English pubs are likely to be spared any new restrictions on social contact to stem coronavirus outbreaks, with the focus instead falling on limiting gatherings in homes, Downing Street has indicated.
There has been significant speculation about potential further curbs on freedoms if Covid-19 cases rise after the summer, particularly given the government’s commitments for all schools to open to all pupils in England.
Speaking on Friday after Boris Johnson delayed some easing measures as infection rates increased, Chris Whitty, the chief medical officer for England, said the country was “at the outer edge” of what could be reopened, and that if further rules were lifted, others would have to be tightened to compensate.
Prof Graham Medley, who chairs the Scientific Advisory Group for Emergencies (Sage) subgroup on pandemic modelling, said on Saturday that one option might be to close pubs when pupils return to school.
Johnson’s spokesman, however, played down the idea and stressed the desire to avoid nationwide measures if possible.
“Our approach is a localised one, where you would assess the situation on the ground and take whatever steps were required to slow the spread of the virus,” he said. “More broadly, we are committed to supporting the hospitality industry, which has had a very tough time. It employs more than 2 million people, predominantly young people, and it’s important that we continue to support it.”
Asked what, if any, compensatory measures might need to be taken, he pointed to measures introduced at the end of last week in the north of England, which barred people from different households from meeting indoors, and the subsequent declaration of a major incident in Greater Manchester.
“Decisions will always be based on local evidence and scientific guidance,” he said. “We have in place a system now for localised lockdowns. You will see that in Greater Manchester, and in other areas, the steps that we have taken have been to restrict social contact, because that was what the experts considered was responsible for an increase in the prevalence of the virus.”
The Covid-19 pandemic is currently unfolding in “one big wave” with no evidence that it follows seasonal variations common to influenza and other coronaviruses, such as the common cold, the World Health Organization has warned.
Epidemics of infectious diseases behave in different ways but the 1918 influenza pandemic that killed more than 50 million people is regarded as a key example of a pandemic that occurred in multiple waves, with the latter more severe than the first. It has been replicated – albeit more mildly – in subsequent flu pandemics. Until now that had been what was expected from Covid-19.
How and why multiple-wave outbreaks occur, and how subsequent waves of infection can be prevented, has become a staple of epidemiological modelling studies and pandemic preparation, which have looked at everything from social behaviour and health policy to vaccination and the buildup of community immunity, also known as herd immunity.
Is there evidence of coronavirus coming back in a second wave?
This is being watched very carefully. Without a vaccine, and with no widespread immunity to the new disease, one alarm is being sounded by the experience of Singapore, which has seen a sudden resurgence in infections despite being lauded for its early handling of the outbreak.
Although Singapore instituted a strong contact tracing system for its general population, the disease re-emerged in cramped dormitory accommodation used by thousands of foreign workers with inadequate hygiene facilities and shared canteens.
Singapore’s experience, although very specific, has demonstrated the ability of the disease to come back strongly in places where people are in close proximity and its ability to exploit any weakness in public health regimes set up to counter it.
In June 2020, Beijing suffered from a new cluster of coronavirus cases which caused authorities to re-implement restrictions that China had previously been able to lift. In the UK, the city of Leicester was unable to come out of lockdown because of the development of a new spike of coronavirus cases. Clusters also emerged in Melbourne, requiring a re-imposition of lockdown conditions.
What are experts worried about?
Conventional wisdom among scientists suggests second waves of resistant infections occur after the capacity for treatment and isolation becomes exhausted. In this case the concern is that the social and political consensus supporting lockdowns is being overtaken by public frustration and the urgent need to reopen economies.
However Linda Bauld, professor of public health at the University of Edinburgh, says “‘Second wave’ isn’t a term that we would use at the current time, as the virus hasn’t gone away, it’s in our population, it has spread to 188 countries so far, and what we are seeing now is essentially localised spikes or a localised return of a large number of cases.”
The overall threat declines when susceptibility of the population to the disease falls below a certain threshold or when widespread vaccination becomes available.
In general terms the ratio of susceptible and immune individuals in a population at the end of one wave determines the potential magnitude of a subsequent wave. The worry is that with a vaccine still many months away, and the real rate of infection only being guessed at, populations worldwide remain highly vulnerable to both resurgence and subsequent waves.
Action would not always be directed at households, he added, pointing to earlier measures closing factories connected to outbreaks of Covid-19.
He also reiterated the government’s determination to fully reopen schools. “You’ve heard from the prime minister on many occasions his absolute commitment to getting out children back into school in September. That’s vital for their education and their development. We are planning for all pupils in all year groups to return to school full time from the beginning of the autumn term.”
The only exception could be “a very specific localised lockdown that might require a single school to close”, he added.
The London mayor, Sadiq Khan, said on Monday that it was “totally unacceptable” that ministers had reportedly discussed the possibility of sealing off the capital if infections rose sharply there.
Johnson’s spokesman said there were no plans to do so, but stressed that the idea of restricting travel into a badly affected area had already been outlined as a possible course of action.
“If you look at the contain strategy, which we published just over two weeks ago, it sets out … the possibility of putting in place restrictions on travel if there’s an area that is particularly badly affected. One of the steps within that potentially includes closing down local transport networks. So it’s there, it’s contained in the document. It’s not a new thing.
“But to be clear, it’s not something that is specific to London or anywhere else.”
He also dismissed reports at the weekend that people over 50 might be asked to shield in the event of rising infections in the winter as inaccurate.