Can the spreading fire be stopped without a reversal?

MAKING a bad decision is never good. But there is nothing worse than jumping into a fire when all your instincts tell you to move the other way.

Matt Hancock, the Health Secretary, made this point in the Commons last week. He said he had heard from China in January 2020 that the virus was spreading asymptomatically but was assured this was not the case.

“The formal advice I was receiving was that asymptomatic transmission is unlikely, and we shouldn’t base policy on it,” he said. “I bitterly regret that I didn’t overrule that scientific advice at the start and say we should proceed on the basis that there is asymptomatic transmission until we know that that isn’t, rather than the other way around.”

I’ve limited sympathy for Mr Hancock. A quick search of Google Scholar would have told him the spread of previous coronaviruses and indeed influenza – the disease the UK’s pandemic plan was based on – all have an asymptomatic element.

Once burned, twice shy? It would be nice to think so – but the second wave of the pandemic was predicted by the Government’s own Reasonable Worst Case Scenario published in July last year, and still we walked straight into it, recording a further 90,000 deaths.

Now that we face a third wave of Covid-19, we must hope for “twice burned, thrice shy” – but there are reasons to think that even that die may already have been cast.

Tomorrow, the Prime Minister is expected to announce that the June 21 unlocking – the point at which “all legal restrictions” were to be lifted – will be pushed back a month.

It makes sense not to pour fuel on the nascent wave of the new Indian variant, but can a fire that is already spreading exponentially really be stopped without reversing course and cutting new fire breaks?

This is the real question occupying minds across Whitehall at the moment.

Will we get lucky and see the third wave briefly flare up before petering out as vaccines douse it? Or will it grow to consume like the others because we failed to stamp out the first sparks?

Following the data

The figures do not look good. Cases of the Indian variant have been growing exponentially from a low base since early May, and for the past seven days have averaged about 5,000 new cases a day.

Hopes that its transmission would turn out to be moderate have been dashed, as its estimated reproduction (R) number has accelerated.

It now appears to have settled at about R1.55 with a doubling time of nine days. If you start from 5,000 and double three times you get to 40,000 cases a day by early July. If you double that again you get to 80,000 cases nine days later – a number that bursts through the January peak.

Adam Kucharski, the epidemiologist, notes that the variant’s estimated growth rate already “prices in” our existing firebreaks. He said: “Without vaccination and the social distancing still in place, R would be much higher.”

Vaccines and immunity

Cases, of course, are only a worry if they lead to hospitalisations – and this time we have vaccines to protect us.

But here, too, the news is not all good with the Indian variant. The latest Public Health England (PHE) data put the vaccine’s effectiveness against symptomatic disease at 33 per cent after one dose and 81 per cent after two.

James Ward, the mathematician and Covid modeller, estimates this should rise to something like 80 per cent and 95 per cent respectively when it comes to protection against “severe disease and death”.

On one level, those numbers are reassuring but supporting evidence is incomplete. PHE is still awaiting evidence on how well the AstraZeneca vaccine, which accounts for about 70 per cent of all UK jabs, performs after two doses against the Indian variant.

“There is uncertainty around the magnitude of the change in vaccine effectiveness after two doses of Oxford/AstraZeneca vaccine,” says its latest report. The same report reveals that of the 42 people known to have died so far with the Indian variant in the UK, 29 per cent (12 people) were fully vaccinated. Of note is the high percentage of severe outcomes among people [with vaccine] breakthrough infections”, observed Meaghan Kall, the PHE epidemiologist. “Who are they and why is that happening? Work ongoing to understand the profile of fully vaxxed people with severe outcomes.”

A Lancet study last week found the Government policy of spacing doses of the Pfizer jab beyond the manufacturer’s three-week recommendation causes immunity to tail off faster than it otherwise would, especially in the old.

“These data therefore suggest that the benefits of delaying the second dose, in terms of wider population coverage and increased individual [protection] after the second dose [of Pfizer], must now be weighed against decreased efficacy in the short term, in the context of the spread of B1.617.2 [Indian variant]”, said the authors.

‘Will we get lucky and see the third wave peter out as vaccines douse it, or will it consume like the others?’

‘If you get a big wave of infections, the total number being hospitalised could be too big for the NHS’

Hospitalisations and the NHS

Ultimately, it will be the number of hospitalisations that determines if the roadmap ends up having to be reversed and a new lockdown imposed.

What cannot happen is for the NHS to be overwhelmed as this leads to a wider socio-economic breakdown as seen in India last month.

The latest Sage modelling on hospitalisations is expected to be released tomorrow to coincide with the Prime Minister’s statement, and seems unlikely to contain good news.

The last set of modelling, published in May, contained projections for what might happen if a new, more transmissible variant broke loose, and the numbers were not pretty.

The University of Warwick’s model showed a variant that was 50 per cent more transmissible would more or less take the course that the Indian variant has to date. It would then breach the second wave peak of about 4,000 hospital admissions a day in late July even if the final stage of reopening was postponed. A paper published by Warwick on Friday shows a similar, if slightly more optimistic, pattern. The two scenarios that seem to best match the known characteristics of the Indian variant still breach the January peak if lockdown is ended on June 21 but come in underneath it’s deferred.

The projections published by Sage tomorrow will no doubt differ in detail but the broad logic will remain the same. We have a lot of people vaccinated but about 57 per cent of the population are not yet fully protected. If you get a very big wave of infections, the total number being hospitalised could still be too big for the NHS to handle. But we may yet get lucky. The Indian variant remains unevenly spread across the country, with cases still concentrated in about a dozen areas. As Ms Kall of PHE points out, we were seeing a much wider dispersion of cases eight to 10 weeks after the Kent variant was first spotted. “This is cause for optimism that vaccines are indeed slowing and in some populations halting the spread of Covid 19,” she said.

But in the fireball scenario of the Indian variant exploding across the UK in coming weeks, we’ll remember the instinct of those in Whitehall who tried to sneak in local restrictions under the radar even as the PM pushed ahead with the last reopening on May 17. And we’ll ask: why didn’t you jump the other way?