The Indian variant arrived too late – we should not delay reopening

Do we risk swamping the NHS with Covid-19 cases if the Government proceeds with step 4 on time on June 21? In the spring peak of 2020, there were about 22,000 Covid cases per week admitted to hospital. In January 2021 weekly admissions peaked at about 29,500.

Neither occasion produced any British equivalent of the distressing scenes we recently saw in India where hospitals ran out of resources and turned sick people away, with relatives forced to watch their loved-ones die, untreated, in hospital car parks.

The NHS was not swamped, in that sense, on those occasions. And we should not understate how important it was that it was not. Estimates from India suggest that the death rate from Covid is around five times as high when people cannot get hospital treatment.

Here the NHS coped. Obviously it was stressful and distressing for the doctors and nurses and part of the coping process involved deferring many non-urgent hospital treatments (such as hip operations or cancer checks) – with potential consequences for those whose treatments were delayed. We should not be eager to go through either of our past two peaks again. But at least we know that the NHS could cope if it really had to.

Fortunately, it is unlikely that any exit wave we will get this summer, as we are fully released in step 4 of Boris Johnson’s roadmap, will come close to either the spring or winter peaks. That is true even though the latest data on the Indian variant have been rather grim, suggesting it may hospitalise nearly two and a half times as high a share of cases as the Kent variant does, that it partially escapes the protection given by the first dose of the vaccine, and that it spreads around 50 per cent faster than the Kent variant.

The reason the wave we will get will be only modest is we are sufficiently close to herd immunity already (via the combination of vaccines and the infection-acquired immunity of young people who have recovered from Covid), and the vaccines are effective in protecting us from hospitalisation.

I have modelled the situation for you, as shown in the graphs. This is a model that works in much the same way that the Government’s models presented to Sage work. The difference is that I have populated my model with the assumptions I think most likely to be correct. These include a spread rate for the Indian variant of nearly six (ie, the average sick person would have infected six other people in February 2020), a hospitalisation rate two and a half times that of the Kent variant, some escape from the protection the first dose of vaccines give, onwards transmission by vaccinated people being cut by 50 per cent for first doses and more for second, and seasonality (so the virus spreads less well in the summer). We can see that, whereas last winter weekly positive tests peaked at 430,000 a week, the peak in my model is only 117,000. Our model weekly hospitalisations peak at only 7,800.

Obviously for those thousands of individual people hospitalised, some of whom will die, the scenario is grim. And maybe it might involve some brief disruption again to non-urgent treatments (as sometimes happens with winter flu epidemics). But viewing it from the overall policy perspective, as the Government must, a wave of this scale is eminently tolerable and would come nowhere near swamping the NHS. It has said it expects an exit wave. This exit wave is not too big to cope with.

We may not want to depend upon everything about the model being perfect – though of course things could turn out better (eg, the Indian variant may not be as much as 2.5 times as severe as the Kent variant) as well as worse. If the spread rate is not just under six but is instead 6.5, then the peak hospitalisation rate is 11,300 per week – still way below the peaks of spring 2020 or last winter. If first doses of the vaccine provide only 30 per cent protection, hospitalisations rise only to 10,000 per week. Given how close we are to herd immunity, provided the second doses do give full protection against the Indian variant, as the evidence suggests, it is extremely unlikely that hospitalisations will rise much higher than shown here.

We are nearly home. The Indian variant may cause serious problems internationally, where their vaccination programmes are not as advanced as ours. But it has arrived too late to give us a serious problem. We should be able to proceed safely with step 4.