Coronavirus Update Briefing - 21st September 2020

Please see the transcript from today's briefing below. The slides, presented by Sir Patrick Vallance and Professor Chris Whitty, are also attached.

Sir Patrick Vallance, Government Chief Scientific Adviser:

We wanted to give you an update on where we see the epidemic at the moment, some of the knowns and some of the uncertainties.

Let me just start by reminding you that this disease spreads by droplets, by surface contact and by aerosols. Hence the hands, face, space but also to remind you that the way that we reduce the spread is by limiting our number of contacts, by reducing contact in environments where spread is more likely. Those are crowded environments, indoor environments, poor ventilation. And making sure that we reduce the probability of coming into contact with anyone who is infectious and that’s the importance of self-isolation, keeping out of circulation if you have or may have the virus.

I want to start by talking about the rise in cases elsewhere and what we can learn.

• We’ve seen increase in cases across Europe.
• It started with younger people in their twenties and spread gradually to older ages as well.
• That increase in case number has translated into an increase in hospitalisations.
• As the hospitalisations have increased, deaths are also increasing.
• As the disease spreads, as it spreads across age groups, we expect to see increase in hospitalisations and unfortunately those increase in hospitalisations will lead to an increase in deaths.
• The virus has genetically moved a bit but it has not changed in terms of its propensity and its ability to cause disease and to cause death, even though of course most of the disease deaths occur in the older population.

These are data from testing. They’re data for England but the picture is fairly similar across the UK.

• We see from July, as we look at the increase in cases per 100,000 of population, an increase which has occurred over August and has increased into September.
• This is by different age groups.
• The top line, the blue line is amongst the 20 to 29-year-olds. (See Presentation Slides)
• There has been an increase in cases across all age groups.
• The lowest increase has been in children and in the population aged 70 to 79.
• In every age group we’ve seen an increase.

We are in a situation where numbers are clearly increasing.

• In the ONS study, it’s now estimated that roughly 70,000 people in the UK have Covid infection and that about 6,000 people per day are getting the infection.

• They’re increasing across all age groups.
• This increase in numbers is also translating into an increase in hospitalisation. 

The UK reported cases per day against time.

• There are up to roughly 3,000 cases per day or so in September, middle of September.
• At the moment, we think that the epidemic is doubling roughly every seven days.
• Let's say that there were 5,000 today, it would be 10,000 next week, 20,000 the week after, 40,000 the week after. And you can see that by mid-October if that continued, you would end up with something like 50,000 cases in the middle of October per day.
• 50,000 cases per day would be expected to lead a month later, so the middle of November say, to 200 plus deaths per day.
• This graph is not a prediction. It is simply showing you how quickly this can move if the doubling time stays at seven days.
• The challenge therefore is to make sure the doubling time does not stay at seven days.
• There’re already things in place which are expected to slow that.
• To make sure that we do not enter into this exponential growth, it requires speed, it requires action and it requires enough in order to be able to bring that down.
  • Cases are increasing, hospitalisations are following. Deaths unfortunately will follow that, and there is the potential for this to move very fast.

Regarding immunity

• When people have an infection, the vast majority of people get an antibody response, and we know that some of those antibodies are so-called neutralising antibodies.
• They do indeed protect against the virus. We also know that they fade over time, and there are cases of people becoming re-infected.
• This is not an absolute protection, and it will potentially decrease over time. What we see is that something under eight per cent of the population have been infected as we measure the antibodies.
• Roughly 3 million or so people (8%), may have been infected and have antibodies.
• The vast majority of us are not protected in any way and are susceptible to this disease.
• The number of people with antibodies is a little higher in the cities, and it may be as high as 17 per cent or so in London. That may confer a little slowing of spread but not much more than that.

Professor Chris Whitty, Chief Medical Officer for England:

We have two maps from England but are similar to Scotland, Wales and Northern Ireland.

• The darker colours are the rate of transmission.
• On the map, orange or yellow or brown represent an increasing rate of transmission. The darker that colour, the greater the rate of increase.
• Green or blue colourings represent a stable or falling situation.
• At the moment, the very high rates of transmission in the UK are highly concentrated in particular areas.
• There are also significant rates of transmission in many parts of the UK with the darker colours.
• After the remarkable efforts which got the rates right down across the country, firstly we saw very small outbreaks, might be associated with a workplace or another environment.
• Then we’ve seen more localised outbreaks which have got larger over time, particularly in the cities.
• Now we’re seeing a rate of increase across the great majority of the country. It’s growing at different rates but it is now increasing.
• Anywhere which was falling is now moving over to beginning to rise.
• This is not someone else's problem, this is all of our problem. Next slide, please.

This graph is shows the number of inpatient cases in England over the period from the first of August.

• Until that point in time, there had been a steady fall over a long period of time from early April.
• It stabilised for a period and flattened out.
• Since the 1st September, you can see a steady, sustained rise in numbers with a doubling time, as with the cases, of probably seven or eight days.
• If this carried along this path, the number of deaths directly from Covid will continue to rise, potentially on an exponential curve.
• That means doubling and doubling and doubling again, and you can quickly move from really quite small numbers to really very large numbers because of that exponential process.
• I think everybody will realise that at this point the seasons are against us.
• We’re now going into the seasons late autumn and winter which benefit respiratory viruses, and it is very likely they will benefit Covid as they do for example flu.
• We should see this as a six-month problem that we have to deal with collectively.
• It’s not indefinite and science will in due course come and ride to our rescue.
• In this period of the next six months I think we have to realise we have to take this collectively, very seriously.

We see no evidence that this is a milder virus than it was in April.

The cases started to rise most in the lowest age bands, in young adults, not in children, children the rates have really not increased.

• These are the group who are least likely to end up in hospital.
• For many people this remains a mild infection.
• As you move up the ages, if you move into people who are more vulnerable, then the mortality rates, rise to quite significant rates.
• We’ve seen in other countries, that they’re not staying just in the younger age groups, they’re moving up the age bands and the mortality rates will be similar to, slightly lower than they were previously.
• These are significantly greater, for example, than ordinary seasonal flu.
• For reference, seasonal flu normally in the UK would on average a year would kill around 7,000 people a year tragically, and in a bad flu year, as there was for example about three years ago, it might kill upward of 20,000 a year.
• This virus is more infectious than flu.
• Treatment is better.
• Doctors, nurses have learned to treat this much more effectively.
• We have new drugs such as dexamethasone. These will reduce the mortality rate, but they will definitely not eliminate or take it right down to trivial levels.

Four ways in which this virus is going to have a very potential significant effect on the population's health if we let it grow out of control:

• The easiest to identify is direct Covid deaths. People who get the virus and die of the virus.
• If the NHS emergency services were overwhelmed by a huge spike, and that is what the extraordinary efforts of the population allowed to prevent happening in the first wave we met.
• The importance of this point should not be understated. If the NHS is having to spend a large proportion of its effort in trying to treat Covid cases because the numbers have gone up very, to a very high levels and trying to put in case, in place, large numbers of systems to try and reduce the risk of transmission in hospitals, it will lead to a reduction in treatment for other areas, in early diagnosis of disease, and in prevention programmes. There is an indirect effect on deaths and on illness from this impact on the NHS if we allow the numbers to rise too fast. We also know that some of the things we’ve had to do are going to cause significant problems in the economy, big social impacts, impacts on mental health, and therefore ministers making decisions, and all of society, have to walk this very difficult balance. If we do too little, this virus will go out of control and we will get significant numbers of increased direct and indirect deaths, but if we go too far the other way, then we can cause damage to the economy which can feed through to unemployment, to poverty and to deprivation, all of which have long-term health effects. So we need always to keep these two sides in mind.
• My final point is that if I increase my risk, a lot of people say, well, can't people just be allowed to take their own risk? The problem with a pandemic or an epidemic infection like this is if I as an individual increase my risk, I increase the risk to everyone around me and then everyone who’s a contact of theirs, and sooner or later the chain will meet people who are vulnerable or elderly or have a long term problem from Covid. You cannot in an epidemic just take your own risk. Unfortunately, you’re taking a risk on behalf of everybody else.

It's important that we see this as something we have to do collectively.

1. The first of which is reducing our individual risk.

• Hands, face, space; washing hands, using masks, particularly in environments which are enclosed, public transport and in particular, having space between people whenever we can achieve it. Especially when indoors.

2. We need to isolate the virus. If people have symptoms they must self-isolate and people who’ve travelled from high risk areas, they also should isolate.

• They are taking on behalf of society a big step forward to keep the virus out of circulation whilst they are still infectious. This is an absolutely critical part of the response.

3. The most difficult one is that we have to break unnecessary links between households, because that is the way in which this virus is transmitted. This means reducing social contacts.

We all know we cannot do this without some significant downsides, and this is a balance of risk between if we don't do enough the virus will take off, and we at the moment, that is the path that we are clearly on. If we do not change course, then we’re going to find ourselves in a very difficult problem.

The final thing we can do is the science, is investing in drugs, vaccines, diagnostics.

PV: This virus is now circulating amongst the population worldwide, it will continue to do so. We will be learning how to live with it.

One important part of that is vaccines.

I'm pleased to say that there is good progress that’s being made. Many vaccines now have shown they generate an immune response of a type that ought to be protective, and several vaccines are in very late stage clinical testing, aiming to show that they are both effective and safe.

The UK, through the Vaccines Task Force, has got access to a number of these with a range of different vaccine technologies from a number of different companies.

• The UK therefore has put itself in a good position in terms of vaccine supply, and the possibility that one of these will work.
• We don't yet know that they will work, but there is increasing evidence that it’s pointed in the right direction, and it’s possible that some vaccine could be available before the end of the year in small amounts, for certain groups.
• Much more likely that we’ll see vaccines becoming available over the first half of next year.
• In the meantime, we’ve got to get control of this in the way that is sustainable and protects health and society overall.