The Daily Telegraph
Spectre of winter lockdown returns
Johnson warns of ‘pivot point’ in pandemic and says he will take whatever action is necessary
BORIS JOHNSON put the public on alert last night that a new wave of Covid-19 restrictions, possibly even including a lockdown, could be introduced this autumn.
Unveiling the Government’s winter Covid plan, the Prime Minister warned that the situation this year was in some respects “more challenging” than last year as his scientific advisers said that the next few weeks would represent a “pivot point” in the pandemic which may need early interventions.
In a downbeat press conference, Prof Chris Whitty, England’s Chief Medical Officer, showed graphs demonstrating that the numbers of infections, hospital admissions and deaths were higher this year than at the same point in September 2020.
However, crucially, ministers and experts are confident that the high levels of vaccination should stop the number of people being hospitalised escalating quickly in the coming weeks and their central plan still focuses on vaccines protecting the country from the economic and social turmoil of another lockdown.
The Government’s “plan A” for the forthcoming winter involves rolling out third jabs for the over-50s and immunosuppressed, starting next week, and continuing with the test and trace programme. Scientific models also predict that large numbers of people will continue to work at home.
However, ministers also disclosed a so-called “plan B” if the pandemic becomes more serious than expected. This involved vaccine passports being introduced for large indoor gatherings, masks becoming mandatory again and a return to working from home.
A return to lockdown has also not been ruled out, as the plan commits the Government to “taking whatever action is necessary to protect the NHS from being overwhelmed”.
The trio did not disclose what would prompt the tougher restriction plans to be introduced. There was also no detail in the winter Covid plan for how the NHS would cope with a surge in hospitalisations, such as by reopening the Nightingale hospitals.
Sajid Javid, the Health Secretary, was heckled in Parliament when he spelt out the details of the plan to MPS, as Tory backbenchers expressed astonishment that further restrictions were once again being considered.
Mark Harper, the chairman of the Covid Recovery Group of lockdown-sceptic Conservative MPS, last night declared it “disappointing” that the Government had set out a “slippery slope towards more restrictions that many fear is already a foregone conclusion”. Fresh Covid measures would cause “significant disruption to businesses and costs to the economy”, he added, as he called on the Prime Minister to put any new restrictions to a Commons vote.
However, Mr Johnson defended the plan, saying he was confident the vaccines would mean the Government would not need to resort to some of the more drastic measures in the plan.
“The result of this vaccination campaign is that we have one of the most free societies and one of the most open economies in Europe and that’s why we’re now sticking with our strategy,” Mr Johnson said.
“We’re confident we can proceed with plan A, but I think what I would stress about plan B is that it contains a number of different shots in the locker. And you wouldn’t necessarily play them
Winter is coming, and with it the bleak prospect of a return to enforced mask wearing, working from home and vaccine passports.
At last night’s press conference, Boris Johnson warned that “our position today is actually more challenging” than last September, with cases, deaths and hospital admissions all creeping up.
While it’s true that the country is indeed reporting higher daily cases – yesterday 26,628 cases were recorded compared to 2,621 on the same date last year – we are now in a very different pandemic.
For a start, testing has hugely increased since last September when only around 200,000 tests were being carried out a day. In contrast, recent daily testing has seen highs of
Vaccinations have also severed the link between hospitalisations and deaths, meaning that we will not see such a devastating wave as last year even with similar peak case numbers.
Britain saw similar case numbers to now in mid-december last year, which led to about 700 deaths a day by the end of December. There is a two-week lag between cases and deaths.
In contrast, although cases have reached highs of 44,000 in recent weeks, the daily death figure is yet to pass 145.
The gloomy outlook, presented by the Prime Minister’s scientific advisers at last night’s press conference, also fails to take into account that the country opened up earlier this year – with restrictions gradually lifting nationally between May and July.
Last year, widespread lifting of restrictions did not occur until August, with some regional areas remaining in local lockdowns. So we cannot compare the pandemic now to the same time last year.
Likewise, although the number of hospital admissions is five times higher than it was on September 14 2020 – a weekly average of 461 compared to 140 – current data also shows no sign of a worrying surge.
Over the past week, the number of people in hospital with Covid has increased by just 10 patients a day, meaning occupancy would not reach levels seen at the point the Government triggered the November lockdown until mid-spring next year – around 300 days from now.
In fact, over the past few weeks, the percentage increases have been largely flat, running from -0.1 per cent to +0.1 per cent. In contrast, last year’s average daily increases were around nine per cent.
Even government scientists appear to agree that this winter will not see a repeat of last year. In the most recent published minutes from the Scientific Advisory Group for Emergencies (Sage), experts admitted “the future trajectory is increasingly unlikely to reach the peak of the January 2021 wave”. So why is the Government so alarmed that it is considering the nuclear deterrent of Plan B?
At yesterday’s press conference Prof Chris Whitty, the Chief Medical Officer, said that the “overall state of the NHS” must also be taken into account.
The health service always struggles in winter, but it is likely non-covid pressures this year could cause significant problems.
Since the start of the pandemic, the number of people waiting for NHS treatment in England has grown by a fifth and Sajid Javid, the Health Secretary has warned it could hit 13 million.
A recent report from the Institute for Fiscal Studies (IFS) warned that millions of people who delayed, or were unable to access, treatment would be needing NHS care in the coming months and their conditions may have badly deteriorated in the interim.
Experts are also predicting an unprecedented spike in influenza and RSV (respiratory syncytial virus) infections due to a lack of natural immunity as a result of lockdowns and
‘Britain could find itself in an ongoing loop of restrictions long after the Covid pandemic has abated’
mask wearing. A report commissioned by Sir Patrick Vallance in the summer, projected flu deaths could reach 60,000 this winter in a worst-case scenario.
Report authors also warned that RSV cases could reach twice their normal levels leading to paediatric intensive care units being overwhelmed.
And there are fears that the flu jab could fail because global Covid surveillance prevented laboratories gathering sufficient data on the dominant variants.
The World Health Organisation (WHO) made the recommendation about what to put in northern hemisphere jabs in late February, but vaccine makers say that global genetic sequencing of flu had dropped by up to 94 per cent in the months preceding the decision.
So the Government now finds itself on the horns of a dilemma. While imposing new mask or home working rules may give some respite to a struggling NHS, it will again prevent natural immunity from building, storing up problems for next winter.
If we are not careful, Britain could find itself in an ongoing loop of restrictions long after the Covid pandemic has abated.
The Prime Minister likes to make grand pronouncements about Covid-19 – but experience should have taught us to look carefully at the small print. “Freedom Day” on July 19 turned out to be nothing of the kind, with a host of restrictions maintained throughout the summer. Even where restrictions were lifted, as in mandating face coverings, people were told to continue behaving as if they were still in force. There was no effort to push back against freelance enforcers like Transport for London. The public address system at my local Sainsbury’s still cranks out a mantra about making a personal choice to continue wearing masks.
Yesterday’s announcements are just as deceptive. Obvious provocations are to be removed in the hope of placating the Government’s backbench critics. Vaccine passports will not go ahead this month – but the Government will press organisations to use the NHS Covid Pass, which amounts to the same thing. Large sections of the Coronavirus Act will be dropped – except that comparable powers exist under the Public Health Act 1984 (and the Civil Contingencies Act 2004).
The UK population will be urged to go on behaving as if restrictions were in force or they might be reintroduced anyway. The discredited use of lateral flow tests for asymptomatic case finding will continue, although the Royal College of Paediatrics and Child Health has called for it to stop in schools and it is unlikely to offer more value elsewhere. Despite the lack of investment in research to establish what works, the same portfolio of non-pharmaceutical interventions will be continued. Don’t expect Sainsbury’s to shut up about masks any time soon despite the lack of evidence of benefit.
Healthy teenagers will be “offered” vaccination in a context where it is likely to be unrealistic to refuse, given a barrage of official information designed to promote uptake and intensify peer pressure. It is hard to see how any of the normal expectations of informed consent will apply to production line vaccination in schools. Having placed Gillick competence at the centre of this strategy, the Government may, of course, still run into trouble with the courts. The case law on Gillick strongly suggests that judges would expect a degree of personalised assessment of understanding and consent that is not compatible with talk of vaccinating three million teenagers in six weeks.
The core problem here is the Prime Minister’s reluctance to stand up and say “this is as good as it gets”. I am reminded of Jonathan Van Tam’s dictum that you should never start a medical or public health intervention without being clear when you are going to stop it. While the Government may have seen off the Zero Covid lobby, it is still behaving as if elimination were the goal.
Ministers are not publicly acknowledging that Covid-19 is taking its place alongside other endemic respiratory viruses, and is not necessarily the most dangerous or burdensome of them in a largely vaccinated population. The infection fatality ratio – the chance of dying if you get Covid-19 – is currently estimated by the MRC Biostatistics Unit in Cambridge to be around 0.26 per cent, and most of this is in the over-75s, where the rate is 3.3 per cent.
This is broadly comparable with the rates for influenza and RSV, another common respiratory virus. Both of these represent more of a threat to the very young, as well as having a significant impact on the over-80s. Covid deaths seem to overlap with both so there is little impact on the overall mortality rate in a vaccinated population.
What this means in practice is that the vaccine rollout, even before any extension to healthy teenagers, has got us close to the position of November 2019 in terms of the risk of death or hospitalisation faced by any individual at any age. This is why the test for the winter should be: would we have done this in November 2019 as the other seasonal respiratory viruses worked their way through the population?
A braver Prime Minister would be declaring that the pandemic is over, as the Danes have done. The vaccination programme has taken the place of early childhood exposure to the virus as the basis of life-long immunity, renewed by periodic mild reinfections until quite late in life when our immune systems begin to decline. This is what happens with other respiratory viruses that we live alongside. There should be no truck with the notion of trying to eliminate respiratory viruses as a class of infections, which is plainly held by some in the scientific world. This is the first step in defusing the allpervasive fear that has been sustained and amplified over the past 18 months.
The great German poet Johann Goethe wrote of his anxiety that, in the future and motivated by good intentions, the world would become one great hospital with each of us the nurse of the other. This is the last battle of the pandemic: who defines what lives we shall live? Will it be a scientific and medical elite or will it be the processes of democracy? Which side will the Prime Minister take?