Coronavirus: UK may have to learn to live with ‘endemic’ disease, scientist warns MPs

Asian countries show disease can be controlled with mass testing and surgical lockdowns, inquiry told

Britain may have to learn to live with coronavirus, as the disease becomes a permanent presence in human populations, scientific experts have told MPs.

Prof David Heymann said that large-scale test-and-trace operations and “surgical” local lockdowns may have to be deployed over the long term, if vaccines and treatments do not become available.

And a member of the government’s Sage advisory group, Prof John Edmunds, told an inquiry by the House of Commons health and science committees that there was “very little” chance of Covid-19 being eradicated.

But a hearing of the committees was told that the UK is still not doing enough testing to keep on top of the disease.

Data expert Dr Max Roser, said that despite the massive surge in tests - which ministers say will reach 500,000 a day by the end of October - the proportions of patients testing positive indicate that more needs to be done.

On that measure,  “the UK wasn't doing well in the first surge and isn't doing very well right now”, he told MPs.

Prof Edmunds, an epidemiologist at the London School for Hygiene and Tropical Medicine (LSHTM) told the panel of MPs that it was “certainly possible” that a vaccine would be developed by the end of the winter.  

But he warned: “We are going to have to live with this virus forever more. There is very little chance that it's going to become eradicated.”

Prof Edmunds said the UK should be in a “reasonable” position within a few months.

"I don't think we are going to be vaccinating everybody, but to start maybe the highest risk people, healthcare workers and so on," he said.

"If vaccines are just round the corner, in my view we should try to keep the incidence as low as we can now because we will be able to use vaccines in the not-too-distant future."

But Prof Heymann told the committees that previous coronaviruses have not been eradicated but have become “endemic” in human populations.

He pointed to Asian countries like China and Taiwan as examples of the approach which may have to be taken to Covid-19 over the long term.

And he said that Germany has shown, through its use of mass testing and a fleet of “Covid taxis” to transport infected people, that Asian methods can be applied effectively to European countries.

Prof Heymann, the LSHTM’s  professor of infectious disease epidemiology and head of the Chatham House Centre on Global Health Security, told the inquiry: “What's happening in Asia is that they're learning to live with the pandemic.

“That's very important because, at present, it appears that this infection may become endemic in human populations, like for previous coronaviruses.”

Prof Heymann told the committees that a technical advisory group which he chairs has already produced a paper looking at “living with the pandemic using the tools we have at present, and not waiting for a vaccine that might not come or that might not be what we're anticipating, or a therapeutic”.

He explained: “That's what the Asian countries have done and they've been able to keep transmission at low levels … and at the same time they've had decreased mortality, compared to other countries.

“They don't just lock down bluntly. What they do is a surgical lockdown. If they have good epidemiological tracing of where transmission is occurring, they shut those areas down, plus they mitigate by making sure that mass gatherings in places where people congregate are not occurring.”

Asked whether he would advise other countries, such as the UK, to follow the Asian approach, Prof Heymann said: “The reason that they can do this in Asia is because they started early with contact tracing and made sure that they stopped the outbreaks that occurred, and therefore they decreased transmission into the communities.

“Germany has continued with contact tracing from the very first imported cases from China, and they've continued to do that with massive numbers of contact tracers and ‘Covid taxis’ that take these people around.

“What they've shown is that it can be done in European countries as well. 

"And I think that's a very important lesson we can all learn, that by finding discrete outbreaks and decreasing transmission from those outbreaks, you can in fact control the outbreaks in a very good way, using surgical shutdowns when you need to - for example in nightspots in areas where the outbreak is shown.”

Dr Roser, the director of Oxford University’s Martin Programme on Global Development, said it was “very clear” that Germany tested more people more rapidly than the UK during the first wave of the outbreak in the spring, while Britain was “very very late” in ramping up its capacity.

But he said it was a “mistake” to assume that the countries conducting the most tests were delivering the best response.

He pointed to World Health Organisation guidance suggesting that if more than 5 per cent  - and ideally more than 3 per cent - of those tested are positive, then more tests are needed.

“The positive rate in the UK is now standing at 6.2 per cent,” said Dr Roser. "So it's a high positive rate.

"In Germany, the latest data shows a positive rate of 2 per cent. 

“So it's really that that metric that we should be focusing on. It's the relation between testing and the size of the outbreak, and the UK wasn't doing well in the first surge and isn't doing very well right now.”