England reached a grim milestone over the New Year weekend as hospitalisations from coronavirus surpassed the first wave peak, with this number expected to grow over the coming weeks as cases continue to soar amidst a new strain of the virus – believed to be up to 70% more transmissible. On Monday evening, Boris Johnson announced a third national lockdown to combat the spread of the virus, with schools set to be shut until at least the February half-term. Though focusing on the measures needed to bring infections, hospitalisations and deaths down is of utmost urgency, in addition to ramping up the vaccine roll-out to ensure as many people as possible become protected, looking back at what got us in this position in the first place is also helpful for understanding what we need to do in the months ahead. This new strain has made managing the virus more difficult, but the government was failing to do this before the new variant emerged.
EMERGING FROM THE FIRST LOCKDOWN
Throughout the summer, Boris Johnson continued easing restrictions from the first lockdown. Some children went back to school in June (Reception, Years 1, 6, 10 and 12), non-essential shops reopened from June 15th and hospitality began serving customers again from July 4th. These easings were made possible by the tremendous effort of the population to bring the virus under control. Case numbers over the summer were extremely low, reaching their lowest point in early July with just 3,866 cases recorded in the week of 6th-12th July. Yet infections slowly began creeping up from this point onwards as people enjoyed doing the activities that they weren’t able to do during lockdown, including going on holiday and making the most of the government’s Eat Out to Help Out scheme. What really sent cases rocketing, however, was the return of schools in September.
THE RETURN OF SCHOOLS
Nationally, England experienced six weeks of <20% growth from mid-July to the end of August. Given the prevalence of the virus was so low, these small increases saw the number of cases grow from 3,866 cases per week to 8,063 (week of 24th-30th August). At the time, many believed this increase was due to more testing, however, the weekly positivity rate also increased from 1.26% to 2.43% during that period, suggesting the virus was growing in prevalence. Yet the following week (31st August – 6th September) saw case numbers jump almost 90% to 15,310. As a 100% weekly increase corresponds to a 7-day doubling period, this increase was worrying. It came directly after the August bank holiday weekend and contained the return of schools, which provided further opportunities for the virus to transmit. Though great efforts were made to make schools COVID secure, the increase highlights the difficulty of stopping the spread of the virus in these settings. In subsequent weeks, England continued to see weekly increases of cases (25%, 40%, 50%, 75%, 30%) and this did not stop even when the first tiered system was introduced in mid-October. Below is a graph showing the percentage change in England’s weekly positive case totals (by specimen date).
The only times we have experienced a decrease in cases was during the early summer period when many places had not fully reopened yet, or during November when we were in our second national lockdown. These consistent weekly increases may not seem like much either, until we situate them against England’s weekly positive case totals.
THE PROBLEM WITH NOT DOING ‘ENOUGH’
The problem with coronavirus is that it is an exponential virus. This means as time goes on, the increase becomes more and more rapid. We can see this from our weekly positive case totals. What started off as 3,866 cases per week (1.26% positivity rate) in early/mid-July became 147,156 cases by the week of 2nd-8th November (18.2% positivity rate), when England entered its second national lockdown. This happened despite Boris Johnson attempting to halt transmission by implementing various control measures, from the rule of six and the 10pm curfew, to the regional tiered system. Yet these measures were never enough to stop the virus increasing nationally. By failing to get R below 1 and the virus to decrease, Johnson kept making a bigger problem. Cases kept growing and growing and a bigger caseload unfortunately leads to more hospitalisations and then to more deaths. It is why many experts advocate the precaution and prevention principle – act now before things start getting really bad.
DITHER AND DELAY
Throughout every step of the way since summer, Johnson and his government have not acted soon enough – or harsh enough – to get the virus under control. If they had, we would have seen weekly case numbers decrease at various points during the period from schools going back (early September) to the announcement of a second national lockdown (early November). What’s more, Johnson lifted the second national lockdown far too early while our case numbers were still very high (~90,000 cases per week). It meant the virus was still very prevalent in the community and took off again when restrictions were eased in December. These failings are important given the emergence of this more transmissible strain. It would have been easier to deal with this new variant if our overall case numbers were lower because contact tracing works more effectively when the virus is at a lower prevalence in the community. Finding the contacts of 10,000 people is a far easier task than finding the contacts of 150,000. Therefore, the reason England is in such a precarious predicament currently cannot be answered simply by looking at the dangers of this new variant. It has been exacerbated by the continuous inability to get coronavirus into remission since we eased restrictions over summer.