Witnessing England’s response to Covid at first hand has profoundly shocked me
England ended all pandemic restrictions on Monday. Nightclubs reopened, along with other large events and gatherings – with masks, testing and other mitigation measures “encouraged” (which is another way of saying “optional”). This is against a background of skyrocketing case rates due to the Delta variant.
In January, at the height of the second wave, the daily total hit 60,000 cases, but at the current rate of increase that will be eclipsed within days – even in the absence of all the renewed superspreading opportunities that the virus will now enjoy. Thanks to the Covid-curious policies of the past few months, the UK is already in the grip of an uncontrolled epidemic among unvaccinated people, with significant numbers of breakthrough infections among the vaccinated. And both are about to get worse.
Because of the nature of exponential spread, actions taken early pay dividends later. Israel has understood this and – despite having vaccination rates comparable to or better than the UK – responded early to the Delta variant, reintroducing indoor mask mandates while accelerating vaccination in younger age groups.
For England, on the other hand, it is not fatalistic but realistic to say that the Delta variant will not be put back in its box, because exponential spread has been permitted for months. The prime minister stated he would be guided by “data, not dates” – but, not for the first time, the reality has turned out to be the direct opposite of what he said.
Fortunately, the consequences will not be as immediately grave as at the start of the year. Vaccination protects well against hospitalisation and death, which is why it should be accelerated, so those worst consequences of the virus are not rising at the same rate. But they are rising. The UK suffered more pandemic deaths in the past 18 months than its civilian death toll for the entirety of the second world war, while a prime minister who conspicuously admires Churchill belittled the dangers on WhatsApp. It is not over yet. Daily death figures in the hundreds are far from implausible – the period of the very steepest increase in case counts has been the last few weeks, too early to be fully apparent in the fatalities. Models predict thousands more deaths.
While deaths understandably make headlines, and hospitalisations drive policy, preventing them is only the start of an effective public health response. This stage of the pandemic is different from those preceding it, but the result of this wave will be yet further delays to other vital NHS services.
Health administrators are already warning that things are getting dicey, and even if the events of last winter are not repeated, we should not want to get anywhere near them. The damage in terms of delays to waiting lists is already serious, and the current surge will exacerbate that.
Among the other impacts, we must consider the lives that will be blighted by long Covid. More than 2 million adults in England have experienced long Covid symptoms, and the million or more infections that have happened since the latest exponential kicked off, overwhelmingly in the last month, will add to them. Because the unvaccinated are bearing the brunt of infections, that means younger people will suffer.
Though you’d never realise it from the rhetoric, only around half of the UK population are actually fully immunised and vaccine uptake has been slowing down. Close to 70% have had at least one dose, but those who have received one dose are more vulnerable than people with both doses to breakthrough Delta infections. Some will end up bedridden for days and the numbers will increase over time, because exponential growth can outpace any vaccination campaign.
Overall, it’s quite simple. Yes, vaccines make it much less likely you’ll get infected or ill; but if the virus isn’t there, it definitely can’t infect you. Tens of thousands of new cases every single day mean you are more likely to be exposed to multiple potential sources of infection, meaning more people becoming ill.
But perhaps the most serious impact of this outbreak will be on those who are, for whatever reason, unable to benefit from vaccination. This includes people with other conditions that mean it is not safe to vaccinate them, or those who are immunocompromised for whatever reason and may not be able to mount a good immune response. It includes too those who have been struggling with vaccine access and are concentrated in deprived areas where infections can spread more quickly.
Having spent the pandemic to date in the US, I travelled to south London this month and got a taste of the incoherent pandemic theatre which proved so unequal to handling the Delta variant. At a funeral, due to Covid restrictions, vaccinated mourners were not permitted to place a flower on a coffin. At the same time, masks were optional in schools, and tens of thousands of fans crammed into Wembley and pubs around the country to watch football.
People are still lining up to get vaccinated – I’ve seen it myself. At the chemist where I took my test, there was a steady stream queueing outside the door to get the jab. They weren’t all in their 20s or 30s, either. A large uncontrolled Delta wave adds to the risk of these groups getting infected.Of course, everyone is exhausted and wants the pandemic to be over. The English government has opted to hasten that with a massive uncontrolled exit wave. You can almost hear the anxiety in chief medical adviser Chris Whitty’s voice as he gives his televised briefings. He knows that you toy with exponentials at your peril. After the last year, it is hard to imagine anyone could forget.
Various politicians are nervily muttering about voluntary mitigation measures such as masks, which would be eminently sensible in a situation where infections were low but which will do little right now.
We test vaccines with exquisite care to ensure they are safe, and sometimes rare side-effects are found only after millions of doses have been administered. We don’t need to see that number of Covid cases to know that the risks of infection are vastly greater than those of vaccination, even in the younger age groups in which the pandemic is now rampant.
Some of those people might not even get the chance to be vaccinated. Instead, the exponential growth that has been allowed for months means the virus will continue to kill people and leave others to suffer before the doses even get to them. Because when it came down to it dates, not data, are what mattered.
Dr William Hanage is a professor of the evolution and epidemiology of infectious disease at Harvard