Since testing capacity proved inadequate, he seems to have moved on to schemes to punish people for having Covid-19.

The latest of these will (we are assured) introduce a system of fines up to a maximum of £10,000 for those who have tested positive for Covid-19 and failed to observe the required period of quarantine, or for close contacts of the infected who have been traced and told to remain in quarantine.

As the only means of discovering who has tested positive, or is a traced contact, is to access the strictly protected database of the Test and Trace service, the only way that this could be effectively implemented would be for that service to share personal and clinical data on identified individuals with law enforcement agencies including the police.

This is familiar territory to anyone who knows the slightest about public health, the conflict between the public interest and the protection of private medical information. Imagine how you can try to manage the HIV pandemic in countries where homosexuality is illegal. One lesson which everyone who has had the slightest involvement with public health understands is that patient confidence must be respected absolutely unless there is an overwhelming reason that it cannot be – tragic cases such as Typhoid Mary.

If the official Test and Trace service routinely releases medical and personal information to law enforcement agencies, then many of those who you want to be tested and have their contacts traced will simply not come forward in the first place. This drives infections underground, and has a far worse effect on spread of disease than encouraging cases to come forward by maintaining the trust that is so essential.

So in the UK at the moment, any prospect that we had outsmarted a virus has long since faded. But so has it in the countries which but a few months ago were being held up as examples of how we should have tackled the first wave. The Czech Republic, Israel, Austria, Hungary, Myanmar, even New Zealand have each found Covid-19 harder to beat. In the last few weeks and days those nations, many of which had almost no cases at all in the first wave, have succumbed to a second wave worse than any deserved.

It would be good, though, if we could learn a little more, even lessons from what we got wrong back in March: give the coronavirus a few days to take hold, and it will take months of pain to recover. Here we go again…

Data used are taken from official UK figures at this Government site. Figures are cases classified by specimen date (not the date reported), and represent the date on which each person’s first positive specimen was taken. Unless otherwise stated, data are processed and charts prepared using DataGraph, with curves fitted using LOESS by eye and residuals.