This is not your standard interview. Instead of sitting across from Paul Hunter, UEA professor of Medicine, microbiologist and expert on the coronavirus pandemic, I’m chatting to him over the phone since the UK is in lockdown. The coronavirus pandemic has gripped the world and left many in disarray. I start by asking him the one question on many people’s minds. When will this lockdown end?
“I suspect that we won’t be relaxing the lockdown measures at least until mid-May, possibly even as far as early June,” Prof Hunter tells me. “In the early days that relaxation would be around allowing more people to go to work. I would be very surprised if there are many large gatherings or concerts happening. There will not be a complete relaxation but a gradual one. A bit like what’s been happening in Spain right now. The big problem with these things is that if you relax too much too soon, you’ll end up kicking off another spurt in cases and then you’ll be back to square one”.
“I suspect in January nobody thought that it was going to be as big as it has turned out to be. One of the things that you really don’t want to do is start scaremongering until you have the evidence. Reading back the interviews I was giving, I was starting to talk about a need for a lockdown, round about the 10th, 11th of March, a couple of weeks before it actually happened”.
“A lot of the difficulties that we are experiencing at the moment [are caused by] an overreliance on an influenza paradigm in January and early February. I think if we were able to move away from that sooner we might have been able to avoid some of the difficulties that we’ve had”.
The UK is testing 5,500 people per million whereas Germany is testing nearly three times as many at 15,000 people per million. This means they will be spotting COVID-19 cases in the earlier stages. By contrast in the UK we are only testing people who are severely ill.
Prof Hunter believes we should have followed Germany’s lead in terms of mass testing and contact tracing. “It is, however, still far from clear how we are going to end lockdown in this country,” he tells me. “I suspect what will happen is that as numbers start decreasing, we will gradually lift constraints. If we get a drug that reduces the progression to a more serious illness that might have a big impact [for people in the early stages of the illness]”. He adds, “This is not going to go away this year. It is going to be around for a while yet, possibly several years”.
I ask Prof Hunter why Public Health England has no capacity for mass testing. He says, “Part of the problem is that we didn’t realise that we would need as many tests early enough. By the time the UK realised, it was difficult to get some of the reagents. [There has also been] a gradual rationalisation in pathology and microbiology services over the last 20 years. We’ve moved from a situation where most hospitals had their own microbiology lab and there was a network of public health laboratories. They were effectively closed”. In this country, this has been implemented to save money. The problem is now we “don’t have the space or the people trained to run the necessary tests”.
Prof Hunter’s research on face masks and policy surrounding them was mentioned in one of Downing Street’s daily coronavirus press briefings.
The renowned medical professor tells me, “There is a big debate going on at the moment about whether face mask use in the people in the community is a good thing or not. I think the evidence for having face masks in healthcare settings is unequivocal. There initially was a worry that if everybody in the community wore face masks there wouldn’t be enough for healthcare workers and there is an element of truth in that”.
However, if we had enough face masks would we be telling everyone to wear them?
“If you’re wearing a face mask you’re not going to be spreading the illness as easily, which is true, and therefore they say, because you become potentially very infectious very soon after contracting the illness, if everybody wore a face mask we could reduce the risk. That is a cogent argument. The other side of the debate is that the evidence of the benefits of wearing face masks is not that great, which it isn’t. The reason for this is the studies done to prove them are very hard to do and most of [the studies] are of quite poor quality”.
Prof Hunter tells me, “I think we’ve got a pretty good idea that it’s spread by droplet, and I think all the evidence that is coming out (particularly from the far east at the moment) is that droplet control works. Droplets are generally bigger things that drop out of the air column. It’s mainly droplet, spread either by breathing in droplets as one coughs or talks, or touching surfaces where the virus might still be alive. Depending on the type of surface they fall on to, these things can last anything from a few hours to 2-3 days at the very most. We’ve got a pretty good handle on that”.
But his “big concern” is whether the debate over face masks would lead to the public having access to them before healthcare workers. He also wonders whether people may use wearing a face mask “as an excuse to go out and think that by wearing masks they’re okay”.
“If everybody wore masks religiously that probably would have a big impact, but the evidence that it would is not strong. The problem is that if everyone had masks and was told to stay at home, but if you go out wear masks, would everyone stay at home? Or on rare occasions think that, because they’ve got a mask, they can go out and see friends etc. Also, there is some evidence that if people wear masks, they will stop taking other precautions like washing their hands frequently and avoiding getting close to people”.
“What we really want people to do is be stringent on staying at home”.
In the early stages of the government’s response to the pandemic, Chief Scientist Patrick Vallance’s statement about herd immunity received much criticism. He suggested for the UK to achieve herd immunity 60% of the population would need to catch coronavirus. But Prof Hunter isn’t sure the criticism is warranted.
“I listened to what the Chief Scientist was saying and he wasn’t pushing this as an actual policy. My impression was he was just talking about the inevitable consequence rather than using it as a strategy. I think to a certain extent the Chief Scientist has been misreported on this [in making it sound like this was what the government wanted to achieve]”. This was a “media storm” during which time “half the journalists on the planet were trying to talk to somebody who knew what herd immunity was”. He concludes, “Personally listening to what he said, I wouldn’t have any criticism”.
When I ask Prof Hunter what has stuck out most for him about the pandemic so far, he says, “The UK didn’t act as promptly as it should have done in early March and I think that’s the point when I started to get anxious it must be said. Up until then the UK were doing an excellent job. I think we managed the first batch better than anybody globally.”
Boris Johnson has said that there will be a “reckoning” for China over how they dealt with the outbreak. Prof Hunter says, “From January the first onwards really, the Chinese have done an incredibly good job. I, like many of my colleagues, were quite impressed with the way China dealt with it… I think once they realised that there was a significant problem they managed it quite well”. The issue was however “the way they dealt with it in December, from what we know about it now, is open to substantial criticism.”
I ask Prof Hunter about whether border control will be instrumental in stopping the spread of the disease globally.
“I must admit that I’m not a fan of controlling borders, because the evidence is that it doesn’t really stop the spread of disease effectively. In fact, the early cases in the UK, most of them came via Singapore and France. So even if we’d closed the borders to China early on it wouldn’t actually have made that much difference. Governments screen at airports because it always looks like you are doing something, but actually the evidence is that it doesn’t work that well. It misses the large majority of those infected, either because they are not yet ill or because they are not being honest with the authorities”. He added “you only become positive once you are symptomatic” and that “testing at the borders is only about fever at the moment [which is not solely a symptom of coronavirus]”.
He adds, “When you are looking at reported cases, it is difficult to be sure because different countries have different testing frequencies. Currently Italy has 70% more cases reported than the UK, so you would think that Italy had a much nastier outbreak than we have, however they are doing three times as much testing so they will be picking up more cases. It would not surprise me if we ended up with more deaths than Italy or Spain, but it could go either way. You can’t strictly compare Italy to the UK”. He added “I think we will certainly have one of the highest numbers of deaths in Europe”.
There have been measures in Spain and Italy to ban outdoor exercise, I asked Prof Hunter whether he thought the UK should look at taking similar measures: “I personally don’t. I think we have got the right level on that. I think if you ban all forms of outdoor exercise you are also causing a degree of harm”.
The issue lies in whether people are abusing their freedom. Prof Hunter believes “By and large they are not […] but we do have some incredibly irresponsible people in the UK” who flout the rules. He hopes this will not result in the need for more stringent controls.