Winter COVID plan: How bad is the pandemic compared with this time last year?

On 31 October, 2020, Boris Johnson announced that England would go into a second national lockdown in order to avert "medical and moral disaster" for the NHS.

On that day, England recorded a seven-day average of 19,686 new COVID cases. On 6 September, 2021, the most recent date for which complete data is available, the figure was 25,968.

Amid these figures, the prime minister has set out plans for a COVID booster jab campaign, along with a blueprint for living with the virus through the winter.

The PM remains determined to avoid another lockdown in England.

And on Tuesday morning, vaccines minister Nadhim Zahawi told Sky News a future lockdown would be an “absolutely last resort” in the face of rocketing COVID-19 cases in the coming months.

Watch: Boris Johnson 'confident in steps taken' as winter approaches

Nearly all restrictions to limit the spread of coronavirus were lifted in England on 19 July, 2021 – a move the PM called "irreversible".

But the lifting of lockdown ruled last summer was reversed as cases began to rocket and hospitals filled up with coronavirus patients. Can we expect the same to happen again this winter?

COVID cases set to rise

New daily cases in England are much higher than this time last year.

The seven-day average for new daily cases on 6 September, 2020, was 2,687. The current number of new infections is almost 10 times that at 25,968.

At a local authority level, the UK's highest case rate a year ago could be found in Bolton, with a seven-day rolling case rate of 152.3 new cases per 100,000 people.

A year later the highest case rate is in West Dunbartonshire, with a seven-day rolling case rate of 1,288.8 cases per 100,000 people.

With schools now open after the summer holidays, cases are likely to increase in the coming weeks, according to Professor Neil Ferguson, whose modelling was instrumental to the UK going into lockdown in March 2020.

Speaking at a webinar last week, Prof Ferguson said: “We expect to see quite a significant surge in cases, to some extent in hospitalisations, but whether that’s going to require any rolling back of the relaxation of restrictions is too early to say. It really depends on the level of healthcare demand.”

Hospitalisations and deaths

Case numbers taken on their own might make for troubling reading. However, ministers have been clear throughout the pandemic that decisions to introduce lockdown have been made on the basis of whether the health service can cope.

As the chart below shows, while hospital admissions are higher now than they were last year, they are well below the level when England was forced back into lockdown in November. This is down to the protection offered by vaccines,

Crucially, rapid increases in cases are no longer leading to sharp spikes in hospitalisations.

Therefore, though daily hospital admissions remain in the high hundreds, there is so far no sign of the sharp rate of increase that drove the country into the first winter lockdown.

A similar trend can be observed in the numbers of deaths from COVID, as seen in the chart below.

While the number of deaths has been rising in England in the past months, the upward trajectory is far less steep than in previous waves.

The Delta variant

Higher case numbers are, in part, due to the emergence of new variants.

The Alpha variant, first discovered in Kent, drove the 2020 winter wave of COVID.

It has since been overtaken by the more transmissible Delta variant.

Delta is considerably more infectious, making it more difficult to keep transmission down.

The vaccine rollout

The key difference between the wave of cases at the end of last summer compared to this summer is the rollout of the coronavirus vaccines.

Some 88.9% of over-16s in England have had one dose of a COVID vaccine, and 80.7% have had two doses.

On Monday, health secretary Sajid Javid confirmed that children aged 12 to 15 in England are to be offered their first dose of a COVID vaccine, following the advice of the UK's four chief medical officers.

Data from vaccine trials is encouraging. According to Public Health England (PHE), one dose of the Pfizer or AstraZeneca vaccines offers between 55 and 70% protection against symptomatic disease from coronavirus, and more than 75% protection against death.

As a result of this, PHE estimates that up to 116,200 deaths have been averted by the vaccine rollout in England.

The success of the vaccine rollout does not mean the NHS is shielded from pressure from the current wave of cases.

As it stands, the health service is facing particular strain as it struggles to dislodge the backlog of care that built up during previous lockdowns.

Plus, there are additional concerns that there could be a particularly bad flu this winter due to low levels of immunity as a result of coronavirus restrictions.

Writing in the British Medical Journal, John Middleton, honorary professor of public health at Wolverhampton University, warned that the government is at risk of “vaccine over-confidence”.

He wrote: "The UK potentially faces a perfect storm of COVID-19, winter flu, a large backlog of untreated long-term conditions, and excess cold-related mortality, along with the impact of Brexit."

This could lead to unmanageable strain on the system, Middleton warned, adding: "While hospital admission and deaths are levelling, they are doing so at high levels, so it is hard to imagine we are through this. It seems likely that the NHS and public health authorities will be stretched again this winter with children’s care and wellbeing the new frontline."

Professor Ravi Gupta, a member of Nervtag, the group that advises the government on the threat posed by new and emerging respiratory viruses, said the current data "doesn't bode well for going into winter at all".

Read more:

8 coronavirus hotspots in England revealed as PM unveils COVID winter plan

Vaccinating children aged five and over 'next issue on horizon'

He told Sky News: "We're now in a position where we're talking about lockdowns again.

"With the correct planning, this could have been avoided."

However, few experts predict a return to full lockdown this year.

Sage member Calum Semple predicted that measures such as mandatory masks could be brought in locally.

He said: "That's the kind of thing that I would expect, some degree of regional common-sense approach.

"If you see a high amount of virus in Liverpool or Manchester or Birmingham, then it wouldn't surprise me if there was local leadership in that area."

Watch: Boris Johnson tight-lipped on winter COVID plan

James Gaughan and Peter Sivey, research fellow and reader in health economics at the University of York, argue the vaccine rollout has "changed the prognosis" for the NHS this winter.

"The coming winter will inevitably bring more cases of COVID-19 and other infectious diseases, and hospital numbers for COVID-19 are already high," they wrote in analysis for The Conversation.

"There is unlikely to be the same rapid increase in hospitalisations as seen previously.

"Some return of more minor restrictions in the winter is possible if hospital numbers continue to rise, but a full national lockdown remains unlikely."