Those who predicted that 2021 would feel different from 2020 have been proven correct — but not in the way that anyone wanted. Despite the existence of several effective Covid-19 vaccines, the UK, many European countries, the US and Brazil appear headed for their darkest moments in the pandemic.
The number of people testing positive in the UK now routinely exceeds 50,000 a day. Infections are rising in London, the east of England and south-east; they are also plateauing in other regions where rates had been falling. That is despite universities and schools having been closed for the seasonal holidays. A full reopening has been delayed.
The number of people in hospital with Covid-19 is already higher than the April peak. Sir Jeremy Farrar, director of the Wellcome Trust and a pandemic adviser, told me we are past the point at which the NHS is in danger of collapsing; parts are already buckling. Healthcare staff, the same key workers being called on to roll out the vaccines, are exhausted. Many are isolating or sick. The current tiering system is not keeping infections down.
The situation is so grave that a national lockdown, including school closures, looks imperative. “What we’ve got is two or three months now of something that will feel and look and is worse than March and April,” Sir Jeremy says, adding that schools may have to shut into February given the prevalence of the new variant in young people, which risks turning schools into more significant sources of transmission. He emphasised he was speaking in a personal capacity.
The reality is that there is rampant spread, fuelled in the UK by the combination of a new variant that is around 50-70 per cent more transmissible, plus a lifting of restrictions at the beginning of December when the R number was hovering around 1.
A lockdown would starve the virus of the human contact on which it feeds and offer breathing space: to expedite the rollout of vaccines and get ahead of the virus; to get a proper testing regime up and running in schools, so that they can reopen with confidence as the R number falls; and for ministers to display honesty and humility about the immense challenges that still lie ahead. The promise of vaccines should not be a cue for complacency but rather a spur to curb transmission, so that the virus has fewer opportunities to mutate before people can be immunised.
That race between immunisation and mutation has never been more urgent — a fact recognised in the UK’s pragmatic decision to delay booster vaccines so that more people can be given a first dose. A variant with superior transmissibility, even if no more severe than its predecessors, is deeply concerning. The arithmetic of contagion means that more infections, as with the B.1.1.7 strain currently dominating in the UK, inevitably translates into more deaths (despite improvements in therapies and patient care). As well as the personal tragedies that come with increased infections, unrestrained transmission risks brewing further variants that could evade current vaccines. Brazil, India and Mexico are hotspots to watch.
According to the World Health Organization, an even more troubling variant first reported from South Africa has been clocked in at least four other countries, including the UK. This strain, known as 501Y.V2, has already shown some resistance to monoclonal antibodies, a potentially promising treatment. A new variant can arise anywhere and spread everywhere, making the race to conquer coronavirus global not national.
If 2020 taught us anything it is that countries can never act too early and that postponing the inevitable leads to protracted agony. A recent Imperial College London analysis suggests that locking down one week earlier in the first spring wave would have cut UK deaths from around 37,000 to about 16,000.
Taiwan, Vietnam and New Zealand demonstrate that early, aggressive intervention delivers a healthy population able to participate in a healthy economy. Treading a middle way between public health and the economy, as the UK has tried to do since March, is a half-measure that protected neither. It is like trying to keep a motorway open after a pile-up and hoping drivers can swerve to avoid the debris, rather than shutting the road and clearing it so traffic can flow normally. Further collisions simply produce more debris and casualties.
Eventually, the road will have to be shut anyway and take longer to clear. This was the pattern with UK lockdowns in 2020. Only if we act more swiftly is there a chance 2021 may feel different.
The writer is a science commentator