Boris Johnson faces tough call on Monday's reopening as Indian variant cases continue to rise

·4-min read
Bolton where several notice boards have been put up to share Covid guidance
Bolton where several notice boards have been put up to share Covid guidance

Nothing in this pandemic is easy, and on Friday Boris Johnson will face one of his most difficult decisions yet - to delay or push ahead with Monday’s long awaited reopening which will see indoor mixing in pubs, restaurants and homes fired up again.

The problem is the Indian variant. It is making worrying progress in a series of hotspots across the country and, if left unchecked, could undo the huge progress made over the last few months.

Despite the speed of the UK vaccination rollout, we remain vulnerable: over 40 percent of the population are unvaccinated and less than 30 percent have received both jabs.

The prime minister’s decision will be informed by Sage, which convened on Thursday to consider the fast-moving situation. But that briefing, when it arrives, is likely only to pose hard choices.

Chief among the evidence Sage will consider is a paper published on Monday by the Covid modelling group at the University of Warwick. Like Imperial, its projections for a third wave of infections - assuming the current Kent stain remains dominant - are now relatively benign.

It predicts only a moderate bump in new cases and hospital admissions in mid to late summer, assuming the lockdown is lifted as planned, resulting in some 7,250 additional Covid-19 related deaths.

But the Warwick modellers also considered what might happen if a new variant of the virus got a grip - and here the mathematics look more worrying.

“England remains extremely vulnerable to novel variants,” says the paper. “A variant that is 30-40 per cent more transmissible than B.1.1.7 [Kent] is projected to generate more total hospital admissions than the first wave. Variants that escape immunity (either from infection or vaccination) could generate outbreaks larger than the second wave.”

So what do we know about the Indian variant? First, the good news. The vaccines seem to protect against it for serious disease at least. There is some laboratory evidence it may reduce their effectiveness, but not catastrophically. In India, where most health workers were vaccinated early, there have been only a handful of reports of hospitalisations and deaths.

The real worry is around transmission. Public Health England think it “at least” as infectious as the Kent variant and other data suggest it is out-competing the Kent strain, here and around the world. The latest PHE data released on Thursday show cases more than doubling in a week, albeit from a very low base (520 to 1,313).

The Warwick modelling looked specifically at the impact of a variant that vaccines continued to protect against but was between 10 and 50 percent more transmissible (see charts below). For all degrees of transmissibility, it found the spike in hospitalisations would be distinct but modest if the reopening on Monday is cancelled.

But if the reopening goes ahead and the new variant turns out to be 40 percent more transmissible, proceeding with Monday’s reopening would produce a surge in hospitalisations close to that seen in the first wave. Steps three and four for the exit plan combined (Monday’s changes and then the further lifting of restrictions on June 21) would have a similar impact with just a 30 per cent increase in transmission.

We talk a lot about hard choices in politics and data like this show why.

Some experts like Prof Devi Sridhar, chair of global public health at the University of Edinburgh, urge a cautious approach if it is concluded that the Indian variant is outcompeting the domestic strain. “We probably have to slow the roadmap to recalibrate that speed compared to our vaccination programmes,” she said.

But to call off Monday’s reopening now would create huge indirect harms to individuals and businesses - not to mention a terrible political storm.

An alternative might be local lockdowns, but that strategy failed last year. The distribution of the Indian variant, with hotspots in the north and in south Asian communities, makes the political optics of that all the more difficult still.

A fall back might be “surge vaccination” in the affected areas. By diverting vaccine supplies to the hotspots, the prime minister may calculate the variant can still be kept under control - even if it takes a week or more for immunity to start to kick in.

Yesterday, exactly such a policy was announced - and then reversed - by Blackburn with Darwen Borough Council, with all those 18 and over urged to come forward for vaccination in three wards known to be harbouring the Indian variant.

It is a strategy that may work, but it is not one for which there is a model to fall back on.

Protect yourself and your family by learning more about Global Health Security

Our goal is to create a safe and engaging place for users to connect over interests and passions. In order to improve our community experience, we are temporarily suspending article commenting