As predicted “Freedon Day”, when covid restrictions were due to be lifted, has been postponed from 21 June. And as usual most of the sceptical comment seems to have missed the point. They are suggesting that the government will keep on postponing through dither and indecision. But in fact I thought the government was being quite clear, and there is good reason to think that they will stick with the new proposed date of 19 July, though doubtless some restrictions will be long-term. Meanwhile there is not nearly enough debate on what is an acceptable balance between risk and danger in future while the virus remains prevalent in the world at large – which may well be forever.
The government’s narrative is that the we are in a race between vaccination and the virus. This suggests that there is some kind of equilibrium to be found between the proportion of the population that is vaccinated and the infectivity of the virus, which might bring the reproduction rate to below one, depending on the level of restrictions in place. There is good reason to think that if 75% of the population is vaccinated, then the R rate will stay below one even with most restrictions lifted. The government’s calculation seems to have been that, with the previously dominant Alpha variant, R would be close enough to one on June 23, when 80% vaccination has been reached for one dose. But with infection rates increasing at an alarming rate, this is clearly not true. The now-dominant Delta variant seems to be to blame. They have now calcualted that 75% or more people need both vaccine doses for this equilibrium to be reached.
It isn’t as simple as that of course. There is plenty of evidence that vaccinated people who do become infected do not suffer severe disease, while the mainly younger people who are not vaccinated are less likely to suffer severely too. So we might be able to weather higher infection rates just like we already do for flu. Against this I think two arguments have been accepted. First is that there are still a lot of unknowns about the Delta variant, including whether the earlier assumptions about the vulnerability of younger age groups still hold. India seemed to be less vulnerable than us to covid, mainly it was thought because its population is younger: until it was hit by Delta. Second the NHS is distinctly fragile at the moment. Waiting lists are massive in many places; the Financial Times has reported that many staff are leaving, exhausted by the stress of the last 18 months, and without substantial improvements to pay and conditions on offer. While it is true that the NHS can cope with high levels of flu, that is because it is seasonal – and even then it can be touch and go. So it seems more sensible to wait. Most people agree.
But the most significant thing I picked up from the announcements was that ministers were saying that we must learn to live with the virus, rather than expect that it will be beaten. What does this mean? Hospitalisation rates need to be stable and reasonably low, and likewise deaths. Current levels are surely close enough to this – but the exponental growth of infections is a clear threat. But that comes with significant restrictions on public events, hospitality, social distancing and so on. The big question is whether we can relax all of these. What measures can be kept in place that would reduce risk of infection (and not just from covid), without annoying too many people? Better ventilation standards for public places is an obvious one. I suspect we need to adopt more Asian approaches to mask-wearing (though this is more a metter of social mores than regulation). Certain settings, hospitals and care homes perhaps, will doubtless need higher levels of infection control.
These are the questions we should be asking ourselves. We need to watch and learn from what is happening in the rest of the world. Alas instead we get the usual nonsense about whether lockdowns are evil in principle, or whether the government lost two weeks by not restricting travel from India earlier.