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Will there be a winter lockdown? Experts set out three scenarios - the good, the bad and the ugly

scenarios
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Perhaps it betrays the UK’s approach to fighting Covid-19, but the only real question we Britons are asking at the moment is this: will there be another lockdown this winter?

On Wednesday, the Prime Minister set out a two-part “Autumn and Winter Plan”. Plan A relies on vaccines and booster shots to hold the virus at bay. Should that not prove adequate, Plan B would then be instigated “hard and early”. This would involve mask mandates, vaccine passports and the nation getting what amounts to a stiff talking to.

“In a Plan B scenario, the Government would issue clear guidance and communications to the public and businesses, setting out the steps they should take to manage the increased risks of the virus,” says the document.

There is no official Plan C but it is, of course, another lockdown, or what the new plan refers to as “more harmful economic and social restrictions” only to be considered “as a last resort”.

Ministers believe Plans A and B will be “sufficient to reverse a resurgence in autumn or winter”, but add that “the nature of the virus means it is not possible to give guarantees”.

When push comes to shove, “the Government remains committed to taking whatever action is necessary to protect the NHS from being overwhelmed”.

So how might things pan out in practice over the next six to nine months?

On Saturday, the former prime minister Tony Blair has called on the Government to introduce vaccine passports now or "risk further lockdowns.

We spoke to many of the country’s leading experts. Here are their thoughts on the months ahead - the good, the bad and the ugly.

The Good

In the best-case scenario, things continue pretty much as they are today, with everything open and people - slowly but surely - returning to life as normal.

The considerable immunity built up in the population through natural infection and vaccination - already upwards of 90 per cent - will be topped up by the one-in-70 who currently have the virus, the vaccination of children aged 12 to 15 and booster shots for the over-50s.

All those antibodies push R below one and cause the incidence of the virus to start shrinking exponentially, reducing hospital admissions and taking the strain off the NHS. This continues even as more and more people venture back to work and average daily contacts more than double to return to their pre-pandemic levels.

The most vocal proponents of this view, including the economist Andrew Lilico, believe that “in England at least, the coronavirus epidemic is now de facto at an end”. Herd immunity has been reached and another “extended period” of hospitalisations and deaths is “no longer possible”.

On this view, Christmas will once again be a jolly affair with all the relatives in attendance. There will be turkey and goose aplenty due to the brimming good health of farmers and triple jabbed HGV drivers. February half-term will witness a return of Britons to the Alps, where bookings are already hard to come by. Who knows, Tyrolean “beer pong” may yet become a thing again.

Prof Francois Balloux, the director of the University College London Genetics Institute and a professor of computational biology, is quick to say he is not “doing a Lilico” and declaring the crisis over, but admits to being “overall, quite optimistic”.

“I might say something like, it looks like the beginning of the end, at least in the UK and most of Europe and in the US”, he told The Telegraph on Thursday.

“I think the UK’s numbers will be decreasing over the coming weeks. And each week that we don't have an explosion in cases is another week where essentially you are building your defence of immunisation… If anyone had said this was on offer a year ago, I would have happily taken it.”

But Prof Balloux warned that the coming winter in the UK could still be tough.

He said we should expect “flare ups” in communities where immunity remains low and warned that the lack of capacity in the NHS compared with other developed nations was “a real concern”. The population was also in “much worse health” after two years of restrictions, he noted.

“Many healthcare systems have been stretched to breaking point, and some services - and healthcare workers - are actually broken,” he said.

Many healthcare workers are broken already after the past 18 months, even before winter comes along again - Andrew Redington
Many healthcare workers are broken already after the past 18 months, even before winter comes along again - Andrew Redington

James Ward, a leading amateur modeller whose projections have been among the best over the past six months, also leans towards a positive outcome this winter.

“For Covid alone I don’t think it will get as bad as last January, but it could approach April 2020 levels, and we know the NHS is under pressure... so it could get very challenging,” he said.

Mr Ward says the degree to which the protection provided by vaccines wane would prove crucial. His model also highlights the length of the winter ahead, with waves of infection hitting in the UK in spring 2022 in some scenarios.

“The best-case scenario is that cases fall away fairly quickly in Sept/Oct and we don’t see much activity after November - that could happen if waning is quite slow or if boosters are highly effective,” he said.

“The worst case is that waning is faster and/or boosters only provide a short-term boost, in which case we could have quite substantial waves of hospitalisation and death, probably two to three times current levels.”

The Bad

“No, no, no, no, no… Yes. I’m sorry to announce that from midnight tonight I’m asking everyone to stay at home to once again protect our NHS.”

A bad outcome, say experts, will essentially be what the UK has suffered twice before. Immunity alone turns out not to be enough to hold the reproduction rate of the delta variant below one in winter. Cases start to rise again, followed by renewed growth in hospitalisations and deaths. Masks, vaccine passports and stronger communications are introduced but to no avail.

It’s too little too late. Hospitals - already with 6,000 Covid patients on their wards - quickly become overwhelmed. A despondent Prime Minister has no option but to cancel Christmas for the second year in a row.

There are two parts to this scenario - the epidemiological progress of the virus and the condition of the NHS.

On the former, an Israeli study published last week warns that booster jabs alone would not have been enough to stop the delta wave in Israel, where masks, vaccine passports and social distancing rules were reintroduced this summer. “To mitigate the outbreak, effective non-pharmaceutical interventions are required,” it concluded.

Adam Kucharski, associate professor in infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, puts it like this: “It's reassuring that we haven't seen case numbers climb to higher levels since mid-July, which shows we're now at a point where we can enjoy a lot more interactions without a growing epidemic.

“But we're not fully back to pre-pandemic patterns yet, especially with regards to office working. There is still the risk of an epidemic that creeps higher and higher as these additional interactions resume.

“Reintroduction of moderate measures like masks, vaccine certification and wider Covid testing may well be enough to stop any growth but not bring it down quickly, which in this scenario would leave us at a higher plateau going into winter.”

Alastair McLellan, the editor of the Health Service Journal and chronicler of the NHS for more than 30 years, is not optimistic. Asked for his good, bad or ugly prediction he said: “It's either going to be bad or very ugly. The obvious thing to say is that it's bad right now. The system is already very overstretched.”

Mr McLellan said emergency demand is higher than it had ever been and that waiting lists for surgery and diagnostics were also at record levels. Staff are exhausted and long-term plans to increase the number of GPs and other doctors had been scuppered by the cost of the current crisis, further impacting morale.

“It’s as if every hospital now has a new Covid wing,” he said. “It's like, suddenly, out of nowhere, at a really busy time for the NHS, this new disease comes along, which requires a whole set of resources to meet it - buildings, staff, technology, management … the system’s more stressed than it has ever been”.

Prof Devi Sridhar, the chair of global public health at Edinburgh University, said a scenario in which “we struggle along as we are now and hope the NHS can cope” was the most realistic. Asked if she thought the NHS would end up being overwhelmed , she said: “Yes - it’s already struggling.”

Dr Duncan Robertson, a policy and strategy analytics academic at Loughborough University, added that a weakness in the current UK strategy was the low numbers vaccinated in poorer communities.

“Delta or its successors will find the susceptible in the population: seven out of 10 adults in the most-deprived areas have been fully vaccinated compared with nine out of 10 adults in the least deprived areas. Two-thirds of black over-50s have been vaccinated compared with nine out of 10 white over-50s. Those are huge disparities.

“The Government has set out its Plan A, with Plan B as a contingency if things start to get out of control. The problem is that if you implement Plan B too late, you need a Plan C. And we don’t have one.”

The Ugly

An ugly scenario for the UK - one in which a hard lockdown was forced by factors beyond our control - is less likely but could be caused by a new vaccine-evading variant of Covid emerging.

A recent Sage paper described that scenario as a “reasonable possibility”, meaning it was between 40-50 per cent probable. If such an event did happen, it could set us back to square one as we would need to build up population immunity all over again.

Prof Balloux thinks the risk of this has been overblown. He notes that no major new variants of Sars-Cov-2 have emerged since vaccines started going into arms 10 months ago. This suggests that the current virus may struggle to quickly find a way around them. An entirely new outbreak caused by a fresh spillover event was more likely, he said.

“I think the risk of another coronavirus jumping into humans is actually much worse. I'm more worried about that than Sars-Cov-2 suddenly having a massive evolutionary jump and us having to start again. That’s very, very unlikely”.

But Covid is not the only virus that could throw us a googly. “To what extent will influenza come back this winter? And if it comes back, how good will the vaccine be?”, asks Prof Balloux and others.

“These are difficult questions in a normal year. In a pandemic, they add huge uncertainty”.

During the pandemic, the measures taken to stop Covid have dramatically suppressed influenza but in India, Qatar and China there are signs it is reemerging.

The fear in the UK is two-fold: that the NHS would not be able to cope with two respiratory outbreaks simultaneously and that a flu outbreak - if it did occur - could be especially nasty as we have been nearly two years without one.

“We are likely to be more susceptible to flu since the overall population immunity will not have been built up last winter and so will have waned”, said Dr John McCauley, the director of the Worldwide Influenza Centre at the Francis Crick Institute in London.

On the other hand, we may be less vulnerable to an outbreak because the level of flu in circulation globally remains relatively low. That’s “the balance”, he said.

It’s this uncertainty that is causing leading voices to urge stronger government action.

“The Government has set out the measures it believes can allow the country to manage the autumn and winter period,” said former prime minister Tony Blair in a new report released today which, among other measures, calls for the rapid introduction of vaccine passports.

“In our view this plan needs to be accelerated and additional measures introduced, or we run the risk of further lockdowns,” Mr Blair added.

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