Tim Spector

The second wave appears to have peaked before lockdown

The second wave appears to have peaked before lockdown
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It was only four weeks ago that Boris Johnson plunged Britain into a second lockdown. The Prime Minister, flanked by Chris Whitty and Patrick Vallance, said that he could not ignore the modelling. Deaths, the Prime Minister explained, could reach ‘several thousand a day’, with a ‘peak of mortality’ worse than April. ‘Doctors and nurses would be forced to choose which patients to treat, who would get oxygen and who wouldn't, who would live and who would die,’ he warned.

Today, however, with the country about to enter a new, tougher tiered system, the latest figures raise serious questions over those claims – and consequently, the need for a second lockdown.

Since March, I’ve been running the ZOE app assisted by King’s College London to predict the number of Covid cases across the UK. Over a million people use it to report any symptoms they might have on a weekly basis and from there we set about analysing the data. This sets it apart from other studies and allows us to generate rapid, near real-time data. Our numbers track cases in line with other sources, including the Office for National Statistics’ Covid-19 Infection Survey which randomly tests households across England, the Imperial College React-1 study, and Department of Health test figures.

This graph from last week shows how the ONS, government and the ZOE surveys compare. The graph suggests that all three studies saw us pass the peak of new infections before the new lockdown started, with our data showing the trend a few days earlier.

Covid-19 rates for the UK are now falling in nearly all major regions. The government and the opposition, who believe in lockdown, will say that the fall in the number of confirmed cases, deaths and hospitalisations proves lockdown 2.0 was a success –regardless of the extra health costs associated with lockdowns.

Looking at our data, I concluded last month that we had passed the peak of new Covid-19 cases before we went into the second English lockdown. Our data has since been backed up by the ONS survey and GP surveillance records that track new consultations. Hospital admissions, which lag new cases, also peaked shortly after 5 November lockdown.

This suggests the impact of the tiered system was being felt before the lockdown started. Chris Whitty has said that it takes two to three weeks for the effects of lockdown to appear. Were lockdown essential then we would have expected hospital admissions to peak far later, possibly around now. The below is what the Zoe data suggests:

Areas that were under relatively strict tiered restrictions in October – including in the North East and North West of England – are all seeing a continued drop in the number of new Covid-19 cases after peaking around the second half of October. Some in the North West have the same number of daily cases as we saw back in mid-September.

Other areas, like the Midlands, peaked in mid-October but plateaued despite tough restrictions. Then, just a few days ago, levels started falling. Explaining this is difficult, but it may be due to the now recognised effect of compliance fatigue. This effect is observed by government surveys, which show compliance waning over time and a flurry of last-minute socialising just before restrictions tighten.

Areas under lighter Tier 1 restrictions in October that had a relatively low numbers of cases – such as the South East, South West and the East of England – showed initial rises during the first two weeks of lockdown, which have since plateaued and are now falling again.

London, which was badly hit in the first wave, did not see a dramatic increase as feared. It is possible, although far from certain, that this may have been because many Londoners already have a degree of immunity following the first wave.

The higher rates are still among people in the 20 to 39 age group, who are probably most exposed to the virus because they are more likely to be carrying on with their lives; and the lowest is in people over 60. It appears younger people are driving the current wave of infections that we are seeing. The numbers are still relatively low among those in the older age group who are most likely to become seriously ill or die from the disease. The figure below shows that rates in this key group are dropping in most regions, which is good news for the NHS.

Our data, plus other official statistics, shows that England’s tiered system appears to have already been working when the decision was made to enter a second national lockdown. According to NHS data up to 18 November, hospital admissions had stabilised as well, with the seven-day average beginning to fall for the first time on 11 November. This cannot be accredited to the second national lockdown, which, theoretically, should have taken at least two weeks to have an effect on hospital admissions. Rather, these statistics reflect the changes in infections pre-lockdown.

Deaths have also now stabilised since 11 November and, again, this can only be due to a reduction in infections pre-lockdown, since it would take around three weeks for someone to catch the virus, start to develop symptoms, become hospitalised and eventually die.

This should mean that this second wave of infections, and resulting hospital cases, will slowly decline further. Voluntary measures and the public response of staying at home and social distancing – general guidance under Tiers 1 and 2 – appear to have worked and they should be trusted to continue.

It is clear that we are going to be stuck with tiers for a while, but additional restrictions should only be used when absolutely necessary and proven to produce more benefit than harm. We know that as intense restrictions continue, the public’s willingness to adhere to them falls. We should withhold our most effective weapon for when it’s really needed, otherwise we risk running out of ammunition.

Any further restrictions should be based on encouraging voluntary behavioural changes – persuasion is a far more effective long-term strategy than coercion. And persuasion benefits from transparent, local and up-to-date data, as Tory whips discovered this week when their backbenchers demanded just that in response to the stricter tiers system. The public must be able to see exactly what is happening – and be trusted to take the right actions for themselves.

Written byTim Spector

Tim Spector OBE Professor of Genetic Epidemiology at King’s College London lead scientist on the Zoe Covid Symptom Study app and author of Spoon Fed: why almost everything we’ve been told about food is wrong (Vintage 2020).

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