The British government attempts a covid endgame

In England 19 July is “Freedom Day” when most covid-related legal restrictions will be lifted in England. This was first trailed a couple of weeks ago, when the government billed it as a major step forward in the battle against he virus, and delighted lockdown sceptics, which include a substantial number of Conservative MPs. Alas it looks like heavy going for the government.

Freedom Day was originally billed for 21 June, but the government lost its nerve. At the time I defended this postponement, based on the government’s narrative that we were experiencing a race between the virus and the vaccine, and that the extra four weeks will allow the ever increasing number of vaccinations to slow the progress of the virus. Alas for my understanding of epidemiology. There is no sign that the level of vaccinations is having much impact on the spread of the new Delta variant, which is following a similar exponential path to the Alpha variant in the Spring. There is no sign of the vaunted herd immunity, so beloved of lockdown sceptics. Delta may be just too contagious.

Instead the government’s strategy, as originally explained by the new Health Secretary Sajid Javed, is to let the disease rip, and rely on the vaccine to keep people out of hospital, and so limit the stress on the health system. Mr Javid made no attempt to deny that infections would continue their exponential path, up to 100,000 a day and beyond. Reckless as this sounds, this is perfectly logical, and even shows a degree of leadership in the face legions of people urging caution of some sort or another. There has to be an endgame, and ours is based on a high level of vaccination, using the more effective vaccines, such as Pfizer, Astra Zeneca and Moderna. We only have to look at Australian, where Delta is breaking out into a population with a low vaccination rate. Australia had managed the disease by keeping people out, but failed to focus on the endgame, and messed up its acquisition and roll out of vaccines as a result.

But the government’s strategy had clearly not been thought through. This was evident from one of the goverment’s core arguments: “If not now, when?”, whose logic I find unfathomable. They seem to be hoping that the disease will burn itself out before the busy winter season, but it looks just as likely to make things worse. Two big problems have emerged. The first is the use of face masks. Some people can’t be vaccinated; others will derive less protection than the norm; many more (I have to include myself) are far from sanguine about catching the virus, even though double vaccinated. Even most vaccine sceptics have understood that some efforts need to made to protect the vulnerable – they just don’t want the tail to wag the dog, as they see it. Where this has come to a head is on mask-wearing. As we have better understood the virus, our appreciation of the effectiveness of masks in stopping the spread has grown. It seems sensible to most people to continue to require people to wear them in those public spaces which vulnerable people will find it hard to avoid. This does not include pubs and night clubs – but surely does include public transport and most shops. And the government yet wants to drop all legal requirement to wear a mask, and at first suggested that such matters could be left entirely to personal discretion. One Tory MP (admittedly not a minister) suggested that freedom from mask wearing was essential to getting people using public transport again – his argument seemly was that if we ignored the disease our worries would cease. Slowly but surely the government is being forced into retreat on this; by this morning they were suggesting that operators should use their powers to enforce mask -wearing on public transport. But the messaging has been fatally mixed.

And them came a problem with the NHS covid app, which pings people who have come into near contact (within 2 metres for 15 minutes) with somebody who has tested positive and tells them to self-isolate for 10 days. The government said that it was going to leave this in place until mid-August, when double-vaccinated people would asked to do a test instead. They weren’t very clear on why this delay was being instituted – I suspect it simply takes that long to change the app and test it. But the consequences look worrying if infections are likely to reach 50,000 a day next week, and 100,000 a day not so long after that. The opening up was supposed to help the economy to get moving again, but the projected volume of people being told to self-isolate will hit it right back down again, remembering that these self-isolation requests will tend to cluster in particular workplaces, the disease being what it is. The government’s response has been to suggest that it would de-sensitise the app, so that fewer people would be pinged – within one metre for 30 minutes, say. As a response to the virus becoming more contagious this is nonsense – it leads to the question of what they are hoping to achieve by keeping the app in being. And it points to an easy answer to the government’s “If not now?” question. Then again, if the government wants to let the disease rip and peak before the winter comes, won’t the app just slow things down? Unlike mask-wearing it looks an inefficient way of trying to protect the vulnerable.

The government have clearly thought a bit harder about ta third issue – the effect increased infections will have on the NHS. The link between infections and hospitalisations – and that to ICU usage and deaths – has been weakened but not broken. Hospitalisations for covid now seem to be doubling every month, and we can expect that to increase after the loosening up. The levels are nothing like those experienced in previous peaks, but the NHS is fragile. Backlogs are massive; there are press reports of staff leaving, exhausted after the pressure placed on them over the last 18 months. Given the quality of the government’s ability to think things through elsewhere, there must be a degree of scepticism that they have got their calculations right.

I am more sympathetic with the government on another widespread criticism: that loosening up increases the chances of a new and deadlier variant turning up. With the virus rampant in the rest of the world, where vaccination is woefully slow in many places, what happens in Britain will make little difference. Besides, scientists are reporting that new variations are repeating. The possibilities of new variants for a simple thing like a virus must be limited, so maybe the chances of a significantly more dangerous new variant are not as high as some people are making out. That’s a bit speculative, of course.

So the government is facing a sticky few months, when it will continue to be on the defensive. Other issues loom. The government plans to withdraw the fiscal support it is giving to the covid-stricken economy. This is bound to lead to hardship and criticism; it is also likely that the economy will start to slow as well.

A government that was well-led and with a core of first-rate ministers would command a lot more confidence. But this government cannot seem to think anything through properly and lurches from one crisis to the next. It will be determined not to reimpose lockdown. Twice before it has thought it could wether the storm without reversing course, only to U-turn in the end. What odds would anyone offer that this does not happen again?

4 thoughts on “The British government attempts a covid endgame”

  1. I agree that the Government should be in for a sticky few months. An additional factor is that if citizens do not feel safe, they will spend less, thus detracting from the economic adjustment back to normal. It is also in for the -by now normal – charge of mixed messaging. Most people would see wearing a mask on public transport as a matter of social obligation requiring regulatory report, not ‘personal responsibility’.

    I am more hopeful than this post about the virus abating sometime – the concept of ‘herd immunity’ seems to me to make sense in scientific terms and therefore to have predictive value that once sufficient people are immune to the virus in one way or another , it will decline. However, with an additional boost to the virus coming down the track when winter conditions drive socialising indoors, it will take time, and the decline will be incomplete due to some people resisting vaccination amongst other things. Roll on vaccine passports as a legitimate pressure to vaccinate, which is better that compulsion! – at least in my view.

    1. The government is working on the assumption that the extra number of infections which this ‘freedom’ will inevitably allow will be manageable and will not lead to the NHS being overwhelmed.

      A quick look at the numbers should be enough to show the very high risk nature of the current policy. It looks designed to cope with the older variants which had a lower transmissibility expressed as an R0 number. Whereas it was about 3 previously the reported R0 for Delta is 6. This means that in a completely unvaccinated and previous infection free population we would see, in the absence of any social distancing, on average, every infected person infect six others.

      This number is going to vary from society to society so there is naturally some uncertainty in its value and to what it will be and mean for the UK. But, we know we’ll have a higher rate than many other countries because of our relative poor and crowded housing.

      An R0 of 6 does mean that if we had a perfect vaccine we would need to vaccinate 5 out of 6 people to stop the virus from spreading. This is 83% of the population including children. We’re somewhat short of that and the vaccine is not 100% effective. Some of the population have only had one jab. On the other hand many will have had a natural infection which will give them some immunity.

      So in rough ball park calculation which does include some guesswork we can say that we are probably around 50% protected whereas we need to be at 83%. Another way to look at this is to say we are in approximately the same position as we would be if two thirds of the population were fully protected and a third had no protection at all.

      A third of the population is 20+ million people. It will consist mainly of the younger people who are at less risk but also some older people for whom the vaccines do not work at all well. Not all 20+ million will be infected but even if a third are we will be looking at a serious problem looming before we get anywhere near ‘herd immunity’

      It’s all far too risky.

      I really hope both myself and Prof Christina Pagel have got our sums wrong but I don’t think we’ll be far out!

      1. Well, infections are stating to fall, so maybe the government sums are right. In fact the calculations depend on too many unknowns, and even if they are proved right, it was too risky a step to take with the public health.

        1. Yep. It looks like the Govt chose to ride its luck and so far it’s worked out much better than many expected.

          It was still the wrong call, as you are saying too, given what was known at the time. The sensible approach was to wait an extra few weeks until both the infection and hospitalisation rates had started to fall. Even then it would have made sense to keep some restrictions, such as a requirement to wear masks.

          On the other hand I’m not at all sure if we would be better off if we’d been more like Australia. They are going to be locking down for years after such slow progress in vaccinating their population. It’s not all the Govt’s fault. There is a higher level of vaccine scepticism there which will mean they won’t be able to reach herd immunity in the foreseeable future unless a rampant Delta or yet to emerge variant does that for them in its own way.

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