The Observer view on a second Covid Christmas
The hope was always that Christmas 2021 would have a lighter, more joyous feel than a year ago. Not clear of the pandemic, but coping with it much better, with the vast majority of the population benefiting from the immunity conferred by vaccination. But the extraordinarily rapid spread of the Omicron variant has imbued this year’s festive season with a gloomy sense of deja vu.
The situation facing us now is materially different. A year ago, just a sliver of the population had received their first vaccination and social restrictions were the only way to hold off an impending second wave of Covid. Today, we have a much stronger wall of immunity as a result of vaccination and prior infection.
But the arrival of Omicron is a cause for grave concern. The first case in the UK was documented on 27 November; just three weeks later, and it is estimated to be the dominant variant in the UK, accounting for four out of five positive test results in London. Daily case numbers are the highest they have been during the pandemic, and rising. This is being driven by Omicron’s extra transmissibility: the number of Omicron cases is doubling in less than two days.
The impact of Omicron on the NHS will depend on the degree to which catching it is associated with serious illness and hospitalisation. But as yet there is a lack of real-world data as to the strength of this link in the UK. We know that Omicron is more vaccineresistant than Delta, with double vaccination providing much less protection against symptomatic infection, but a booster jab restoring this to very good levels. Estimates based on early data suggest that a booster jab is 80-86% effective against hospitalisation, compared with more than 95% effective against Delta. But better data on the link between catching Omicron and hospitalisation is not expected for at least another week.
The other route through which Omicron will affect not just the NHS, but all emergency services and essential infrastructure, is through staff shortages, as record case numbers lead to more people having to self-isolate than at other points during the pandemic. Guy’s and St Thomas’ Trust in London was forced to cancel nonessential services and redeploy staff to emergency medicine last week as hundreds of staff were self-isolating, and almost a third of fire engines in London were out of action last week, also due to staff shortages.
The lack of data means ministers are having to take decisions amid a high degree of uncertainty. Should the government swallow the cost of imposing further social restrictions in England before Christmas – as Wales and Scotland have already done – to try to slow the spread as a precaution, in case of the entirely plausible scenario that the link between getting Omicron and hospitalisation is strong enough to pose a very serious threat to the NHS’s ability to respond to this wave? Or should it wait until there is more data and hope for the best, but impose restrictions if needed later on? Compounding the high stakes is the reality that with a virus that is growing exponentially – particularly with as rapid a spread as Omicron – taking action later means imposing tougher measures for longer to flatten the curve of infections and hospitalisations, and that to wait might be to leave it too late.
In the face of these critical choices, it is vital that the public can trust Boris Johnson to make decisions in the national interest, based on the best data and scientific advice. Yet he inspires little confidence; partly as a result of his track record in consistently being too slow to act in the pandemic, which led to thousands of avoidable deaths in earlier waves. But also because weeks of self-made scandals have stripped him of all authority within his own party. These include the allegations of Downing Street Christmas parties that broke last year’s Covid restrictions, which it seems implausible Johnson himself was not aware of.
This has left him an irrevocably weakened and damaged prime minister. Last week, 99 Conservative MPs rebelled against the introduction of vaccine passports for large venues even as Omicron was sweeping through the capital. The wing of his party that opposes necessary Covid restrictions is out of step with the nation, but will be even more emboldened by the Conservatives’ shocking byelection loss in North Shropshire.
Johnson’s political crises will therefore not only pull him away from the crisis at hand, but will discourage him from taking the timely action needed to protect the NHS for fear of further upsetting his rancorous party. And the whole cabinet is likely to be distracted by the potential for a Conservative leadership election, with contenders positioning themselves rather than focusing on the national crisis under way. It is already interfering with government public health communications: Johnson has struck a far more ambiguous note than the chief medical officer, Chris Whitty, in terms of advising people on reducing socialising before Christmas. Whitty’s suggestion that people prioritise the social engagements that really matter to them led some Conservative MPs to launch disgraceful political attacks on him.
There is still a chance that the link between catching Omicron and hospitalisation may be sufficiently weak to minimise the impact of the next wave on the NHS. Thanks to a stellar effort by the NHS, the booster vaccine rollout is proceeding apace, after a sluggish start that left the UK more exposed than it needed to be. But there is a very real risk that January 2022 is no less challenging than January 2021. We go into it with a prime minister no more competent than he was a year ago, but whose power and authority has all but leached away. It is a grim way to end the year.