IT IS no shock that many European countries are again facing rising coronavirus cases – this is exactly what researchers anticipated. Modelling in March by Mark Woolhouse at the University of Edinburgh, UK, suggested that a two-month UK lockdown would lead to low cases and an imperceptible rise over the summer before new measures were required at the end of September. Which is roughly what happened. Other models foresaw similar patterns. “I’m not claiming a prediction, but it’s a scenario that was predictable,” says Woolhouse.
The speed and size of the wave in Europe has been a surprise though. “Every infectious disease epidemiologist has been expecting a big increase, but it’s been bigger and sooner than most of us would have expected,” says Paul Hunter at the University of East Anglia, UK. While we don’t know how big the epidemic will get this time round in the UK, he says it will probably dwarf the one in March and April. Deaths may be lower this time, Hunter adds, due to a higher proportion of younger people being affected and better treatments.
“Epidemiologists have been expecting a big increase, but it’s been bigger than most of us expected”
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The key question now is whether second national lockdowns are inevitable and, if so, will they differ from the first time? Israel is the only high-income country to have begun a full national second lockdown. It started on 18 September, with a further tightening of restrictions a week later. It is too soon to know the impact of this lockdown.
Several countries, including Australia and the UK, have opted for local lockdowns as cases rise. On 22 September, England stopped far short of a second national lockdown, instead . UK Prime Minister Boris Johnson made it clear that he didn’t want a full lockdown, but didn’t rule one out.
The severity of a second lockdown may depend on how well countries managed their first one. The UK’s initial peak lasted longer than those in many other countries, and measures were relaxed when cases were still relatively high compared with other nations, says Stephen Griffin at the University of Leeds, UK.
“Is lockdown inevitable? It’s inevitable if you’ve not acted properly the first time round,” he says. “Countries that have got it under control from the outset – New Zealand, Singapore, South Korea – have not only returned to normality far better, but also when they’ve had another outbreak, they’ve controlled it.”
New are growing much faster in the UK, France and Spain than in Italy and Germany. Experts think the diverging paths are due to differences in testing and tracing, demographics, public health messaging, but also, importantly, public behaviour and compliance with the restrictions that remained after lockdown eased. In England, , with only a fifth of people with symptoms fully self-isolating. .
The recent measures Johnson announced, which also include encouraging people to work from home if they can, are seen by many researchers as too little, too late, and unlikely to do much to prevent cases in England from doubling every week. For example, the 10 pm closure of pubs is so modest a change, it is impossible to model, says Woolhouse. “We are approaching [more] severe restrictions,” says Griffin.
Such restrictions may well be more targeted than the strict lockdowns of March, April and May. “You can’t expect a second lockdown to be identical to the first, that would imply we’d learned nothing,” says Woolhouse. It is thought unlikely that nations will return to the blanket instruction of everyone staying at home aside from essential shopping and limited exercise outdoors.
Bans on unnecessary gathering indoors and mixing with other households – things Scotland has already done – are sensible steps, says Griffin. Hunter expects the UK hospitality industry to close again.
Scientists have learned that the virus transmits poorly outdoors and that although children do transmit the virus, they aren’t driving the epidemic, Hunter adds. “The clear implication of that is we don’t have to be too restrictive on outdoor activities. And we don’t need to close schools.”
While some epidemiologists think the UK government’s strategy is to continue suppressing the virus until a vaccine is available, others question how sustainable this goal is. Woolhouse points out that as soon as the next set of restrictions is relaxed, a third wave is a plausible scenario.
, there has been discussion of whether it is time to look at alternatives to suppressing countries’ epidemics (see “Let the coronavirus spread among young people? It’s not a good idea”). What might those look like? One is better protections for those we know are more vulnerable to the illness: the over-65s and those with existing health conditions. Countries such as the UK have begun regular testing for care home workers to protect residents. But an equivalent testing scheme for carers, spouses and others in close contact with vulnerable people in the community isn’t yet in place. Having millions of tests a day, as the UK has proposed, could be another option. But that doesn’t exist yet.
In the short term, says Woolhouse: “All we’re left with is increased social distancing, partial lockdown.” But all the strategy will do in the medium term is defer the problem, he believes.
One step that governments could take is messaging and interventions that are more tailored to individuals, says Hunter. “It’s plausible we could have something like personalised public health interventions,” he says. “If you’re female, white, fit, 64 years old with no pre-existing disease, then probably you’re not in the vulnerable group. If you’re an overweight, white, male professor you certainly are more at risk. If you are from a [black, Asian and minority ethnic] background and have diabetes, you are even more at risk. There should be a way of being a bit more focused.”
