The question of how the Government should respond to Omicron has concerned many of us. So what is the Government actually proposing? There are a number of changes being proposed: increased mask wearing in shared public spaces, advice to work from home if you can, the requirement for patient-facing members of the NHS to be vaccinated and removal of the need to isolate if closely associated with a person who has tested positive. But the most controversial proposal relates to the need to show a negative LF test before entering a very large venue. To be clear, this is NOT a proposal for mandatory vaccine passports. In fact, it is exactly the opposite. In higher risk areas: nightclubs, indoor venues with seating for more than 500 or standing for more than 4,000, the requirement is that you show a negative lateral flow test. Why? Because there is greater risk of spread in these large venues. As I said, the requirement is to show a negative test. You don’t even need the NHS App to do so since you can simply show the NHS text message. If you choose to bypass that requirement you can show your vaccine record instead. That is all.
Nor is this the “thin end of the wedge”, giving the Government power for a mission creep. The proposal has an automatic sunset clause on 22nd January 2022. This means that any extension or increase in scope would have to have a new vote in Parliament.
We should assess whether the current risk posed by Omicron justifies this potential curb to our liberties. To do so we need two areas of data: on transmissibility and on severity.
On transmissibility, there is an increasing amount of UK and European data. This is by some distance the fastest spreading variant to date. I had a briefing call with Rt Hon Sajid Javid MP yesterday: the estimated doubling period has now been shortened to 2-3 days. In London last week it was 2 days, starting the week at 2-3% of infections and is now at 44%. Given this, any action taken by the Government has to have the next 4-5 doublings of numbers baked in. These assessments of increased speed are being replicated across Europe where testing infrastructure is most advanced: Germany, Denmark and Norway.
The next factor is the estimated difference between the case rate and the estimated infection rate. The best estimate is that the case rate is currently 1/15th the infection rate. Add these two numbers together and you can see why the Government is not keen to wait for definitive data on severity, because by then it would be too late to take any effective action at all.
The latest data is that protection from infection with 2xAstraZeneca vaccines is minimal after five months. With Pfizer it is c20. However, it is likely that there remains increased protection against severe disease. A booster dose increases this protection to c75% from symptoms and 85% for severe disease (the corresponding data against Delta is 85% and 95%). This is why the Government is going all out for booster jabs, aiming to offer jabs to every adult in the country by the end of December. This means 1m+ injections per day. From the evidence so far available it is the only way to manage the impact of Omicron. As of today, 23m doses have already been administered, amounting to 42% of adults.
What about the severity of Omicron? The current data is incomplete, but that is not the same as saying that the Government is ignoring the science. If Omicron turns out to have a severity anywhere near the previous variants, then I am afraid that we are looking at a very serious situation in the early New Year. However, the data so far from South Africa is at least not inconsistent with a significantly milder severity, though we are not yet sure by how much or why this is the case (e.g. nature of the disease vs age of population, resistance built us by previous waves, particularly the similar Beta variant that was widespread in SA and not in the UK). Whilst hospitalisation rates have increased, death rates are not rising anywhere near as fast, and anecdotal evidence strongly supports much milder symptoms in the main. I am hopeful that the data firms up over the next few days. The problem that we face is that the speed of spread makes waiting for clear data impossible. As it is, any decision taken today already has 4-5 doublings baked into the assessments before meaningful change can take place.
What previous experience with Covid has taught us is that waiting to receive lagging data (particularly mortality rates) means that any subsequent restrictions would have to be much more severe, and imposed for longer, to have a similar impact on infection spread.
In terms of risk analysis I agree that there is a small chance of an adverse event, but the impact of that adverse event, were it to materialise, would be huge, so it does make sense to take reasonable steps to mitigate that risk whilst minimising adverse impacts. Schools are just about to break up, which will help, working from home if you can, the small additional protections that we have been discussing, and going full out for booster protection strike me as a balanced approach to the risks posed. The downside is relatively small if it proves to be an overreaction, which I profoundly hope it is. This is not the case when you consider the alternative. I am told that we will know one way or the other by very early January.
To my mind, the strongest argument against action is the long term need to learn to live with this, and subsequent, variants. True, we do have to do this, but that does not mean accepting a potential collapse of health provision without taking steps to mitigate this risk. The current proposals are exactly that, proportionate steps to mitigate some of the worst risks whilst minimising the impact on people’s lives. Learning to live with Covid is not the same as taking no action. Tens of millions of us have a ‘flu jab each year, and even with a cold you isolate sufferers to prevent further infection.
I fully accept that many people do not agree with me and I recognise that each view is profoundly held. But I hope that you can at least see the reasons behind the view that I have taken.
