The government must act now, or be faced with much tougher decisions and less popular choices as the winter kicks in, says John Middleton<\/p>\n
One person in 55 is now infected with <\/span>coronavirus in the UK<\/span><\/a>. The odds are that every time you step onto a crowded bus or train carriage you meet someone who is infected with covid-19. Every time you are sitting in a restaurant maybe, or walking down a supermarket aisle, you will likely meet someone who is infected too. In early October <\/span>one in 12 children<\/span><\/a> were estimated to have had covid, and on 22 October<\/span>\u00a0there were 180 deaths in the UK. Every four hours, as many deaths are occurring in the UK as New Zealand has had for the whole pandemic.\u00a0<\/span><\/p>\n We are still in <\/span>groundhog day<\/span>, with a few new repeating scenes. The secretary of state for health and social care, Sajid Javid, has repeated what he said when first taking up the role: that “<\/span>there could be 100 000 cases a day<\/span><\/a>,” yet he doesn’t see this as a need to act, either then or now. <\/span>English directors of public healt<\/span><\/a>h have again broken from national guidance that they know is inadequate for their areas. <\/span>NHS leaders<\/span><\/a> and <\/span>the BMA<\/span><\/a> have called for urgent action “to protect the NHS.”\u00a0<\/span><\/p>\n Plan A of the government\u2019s winter plan<\/span><\/a> has only ever been the “do as little as possible” option. The government’s eggs are all in the vaccination basket: offer flu vaccination and a third dose of the covid vaccine as a booster (<\/span>or not<\/span><\/a>) then let everything else run loose and <\/span>it\u2019s the people\u2019s fault <\/span><\/a>if they get ill or infect others.\u00a0\u00a0<\/span><\/p>\n Malta, Spain, Portugal, and the Netherlands have now overtaken the UK and Israel in <\/span>the vaccination stakes<\/span><\/a>. France, which had a high level of vaccine hesitancy, has climbed up to a comparable level of coverage to the UK, mainly because the French are using vaccine passports. <\/span>Eastern and southern Europe, along with the Baltic countries<\/span><\/a>, are now experiencing severe epidemics. They have had high levels of vaccine hesitancy and lower vaccine uptake. In some cases, health systems have been less well prepared to implement mass vaccination, or lost out in the chaotic <\/span>EU central purchase<\/span><\/a> earlier this year.\u00a0<\/span><\/p>\n Vaccination is still the best hope we have at reducing the virus to very low levels. Countries that have <\/span>the highest rates of vaccination<\/span><\/a> have seen an encouraging <\/span>levelling of death rates<\/span><\/a> throughout this year. Yet there is still no evidence of collective (“herd”) immunity even in countries where there is a very high level of vaccination or where there have been persistent waves of infection, <\/span>as in Iran. <\/span><\/a>\u00a0Reinfection occurs, <\/span>especially with the delta variant<\/span><\/a>, and <\/span>vaccine efficacy declines over time<\/span><\/a>. Vaccines<\/span> still have <\/span>a high level of efficacy<\/span><\/a> against the delta variant, although less than with early variants. Yet where there are areas of low vaccine uptake within countries and with social mixing, these weaken a country\u2019s ability to suppress the virus. In the UK there are areas where public <\/span>confidence in the vaccine is being improved<\/span><\/a> with interventions from local public health teams and community support, but more investment is needed in this localised action. Vaccines prevent serious illness as measured by hospital admission and death but do they prevent debilitating illness\u2014persistent or long covid<\/span>? Social mixing without masking enables the virus to find new unprotected, vulnerable people to infect and harm. Every time the virus finds a new host, new mutations occur, and new, potentially more vaccine resistant, variants will be formed in the UK\u2019s <\/span>“new variant factory.<\/span><\/a>” So vaccination is not the sole answer.\u00a0<\/span><\/p>\n UK politicians have been too attracted to single technological fixes (testing, vaccination, the covid app, Nightingale hospitals), when what we need is the <\/span>“Swiss cheese model”<\/span><\/a>\u2014using everything we\u2019ve got at the same time to prevent viral spread. All of the European countries now enjoying high levels of double vaccine coverage with <\/span>MRNA vaccines have still kept their social measures in place,<\/span><\/a> in differing degrees throughout the summer. Masks have continued to be a requirement in public enclosed spaces in France, Portugal, and Spain. Germany requires FFP2 masks in enclosed public spaces and vaccine passports. Gatherings in public places have been strictly limited in Portugal and Spain until recently, despite high levels of vaccine coverage. France, Ireland, Montenegro, and Israel are other examples of countries requiring\u00a0 vaccine passports.\u00a0\u00a0<\/span><\/p>\n Living with covid<\/span><\/a> does mean masking up in enclosed spaces, meeting outdoors when possible, working from home if we can, and if we can\u2019t do without our night time entertainment it means vaccine passports. Vaccination, or evidence of a recent negative test, are a small price to pay for “normality.” Every vaccinated person has their vaccination card, and at least 10 million people now have <\/span>the NHS app.<\/span><\/a> It would seem a very small step to have to show it to gain access to somewhere you want to go\u2014especially where employers should be protecting their staff. Millions of airline passengers have accepted <\/span>the testing regimes of countries<\/span><\/a> they wish to go to and the mask requirement on planes. The requirements in <\/span>the UK plan B<\/span><\/a> need to be put back into law for consistent control of the virus across the UK. None of them are major restrictions on our freedom.\u00a0\u00a0<\/span><\/p>\n The government has now asked local authorities what they think about <\/span>moving towards plan B<\/span><\/a>. They are, once again, caught stalling on <\/span>actions that experts called for in the summer.<\/span><\/a> Government ministers trivialise what is at stake with the ill informed debate about masking in Parliament, with careless contributions from the <\/span>leader of the House of Commons<\/span><\/a>, the care minister<\/span><\/a>, and <\/span>now the chancellor<\/span><\/a>.\u00a0 They have chosen to pick a <\/span>destructive and meaningless fight<\/span><\/a> over the non-issue of face to face consultations in primary care, when they should have been praising the extraordinary effort of healthcare staff who’ve rolled out five rounds of covid and flu vaccinations. High <\/span>levels of satisfaction with GP services continue<\/span><\/a>, patients who need to get a <\/span>face to face consultation get them,<\/span><\/a> and the digital revolution envisaged by the NHS Long Term Plan<\/a> has arrived. Calls to “protect the NHS” are not the bleatings of frightened and lazy health professionals, they are the <\/span>voice of realism, distress, and burnout<\/span><\/a> on the frontline. Protecting the NHS is indeed vital if the <\/span>record 5.7 million patients on waiting lists<\/span><\/a> are to be seen.\u00a0<\/span><\/p>\n Sajid Javid says that the British people will “<\/span>learn to live with covid<\/span><\/a>.” He has been heralded as the <\/span>secretary of state for health who cares about the economy.<\/span><\/a> With <\/span>half a million cases of covid-19 in the UK<\/span><\/a> in the past 14 days and perhaps one and a half million people in isolating households, he needs to recognise that the virus is the major threat to the economy. Morocco has <\/span>banned travel from the UK<\/span><\/a>, the global capital of covid. This may only damage tourism at first, but the restrictions from other trading nations that could follow risk damaging the economy more.\u00a0\u00a0<\/span><\/p>\n Emergency restrictions have been reimposed in Romania, Lithuania, and Latvia. Latvia has imposed a four week lockdown from 21 October<\/span>. The government must act this week, or <\/span>be faced with much tougher decisions<\/span><\/a> and less popular choices as the winter kicks in.<\/span><\/p>\n John Middleton<\/strong>, honorary professor of public health, Wolverhampton University, and p<\/span>resident, Association of Schools of Public Health in the European Region. Twitter @doctorblooz<\/a><\/span><\/em><\/p>\n