The Sunday Times - UK (2021-12-19)

felt an obligation to do his part too and

did 25 hours of training as a vaccinator so

he can deliver jabs himself. “It’s good for

everybody else, but it’s good for us too,”

he says. “It helps to be able to play a tiny

part in dispelling the misery.”

Chowdhury estimates he has done

5,000 injections, each one helping lift a

fraction of the malaise that has settled on

Britain this second pandemic winter.

“The spirit of this country is extraordi-

nary,” he says. “Whenever you worry

about losing faith, you read all this doom

and gloom and it seems everybody is try-

ing to tear each other apart over politics,

then you see how polite and considerate

people are to each other at the vaccina-

tion centre. It’s so cheering. You realise

this is a great country after all.”

Isn’t the NHS supposed to save us,

News Review, page 27

lower severity of disease”,

researchers said.

Many are sceptical.

Professor Neil Ferguson, a

government scientific

adviser, said on Friday that

there was “no evidence” that

Omicron was less severe than

Delta. Yet severity, whether

because of the virus itself or

thanks to immunity, is the

question of the moment for

the NHS.

If infections soared to

400,000 a day, of which

about 200,000 might be

detectable as cases, we could

expect just under 4,000 daily

admissions if Omicron is as

severe as Delta. That is just

shy of the peak last January,

at a time when the NHS is

struggling to cope. If Omicron

“mildness” cuts that by

another 30 per cent, it will

make a big difference.

All eyes will be on London,

Britain’s Omicron capital, to

see if the sharp rise in cases is

followed by an equally sharp

rise in hospital admissions

over the next few days.

We cannot do anything

about the severity of the

virus. But by getting boosted,

limiting contacts and being

cautious, the height of the

peak over the new year is just

about within our hands.

@TomHCalver

thanks to much higher levels

of immunity. This is mostly

down to vaccines but also the

result of sustained levels of

infection throughout the

year: at least eight million

people have tested positive

for Covid during the year.

Even if immunity is less

effective at stopping people

from catching Omicron, it is

likely to be good at stopping

them from getting seriously

ill. This is why it is likely that

an Omicron wave will appear

“milder” in Britain than

previous waves of Covid.

It could also help explain

why the data out of South

Africa shows such a drop in

severe illness. Although its

vaccination rates are poor,

the country had a substantial

wave of the Delta variant in

July during which nearly the

whole country was infected.

Other experts have gone

further, however. Could the

virus itself be intrinsically

milder? It is too early to tell,

but last week a paper from

Hong Kong University found

that although Omicron

multiplies about 70 times

faster than Delta in the

bronchus, the tubes from the

windpipe to the lungs, it

replicated at a ten times

lower rate in human lung

tissue. This “may suggest

“The public seem broadly

content with the

government’s new balance:

caution and advice rather

than ban outright,” said

James Johnson, who carried

out the polling.

The LSHTM modellers

suggested, on their optimistic

scenario, a peak of about

300,000 daily infections in

England by mid-January.

However, the latest case data

suggests that infections may

be growing faster than their

model suggests. This would

mean a higher, sharper spike,

coming earlier, perhaps over

the new year, but also falling

faster.

NHS pressures

A quick and early spike would

undoubtedly be tough on the

NHS — but how tough

depends on another crucial

ratio that has shaped our

pandemic response from the

start. What percentage of

people infected end up in

hospital?

This ratio, although hard to

measure, has fallen since the

start of the pandemic. In

January, about 60,000 daily

cases led to the winter peak

of 4,200 admissions a week

later, a ratio of 7 per cent.

Nearly a year on, that figure

has fallen below 2 per cent,

ban on household meetings

over Christmas. Nonetheless,

there are signs of growing

concern: the share of people

saying they would rather limit

the spread of Covid has risen

from 42 per cent to 46 per

cent, while those who would

rather keep the economy

open have fallen from 36 per

cent to 34 per cent.

Whitty, England’s chief

medical officer, advised

people to “prioritise what

matters” when socialising

before Christmas.

Restrictions remain

unpopular, according to

polling by Kekst CNC — 58 per

cent of people oppose closing

all pubs and restaurants,

while 60 per cent oppose a

ESTIMATED WEEKLY RATE

OF OMICRON CASES

109 (27%)

Northeast

England

178 (46%)

Yorkshire and

Humber

286 (51%)

East Midlands

447 (62%)

East

844 (81%)

London

418 (56%)

Southeast

265 (48%)

Southwest

263 (52%)

Northwest

per 100,000 people

(51% of all Covid cases)

Scotland

241

Source: UKHSA, Coronavirus.data.gov.uk Full sequencing data not available for Northern Ireland and Wales

251-

400-

800+

100-150 per 100,000 people

151-

201-

217 (46%)

West Midlands

could be above 34 million.

Fortunately, there are signs

that we may be heading

towards the optimistic end of

the scale. Data from the UK

Health Security Agency

suggests that three doses of

Pfizer is about 75 per cent

effective against symptomatic

disease — much closer to the

most favourable scenarios

considered by the modellers.

Flatten the curve

The key question for the NHS

is when will we get our

21 million infections: all in

one go at the start in a sharp

spike, or spread out over

several months? Much of it

will come down to how much

mixing we all do.

For the first year of the

pandemic, we relied on blunt

instruments such as

lockdowns to suppress Covid-

19. Government rules limited
    the number of people we
    could meet and spread the
    virus to and, during
    lockdowns, cases went down
    in predictable fashion.
    Now, though, it is more
    complicated. We have much
    more population immunity
    than before, which is partly
    why the government has
    been less willing to impose
    restrictions. It may not have
    to. Last week, Professor Chris

When will Omicron infections peak? And how many deaths will we suffer?

How high will infections

get, and when will they peak?

And more importantly, how

many deaths will follow?

Peak predictions

Experts warned last week of

doubling times as low as two

days. The latest figures

suggest that there were about

40,000 Omicron cases in

England on Tuesday. By

Saturday, doubling every two

days, that figure would have

been 160,000. More than a

million cases a day by

Christmas Eve.

That is not how pandemics

work. With each passing

round of Omicron, the

number of new people who

can be infected shrinks.

Omicron is good at evading

immunity from prior

infection and vaccination —

but cannot evade protection

from itself. The wave will

have a finite peak.

Modelling from the

London School of Hygiene &

Tropical Medicine (LSHTM)

suggests that if boosters are

80 per cent effective at

stopping symptomatic

disease, then under the

“good news” scenario,

21 million people might catch

it in the next six months. But

if boosters were just 47 per

cent effective, the figure

The World Health
Organisation classified the
B.1.1.529 Covid strain,
Omicron, as a “variant of
concern” on November 26.
That same day two
travellers who had recently
returned from South Africa —
one in Brentwood, the other
in Nottingham — took tests
that would confirm them as
the first cases in Britain.
Omicron’s takeover
needed under three weeks.
On Tuesday it became the
dominant variant in England.
London has been an Omicron
city since Sunday.
For evidence of its
daunting growth, look no
further than daily case
numbers. Since “freedom
day” in July, we have become
used to tens of thousands of
infections — but last week
59,610 daily cases became
78,610, then 88,376, then
93,045. For months cases
were bumpy; now we are in
exponential growth, where
the language of “doubling
times” takes over.

TOM
CALVER

Data Projects Editor

missing that make it

impossible to judge how bad

the impact on hospitals will

be: first, how well do our

vaccines hold up against

Omicron; and, second, what

is the severity of illness when

people become infected.

Don’t we already have

these answers? Why does

it matter?

Early studies are beginning to

trickle in suggesting that two

doses protect against severe

disease, if not infection, that

boosters restore much of our

immunity, and that Omicron

might result in a milder

disease than Delta. But the

precise degree of the strength

of protection, and the

severity of disease, is unlikely

to be available before

Christmas. This has big

implications for how the NHS

copes this winter. Every

reassuring statement about

our personal protection

against Omicron means

nothing if the NHS becomes

overwhelmed. The

government has

demonstrated again and

again that they will stop at

nothing to protect our

hospitals. The spectre of

northern Italy in March 2020,

with patients being turned

away, the rationing of

ventilators, and people dying

in corridors, continues to

haunt ministers.

How can I reduce my

own risk?

This is exactly the question

ministers hope people are

asking. If people take matters

into their own hands — and all

the signs are that they are

already — the government

could be spared from

imposing restrictions. Whitty

provoked fury from Tory

backbenchers when he

advised that people prioritise

those events that are most

important to them — for

example, Christmas dinner

with family — and spurn

others. On an individual

level, this makes absolute

sense, and people are already

We can avoid a new year

lockdown — but only if we

embrace boosters and tests

Christmas and new year is

looking like the most likely

timing for new restrictions to

be introduced although if

hospital admissions rise

faster than expected it could

come earlier.

How long might

restrictions last?

Possibly not very long. One of

the options at the prime

minister’s fingertips is a two-

week “circuit-breaker”. To

understand why such a short

restriction would work, it is

worth considering how things

have changed since the

previous lockdown was

ordered, nearly 12 months

ago. At that stage the vaccine

programme had only just

begun. Now more than 95 per

cent of over-65s — the most

vulnerable group — have been

double vaccinated and more

than 83 per cent have also

had a booster. Locking down

would not be done, as it was

last year, to save hundreds of

thousands of lives, but to

protect the NHS. At the

breakneck speed Omicron is

spreading, the main danger

now is that thousands of

people become ill at the same

time and overwhelm

hospitals. A relatively short

circuit-breaker would slow

this spread and ease the

pressure, while allowing

more people to get boosters.

How much can the

NHS take?

At the peak of January’s wave

more than 4,200 people

arrived in hospital each day.

The government’s modellers

suggest that without new

restrictions, admissions

could reach at least 3,000.

With the NHS already under

huge pressure, doctors say

they would struggle to cope

with numbers they saw last

year. Plans to treat up to

1.3 million Covid patients in

their own homes using new

antivirals could significantly

ease this pressure. Chris

Whitty, the chief medical

officer, has also stressed that

several key pieces of data are

Are we heading back into

lockdown?

Covid cases are soaring,

hospital admissions are

creeping up and the NHS is

struggling. So far, so familiar.

Boris Johnson is facing a

dilemma — act now to stop

the rise in its tracks or hold

off to save Christmas and

prevent more damage to

the economy.

What are the options?

At the mildest level, the

prime minister could ask

people to self-impose their

own limits. Nicola Sturgeon,

who has taken this approach

in Scotland, asked families to

limit gatherings to three

households and to keep

Christmas celebrations as

small as “family

circumstances allow”. But

Johnson has also been

presented with a range of

increasingly severe options,

including a ban on all indoor

mixing. This would take us

back to the situation in March

last year, step two of the

“road map” out of lockdown.

If this option was chosen,

schools and shops would

remain open but pubs and

restaurants would be allowed

only to serve outdoors. Clubs

would close.

When might restrictions

come in?

Johnson is determined not to

cancel Christmas for a second

time. But his scientific

advisers have made it clear

that the longer the delay, the

more severe the restrictions

will have to be to be effective.

Sage scientists have advised

him that waiting until 2022

would be too late. Minutes

of a meeting on Thursday

say any measures “would

need to be implemented very

soon”. The week between

BEN

SPENCER

Science Editor

doing this. If you are forced to

isolate for ten days after

catching Covid at the work

party, for example, you will

not be able to visit your

relatives on Christmas Day.

Backbenchers were furious

that Whitty went beyond

government advice, but he

defended his actions: “Chief

medical officers have always

given advice to the general

public ... and I don’t actually

think that any ministers [are]

feeling [we] are treading on

their toes. This is my job.”

What else can I do to

protect myself and my

family?

First, get a booster as soon

as you can. Some may be

tempted to hold off,

influenced by trial results

that suggest a longer gap

between second and third

doses results in more robust

immunity. This may be true,

but that will not protect

you if you get infected before

your third dose. All evidence

now suggests two doses are

not very good at protecting

against infection. Three

doses, however, are very

strong.

What about tests?

Lateral flow tests are far more

effective than initially

thought, and work as well at

detecting Omicron as other

variants. Taking a test before

visiting others is a remarkably

good way of protecting them.

While lateral flows are not as

good as the gold-standard

PCR tests at detecting the

presence of the virus, they

are very effective at telling if

you are infectious at the point

you take it. This comes with a

caveat — you may not be

infectious one day, but

become so the next. Lateral

flows will not predict this.

Taking tests in the days after

mixing with many people —

for example, if you go on a

long train journey or to a

theatre production — is also a

useful way to make sure you

haven’t picked up the virus.

@Ben_Spencer

through the winter without hospitals
being totally swamped.
Although this surge in volunteering is
focused on Omicron, some charity lead-
ers hope Britain can maintain high levels
of enlistment to help relieve pressure
from the NHS long term. “We’ve already
seen thousands of volunteers stepping
forward to support the national vaccina-
tion programme,” said Sir Thomas
Hughes-Hallett, the founder of Help-
force. “Now we urgently need to har-
ness that power and potential across
many more aspects of healthcare.
Volunteers can be a vital part of bol-
stering the NHS.”
It’s possible that many of these
new volunteers have developed a
taste for it. Saalim Chowdhury, 38,
is a venture capitalist in his day job.
Both of his parents are doctors so
when the vaccination drive began he

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is a Covid

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*Figures exclude Friday’s jabs in Wales