On Monday night (4 January) the UK government finally accepted the inevitable and ordered England into a third national lockdown. Restrictions are broadly similar to those the country lived under in March, with a few exceptions – support bubbles continue, as do acts of worship, and people can meet one other friend outside for exercise.
The move was neither unexpected nor for the most part opposed. Calls from scientists and public support for tougher rules had both been growing, making a government U-turn inevitable.
In fact, the only real question based on the Covid-19 data is why the decision came so late. Analysis of the figures shows a worrying increase in case rates, hospitals struggling to cope with a surge in patients and a death toll that is set to rise for weeks to come. And that’s even before the effects of household mixing over Christmas are felt.
It is apparent that the tier system of localised restrictions has failed to control the new variant of the virus, compelling the government to pull the remaining levers at its disposal in an attempt to stop the spread. As in March (and as Sage scientists warned the government before Christmas), new measures including the closure of schools had become necessary to keep the reproduction (R) number below one. It may be that even these measures are insufficient to halt the spread of Covid-19 and that the UK’s best hope of taking back control of the epidemic lies in its vaccination programme.
Cases are at a record high
The UK is now experiencing a higher number of cases than at any point throughout the pandemic, and the figure continues to rise. Some 58,784 new cases were reported on 4 January, while a look back at the date people were tested shows 80,664 tested positive for the virus on 29 December – a figure that could still be revised upwards. Case rates on a local level are also reaching new heights with nearly 30 local authority areas recording rates in excess of 1,000 per 100,000 population over the past week. This is, of course, partly due to increased testing. During the first wave, the only people getting tested were those in hospitals, whereas now mass testing is open to the public, with more than 400,000 tests conducted a day when including the newer lateral-flow tests.
However, the increase in testing doesn’t mean that this rise is simply a “case-demic”. Based on the proportion of tests returning positive, no part of England is escaping a rise.
According to the World Health Organisation, anything above 5 per cent of tests returning positive is a sign that the pandemic is out of control. As of 30 December, Newham was seeing 35 per cent return positive, Tower Hamlets 34 per cent and Enfield 32 per cent. Outside the capital, Broxbourne, Dartford and Medway were all seeing 32 per cent of tests return positive. It’s clear that even with the new lateral flow tests, the system is struggling to keep up.
The failure of the tier system made school closures inevitable
Owing to the reopening on Christmas Day, it’s hard to say how well the tier four restrictions were working. However, there are no signs of significant case rate decreases in tier four areas and many areas in lower tiers are showing significant increases. In Kent, which had been in the highest tier since the November lockdown, the restrictions appeared to be having some impact, with cases falling slightly over the festive period. London and Essex, most of which had been in tier four since 20 December, also recorded a slight drop. However, after Christmas, cases rose again notably.
You can find out how the virus is progressing in your local area using our local Covid-19 tracker here. The new lockdown in England announced last night adds some additional strength to tier four measures. The main change has been the imposition of school closures, which look to be an effective way to slow the spread. The ONS infection survey for England shows that schoolchildren were the most likely to test positive in the week before Christmas. One in 34 secondary school age pupils – nearly one per class – were estimated to have the virus on 15 December, while the figure for primary school pupils was nearly one in 50.
Until this week, the government’s message on schools was that they were “safe” for pupils. This was true – up to a point. Children are far less likely to become seriously ill from Covid-19 and the risk to them is minimal.
However, the role that schools play in spreading the virus between households had become too important for the government to ignore. This should not and would not have come as a surprise: Sage papers from 17 December show that secondary school children were seven times more likely to bring Covid-19 into their household than adults were, while primary school children were nearly three times as likely. Both groups were more than twice as likely to then infect somebody else within their household.
Separate figures obtained by the teacher’s union NASUWT from three councils found that Covid-19 rates among school staff far outstrip local average rates. In Leeds, secondary school teachers were four times as likely to become infected, in Birmingham more than three times and in Greenwich they were more than twice as likely. With the tier system failing to halt the new variant, schools had to close.
Hospitals are reaching capacity
One of the main aims of the government throughout the pandemic has been to prevent the NHS becoming overwhelmed by an influx of Covid-positive patients. The data shows that we have never been closer to that eventuality than at present.
The number of patients with Covid-19 in English hospitals on Monday morning stood at 26,626 according to the government’s dashboard, far in excess of the 18,974 in hospital at the peak of the first wave and still rising. In Wales, the latest figure is more than double the peak of the first wave, while it is a similar story in Scotland and Northern Ireland, albeit with numbers starting to drop.
In his address to the nation on Monday night, Boris Johnson announced that the country was moving to alert level 5, indicating that NHS services may be overwhelmed if there continues to be a sustained rise in case numbers over the next three weeks.
Some hospitals in London and the south-east and east of England, where cases are highest, have been taking emergency measures for several weeks. Elective surgeries have been cancelled and there are plans to transfer patients hundreds of miles from overwhelmed intensive care units in the capital to less affected hospitals in the south-west.
Data on the number of hospital beds available across England suggests that the NHS is so far coping well – there were more unoccupied beds on 29 December than in mid-November – but this masks the significant strain some hospitals are facing. The proportion of beds taken up by Covid patients has been increasing steadily over the past month, with 12 trusts now seeing more than 40 per cent of beds filled by Covid-positive patients. North Middlesex University Hospital in Edmonton has the highest proportion of beds occupied by Covid patients in England, at more than 60 per cent.
Deaths are rising again, and likely will for some time
Across the UK, the number of people dying within 28 days of infection continues to rise. On New Year’s Eve 961 deaths were reported, and the number of deaths recorded by date of death (which take longer to filter through the system) is also up 21 per cent from the week to 28 December.
These figures are, as yet, unlikely to contain many deaths that will have occurred as a result of Christmas mixing – meaning the number of fatalities will continue to rise even as England enters lockdown, as people who are currently already infected or hospitalised lose their lives. Unsurprisingly, the rise in deaths is mainly happening in those areas that have experienced a surge in cases: London, the south-east and the east of England.
Hopes rest on vaccinations
With a national lockdown now in place in England for at least the next seven weeks, the NHS’s vaccination programme is our best hope of getting the virus back under control. Monday also saw the first patients in England receive the Oxford/AstraZeneca vaccine, which will comprise the bulk of the UK’s vaccination programme. The Prime Minister said this evening (5 January) that 1.3 million people – almost two per cent of the UK population – had received one dose of the vaccine.
Roughly 23 per cent of people over the age of 80 have also been vaccinated and this figure should increase significantly in the coming weeks if all goes to plan. These vaccinations provide some hope for people across the country who have been placed under greater restrictions. They also highlight why a new lockdown was so important. Unlike during the first lockdown, a potential end to the pandemic is in sight, so there is a heightened incentive to stop the spread of the virus.
Every life lost as a result of Covid-19 at this stage is one that we now know may have been saved by vaccination in a few months’ time.