As the days become shorter and colder, and the country gets ready to head into autumn and then winter, two key questions I am repeatedly asked are: what will the next six months look like; and will there be another national winter lockdown?
We scientists are struggling with our crystal balls as we try to predict a future determined by complex interlocking factors. These include potential new variants; a resurgence of seasonal illnesses such as flu and RSV (a common respiratory virus that usually causes mild, cold-like symptoms), putting pressure on the NHS; a vaccination programme that has proved effective but still requires greater uptake; and public fatigue.
Last September, we heard a more euphoric Boris Johnson declaring normality by Christmas. With hindsight, we know the consequences of this laissez-faire approach, as a deadly second wave led to a brutal winter lockdown and families separated over the festive season. In stark contrast, Johnson’s tone yesterday was more serious and sombre, and the plan he outlined is cautious and on point.
Vaccines are being relied upon to do the heavy lifting in damping transmission, stopping severe illness and keeping pressure off the NHS. A concern among scientists is waning immunity, which is to be addressed through a booster programme for priority groups such as health and social care workers, those over 50 and those with underlying health issues.
Another concern is teenagers, which has been addressed through the green light for a mass vaccination programme for 12- to 15-year-olds, similar to those in the US, Canada, Germany, France, Singapore and Israel. This will keep pressure off busy paediatric units and avoid children having prolonged Covid-19 symptoms. In an effort to increase uptake among younger groups, as well as keep businesses such as nightclubs open, vaccine certification is being kept as a reserve policy in England should it be necessary, while Scotland is already moving ahead with these plans.
The second pillar that we are relying on is community testing to catch positive cases so that those infected can isolate for 10 days and not pass on the infection to others. Home testing has been a success, with lateral flow tests finding almost a quarter of positive cases, and preventing infectious individuals from going to schools, workplaces and social events. This will, fortunately, continue over the winter period.
In support of these pillars, the government is advising people how to avoid respiratory infections in general: getting outside as much as possible, opening windows and ventilating indoor spaces, wearing masks indoors in shops and on public transport, and avoiding crowded and busy places.
The plan then looks at how better to support the NHS through the winter, including long Covid services and additional financial investment. Little detail is given on what the cash will be used for. Even before Covid-19, the NHS was stretched during winter, and real investment is needed in not only infrastructure such as beds and equipment, but in recruiting adequate staff and ensuring they are treated properly. The recent backlash against GPs risks upsetting those who are the lifeblood of the NHS and adding to the growing mental health toll and burnout of medical staff. There’s no point having a ventilator if there’s are no trained intensive care staff to operate it.
And while it has a heavy focus on national policies, the plan also notes the importance of helping to vaccinate the world, focusing on Covax, a multilateral mechanism where richer countries donate doses to poorer ones. A more effective measure, however, would be moving from the charity model of donating vaccines to one in which regional manufacturing hubs are set up – so that low-income countries can procure their own supplies, with assistance from the World Bank.
Like every country in the northern hemisphere, the UK government will be steering us through increasingly stormy waters in the months ahead. While a lockdown could become inevitable if health services look close to collapsing, there’s a real chance to avoid harsh winter restrictions.
To avoid a lockdown, we need the various components of the system – vaccination, behavioural changes and widespread testing – to work together. Covid-19 is still here, and we are still in the midst of a pandemic. Let us hope this autumn brings a move away from a divided society arguing over how serious Covid-19 is, to one where we collectively work towards managing this problem, slowing the spread of the disease, and saving lives and livelihoods.
We all want the same thing: for the pandemic to end, and to get back to normal life. Let’s focus together on how we get there.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh