Why a Covid winter spike will not lead to another national lockdown

·7 min read
File photo dated 03/10/14 of a NHS hospital ward, as the NHS is facing its worst winter in recent history if it does not receive an immediate cash boost, health chiefs have warned. PRESS ASSOCIATION Photo. Issue date: Sunday September 3, 2017. NHS Providers, the trade association that represents hospital, mental health, community and ambulance service trusts in England, called for an emergency cash injection of between £200 and £350 million to enable the NHS to manage patient safety risk in the winter months.  - Peter Byrne/PA Wire
File photo dated 03/10/14 of a NHS hospital ward, as the NHS is facing its worst winter in recent history if it does not receive an immediate cash boost, health chiefs have warned. PRESS ASSOCIATION Photo. Issue date: Sunday September 3, 2017. NHS Providers, the trade association that represents hospital, mental health, community and ambulance service trusts in England, called for an emergency cash injection of between £200 and £350 million to enable the NHS to manage patient safety risk in the winter months. - Peter Byrne/PA Wire

It feels eerily familiar: end-of-lockdown excitement, meeting friends in the sunshine, and even the possibility of a holiday abroad. The numbers are almost identical too. Last year, as this May, new Covid-19 cases drifted well below 2,000 a day. Then as now, summer (and freedom) was unleashed at last. 

But we know how 2020 ended. A brutal spike and an equally brutal lockdown. Educations were trashed. Christmas was cancelled. So if we do – as many suspect we will – get a new winter take-off of what appears an ever-more seasonal virus, will we face the same misery again?

Vaccine threats

Last year, cases began to pick up again towards the end of August, and by the end of September were over 10,000 a day again. 

This time around, the Government hopes, vaccines will halt that rise. All adults will have had their first jab by the end of July. But there’s a wrinkle to the success of the rapid rollout, as the virus potentially surges back in the autumn the most vulnerable people, including the elderly, will have had the longest gap since their first injections. 

“We might see some immunity waning, particularly among older people,” said Prof Sarah Lewis, professor of molecular epidemiology, University of Bristol. No wonder that this week Vaccines Minister Nadhim Zahawi announced autumn boosters, most likely for everyone over 50. 

Watch: What is long COVID?

The second big threat is not waning antibodies, but new variants of the virus itself, which have previously shown they can be deadlier or spread faster, and partly elude the protection conferred by some current vaccines

The impact of such mutations can be dramatically seen in the statistics for last November, when the post-summer surge in cases was abating, only for a huge third wave to crash over Britain as we retreated indoors for winter. The “Kent variant” forced us into a new lockdown

As with waning antibodies, there is an official response to the variant threat too: the Government this week announcing almost £30 million to build labs at Porton Down specifically to monitor vaccines efficiency against worrisome mutations of the virus. 

Nightmare scenario

For those battling the pandemic, the fear is that these two factors – waning immunity and variants – combine to produce the nightmare scenario which now appears to be playing out in the Seychelles. There, more than 60 per cent of the population has been fully vaccinated, only for the archipelago nation now to experience a huge spike in cases, from 15 per day a month ago to up to 145, in a population of just 100,000.

At the beginning of this week, it had 1480 cases per million people, compared to a mere 30 or so in Britain. Per capita, it is worse off than India

As Prof Christina Pagel, director of the Clinical Operational Research Unit, UCL, noted: “Fair to say that high vax rates alone are not necessarily enough to stop a surge in cases.”  

The islands, which thought they had consigned Covid-19 to the past, have now plunged back into lockdown. 

All is not lost

Yet curiously what is happening in the Seychelles does not deny, but actually confirms, the promise of vaccines. The country relied heavily on China’s Sinopharm vaccine, which is rated little more than 50 per cent effective at preventing infection. And just as such protection rate figures would imply, half as many jabbed people as non-jabbed have been infected in the new Seychelles outbreak. 

Significantly, however, the Chinese vaccine, like all vaccines, is highly effective (more than 80 per cent) at preventing serious illness. 

So outbreaks like the one in the Seychelles can be seen in one of two ways. For many they show that this mercurial virus will inevitably overcome vaccine defences.

Tim Spector, professor of genetic epidemiology at King’s College London, and the man behind the Zoe symptom tracking app, acknowledges that “a lot of my colleagues, more than 50 per cent, are in this camp. They are pessimists. They see the march of these variants and worry about them". 

But there is an alternative view, which is to celebrate the fact that in 2021, because of vaccines, the link between cases per se, and serious illness and death is being broken. That, some experts say, is the true difference between this year and last, and has profound consequences for policy.

Last year, we went all out to stop cases because cases correlated strongly with hospitalisations and deaths. Not today. 

“For our immune systems it’s now highly unlikely that we're going to have zero protection as if we've never met the virus before when everyone in the country has either had Covid-19 or a vaccine,” said Prof Spector. “It would really have to be a totally new virus to do that.”

Time, he added, is also on our side. “Generally viruses tend to get less deadly. We hope it's going to mutate into a very mild form that is like a common cold, and all our children will get used to and become immune to.”

A new mindset

For those managing the pandemic, therefore, some experts say a rethink is required. “We need a new mindset,” said Prof Lewis, a mindset that accounts for the fact that while

Covid-19 is not being eradicated, and outbreaks will occur, but time, exposure and vaccines are helping to ensure it becomes a far less deadly disease. “The key thing to watch is the number of hospitalisations and deaths rather than the number of people catching Covid,” said Prof Lewis.

Watch: What UK government COVID-19 support is available?

New measures

So when, from this autumn, the inevitable spikes do occur, what should the Government do?

“Hold your nerve,” said prof Spector. Because of this year’s lower hospitalisation rates with Covid-19, he said, the chances of the NHS being overwhelmed in the coming winter are “extremely unlikely”.

Instead, he added, testing should be localised where there are outbreaks and hospitals and care homes properly protected. Recent intensive hunts of variants in London, he added, offering encouraging signs that “after £30 billion of our money, [test and trace] might be getting their act together.”

From improved financial support for those who need to quarantine, to sourcing outbreaks as well as stemming them, “lockdown is not the only option to control this,” said Prof Lewis. 

Not least because the moment of official hesitation is likely to come when schools go back in September. Educations will once again be on the line, and other diseases will return.

“We’ve been so focussed on this because it’s novel,” says Prof Lewis, who is also a school governor, “but we have to move away from that. We might have a bad flu season. We just can’t have children go through what they did before.”

“As we've seen,” adds Prof Spector, “the Swedish approach has done as well as our approach. Life has got to carry on.

“I've been amazed how, compared to other countries, we’ve put up with these restrictions,” he added. But now that the link between cases and deaths is being broken, he estimates the nation’s acceptance of draconian measures is wearing thin: “I can’t see the British public putting up with a prolonged December lockdown again.”

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