Dr Waqar Rashid

Don’t blame youngsters if there is a second Covid wave

Don't blame youngsters if there is a second Covid wave
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Deaths of Covid-19 are overwhelmingly concentrated among the elderly. But now there is a new eagerness to blame young adults trying to live their lives in a normal way for the possible resurgence of the disease. With minimal actual evidence, we are told those under the age of 30 are not socially distancing and, worse still, are actually going out and enjoying themselves with the result that they will bring the virus home to, as Matt Hancock put it, ‘kill granny’.

What is clear is that while some young people (as well as older ones) are flouting the rules, many aren’t. Young adults who would normally and reasonably be out enjoying themselves at this unique time of life have had this pleasure removed from them by a virus they did not cause or ask for. A-Level students have been let down by a government which initially punished them for not being able to sit their exams. School send-off parties were not allowed. And now they face the prospect of huge debts for a university experience which will predominantly involve Zoom lectures and online seminars. As for those in their twenties, many have had to work from home, confined to small bedrooms for which they pay over the odds in rent. Pubs and clubs have been shut. Parks have been closed. In the prime of their lives, young people are having to put up with a lot.

Patience though may be starting to wear thin. The prelude to the first burst of the epidemic was one of harrowing pictures in Italy. By early March, it was clear we were in for our own version and the nation played its part. Adherence to a whole new set of rules and an unprecedented loss of freedom was near impeccable. There was very little joy around and certainly no socialising in the hour a day people were allowed out for.

As hospital admissions started to dwindle in May and June, testing increased and a new term entered the Covid-vocabulary: case numbers. The next phase of the epidemic was upon us. This involved rising positive tests but falling hospital numbers and deaths. Pubs and restaurants opened again, albeit with social distancing, and we were encouraged to Eat Out To Help Out. The handbrake was gently being released and the young quite reasonably wanted to get out and enjoy themselves again.

The rise in these cases, particularly when any increase in hospital admissions is still being measured in double figures, is much more problematic. Fatigue has set in and a taste of freedom has been afforded. The fear is still there when the TV news is switched on but the visible message is less powerful and the argument more nuanced. There is no doubt that the rise in cases is concerning but other explanations exist rather than a predicted second wave.

The conundrum seems simple. Positive Covid PCR tests have increased significantly but this does not seem – until the last week or so – to have had much effect on the numbers of hospital admissions. I’ve heard many explanations as to what is going on. The most popular is that the virus may have been weakening, or that young adults are disproportionately driving the upsurge in cases and are generally less affected by its consequences. There is no doubt the demographics have shifted in terms of who is recorded as having a positive test. But the truth is this: we simply don’t know what is happening.

Test, Track and Trace – the government’s policy to try and limit spread – appears to have succeeded in shifting the age range demographics of those being tested to the under 40s and below, as younger people appear more ready to contact it and report symptoms (and also go abroad on holidays and return to quarantine). It’s important to also remember that positive tests have the potential to beget further positive tests. Why? Because contacts are then drawn in and, if they also develop symptoms, these people are then tested and so it goes on. There also appears to be anecdotal evidence of some younger people applying for tests even when they have no symptoms to allow them to visit elderly relatives and family, safe in the knowledge that they won’t infect them.

If more younger people are getting tested, what is the effect of this? Firstly, it has the potential of creating a cycle of positive tests. Secondly, as the number of tests increases, the proportion of people tested appear to be younger and more likely to have had some contact exposure to Covid. It is very hard to be certain of the latter point as the data of the proportion of people tested who are contacts of previous positive tests is not published, but the motivation is created by the Test, Track and Trace system to promote testing in this very group. This phenomenon can, in theory, affect any age group but it disproportionately is picking out young adults who by and large will have a larger group of contacts.

Is coronavirus weakening or changing behaviour to pick out younger ‘healthier’ people? We just do not know. Comparisons over months in terms of number of tests and hospital outcomes are simply not valid. The numbers tested and the demographics of those being tested has changed due to capacity, changes in quarantine policy and Test, Track and Trace. You are trying to compare apples and pears when trying to determine if cases found now differ from earlier in the pandemic. But what does seem to be true is that the proportion of positive tests or infection within hospital settings has not really changed.

It is highly likely at the height of the epidemic that we were picking up the tip of the iceberg with hospital cases predominating (Pillar One) and disproportionately affecting the elderly and that if additional testing in the community of generally younger people (Pillar Two) had happened (it did not) then many more cases would have been found in generally asymptomatic younger adults. The large gap that currently appears to exist between cases and severe infections ending up in hospital may then not be that ‘new’. It is just a matter of numbers and perhaps, despite the rise we are currently experiencing, we are still well below the sort of the levels that were seen in early March.

‘Better to be safe than sorry’ has been a well-used expression during this Covid crisis. It is entirely possible that, regardless of all the nuance described above, we may be at the early stages of a significant upsurge in the virus that may start to cause serious infection in those who are most vulnerable. But the problem is that, whether or not this is the case, Boris Johnson has opted to take the tough approach almost immediately. Why has the Prime Minister not chosen a more focussed and proportionate response at this early stage? To make matters worse, we have added guilt and stigma into the mix by pointing the finger at a group of people who have only acted in a perfectly normal fashion in trying to live their lives.

As a society during this crisis, many fault lines have opened. And it should worry us that young people are being blamed when many have done nothing wrong. Yes, social distancing may be challenging to maintain but the restraint and general willingness to conform by young people during this pandemic has far exceeded reasonable expectations. To blame this group for an as yet uncertain resurgence of the virus and to use crude messages like ‘Don’t kill your granny’ is unfair and wrong.

Written byDr Waqar Rashid

Dr Waqar Rashid is a consultant neurologist at St George's University Foundation Hospital NHS Trust, London. This article is a personal view and does not necessarily represent the views of the Trust. He tweets at @DrWaqarRashid1

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