Six weeks of stalemate between the UK and coronavirus, with little decisive movement in key indicators of infection and disease, are likely soon to end, experts predict. Cases, hospitalisations and deaths are all widely expected to rise following this month’s return to school, combined with more social mixing indoors as autumn sets in.
Scotland, where schools went back two weeks earlier than in England and Wales, could provide a foretaste of what is to come. According to the Office for National Statistics infection survey, positive tests in Scotland rose to 2.2 per cent of those tested in the week to September 3 — up from just 0.7 per cent a fortnight earlier.
However, case numbers suggest that Scottish infections may have peaked. For the past seven weeks the equivalent rate in England has been about 1.5 per cent.
“In many ways, Scotland’s experience can be viewed as a sneak peek into possible rises in cases that may occur in England over the next few weeks,” said Rowland Kao, epidemiology professor at Edinburgh university.
John Edmunds, professor of epidemiology at the London School of Hygiene & Tropical Medicine and a member of the government’s Sage advisory group, agreed. “Transmission in schools [in England] is only likely to have occurred this week and last, so I think we’ll start to see new cases from now onwards,” he said.
“In the next month or two, we are going to have a lot of cases and that will inevitably result in hospitalisations and unfortunately . . . deaths,” Edmunds added. “I’m worried about these next few weeks. We’ll learn after that what may come next with the twin pressures from Covid and winter flu.”
Some scientists take a more optimistic view. “I don’t think we will see a big surge in cases after schools go back,” said Paul Hunter, professor of medicine at the University of East Anglia.
Current levels of vaccination, combined with the immunity conferred by natural infection with the Sars-Cov-2 virus, will be enough to prevent a Covid-19 crisis during the autumn and winter, Hunter said. “At many international conferences I’ve attended, people have described infections as acting like vaccine boosters, though you don’t hear many UK commentators talking like that,” he said.
Hospital admissions and deaths have ticked up slowly across most of the UK in recent weeks — and more quickly in Scotland. “Scotland is close to getting the same numbers of hospitalisations as in January . . . though Scotland’s January peak was lower than England’s,” said Edmunds.
The NHS is working flat out ahead of any autumn rise in Covid cases, said Tom Wingfield, senior clinical lecturer at the Liverpool School of Tropical Medicine. “We’re busier than I have seen during the summer during my 18 years working in the NHS,” he said, “and the chronic stress in the system is very high.”
“We are not overwhelmed, because the vaccines are working, but we have three wards in one Liverpool Hospital Trust filled with Covid patients — wards that could otherwise have been used for other treatments,” he said. “I’m extremely worried about what this winter will bring, as we’ll see flu and other respiratory infections that we didn’t see last winter because people were not going out and mixing.”
Although the UK set the early pace with its rapid vaccination rollout, it has recently been overtaken by several other European nations that have moved faster to vaccinate young people, particularly in the 12-15 age group. Britain has now administered 138 doses per 100 residents, compared with 150 in Portugal, 149 in Denmark and 144 in Spain.
Neil Ferguson, professor of epidemiology at Imperial College London, said that some countries were in a better position than the UK because they vaccinated more recently, so the immunity had had less time to wane, and they used a higher proportion of mRNA vaccines “which provide better protection against infection”.
“I’m not sure I’d feel that comfortable anywhere but I’d certainly feel more comfortable in countries like Spain, Portugal and Denmark,” Ferguson added. “I don’t want to exaggerate the situation we are in. I don’t think we are in a crisis right now. I just think we do need to get on with boosting immunity in the population at this point.”
However, few experts anticipate the need for another wide-ranging lockdown this winter, even when flu and other respiratory diseases add to the burden of Covid.
“In a worst-case scenario, we can probably reverse a wave of infections with more light-touch measures,” such as telling people to work from home if possible and to wear masks in public places, said Edmunds.
“We do have a lot of immunity in the population and that’s doing what it should be doing — which is putting a limit on the reproduction number,” he said. “So, we won’t need as extreme measures to stop things getting out of hand as we had in place in the past.”
That reassuring conclusion might be invalidated by the emergence of a new variant that is significantly more infectious than Delta and better equipped to overcome human immune defences.
But Hunter said that was very unlikely. “I don’t believe we will get another variant worse than Delta,” he said. “Once the virus has evolved to the best fit with its human host, that is it as far as big evolutionary steps are concerned.”
Ferguson said modelling conducted for Sage “can generate a whole host of scenarios which range from slow, steady increases to a high, sustained peak to much spikier increases in demand for hospital beds.”
“The most difficult one to cope with is a large spike as there you really do put intense pressure on the NHS,” Ferguson said. “If we can avoid that, and we have so far, that’s good news.”
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