Covid-19 spilling out of hospitals and care homes, says UK expert

Prof Neil Ferguson tells Lords committee cases will remain steady until September

Coronavirus infections in hospitals and care homes are spilling into the community and sustaining the outbreak to the point that cases will remain steady until September, a leading scientist has warned.

Prof Neil Ferguson, the head of the outbreak modelling group at Imperial College London, said he was shocked at how poorly care homes had been protected from the virus and that infections in UK care homes and hospitals were now feeding into the epidemic in the wider community.

Ferguson, who quit as a member of the government’s Scientific Advisory Group on Emergencies (Sage) after breaking social-distancing rules, said that infected staff carrying the virus out of the workplace explained why the R value, the average number of people infected by a case, remained only marginally below one. 

“I, like many people, am shocked about how badly European – or countries around the world – have protected care home populations,” Ferguson told a hearing of the Lords science committee. About 16,000 UK care home residents are believed to have died from Covid-19 in outbreaks that have struck 38% of care homes in England and 59% in Scotland. 

“The infections in care homes and hospitals spill back into the community, more commonly through people who work in those institutions. If you can drive the infection rates low in those institutional settings, you drive the infection low in the community as a whole,” Ferguson said. 

With the virus still circulating widely and restrictions being eased, Ferguson said there was “limited room for manoeuvre.” Lockdown reduced the spread of infection by about 80%, he said, “but to maintain control, we need to keep that transmission suppressed by about 65% so we have a little bit of wriggle room.”

Prof Matt Keeling from Warwick University, whose modelling group is now providing the government’s “worst case scenario”, suggested that researchers might have done more to understand the risks to care homes in particular.

“If the lockdown had been very strict, if we’d have thought more about what was happening in care homes and hospitals early on, maybe that was one of the areas where modellers did drop the ball,” Keeling told the hearing. “With hindsight, it’s very easy to say we know care homes and hospitals are these huge collections of very vulnerable individuals, so maybe with hindsight we could have modelled those early on and thought about the impacts there.”

The researchers said it is still unclear what impact the recent easing of restrictions will have on the spread of the virus, but Ferguson dampened any expectations that the epidemic might peter out any time soon. “I suspect that under any scenario, the level of transmission and number of cases will remain relatively flat between now and September, short of very big policy changes or behaviour changes in the community,” he said.

“The real uncertainty is if there are larger policy changes in September, as we move into the time of year when respiratory viruses tend to transmit slightly better, what will happen then? And that remains very unclear,” he added.

Under further questioning about the outbreak, Ferguson described how scientists realised in early March that the UK had been much more heavily infected than anticipated, and that this was one of the reasons the country now has if not the largest, then one of the largest, epidemics in Europe. 

“One thing the genetic data is showing us now is most chains of transmission still existing in the UK originated from Spain, to some extent Italy,” Ferguson said. “It is clear that before we were even in a position to measure it, before surveillance systems were even set up, there were many hundreds, if not thousands, of individuals coming into the country in late February and early March from that area. And that meant that the epidemic was further ahead than we had anticipated.”

“That explains some of the acceleration of policy then. It also explains, to some extent, why mortality figures ended up being higher than we had hoped,” he added.

As ministers ease restrictions in England, health officials will rely on the new test-and-trace system to identify and clamp down on new outbreaks. The tests would be offered to people with symptoms, but since many people were infectious before feeling ill, and many never show symptoms at all, the system would have only limited use, the committee heard. 

“By the time someone shows symptoms they have probably been infectious for a day or two,” said Adam Kucharski, an associate professor and infectious disease modeller at the London School of Hygiene and Tropical Medicine. “As soon as someone becomes symptomatic, you have a very short time window before their contacts may become infectious and then you’ve got another generation of transmission to deal with.”

Ferguson said the test-and-trace scheme “was not a panacea” because it relied not only on what proportion of people developed symptoms, but what proportion could identify past contacts, how quickly they could be contacted, and how many then abided by the self-isolation rules. He told the hearing that if the system worked perfectly, it might at best reduce R by 0.2 to 0.25, describing that as “significant, but not huge”.


Ian Sample Science editor

The GuardianTramp

Related Content

Article image
UK bulk buys hydroxychloroquine as potential Covid-19 treatment
Drug taken by Trump being acquired in case it proves effective against coronavirus

Rajeev Syal and Lisa O'Carroll

19, May, 2020 @6:24 PM

Article image
Covid-19 can damage lungs of victims beyond recognition, expert says
Organs of some who die after over a month in hospital sustain ‘complete disruption’, peers told

Robert Booth

15, Jun, 2020 @6:10 PM

Article image
Coronavirus: April will be 'second dose month', says UK vaccines minister
Nadhim Zahawi hails milestone of 30m first doses and says UK still on track to protect all adults by July

Dan Sabbagh and Andrew Sparrow

28, Mar, 2021 @7:13 PM

Article image
UK hospital tackles PPE shortage by making 5,000 visors a day
Hospital in Wolverhampton believed to be first in NHS to resort to in-house production

Denis Campbell Health policy editor

17, May, 2020 @4:54 PM

Article image
Quarter of Covid-19 deaths in English hospitals were of diabetics
NHS’s first breakdown of underlying health conditions also finds 18% had dementia

Denis Campbell Health policy editor

14, May, 2020 @6:22 PM

Article image
England and Wales hit target to vaccinate top four priority groups
Milestone means 65 to 69-year-olds will be invited for jab and those with underlying conditions are expected to follow

Dan Sabbagh

12, Feb, 2021 @5:30 PM

Article image
How UK government misrepresented Covid projections – explained
No 10 has admitted an ‘error’ in the way data was presented to make case for second lockdown

Niamh McIntyre and Caelainn Barr

06, Nov, 2020 @2:43 PM

Article image
Coronavirus: hospitals in West Midlands 'will be at capacity by next weekend'
Mayor says NEC field hospital will be ready to take patients as data shows 21% of deaths in England were in Midlands

Josh Halliday, Pamela Duncan and Caelainn Barr

03, Apr, 2020 @4:05 PM

Article image
Thousands of Covid-19 cases missed due to late warning on smell loss, say experts
UK direction for those with anosmia to isolate and seek test was overdue, say scientists

Sarah Boseley Health editor

18, May, 2020 @4:00 PM

Article image
Covid-related deaths in care homes in England jump by 46%
Number of deaths at highest level since mid-May and UK toll at more than 25,000, figures show

Robert Booth and Niamh McIntyre

19, Jan, 2021 @3:59 PM