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Commentary: Why are COVID-19 death rates in the UK so high?

Unlike China or Italy, the UK took almost two months to impose a lockdown after its first case of COVID-19, says an observer.

Commentary: Why are COVID-19 death rates in the UK so high?

NHS staff pause for a minute's silence to honour UK key workers who have died during the coronavirus outbreak AFP/ANDY BUCHANAN

LONDON: At the start of the coronavirus pandemic, UK government advisers suggested that keeping the country’s death toll under 20,000 would be a good outcome.

Today, the tally sits at more than 40,000.

There is no doubt the UK has been hit hard by coronavirus. It has the third-largest number of deaths worldwide, trailing the US which has five times the population and over 115,000 deaths.

Where did the UK go wrong? And how will it prevent further deaths if a secondary pandemic wave occurs as it reopens? Modelling and epidemiology give us some clues.

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LOCKDOWN TOO LATE

The UK acted too slowly in imposing its lockdown on Mar 23, which allowed the initial infection to quickly spread out of control. This was the case with infections within the UK and those coming from abroad.

The first case of COVID-19 in the UK was on Jan 31 – that is almost two months before the imposition of the lockdown on Mar 23.

Other countries, such as China and Italy, were much quicker to impose their full lockdowns – in Italy the first case was also reported on Jan 31, but the lockdown was imposed from Mar 9.

EXPLORE: Real-time interactive map of all the confirmed cases reported around the world

We know that the initial spread of coronavirus is exponential. The initial reproduction, or “R” number in the UK was estimated to be 2.6, meaning that for every person infected, another 2.6 further infections occurred.

This quickly increased the size of the epidemic in the initial couple of months while it was crucially important to attain control of the virus.

A sign tells passengers to 'wear a face covering' at Waterloo train station in central London , on Jun 8, 2020. (Photo: AFP / Justin Tallis)

The UK is also well connected with other countries and this possibly helped to gear up infections via imports and travel in and out of the country before lockdown was imposed.

A recent study suggests that most COVID-19 introductions in the UK occurred during March and that 34 per cent of UK infections originated in Spain, 29 per cent in France, 16 per cent in Italy and 23 per cent in other countries.

If the lockdown had been imposed sooner and travel between countries stopped earlier, it’s possible a number of infections and deaths could have been prevented.

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INFECTIONS STILL OUT OF CONTROL

Because the UK let the virus get out of control to begin with, it is taking longer than hoped to come down the other side of the epidemic curve – infections are still in the thousands each week.

The R number varies across the country, and it could be higher than one in some areas. Since deaths lag behind infections by two to three weeks, and R is not consistent, the numbers are not coming down as quickly as hoped.

As long as there is some infection in the population, secondary infections will occur and the virus cannot be fully suppressed and controlled.

NOT ALL DEATHS COUNTED FROM THE START

In the initial stages of the epidemic, the UK did not account for infections and deaths in settings other than hospitals, crucially leaving out those that took place in care homes.

Understanding the roles of hotspots, like care homes, and super spreaders – people who are responsible for infecting an especially large number of others – is crucial at the onset of an epidemic.

Workers and residents of Beane River View Care Home applaud in support of the NHS, Hertford, Britain, April 16, 2020. REUTERS/Andrew Couldridge

The UK government should have been taking this into account from the end of January, not from April, when care home deaths began to be added to tallies.

MISSING SYMPTOMS

The UK has been much slower than other countries in telling people what COVID-19 symptoms to look out for, with a heavy focus on cough and fever.

A loss of taste and smell was added to the UK’s official list of symptoms on May 18, more than a month later than in France and almost a month after a study suggested these as clinical symptoms of infection.

Hence, in the initial stages of the COVID-19 spread, many people could have been unknowingly infected and be infectious and thus carried on with their normal activities, unwillingly passing on the virus and keeping R high.

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FAILURE TO TEST, TRACE AND ISOLATE

Another reason the UK is experiencing large number of COVID-19 deaths is that the country was late to instigate a large-scale testing, tracing and isolation strategy.

Although some testing has been conducted, the stance in the UK was to encourage symptomatic people to solely isolate in order to prevent onwards transmission.

But in a situation where we do not know the extent of asymptomatic COVID-19 infection, it might have been better to encourage testing of symptomatic people and start the tracing of contacts of positive people sooner. This is how South Korea controlled its epidemic.

In the UK, testing was not scaled up and manual contact tracing only launched on May 28.

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GETTING THE PANDEMIC UNDER CONTROL

Since the onset of the pandemic, I have been using mathematical modelling to understand how to control the transmission of COVID-19 and determine the best strategy to exit the lockdown.

FILE PHOTO - An ice cream van is seen as people enjoy the hot weather on the bank of the River Thames in London, following the outbreak of the coronavirus disease (COVID-19), London, Britain, May 31, 2020. REUTERS/Steven Watt

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Our recent pre-print study suggests that reopening schools as the first step towards reopening society, even if done gradually, must be accompanied by a large scale and well-functioning testing, tracing and isolation strategy.

To prevent a second wave after reopening schools as the first step in exiting lockdown, the UK will need to trace around 50 per cent of people with symptoms and 40 per cent of their contacts, and isolate all symptomatic and diagnosed cases.

The UK can turn the coronavirus epidemic around with a strong test, trace and isolate strategy. Our modelling results suggest that if this is comprehensive and efficient, the government can prevent a secondary pandemic wave and bring the number of infections and deaths down.

BOOKMARK THIS: Our comprehensive coverage of the coronavirus outbreak and its developments

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Jasmina Panovska-Griffiths is Senior Research Fellow and Lecturer in Mathematical Modelling at UCL. This commentary first appeared on The Conversation.

Source: CNA/el
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