Coronavirus: UK may face five or six waves of disease, MPs are told

Britain may have to endure five or six waves of the coronavirus, with a total of 40,000 or more deaths, before the development of a vaccine permits a return to normal life, a leading expert has told MPs.

Professor Anthony Costello, of University College London, told the House of Commons Health Committee that the “harsh reality” was that the UK had been too slow in a number of aspects of its response to the outbreak, and that “system errors” meant Britain will have “probably the highest death rates in Europe”.

He called for a massive programme of community testing and contact tracing – including the use of smartphone apps to identify those who may have been at risk, and incentives to keep those most at risk in lockdown – to clamp down on the infection.

He also challenged the government’s decision to cease contact-tracing nationwide after Covid-19 became established, arguing that low-infection parts of the UK, such as Yorkshire, could have remained open while London and other hotspots went into lockdown.

His call for community testing was echoed by the chairman of the committee, Jeremy Hunt, who urged “a massive ramp-up – not just in the testing but also the tracing of everyone who has been in contact with someone who has the virus”.

The former health secretary told BBC Radio 4’s World at One: “If we’re going to be in a position where we can track and trace every single person who has Covid or might have had Covid in three weeks’ time – because that’s when we could next potentially end the lockdown – well, that is a huge logistical undertaking.”

He added: “If we’re going to copy the best in the world then that is what we now need to do ... We now need to see some very rapid decisions.”

In evidence given to the Health Committee by video link, Prof Costello, professor of global health at UCL and a former senior official of the World Health Organisation, said that a “community protective shield” will be needed when the UK comes out of lockdown in order to prevent another large-scale outbreak.

This could involve placing in quarantine up to one in 10 of the population identified as most likely to be infected, while the rest of the country goes back to work, he said.

Prof Costello said “the harsh reality” was that “we were too slow with a number of things”, adding: “We can make sure in the second wave we’re not too slow.”

Despite the foreign secretary, Dominic Raab, claiming on Thursday that a decline in the recorded number of new cases in the UK offers “light at the end of the tunnel”, Prof Costello warned that the end of the first wave of infections would not spell a return to normal life.

He said Britain should emphatically reject the concept of “herd immunity” – under which enough people are infected and recover to reduce the spread of cases to a trickle – and instead focus on suppressing infections until a vaccine is available.

“After this wave – and we could see 40,000 deaths by the time it is over – we could only have 10-15 per cent of the population infected or covered. The idea of herd immunity would mean another five to six more waves to get to 60 per cent,” he said. “We have got to suppress this right down.”

He added: “We are playing for time. We need to damp it right down, we need a community protective shield to keep it that way and then we have got to pray that the vaccinologists come up with something. Professor Sarah Gilbert from Oxford says she is 80 per cent confident she will have a vaccine by September, so we have got to be positive here.”

Prof Costello questioned the decision to simultaneously ditch contact tracing and move to social distancing measures across the UK last month.

He told MPs: “In the UK, this is not a single epidemic. It moves into cities – like it did in Wuhan, and then went out to four cities in China, which they suppressed very quickly with partial lockdown; the same in Korea.

“In this country, it has been in London, Wolverhampton, maybe a bit in Liverpool and Glasgow. But the rest of the country was largely untouched up to 12 March. There were 50 local health authorities that had less than 10 cases.

“I was against the idea that we should stop contact tracing in these communities. It was right to stop it in London, because it was too difficult.

“I’m in Yorkshire right now. They had less than 10 cases identified in a population of 300,000-400,000 around the time that we stopped all our community testing and contact tracing. I would have had a more nuanced view whereby in quieter areas you maintain that.

“Now we have got national lockdown, the aim must be to get all the logistics set up with digital apps and public health teams, maybe volunteers, and with primary care, to have an absolute plan to protect the community as soon as we lift the lockdown and then focus on the people we really want to lock down, which is cases and contacts. Then we can get the economy going again.”

With concern growing about the knock-on health impact of an economic slump, a programme of community testing and contact tracing would be “much less disruptive to the economy”, he said.

Prof Costello told the committee: “We have to get the economy going and if it means locking down 10% of our population, even giving them incentives to stay in quarantine and with digital apps to help monitor their symptoms and give them support, that’s the way to really keep this going until we get a vaccine and safe herd immunity.”

The health secretary, Matt Hancock, revealed that ministers considered and rejected a proposal for a London-only lockdown in the middle of March.

Mr Hancock told the committee: “We did consider having a London-specific lockdown and decided it was better to do it across the country as a whole for two reasons.

“The first is that if you put a lockdown in one part of the country, then there’s still travel from there to the rest of the country, so it isn’t as easy as that,” he said.

“And the second reason is that actually one of the really strong things that’s come through this crisis is that the country is acting in lockstep ... To separate off one part of the country from the rest actually has downsides in terms of the national unity that we’ve seen.”