Coronavirus doctor's diary: Bradford worries about the whack-a-mole mallet

Dr John Wright of Bradford Royal Infirmary says it's not surprising that his city is second in the Covid-19 league table, and potentially at risk of being sent back into lockdown, because it is a league table of inequality.

After Lockdown Leicester the nation's gaze dropped to the next place on the list and Bradford was caught squarely in the spotlight of the news. This media frenzy has been less of a buzz from circling news helicopters and more of a zoom from virtual interviews, but the effect inevitably triggers of a ripple of anxiety that spreads across the city. Will Bradford be next?

The sunny uplands of pubs and hairdressers beckon, and after 100 days of lockdown everyone wants to reclaim their freedom. The looming threat of a giant Whack-a-Mole mallet hovering over our heads is both tactless and disturbing.

We knew back in February that cities like Bradford would be at great risk and we have worked hard to protect our communities, urging lockdown a week before the government announced it. People are wise and they knew what was coming long before the government told them to shelter.

High population density and multi-occupancy housing create ideal conditions for rapid transmission of the virus. Fragile economic existences necessitate low-paid, key worker jobs that have kept the country alive, yet have created such deadly risks of occupational exposure. Large South Asian populations have faced higher risks of death than their white British neighbours.

So it is no surprise to us that we are runners up in the Covid-19 league table, but does this mean we are facing a local outbreak? The famous American statistician W Edwards Deming had a rallying cry of "In God we trust - all others bring data," and that is where we return in epidemiology - to the data on person, place and time.

In Leicester there was great frustration about the lack of data that they were receiving from the testing sites. We currently have a fragmented system with private companies running testing sites and also test-and-trace services, but with gaps in the sharing of information with local NHS and local government organisations. So Leicester had little idea which people had tested positive for Covid-19 or where they lived. Leicester's lockdown was less the targeted mallet of whack-a-mole and more a convoy of JCBs sent to dig up the entire field.

In Bradford the hospital activity is the tip of the Covid-19 iceberg and we remain busier than our neighbouring hospitals in Leeds, Huddersfield and Airedale.

Prof John Wright, a doctor and epidemiologist, is head of the Bradford Institute for Health Research, and a veteran of cholera, HIV and Ebola epidemics in sub-Saharan Africa. He is writing this diary for BBC News and recording from the hospital wards for BBC Radio.

We are seeing more patients from multi-generational households confirming evidence that more young people are catching the virus from mixing together, and then bringing it home to their parents and grandparents. We share lessons with our clinical colleagues in Leicester where they have similar numbers of Covid-19 patients on the wards and in ICU.

When we do get the data it is reassuring.

We have taken the WHO mantra of "test, test, test" to heart in Bradford and are testing more people than anywhere else in the Yorkshire and Humberside region, opening a major testing facility at the heart of the city. We are picking up more positive cases than other districts in Yorkshire, and they tend to be younger and from poorer parts of Bradford.

Crucially, when we look at temporal trends, our cases are falling. We can see spikes over the last three months - perhaps related to socialising from VE Day and Eid. We call the longest, recent spike the Cummings Curve as it follows the widely publicised transgressions of the prime minister's adviser, which led the news at the end of May.

So we are not Leicester yet, but there is no room for complacency and our outbreak plans are well rehearsed. We have worked closely with our communities from the very start - this is their city and we trust our citizens to make the right choices. We are nervous about the pubs - alcohol has a tendency to cloud judgements and lead to love or war: social distancing is tricky for both.

Bars will be the riskiest of places to be for the next few weeks.

(Click here for a sharper image.)

Above all we need more effective contact tracing. The national test and trace system picks up only a small proportion of newly infected people, and we don't know how many contacts isolate or how many go on to get symptoms.

We will continue to keep a nervous eye on the Covid-19 league table, but with insight that tells us that this is not just a league table of infections, it is also a league table of inequality.

A rumour has been circulating in the city that a new lockdown will be announced on Monday. This is fake news, but it is causing understandable worries.

"Many people lost out during the lockdown - businesses losing money, the restaurants just starting up today and everyone preparing for opening - and then the next day it looks like they might close, it's really tough," said shopkeeper Haleem on Saturday.

In reality, we are not at the lockdown stage yet, though it could come.

Accident and Emergency consultant Dr David Greenhorn, who had to treat people who got into fights at VE Day parties, is braced for the same this weekend after the reopening of pubs, and predicts a new spike in Covid admissions in 10 days' time. This, he thinks, could result in a new lockdown - and it's only a second lockdown, in his view, that will teach people the importance of social distancing.

"The reality is that this is a terrible virus and people aren't seeing that any more. I see a lack of social distancing all the time, I see people just ignoring the rules," he says.

This is a point echoed by Haleem, who says a lot of young people are back on the streets, unconsciously spreading the virus.

"It's very difficult to keep teenagers away from each other, and they're bringing it home."

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