Public Health England only had enough contact-tracing capacity to last two weeks before it became ‘exhausted’, scientists warned in February.
A batch of scientific papers submitted to the Government’s SAGE committee were published today and reveal more of what officials were being told in the early stages of the UK’s epidemic.
Researchers said there was ‘no evidence’ that stopping shaking hands would reduce transmission of the virus, shortly after Prime Minister Boris Johnson was ridiculed for continuing to use the greeting.
The papers also showed that there was little evidence in favour of wearing face masks, which have now become mandatory on public transport in Britain.
SAGE’s papers have been published as data today revealed that the coronavirus is fading away in England, with only 0.1 per cent of the population now thought to be affected.
This is around 53,000 people, and a drop from an estimated 133,000 in last week’s data. There are now around 5,500 people becoming newly infected each day.
The SAGE papers revealed the following:
- People were already following social distancing before Britain’s lockdown but up to 54 per cent of people in the extra vulnerable group were not shielding;
- Stopping international flights would not have been a useful measure for the UK during lockdown because there were too many cases already and imported infections would have been drops in an ocean;
- By mid-April there was only ‘weak’ and low-quality evidence that face masks could reduce the transmission of Covid-19 if worn by infected patients;
- People in some settings, such as carers for vulnerable people, may have been better off self-isolating for two weeks. And ‘particular caution’ was urged for discharging people from hospitals to care homes;
- Shedding the virus is ‘relatively low’ early on in the illness’s early stages and peaks about 10 days after catching the virus;
- Contact tracing is of ‘limited benefit’ in a large, uncontrolled outbreak and Public Health England’s capacity would have been exhausted within a fortnight;
- Scientists said contact tracing should be stopped when the first case of coronavirus was diagnosed without any clear link to another country or confirmed case;
- Antibody test data – which shows who has had the virus already – should have been available early on in the outbreak to track the size of the epidemic;
- Evidence suggested children under the age of 10 are infected at similar rates to adults but are more likely to have no symptoms;
- Less than 10 per cent of infectious droplets travel further than 5’5″ (1.65m), and transmission at more than 3’2″ (1m) appeared to only be common in hospitals;
- Public Health England modelling predicted that the peak of infections would be towards the end of April if the outbreak was uncontrolled.
This graph, from a modelling paper produced by Public Health England in March, shows the government organisation predicted that the peak of intensive care admissions would come in late April and stretch up to 60,000 per day if the outbreak was uncontrolled. As it was, the peak was weeks earlier but considerably lower
A paper produced in late January suggested that people were least infectious in the first few days after they caught the virus, with the peak of viral shedding from the breath – when the viruses are being expelled from the body – coming about 10 days after infection. It persisted for longer and at higher amounts in faeces, the study suggested
The SAGE files are now released every Friday as part of a transparency drive by the Government to show the public what advice government officials have been given.
This week’s batch of reports revealed the scientific evidence Whitehall looked at on a number of topics, including international flights, social distancing, face masks, how far the virus travels in the air, when people are most infectious, and how well contact tracing would work.
One of the most damning revelations was that officials were told in February that Public Health England’s contact tracing system would not be enough to cope beyond the very start of an epidemic.
At the time it had the capacity to cope with contacting around 800 people per day, scaleable to 8,000 per day, scientists said.
Contact tracing was brought to an end on March 12 when Professor Chris Whitty, the chief medical officer for England, admitted it was no longer a good use of resources. It has since emerged that this was because too many people had the virus already.
The Government has come under fire for that decision, with other countries like South Korea, which maintained the policy, escaping almost unscathed by the virus.
This is what today’s SAGE papers revealed:
Contact tracing ‘should be discontinued once it is overwhelmed’
A paper sent to SAGE by Public Health England and the universities of Manchester and Cambridge on February 12 warned about the limitations of contact tracing.
A process it called CCI – case and contact isolation – was effective at preventing low-level outbreaks but the capacity in the UK would be quickly overwhelmed if the virus spread out of control.
The researchers said PHE’s capacity – predicted to be good for contacting 800 people per day – should be increased 10-fold at the least.
But it would have to be abandoned when the outbreak spiralled.
The paper warned: ‘Where cases of higher generational numbers become predominant CCI is expected to be of limited benefit outside of certain special cases and should be discontinued.
The current PHE based capacity to provide CCI can be expected to be not sufficient, or sustainable, at the limits of controlling higher rates of incursions into the UK, and should be enhanced…
‘We recommend that CCI should be discontinued when person to person spread is epidemiologically demonstrated to be dominated by second and subsequent generational cases, or, by the contact tracing effort exceeding the management of 8,000 CCI events per day as a proxy.’
Another report suggested that contact tracing should be ended once doctors started to see cases that had no clear links to countries abroad or other confirmed patients.
People were social distancing before lockdown – but not shielding
Survey data presented by the SAGE sub-group SPI-B on March 22, the day before lockdown, found people were already taking many of the measures themselves.
Some 62 per cent of people under the age of 70 said they had already stopped going to pubs, bars and restaurants.
A further 52 per cent said they had stopped going to sports or hobby clubs, because of social distancing advice, along with 30 per cent who were by then working from home.
Half of public transport users had stopped getting buses or trains to try and stop the spread of the virus.
But SPI-B was concerned that between 37 and 54 per cent of the people most at risk from the coronavirus – those who are advised to ‘shield’ themselves – were still meeting up with friends and family.
The report said: ‘Although survey respondents report having stopped or cut down many behaviours, there appears to be room for social distancing to be increased still further.’
Boris Johnson sent the UK into full lockdown the next day, March 23, and urged everyone to stay at home at all times except for essential journeys.
Stopping international flights ‘not a useful measure’ in March
In a paper dated March 22, the day before lockdown, scientists said stopping international flights in a bid to stop people bringing the coronavirus to the UK from abroad was ‘not a useful measure’.
There were so many people already infected in Britain that any imported cases would be drops in the ocean, the paper explained.
It said: ‘The initial view from SPI-M is that given the current widescale transmission of COVID-19 within the UK, measures to stop imported cases would have negligible impact. This might change if the UK were to successfully contain the epidemic.’
On the subject of ‘hotspots’ the SPI-M committee suggested that flights from Spain and Iran were probably the highest risk.
Spain because of the sheer number of passengers – there were some 15,000 per day still arriving on weekday flights that week.
And Iran because of the severity of the outbreak there – even though passenger numbers were low, there was a high chance some of them might have the illness.
It said flights from countries like France, Italy and Germany were low-risk because they were going through the same experience as the UK and passenger numbers were already low because of their government and airline restrictions.
Britain did not force flights to stop but told people not to travel abroad. Airlines took it upon themselves to stop most flights when passenger numbers dried up.
Evidence for face masks as protection was ‘weak’ and mixed
Papers from the first and second weeks of April on the effectiveness of face masks found no clear reason to recommend that British people should wear them.
Researchers noted that scientific studies had had mixed results on their effectiveness and that much of the evidence was not relevant to British society – one had examined how well they worked during pilgrimage.
A paper on April 7 said: ‘Based on the evidence… wearing face mask in the community was not significantly associated with a reduction in episodes of influenza-like illness’.
Another paper dated April 13 rowed back slightly but still stopped short of saying face masks should be worn.
It read: ‘There is weak evidence that use of face masks by symptomatic people may reduce transmission.
‘Evidence from randomised trials do not show a protective effect of face masks in community settings but are often affected by low adherence.’
The study suggested the masks could be beneficial if people were likely to cough, because it would catch infectious droplets, but noted that people should be self-isolating if they were unwell.
Face masks were yesterday made mandatory on public transport for people in the UK.