UK media headlines are warning that the country could soon be in the grip of a third wave of COVID-19 infection. Citing government scientists and advisors there are claims that the death toll from this third wave could far surpass that seen in either of the previous two waves. (1) (2)
But what are these warnings based on? Do they stand up to scrutiny? And if true where does that leave the plans for the UK to lift all restrictions on 21 June 2021?
The term “Wave”
As any pandemic progresses it is normal for cases of infection to surge and fall back even without the availability of a vaccine. The Spanish flu pandemic of 1918-20 saw three distinct waves of infection. (3)
The fixation on the word “wave” may no longer be particularly helpful. It means overwhelming cases of disease and deaths and, whilst this has been seen twice here in the UK, it may be more appropriate now to talk of further “outbreaks” of infection rather than “waves”. Otherwise repeated outbreaks will be labelled numerically ad infinitum and we will be reading about 10th and 11th and 12th waves before we know it. At some point life has to get back to normal and if every increase in cases is declared a new wave by the media, many are going to remain fearful of resuming their previous lives.
COVID-19 is here to stay, it cannot be eradicated.
The consensus of the UK Science and Technology Committee is that the long-term goal has to be to live with the virus - not fight to eliminate it. Their chairman, MP Greg Clark told the BBC, “We can't aim for ‘zero’ Covid deaths, the UK is going to have to live with some level of Covid infections and deaths in the future.”
When pushed for what might constitute an acceptable level of infections and deaths he admitted, “I don’t think you’re ever going to have a precise figure [for acceptable levels], just as we don’t target a figure for road deaths.” (4)
The vaccination programme in the UK has been very successful but even with good vaccines it is virtually impossible to eradicate a virus. Mankind has only achieved it once, with smallpox. The total eradication of smallpox was declared in 1980 but it took decades to reach that point. It was achieved through vaccination but the smallpox virus also behaved very differently to the coronavirus and this aided the work to eradicate it. (5)
Concurrent with stories speculating about further waves, there are repeated media announcements about new variants and how the current vaccines will not work against them.
Just yesterday (3 June 2021) there were headlines claiming a new variant had been identified in Nepal that could be “resistant to vaccines.” (6)
This came as a surprise to Nepalese doctors and scientists who were unaware there was a new variant in their country and led the WHO (World Health Organisation) to make an official statement that no such new variant had been discovered in Nepal. (7)
Continual media scare-mongering about waves and variants serves no good. It alarms people unnecessarily AND means people will cease to take notice of serious and important announcements about COVID-19 when they need to.
Whenever a news article says a vaccine is "ineffective" or "failing to protect" it is important to ask, "What was the end point the failure is based on?"
There are many different layers of protection - protection from death, protection from severe disease, protection from mild disease, protection from asymptomatic infection.
A vaccine that "fails" to prevent asymptomatic and mild illness but protects against serious disease, hospitalisation and deaths is not, in my opinion, a failure.
The Present Reality
Case rates of COVID-19 have been increasing across the UK over recent weeks but hospital admissions and deaths have not.
Most of the rise in cases is from certain “hotspots” which are seeing more rapid rises in case numbers than elsewhere in the UK. The north-west of England and central Scotland are seeing the highest number of new cases. The hotspot areas share some common demographics, they tend to be areas of higher than average deprivation and lower than average vaccination uptake rates. (8)
Across the UK the largest increase in cases is amongst the younger population, particularly the under 30s. There have not been any significant increases in cases in the over 50s. Crucially this was expected as the UK came out of lockdown and unvaccinated, younger people were able to mix socially again. With more than 98% of COVID-19 hospital admissions and deaths occurring in the over 50s (before the vaccination roll out) a balance had to be struck between unlocking at a time when the older population was protected even though younger people were still waiting to be vaccinated and would therefore be at risk of becoming infected.
The increase in cases we are now seeing was predicted and thus far is not translating into serious illness for the vast majority. We should not be rushing to call this increase a third wave, especially when experts are increasingly hopeful that vaccination has broken the link between cases and serious illness.
Dr Simon Clarke, an associate professor in cellular microbiology at the University of Reading, said: “The latest statistics show that while rates of infection are once again rising in the young, the link to infection rates in more vulnerable older people seems to be broken. This would seem to add to existing evidence that vaccines are working at stopping the spread of Covid-19. (9)
Dr Mike Gent, incident director for the COVID-19 response at Public Health England, said: “We are seeing some increases in case rates once again, particularly in younger age groups who are not yet being vaccinated and are having regular testing. This is to be expected as the country opens up and people start to socialise more together. But it provides a stark reminder that we must all follow hands, face, space, fresh air and importantly get vaccinated when it’s offered. We will continue to closely monitor the case rates, hospitalisations and deaths over the coming days.” (10)
And Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said: “There’s a sizeable proportion of our population who aren’t fully vaccinated, and many of these people will be susceptible to infection. Therefore, as we lift restrictions we may well see a continued rise in infections until vaccine roll-out has reached these people. But a rise in infections is not in itself bad news. Provided the vaccines continue to protect the vast majority of vulnerable people, cases of severe disease and death should be kept low. That’s the key indicator here, which is why we need to keep a close eye on it.” (11)
A Note of Caution
Whilst hospital admissions and deaths are not rising across the UK as a whole it is too soon to know for certain that the rising case numbers fuelled by the Delta variant (the new name for the Indian variant) will not cause significant problems in some areas of the UK. It is possible that hospitals in these hotspot regions could become overwhelmed again.
As Dr Stephen Griffin, Associate Professor, School of Medicine, University of Leeds, says specifically about these hotspot areas: “...Cases continue to rise exponentially and it seems spread has not been curtailed within certain hotspots. Also, hospitalisations are rising, with a similar lag time to what we’ve seen too many times before....if enough of the younger population become infected there will be some individuals who end up with serious COVID or with long COVID, plus not all vulnerable people have had a vaccine yet. The now dominant variant is highly transmissible, and has the potential to cause enough cases such that hospitalisation again puts tremendous pressure on the NHS.” (11)
So those areas seeing very high case numbers may be at risk of finding their local health services overwhelmed again even if elsewhere in the UK there is not a problem.
In Conclusion
The next two weeks will be crucial in deciding if all restrictions in the UK can be lifted as planned on 21 June 2021. We know there is always a time lag between people becoming infected and needing hospital admission. Whilst 75% of UK adults have now had at least one vaccine dose, full protection is not gained until several weeks after the second dose and the remaining 25% of the population are yet to be vaccinated.
Whilst we can be cautiously optimistic the UK will not see a third wave of COVID-19 along the lines of the previous waves, I am less convinced we will be in a position to lift all restrictions by 21 June. I suspect some measures, such as limits on numbers who can gather indoors, continued working from home and mask wearing for example, may be extended beyond this date. That decision will be determined by what happens in our hospitals in terms of serious illness and deaths from COVID-19 between now and then.
