Britain's failure to learn the hard lessons of its first Covid surge is a disaster | William Hanage


Britain is in the grip of an extraordinarily dangerous outbreak of forgetfulness. During the spring, more than 50,000 people died – far more than the yearly total for any flu outbreak in living memory. Deaths are, sadly, an expected outcome of any pandemic. But this experience is also an opportunity to learn – assuming governments are willing to do so.

Since the first outbreaks of Covid-19 early in the year, scientists and governments have learned a lot about the virus. They’ve learned that the best way to fight it is through testing, tracing and isolating – and they’ve learned what the consequences of not fighting it can be. But the UK seems to be ignoring most of these hard lessons. Instead of evidence-based policy, its response – initially urging people back into offices, outsourcing testing and tracing to corporate giants, and opting for half-measures in the face of a virulent second wave – looks more like policy-based evidence.

It’s increasingly clear that soaring rates of disease during the spring began with undetected mild infections, particularly among younger people. Because younger people typically have less severe cases of Covid, they are more likely to be missed by testing targeted at those with visible symptoms. This is one of the lessons from the first wave.

But in England, testing is still overwhelmingly targeted at those who have one of three symptoms, even though the true list of symptoms continues to grow. Its contact-tracing system, a key part of controlling the spread of the infection among those who may be asymptomatic carriers, has been widely ineffective (in the Covid hotspot of Bradford, tracers were only able to reach 42.5% of identified close contacts). And its testing system is in disarray, struggling with a backlog of some 200,000 tests, with some people being asked to travel hundreds of miles in order to secure one.

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Once a large number of infections has built up in the young, they start to infect older people. During the summer, we saw this happen across the US sun belt – the south-east and south-west. This was spared the grim experience of the north-east back in the spring, but cases surged as governors rushed to reopen. Between them, Florida, Texas and Arizona have now reported more than 1.5m infections. At the beginning of the sun belt surge, politicians claimed that infections in younger people weren’t cause to worry, because they were unlikely to get seriously ill. But young people still transmit the virus, and many people have since died – more than 30,000 and counting in Arizona, Florida and Texas. This was predictable. Indeed, it was predicted.

In the global league table of incompetent pandemic management, the UK is doing something highly unusual. Its school year is starting with minimal infection control. Teaching is conducted in person and masks aren’t mandatory, unless you’re in a coronavirus hotspot. Kids are grouped into “bubbles” as large as 300 students, which amounts to less of a bubble and more like the planet Saturn (rings included).

The government has repeatedly minimised the threat of coronavirus. At the same time, it has lost control of its testing system during the most crucial moment since the initial surge of coronavirus cases, when greater demand for testing could have been easily foreseen. This is a disaster: England has been effectively blinded to where and how the virus is spreading.

Successfully grappling with Covid-19 through the autumn and winter months relies on the deeply unsexy term “situational awareness”. This means knowing what is really going on, so we can take action where it’s needed and earn people’s trust. Though targeted local lockdowns are a smart way to bring the virus under control, they rely on adequate testing to identify where and at what rate the virus is spreading (situational awareness). Without this, the government is playing whack-a-mole with its eyes closed.

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Ministers had months to prepare for the inevitable rise in cases that would accompany reopening schools, and to ensure the testing and tracing system was up to scratch. Although children are very unlikely to suffer serious illness as a result of infection, they can still transmit the virus to others. Like many young people, children show fewer signs of being infected (even more so among the very youngest age groups). Because of this, scientists have found it hard to estimate the number of infections in children and their overall contribution to transmission.

Coronavirus isn’t like flu, where schools become hotbeds that drive the spread of a virus. But this doesn’t mean that schools are wholly benign. Despite the role that schools play in transmitting coronavirus, politicians including the education secretary, Gavin Williamson, have previously said they could open with minimal consequences, or suggested that children are “immune” to coronavirus and do not transmit.

It’s hard to compare the UK’s education system with that in the US, where I live, not least because school districts here vary so much in what they are doing. But I can tell you about what has been happening in my local school district. At present, all classes are conducted online. When schools open in a few weeks, twice-weekly testing will be available for teachers and staff in schools who request it. Masks will be worn by all students, teachers and staff, and those students who want remote learning will be able to get it, resulting in fewer kids in each “bubble”.

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And in Massachusetts, my home state, we’re currently running more than 17,000 tests a day with a positivity rate of less than 1% and rates of community transmission that, while not as low as we might like, remain stable (despite what many might wish, we have not attained “herd immunity”). Universities even have their own dashboards reporting the results of thousands of tests. There’s a reliable spot to get tested around the corner from where I live, with a line out the door that stretches all the longer for everyone being six feet away from each other. People can even get a test if they wish to visit neighbouring Maine for the weekend.

You know what it has been like trying to get a test in the UK. Why the difference? It might be because the per-capita mortality here in Massachusetts during the spring was much worse than in the UK, and those recent memories make it easier to justify tough restrictions – and illustrate the risks of losing control of the pandemic.

The north-east of the US is bloodied, but it has so far avoided any serious resurgence of the virus, possibly because the hard lessons of the first wave have been taken seriously (even if the federal government is still disgracefully absent). While the pubs in England stay open until 10pm, and home visits are still allowed between households, bars in Massachusetts will remain closed until a vaccine becomes available.

In the spring I despaired that the UK was not learning the lessons of its neighbours. Now it is not even learning the lessons from itself.

Dr William Hanage is professor of the evolution and epidemiology of infectious disease at Harvard



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