Ross Clark

The Scientific Advisory Group for Emergencies (Sage) has warned the government that the second wave of Covid-19 could be more deadly than the first, but may be spread over a greater period. Downing Street is now reportedly working on the assumption that deaths will peak at a lower level than in the spring (when they topped just over 1,000 a day) but will continue in the hundreds for far longer, possibly even for months throughout the winter. More than 25,000 are predicted to be in hospital by the end of November — higher than the spring peak.

Imperial College’s latest React study — an attempt to measure the spread of Covid by testing the general population — suggesting that the number of people in Britain carrying antibodies for the SARS-CoV-2 virus has dropped sharply over the past three months. This led a few headline-writers to run somewhat ahead of the facts. 'Covid immunity only lasts a few months,' claimed one. The reality is a lot more complex — indeed, one of the possible interpretations of the Imperial study is that more people have some level of immunity than has previously been believed. The React study tested 365,000 adults between late June and September, using a self-administered finger prick test to detect for the presence of antibodies.

Worse tales have emerged during the pandemic than that of the ‘Florence Three’ – Rhys James, Quinn Paczesny and Will Castle, who have all now returned home to Britain after 61 days incarcerated in a hotel in the Italian city. Some might say a couple of months stuck in Florence could have been a blessing – and so it might have been, had they not each been stuck in solitary confinement and fed microwaved mush, with no more chance to go out to a trattoria than to visit the Uffizi. But what stands out about the story of the Florence Three is not so much their plight, but what it tells us about Covid-19 tests. The three men, who are aged between 20 and 23, met in Northern Italy while teaching English over the summer.

That the lockdown had a terrible impact on the nation’s health — in ways other than just Covid-19 — is becoming clearer by the day. But just how bad was it? According to a study by the London School of Hygiene and Tropical Medicine, delayed and cancelled breast cancer treatments will cause between 281 and 344 additional deaths. For colorectal cancer, there were an extra 1,445 to 1,563 deaths, lung cancer an additional 1,235 to 1372 deaths and 330 to 342 more oesophagal cancer deaths. A University of Leeds study estimated that there have already been an extra 2,085 deaths from heart disease and stroke as a result of people not accessing timely medical help.

What percentage of people who are infected with Covid-19 will go on to die of the disease? The dramatic response to the pandemic on the part of almost all governments around the world has been based on the idea that Covid-19 is a far more lethal disease than seasonal flu, which is often quoted as having an infection fatality rate (IFR) of 0.1 per cent. The World Health Organisation (WHO) is often quoted as claiming that Covid-19 has an IFR of 3.2 per cent — a claim that goes back to a press conference in early March when it, in fact, said that the case fatality rate (CFR) at that stage was 3.2 per cent.  The CFR is the division of known deaths by known cases — the denominator omitting the many cases that have not been confirmed by diagnosis.

Does catching the SARS-CoV-2 virus give us immunity from further infection by the virus or can we catch it a second time? The question has been given extra poignancy this week following Donald Trump’s tweet on Sunday, quickly censured by Twitter, claiming that he was immune. Before that row has had a chance to die down, a paper emerges in the Lancet Infectious Diseases reporting the possible reinfection of a 25-year-old man in Washoe County, Nevada. The timeline reported in the paper, by the university of Nevada, is as follows. The patient first developed symptoms – sore throat, cough, headache, nausea, diarrhoea – on 25 March. He tested positive for the virus at a community testing facility on 18 April. By 27 April, his symptoms had disappeared.

Two days ago, the Prime Minister told us we are at a critical point in the Covid-19 crisis as a second wave threatened to engulf us. He warned of a second national lockdown. Yesterday, in spite of evidence from Imperial College of a declining R number, Matt Hancock introduced new restrictions in Liverpool and Teeside. But is the government behind the curve, failing to notice that the second wave is already fizzling out? As I have argued here before, the daily numbers of confirmed cases are not a reliable indicator of the path of the epidemic.

So, the numbers of new Covid infections in the UK failed to register a fourth consecutive fall and instead rose to a new record of 7,143. This does not mean that the disease is spreading as rapidly as it did in the spring when far fewer tests were being undertaken, but the rise has nevertheless led morning news bulletins. Week on week, daily new infections have risen by 45.3 per cent: 42,608 in the week ending 29 September compared with 29,323 a week earlier. This is consistent with a doubling every 10 days or so. There are a few observations that have been less-well reported. Firstly, Monday’s sharp rise was exaggerated by an especially sharp rise in Scotland, where newly recorded cases nearly quadrupled from 222 on Monday to 806 on Tuesday.

New confirmed cases of Covid-19 have been rising now since early July — steadily at first and then sharply since early September. But is there any sign of an increase in deaths?    The latest weekly figures from the Office for National Statistics for deaths in England and Wales, released this morning, do record an increase in deaths where Covid-19 is mentioned on the death certificate. In week 38 (ending 18 September) there were 139 such deaths — 40 more than the previous week. To put that into perspective, they accounted for 1.5 per cent of all deaths. They continue to be dwarfed by deaths in which ‘influenza and pneumonia’ is mentioned as a cause — which accounted for 14 per cent of all deaths.

We have had plenty of anecdotes about people failing to be diagnosed with serious diseases during lockdown. This is thanks to either to hospitals cancelling appointments, GP surgeries stopping face-to-face meetings or people picking up the message that they should protect the NHS by trying not to use it.  It seems clear that the rush to lockdown had significant unintended consequences for healthcare But what about quantifying the problem? The National Institute for Health Research has attempted to do just this.