We look back at last week’s coronavirus situation in the UK, the variants, the roadmap out of lockdown, the consequences of school reopening, and more...


First published in April 2021.


Variants of Concern: causing concern more widely

The ‘UK’ or ‘Kent’ coronavirus variant (B.1.1.7) has not only spread to almost every country in Europe, it has now reached many far beyond. This more transmissible variant was reportedly first identified in Kent in September 2020.

Since that time the variant’s journey has been widely covered by the world’s media. More recently, in an article published on 26 March 2021, Andrew RC Marshall, Special Correspondent for Reuters, and his co-writers observed about the variant that, “Scientists at Britain’s COVID-19 Genomics UK Consortium (COG-UK) first detected the B.1.1.7 variant of coronavirus in September in the English county of Kent. It took almost three months before they discovered that the “Kent variant” was 70% more transmissible than existing variants, and further weeks before another shocking discovery: It was also much deadlier.”

The article concludes with the observation that, “B.1.1.7 has now been found in over 100 countries. It was first detected in the United States at the end of December, and the Centers for Disease Control and Prevention predicted it could be the dominant variant in the country by the end of this month (i.e. the end of March).”

Looking back to the beginning, and then forward to where we are now, it is clear that variant B.1.1.7 had an increasing impact as it spread across the UK, and then reached other countries. This impact sadly was indicated through the escalating, and record, numbers of COVID-19 infections, hospital admissions and deaths reported in the UK. The British government must surely take some responsibility for the extent of the transmission.

As the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) reported to the Scientific Advisory Group for Emergencies (SAGE 80) on 11 February 2021:

“NERVTAG is now of the view that it is it is likely that infection with B.1.1.7 is associated with an increased risk of hospitalisation and death compared to infection with non-variants of concern (VOC) viruses. The absolute risk of death per infection remains low.”

The latest data published by Public Health England (PHE), on 31 March 2021, provides a glimpse of the current situation, and the increasing numbers of not only B.1.1.7 but the emergence of other variants of concern in Britain.


It is interesting to note, given the increase in variant numbers, and the increasing number of cases in mainland Europe, that UK ministers have appeared to focus this week on ‘encouraging’ more people to return to their workplace; especially given the observation at that very SAGE meeting in February, that, Requiring more people to come to a workplace is likely to increase the risk of transmission associated with that workplace (high confidence), whereas people working from home where possible is likely to reduce it.”

Equally concerning is the fact that the so-called ‘UK variant’ (B.1.1.7) is, at this moment in time, associated with escalating SARS-COV-2 infections in countries further afield than Europe. In particular, the United States, where the CDC has been closely monitoring variants of concern (VOC), observing the fact that, “These variants have mutations in the virus genome that alter the characteristics and cause the virus to act differently in ways that are significant to public health (e.g., causes more severe disease, spreads more easily between humans, requires different treatments, changes the effectiveness of current vaccines).”

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While the same SAGE 80 meeting in February also noted that, “Maintaining control of the epidemic is easier at low levels of prevalence than at high levels because it gives more time to respond to increases before healthcare systems are overwhelmed; allows test, trace and isolate systems to operate more effectively; reduces the likelihood of needing to make unplanned interventions; and reduces the likelihood of new variants emerging. It is not possible to make quantitative predictions as to the risk of immune escape variants, but keeping prevalence low is the best way to reduce this risk.”

So, the key questions arising from SAGE 80 in February include:

  1. What is low prevalence, and do we have low prevalence at the end of March/beginning of April 2021?
  2. Which variants are currently causing the most concern?
  3. Is the situation under control given the emergence of additional variants of concern and the proposals indicated in the UK government’s Roadmap out of lockdown plan?

And of course, the big question is: What happens next given the escalation of cases in mainland Europe, and the intense pressures (and expectations encouraged) in Britain to begin to relax our restrictions?

How confident are we as a nation in taking the next step? How aware are we all of the significant risks? When the prime minister says that the plan is “irreversible”, does he recognise that to relax restrictions too soon could cause irreversible damage in terms of new infections, additional hospitalisations, and sadly a significant increase in deaths due to Covid-19? Not to ignore the potentially huge impact on long term physical and mental health caused by the virus, including the impact of Long Covid on many hundreds of thousands of people and on our already stretched NHS services?

Is the general public even aware of the risks of rising cases because of the school reopening, the current variants in the UK, the landing of new, more contagious variants on our shores from abroad, and the government’s ‘Roadmap out of lockdown’ plan? According to a recent YouGov survey, 78% of people indeed think that COVID-19 cases will rise again in the next few months.

Pixels


Is the roadmap strategy about ‘feeling’?

There was an interesting moment during the Downing Street Covid-19 briefing on Monday 5 April.

Chief Medical Officer, Professor Chris Whitty, said: “Those are the four tests and, of course, a lot of other data. But these are just a snapshot of some of the data we have to support the government’s feeling that these tests have been met.”

Chief Medical Officer, Professor Chris Whitty, during the coronavirus briefing. | BBC News

Back in February, Prime Minister Boris Johnson told the nation that, At every stage, our decisions will be led by data not dates, and subjected to four tests: first, that the vaccine deployment programme continues successfully; second, that evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths; third, that infection rates do not risk a surge in hospitalisations, which would put unsustainable pressure on the NHS; and, fourth, that our assessment of the risks is not fundamentally changed by new variants of covid that cause concern.”

It is only right that we now ask ourselves what is it that really is leading the government’s decisions? Data? Dates? Or feeling?

Chief Medical Officer, Professor Chris Whitty, in the Briefing Room. | Flickr/Number 10


Are schools safe or not?

Schools have fully reopened across the country now for a number of weeks. So, what is the data telling us? The ONS infection survey data report, published on 26 March, presented a number of interesting sets of data. The charts highlighted the uncertainty in relation to whether infections are levelling off, or increasing, as shown in the report.


Of particular interest is the chart below, which has been created to illustrate some of the ONS data. It shows that schools had seen an increasing number of children testing positive in two categories of school children (Age 2 to School Year 6 & Year 7 to 11). It this a sign of more worrying things to come?

Dr Joe Pajak

As government scientists noted at the 85th SAGE meeting on COVID-19, on 31 March 2021, in their ‘situation update’, “R estimates for England, Scotland, and Northern Ireland are between 0.8 and 1.0. Estimates lag changes in transmission by two to three weeks and will not yet fully reflect the impact of schools reopening in England. The impact of school reopening on R remains uncertain.”

By now perhaps there is more data that scientists have seen...

Is that one of the reasons why the Department for Education has confirmed that secondary pupils will continue to wear face masks after the Easter holidays – until at least 17 May?

PM Boris Johnson visiting St. Mary’s CoE Primary School in Stoke on Trent. | Flickr/Number 10


Awareness and education, always.

It is time for more awareness and education. Perhaps, this short video would help those who may be unsure about how the virus transmits through the air to understand. It is not magic, it is not pretend, it is how nature works. It is how we spread and receive the SARS-CoV-2 virus.

Respiratory Pathogen Emission Dynamics. | JAMA/Lydia Bourouiba


Finally...

As we move forward with the government’s roadmap out of lockdown, let’s do our best to make it a success. Let’s not lift the restrictions too early or too fast. Let’s avoid having to return into lockdown because we wanted to outsmart the virus. Let’s support those who need to self-isolate, especially for work. Let’s keep the new variants out by scanning all travellers. Let’s keep full-vaccinating. Let’s keep wearing masks. Let’s be smart. 


Going Further:



Dr Joe Pajak, professional experience scientific research and development, principal of a community college, director of education, then director of a national children’s charity, trustee of a disability charity, and governor of an NHS foundation trust hospital.
J.N. PAQUET, Author & Journalist, Editor of PMP Magazine.






[This piece was first published in PMP Magazine on 6 April 2021. | The authors write in a personal capacity.]

(Cover: Flickr/Number 10. - Prime Minister Boris Johnson Covid-19 Press Conference. | 29 March 2021. / Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)

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