NHS leaders have ‘very high’ levels of concern over potential second spike

Health leaders have "very high" levels of concern about the possibility of a second spike in coronavirus cases, one expert has said.

Niall Dickson, chief executive of the NHS Confederation, said that the combination of a spike of cases with "exhausted staff" while the NHS tries to rebuild services could prove "challenging".

He told the All-Party Parliamentary Group (APPG) on Coronavirus: "I would say in relation to the second spike issue or something coming, the levels of concern among our members – the people who are leading NHS trusts, who are leading in primary care and all levels in the systems – is very high.

"There's real concern about winter and the compounding factors there, but also about an earlier spike."

He said non-Covid-19 productivity in NHS trusts was currently at about 60%.

Meanwhile, he called for an "Amazon-style" way for the health and care system to order personal protective equipment (PPE) – whereby they can order it and have it arrive the next day.

Dr Chaand Nagpaul, chairman of the council of the British Medical Association (BMA), also raised concerns over PPE, saying there may be an even greater need for protective equipment going forward.

He also called for more transparency over PPE stockpiles, and admonished the Government for publicising "arbitrary figures" of "billions of items of PPE", adding that single gloves were classed as one item – when medics need to wear a pair at once.

In its submission paper for the APPG, the BMA also said that the Government's initial response to the outbreak "was marked by a failure to adequately prepare".

The union said that the Government now needs to provide a detailed plan on how it will provide adequate PPE in the event of a second wave.

Meanwhile, Dr Nagpaul warned the NHS is entering its "busiest" time of year and is already facing a "huge backlog of care".

He said the system needs to "coexist" by treating Covid-19 patients, as well as non-Covid-19 patients and those who suffer winter flu.

But he said that a second spike should not be seen as an "inevitability".

He added: "We need to make sure that the current backlog is dealt with because the patients who have not been seen are patients who might have urgent problems – cardiac patients, respiratory patients, neurological patients.

"We need to systematically make sure that those patients who are most in need, who haven't received treatment, are treated now."

He called for more concise public messaging over measures people can take to stop the spread of the virus and was particularly critical over the Government's "one metre plus" social distancing rule, saying: "Many don't understand this because it's not clear and therefore they are not socially distancing."

He added: "If you look at the figures in the moment – the last ONS weekly figures from last Friday – the infection rate has increased, we're now seeing about 2,700 new cases a day compared to 2,500 the week before. And so I think now is the time, we must be much more robust and rigorous around how we mitigate better."

Yesterday Boris Johnson indicated that quarantine restrictions could be imposed on further European countries if a "second wave" of coronavirus hits the continent.

The Prime Minister insisted the Government would not hesitate to act if flare-ups of coronavirus occurred in other destinations.

One expert said that it is "too early" to say whether some European countries were experiencing a second wave.

Dr Michael Head, senior research fellow in global health at the University of Southampton, said: "It is a little early to say definitively whether some European countries, such as Spain or Germany, are experiencing the start of a second wave, or simply seeing spikes in their caseloads.

"The long-term decline to zero cases of Covid-19 will always see bumps in their graphs within the downward trend. It is up to all of these countries to ensure that these are only 'spikes' and not a 'second wave'.

"Therefore, we simply have to implement a proactive approach that will rapidly squash any emerging outbreaks. This includes the need for rapid case detection, effective contact tracing, immediate sharing of data across public health authorities, and will sometimes require local lockdowns or quarantine measures."

Prof Jose Vazquez-Boland, chair of infectious diseases at the University of Edinburgh, added: "What we are facing is a comeback of community transmission after removing the lockdown measures.

"We have to be clear that the efficacy of lockdowns is only temporary. There will be a resurgence of new cases every time social restriction measures are lifted as long as the virus remains in circulation.

"What is important to consider is that we will most likely have to deal with new peaks of incidence unless SARS-CoV-2 is eradicated.

"These peaks may become shallower if previously exposed people become immune, but whether this happens is unclear at this point.

"Until a sufficiently efficacious vaccine becomes available, the only way we have to achieve Covid-19 eradication is through the mass, systematic, regular screening of the population for subclinical transmitters that maintain the virus in circulation."