Six months on from the UK’s first confirmed COVID-19 case, infectious disease specialist Professor Alan McNally explains what we now know about coronavirus, what remains to be learnt, and what we must do to avoid both a winter spike and to contain future outbreaks.
My name is Professor Alan McNally, I’m a Professor of Microbial Genomics in the Institute of Microbiology and Infection at the University of Birmingham.
Before COVID-19, I was Institute Director at the Institute of Microbiology and Infection, overseeing all of the clinically-related infection research here at the University of Birmingham, and also running my own research group which studies primarily antimicrobial resistance.
As COVID-19 became an issue in the UK, I became fairly vocal in what I thought the government’s response to COVID-19 should be, and one of the big things that I believe was that our ability to test and trace and isolate should have been much better than it was, and the testing should be devolved, for example, to academic labs to assist in the testing effort.
Eventually the government’s decision was that that would not be the route that they would pursue, but rather they would set up a series of labs called The Lighthouse Labs. These would be enormous diagnostic labs working solely on COVID diagnostics to assist with the UK’s need to ramp up this testing capability.
As a result of that, there were three Lighthouse Labs set up with the main one being in Milton Keynes, and after it was set up, I was asked by the government if I would be interested in being seconded to the Lighthouse Labs.
And so for 10 weeks, from the end of March through to June, I worked as a shift lead, and as the infectious disease lead for the Milton Keynes Lighthouse Lab, which meant that I oversaw a team of around about sixty people working 12 hour shifts – day shifts and night shifts – running around about 15,000 to 20,000 COVID diagnostic tests every shift and it was a fairly herculean effort.
I wasn’t the only person from the University of Birmingham to do that. There were six other volunteers from the University who volunteered their time to work on the team at Milton Keynes, and the whole lab was staffed by volunteers from academic labs, from the government veterinary labs, APHA, ranging from newly qualified undergraduates all the way through to really experienced professors and research fellows, and it was a wonderful experience.
For me it made me feel like I was contributing somewhat to the outbreak. It can be very frustrating when you feel that you can contribute and you’re not quite sure how, but certainly that was my outlet – to feel like I made a major contribution and I believe we did.
The Lighthouse Lab in Milton Keynes has now performed one and a half million diagnostic tests of COVID, which is actually phenomenal undertaking in anyone’s books.
While our ability to test COVID has undoubtedly improved as a result of the Lighthouse Labs, there are still many, many deficiencies.
One of them is the ability to test, trace and isolate, and that really is something that we have to get on top of the United Kingdom. If we are to get on top of COVID at the moment, it seems that the United Kingdom is what we would call endemic for community transmission, which is why we see a rather steady state of around about a hundred deaths every day and around 1,000 to 2,000 new cases every day.
That suggests that the virus is continuing to transmit in the community in an undetected way, and so the virus is what we call endemic now, in the community, which means that it’s continuing to infect and transmit undetected. And we really need to get on top of that if we are to combat COVID because what seems quite clear is that it’s not going away.
If we think about some of the big unknowns about COVID-19, the main one is how long is protection against the virus when you have been infected? So the immunity that is raised by antibodies and so on, and T-cells, how long does that last for? Unfortunately, based on experience from other coronaviruses that infect humans and some data that is starting to come out from longitudinal studies of COVID infected individuals is that, that protection may well be very short-lived.
And so people that were infected in March, April, May, may well, again, be able to be infected come September, October, November, which is where our big fear of a second wave comes in. And if we have a virus transmitting in the community in an undetected way, then actually what that means is that well over 90% of the population in the United Kingdom are still naive and capable of being infected by the virus.
Of course, one of the things that gets around that is the talk of a vaccine, but we have to be realistic that a vaccine’s still some way away from, certainly from commercial production and from being administered to patients who would need it. And so vaccines are probably the way to look at how we fix the COVID situation in the short-term.
Great strides have been made in how to successfully treat patients who are seriously ill with COVID. For example, the big study on dexamethasone, an anti-inflammatory which can greatly reduce fatalities in patients in intensive care units with COVID-19. I think we have got much better at treating patients and that may actually be a route that we have to focus on as you go into autumn and winter. And the likelihood, or maybe I should say probability that we see an increase in COVID again, it seems inevitable that there will be further increases and further spikes in COVID cases.
Lots of people have talked about second waves. I think what is and what is not a second wave is up for debate. Certainly epidemiologically it is, but what seems certain is that we will see increases in cases, and that will happen as we go through the end of this year and to the respiratory winter season when people are indoors more and also people with underlying conditions become much more susceptible to respiratory infections. And so it does seem that this autumn and winter will present challenges, significant challenges, with respect to COVID.
In terms of what we’re trying to do here at University of Birmingham in that we are focusing on lots of different aspects that the University has played an enormous role in the forensic fingerprinting, if you like, of the virus as it tracks through the United Kingdom, as part of the COG Consortium, the genome sequencing consortium through Professor Nick Loman. There’s also been a huge focus on diagnostics and testing for the virus, both testing of the virus through PCR and testing for antibodies.
And it’s undoubted that as we continue to move through the autumn and winter of this year, there will be a need for diagnostics, and I still believe there’ll be a need for a localised diagnostics. Particularly if you think about University of Birmingham and the students and staff begin to come back on campus, it seems very important that we’d be able to test our student and staff cohort and our community on a regular basis to ensure that they are safe, to ensure that there’s no undetected transmission on our campus and that if there is a case on our campus, we can very quickly trace that ourselves and get on top of any potential outbreaks ourselves. And that’s why I believe that it’s very important we have a localised testing in place, whether that’s through the University or whether that’s through national ventures, such as the Lighthouse Labs, remains to be seen what’s the best course of action.
But I think undoubtedly, we need some localised testing and tracing with our local public health authorities in order to let us get on top of the virus and maybe get the University back to some sort of normality.