The strain of coronavirus linked to South Africa is “highly likely” to be “much more widespread” in the UK than figures suggest, scientists have warned.
There have been 170 reported cases of the South Africa variant in the UK – called B.1.351 – but health minister Edward Argar acknowledged on Monday that latest figures may be “a day or so out”.
Speaking to BBC Breakfast, he said that while it was “a very small number” it was “still something we quite rightly have got to keep a very close eye on”.
It’s “very possible” the South Africa variant is already circulating widely in the UK, said Dr Mike Tildesley, an infectious diseases expert at the University of Warwick and a member of the government’s Scientific Pandemic Influenza Group on Modelling (SPI-M).
“It’s extremely difficult to predict an exact number of cases there are right now in the UK,” he told HuffPost UK. “The cases that are being reported could have been infected up to a couple of weeks ago, so we’re always a little behind the curve.”
Door-to-door testing was brought in last week after 11 cases of the variant were identified in the previous few days in people who had no links to travel – suggesting it may already be spreading in communities.
“The problem is that we are already seeing community cases, so at least in those local areas, it’s highly likely to already be widespread there. It’s really hard to put a number on it – but the key thing is that it’s clearly more likely to be much more widespread than we’ve already seen in the data.”
So are we back to square one?
“We’re at a point right now that is almost analogous to February of last year when we were only seeing a few cases here and there trickling in throughout the month,” Tildesley said. The good news though is that we are in a very different place from 12 months ago.
For one, we now have vaccines. More than 12m people in the UK have now had at least one dose of a Covid-19 vaccine and it’s hoped 15m people in the top four priority groups will have been offered at least one dose by February 15.
Secondly, we have a much larger testing capacity. When the outbreak first began in the UK, the only people being tested were those who were being admitted into hospitals or presenting obvious chains of transmission. And while our Test and Trace system remains deeply flawed and fairly dismal compared to other countries, it’s still in better condition than a year ago.
“We’re at a point right now that is almost analogous to February of last year.”
Thirdly, the country is already under lockdown. “Even if we had much a more transmissible variant, we know the R-number is not going to be as bad as it was back then,” Tildesley said. “Before lockdown last year the R-number was around 3; now we’re talking about getting it down to below 1. So even with a new variant, it won’t spread out so rapidly.”
Lastly, the new variant is so far not expected to become dominant in the UK. Based on early data, the government’s scientists believe the strain does not have a transmissibility advantage over the Kent strain. “Because of that, there is no reason to think the South Africa variant will catch up, will overtake our current virus in the next few months,” the deputy chief medical officer Jonathan Van-Tam told a Downing Street briefing on Monday evening.
Surge testing
About 80,000 people in parts of Surrey, London, Kent, Walsall, Southport and Hertfordshire – areas where cases of the new variant have been identified – have been offered a Covid test as part of a rapid mass testing programme. On Saturday, “surge testing” – involving on-the-spot doorstep tests, home-testing kits and mobile testing units – was expanded to include Worcestershire, Sefton, Merseyside, parts of Bristol and South Gloucestershire.
The government could not say how much capacity there was for surge testing in the UK should the variant be detected in more postcode areas. On Tuesday evening it was announced that three smaller postcode areas in south London would be targeted.
In Maidstone in Kent, more than 9,600 tests were delivered directly to people’s homes across three days, of which more than 85% were collected and returned for testing. Another 500 took place in the area’s mobile testing unit.
In Hertfordshire, more than 11,500 test kits have been delivered to homes in the Broxbourne area, collected by residents and processed at mobile testing units since the beginning of last week. As of Tuesday morning, almost 9,000 of those tests have been completed.
A spokesperson at Sefton Council told HuffPost UK the public response to its surge testing had been “positive and supportive”. “Thousands of people living or working in the targeted area have already taken a test using a home test kit or at the mobile test unit,” they said.
But there have been reports where people have been reluctant to come forward for tests for fear of the repercussions of testing positive. In Merton, where more than 1,000 tests were delivered in the space of 48 hours, door-to-door volunteers said they had been turned away “aggressively” by a small number of people.
Some experts have expressed scepticism about the effectiveness of surge testing. “I’m not sure how it’s going to contain infection given the time frame – it’s likely to have already spread once it’s been found,” said another virologist at the University of Warwick, Professor Lawrence Young.
“It’s hard to argue against surge testing,” countered Dr David Matthews, a virologist at the University of Bristol. “It will pick up many more people who have the virus and that will help spread the slow of every strain.”
He believes the key to controlling the spread of the South Africa variant lies in more – and better – testing. “It’s going to be very hard at this point to find all the people who are infected and get them isolated,” he told HuffPost UK.
“The only thing the government can really do is test, test and test. If you don’t know where the virus is, then you can’t do anything about it. Surge testing is the only way we’re going to slow the spread of this variant.”
Normal testing only detects if a person is infected with coronavirus or not – it does not identify which strain they have. In order to do that, a longer and more complex process of genome sequencing needs to be carried out. And although the UK is conducting more sequences than any other European country except for Denmark – around 10% of positive test samples – that gives a lot of space for undetected cases.
“There are technologies that are being developed that will enable us to work out what version of the virus is spreading around with a much faster turnaround than sequencing,” said Matthews. “We’re looking at one of them right now at Bristol [University].
He stressed it was still unknown how scalable these technologies would be on a mass testing level. “The other problem is that they can only test for variants they already know about and not find new ones, so it’s not as useful as it sounds.
“The only way we’re going to slow the spread of any variant is surge testing. So while it’s useful to know if a person has the South Africa variant in terms of understanding the scale of the problem, ultimately you just want to know if someone has got the virus or not.”
“Surge testing can work but it needs to have a really high level of uptake as well as a high level of adherence,” Tildesley warned. “You need people to go and get tests when they’re asked to do so and then you also need people to isolate if they test positive.”
In order to maximise its effectiveness, the government must communicate to the public the importance of surge testing. “It comes down to clear government messaging. They need to say: this is really important. We need people to seek those tests when offered. We need people to adhere to isolation.”
He added surge testing needs to take place on a bigger scale. “Cast your net slightly wider than you think you might need to. Why not do it over slightly larger geographical area than postcode areas? It would significantly increase the chances of detecting more cases and putting in the necessary isolation protocols.”
Without a high level of uptake and adherence, then it is “unlikely that we’ll be able to get on top of this,” he warned. “Then I would expect to see a large-scale spread of the South Africa variant over the next few weeks.”
A spokesperson from the Department of Health and Social Care said: “Additional surge testing and sequencing is being deployed in a number of targeted locations to help control and suppress the spread of detected Covid-19 variants, while enabling better understanding of these variants.
“Thousands of tests have been provided to local authorities, and further data on surge testing will be published in due course.”
Mandatory quarantine
From February 15, travellers arriving in the UK from “red list” countries will be required to self-isolate in a government-approved hotel for 10 days as part of a new hotel quarantine system.
Mandatory quarantine is a policy that scientists have been calling for since April last year and follows months of criticism of the government’s decision not to implement tougher border and travel restrictions during the pandemic.
At a meeting last month, the government’s Scientific Advisory Group for Emergencies (Sage) said: “No intervention, other than a complete, pre-emptive closure of borders, or the mandatory quarantine of all visitors upon arrival in designated facilities, irrespective of testing history, can get close to fully preventing the importation of cases or new variants.”
Dr Stephen Griffin, a virologist at the University of Leeds, also believes compulsory quarantine is the only way to control the spread of the South Africa variant in the UK. “Our quarantine policy is the wrong way around,” he told HuffPost UK. “There’s no point in dampening down our epidemic in the UK and driving down cases if we’re just going to continue to import more cases – that’s just daft.
“We should be quarantining everyone coming from everywhere except a few countries that shouldn’t be allowed in at all.”
“Instead of stopping people coming in from certain countries and letting everyone everybody else in, we should be quarantining everyone coming from everywhere except a few countries that shouldn’t be allowed in at all.”
All the same, mandatory quarantine should be far more effective in curbing infection rates than the government’s previous policy of asking arrivals to the UK to self-isolate. “With quarantine, there is a controlled environment where people are monitored and being tested.
“On the other hand, self-isolation is primarily on a voluntary basis. Some people will come into the country and not be aware they’re infected and go about their business. It’s entirely possible that things leak through this way – and obviously, they do leak through.”
He agreed with Tildesley that the UK has always been behind in responding to the pandemic. “We’ve known about the South Africa variant for a long time and yet it was allowed to come into the UK. There needs to a lot of people to be infected and get sick and take the test to have any sort of reasonable number [of cases showing up] – that takes time. In that time, the virus is spreading.
“The problem with some of the government’s policies is that they tend to be reactionary rather than preventative or preemptive, and that’s the reason why we have this issue with the South Africa variant.”
Spontaneous mutation means that certain policy changes – such as hotel quarantines and controlling borders – will have some impact, but not totally remove the problem.
“It’s incredibly important to snuff it where you can and seek it out where you can – and use that time of suppression to maximise vaccination within the population,” Professor Calum Semple, a member of the government advisory group Sage, said on Radio 4.
“But [...] the other mutations that can occur will occur in time. It’s very important to take every opportunity to catch the so-called South Africa variant, suppress it, keep it down and allow the vaccine schedule to get ahead of it.”
Vaccinations
Vaccinations are the “bona fide mechanism of ending this epidemic”, Griffin said. “It’s our way out of this pandemic.”
The Oxford/AstraZeneca vaccine is thought to offer limited protection against mild disease caused by the South Africa variant but does still protect against severe cases.
And although its use has been suspended in South Africa after preliminary data suggested it was not effective at preventing mild to moderate illness from the strain, experts have insisted this should not affect takeup in the UK. More research data is pending but, for now, it’s hoped the Oxford vaccine may still reduce hospital admissions among those with the South Africa variant.
The key question regarding the vaccine isn’t so much its efficacy but whether it stops hospitalisations and deaths, said Matthews. “The only thing that is relevant is whether or not the new variant causes serious disease in people who have been vaccinated. Nothing else matters.”
Vaccines minister Nadhim Zahawi has said the public should continue to have faith in the Oxford vaccine. “We can take confidence from the current rollout and the protection it will provide all of us against this terrible disease,” he wrote.
He also added that Professor Sarah Gilbert, the Oxford vaccine’s lead researcher, said her team was working on having an adapted version of their jab that could tackle the South Africa mutation available for the autumn.
One preprint study has found the Pfizer vaccine does work against the spike protein behind both the strains from the UK and South Africa, which has been cautiously hailed as “good” and “encouraging” news.
Lockdown restrictions
“The current lockdown policy should be sufficient to bring everything under control,” Tildesley said.
The problem is if the government decides to ease restrictions too quickly.
Experts have warned against lockdown being lifted early. Professor Graham Medley, chair of SPI-M, said case numbers were still extremely important even though vaccines would protect the elderly and most vulnerable.
Speaking on BBC Radio 4′s Today programme on Friday, he said: “Vaccination offers a way out and does reduce the impact of infection, but it doesn’t remove it completely. And so case numbers are still important because they represent the risk of having to go back into some kind of national measures.”
Griffin also warns against setting an arbitrary date for the relaxing of restrictions. “What we don’t want is the cyclical locking down and opening back up, where things go wrong again and a terrible number of people die. We need to set the criteria based on the number of cases, hospitalisations and deaths.
“It would be even more tragic now because this time we have a real way out of all of this – the vaccines. But we can’t just vaccinate our way out of this pandemic. We need to maintain controls and implement quarantine because otherwise, the vaccines will only last so long.”
“Lockdown needs to be eased at the rate that the vaccination can keep up with,” agreed Tildesley. “We know that once measures are relaxed, the R-rate will go up – but the vaccinations should reduce that number. So there needs to a balance so things are not easing too soon before the vaccines have had a chance to catch up.”