[Will Hunt]

Apologies if this is a complete punter question but between the regulatory deadlines at work, the into-the-early-hours proof reading sessions, and the school run I'm afraid my brain may have ceased functioning.

Remember that NHS data sharing thing we were getting so animated about on this thread in June? My NHS app has got a bit about my vaccination history which I can view, but to generate a vaccine passport QR code I need to agree to some sort of data sharing. Is this the thing we were worried about or are we good to go? Due to my addled state please have mercy and keep your answers to words of one syllable.

[TobyD]

Apologies if this is a complete punter question but between the regulatory deadlines at work, the into-the-early-hours proof reading sessions, and the school run I'm afraid my brain may have ceased functioning.

Remember that NHS data sharing thing we were getting so animated about on this thread in June? My NHS app has got a bit about my vaccination history which I can view, but to generate a vaccine passport QR code I need to agree to some sort of data sharing. Is this the thing we were worried about or are we good to go? Due to my addled state please have mercy and keep your answers to words of one syllable.

As far as I understand it,  just agree to that, it's only sharing your vaccination status,  which you're doing anyway by using the code.

[colin8ll]

The front pages of the papers make a lot of the large Tory rebellion around COVID restrictions. I'm glad the PM brought in plan B (despite my concerns about how effective vaccine passports may be in curbing the spread), but I fear more restrictions will be needed in the coming days/weeks and the PM will bottle it for reasons of self interest.

The tail gets to wag the dog too often under this and recent Tory governments. That's what got us the Brexit vote, the slow previous lockdowns etc. How do people see this playing out? Can these wingnuts be contained? Any reasons to be cheerful?

[Paul B]

I see it playing out just as you've called it as that's what the Gov's past form suggests. Coupling that with the PM's self preservation interest and he won't do anything that will be viewed as unpopular either by the electorate or the ERG until he absolutely has no choice (which will mean it'll be too late, again).

[spidermonkey09]

The silver lining is one way or another this wave will be over quickly with how transmissible it is. Suspect there will be big gaps in rotas, supply chains etc in January and February.

I remain unconvinced that there is a lot that can be done about this wave. Its so ridiculously transmissible that anything short of a full on authoritarian lockdown won't do the job, and I don't want that. Even people going about minimalist daily lives will keep the R above 1. Looking at it neutrally, taking my opinion about him out of it, the PM is totally fucked here, caught between a rock and a hard place. If he does nothing he risks Italy style NHS collapse in January, supply chains grinding to a halt, loads of deaths and the consequent loss of political capital from the public, maybe even forcing resignation. If he brings in a full lockdown it will be largely ignored over Xmas, won't work, all the above will happen anyway and he will lose political capital from both the public and his party. Its a proper devil's alternative.

[AJM]

It's not binary though is it - even if hypothetically you can't get it below 1 a lower R means a wider and lower peak which means the degree of overload is less.

"we had a lockdown and it didn't even help" would be an easy argument because no-one will be able to prove to what degree the alternative would have been worse - there's no counterfactual so those with axes to grind (CRG, elements of the press and so on) will effectively say the lockdown did nothing, despite the maths obviously suggesting that it did.

But that's what leadership is supposed to be, right? Boris is great (relatively speaking!!!) for implementing something once there's a large enough herd already clamouring for it, but across the last two lockdowns there'd be a lot fewer people dead if he'd been pushing the argument not following it.

[spidermonkey09]

Of course not, but if you commit to a lockdown you're probably commiting to it for about 4/5 months. That's a really long time. I do have some sympathy with those who question whether this will happen every year, every time there's a new variant. It's not a sustainable solution.

There's no counterfactual whatever they decide to do, that's the nature of it surely? We have no idea what would have happened over the summer if we hadn't relaxed restrictions, for example.

Johnson is a shit leader. But being a good leader doesn't magic away the problems of the situation either, there aren't any easy answers. I suspect quite a lot in government would prefer a quick flare of a wave over a long drawn out winter of discontent for reasons of both cultural and fiscal ideology.

[moose]

It all feels like an episode of the Thick of It nowadays

Proponents of "Simulation Theory" (Elon Musk etc.) think our life experiences are figments of simulations being run by hugely powerful AIs in the future.

I'd agree but only with the proviso that the present can only be explained if the sole learning inputs of future AIs are episodes of Brasseye, The Day Today, Thick of It, The New Statesman, Blackadder Goes Forth, and Yes (Prime)Minister. 

[AJM]

Sustainability is tricky. Sure, if a proper lockdown that long were needed every year (for a variety of reasons I don't think that's the most likely outcome, but for the point at hand it doesn't matter), that would feel unsustainable. But then so would crashing your healthcare system every year instead, as would refusing care to a lot of people every year in order to avoid that. If that's the place you end up there is no world where it's rosy if you just don't do anything - it's not a choice of a one off shitshow versus endless lockdowns, it's endless lockdowns versus endless shitshows. You don't have one big wave in which everyone who's going to die does and after that covid is done.

Some counterfactuals are easier than others. Personally I think we have some idea what would have happened if we had maintained restrictions over the summer. But either way, if you believe lockdowns reduce R to some degree (common sense?) and you think there's a limit in the short term to how many people you can care for at once (fairly uncontroversial?) before quality of care disintegrates to the point where the death rate starts to step up, then it's not exactly complex maths to suggest that a lockdown would lead to fewer deaths in the short term via a lower peak spike, assuming the spike breaches the capacity limit? The economy, the longer term picture of what it does for immunity and a route towards endemic state, how society reacts, all that - definitely difficult. But I'm not sure the broad shape of the picture on short term deaths is that hard is it? Particularly at the moment, where its blindingly obvious that theres a race between boosters and cases and that a delay to the rate at which cases rise means more of the future cases will hit fully boosted immune systems and do less damage.

I think you're probably right that some people would prefer to get it over with quickly, although I think they'll be sad to find out covid will still be there afterwards. The current conservative party view does puzzle me a bit. They obviously have this really strong streak of libertarianism and low restrictions and low intervention going through them. But at the same time their voters tend to be older (doesn't tendency to vote Tory basically rise with age?), more importantly in terms of pressure points their party members tend to be older, so in some ways I'm surprised there's been less tension between that low restriction streak and the fact that their core clientele tend to be more vulnerable.

[spidermonkey09]

I don't think I'm suggesting it would be rosy. I think it is about choosing the least worst option, and I'm not convinced the lockdown option *is* the least worst option currently. We might just disagree on that maybe? I have definitely gone full circle on it from March 2019, that's for sure.

The point about maintaining restrictions over the summer, I think, I'd that it wouldn't have actually left us any better off for this wave in any meaningful way. It doesn't future proof the healthcsre system at all, based on the current rate of doubling a summer of restrictions would have bought us about a week of additional time, maximum. I am not denying your maths in the slightest ; but the reason this has become such an interesting and complicated question is that it isn't about maths anymore, it's a much broader picture that will require trade offs.

I think the apparent disconnect you identify between elderly tory voters  and the libertarian streak of the MPs is partially explained by the middle class whiteness of the older tory voters in particular. They are 98% jabbed or something ridiculous so feel fairly safe. They also have delusions of grandeur/war baby/boomer attitudes towards risk. Interesting demographic.

[petejh]

The current conservative party view does puzzle me a bit. They obviously have this really strong streak of libertarianism and low restrictions and low intervention going through them. But at the same time their voters tend to be older (doesn't tendency to vote Tory basically rise with age?), more importantly in terms of pressure points their party members tend to be older, so in some ways I'm surprised there's been less tension between that low restriction streak and the fact that their core clientele tend to be more vulnerable.

As well as the attitude spider points out, I think you're also discounting another view among many older people which can be summarised: 'I'm old, I'll die one day and that's OK, in the meantime I'm not going to live like a prisoner nor expect anyone else to'. Perhaps more elderly people with conservative views feel like this, I've no idea.

During a pandemic of respiratory virus that kills mostly the elderly, increased numbers of elderly people getting ill and dying should not be considered unusual or something that can be prevented at all costs - certainly not at the cost of crashing everybody else's lives and the economy. That wider question won't go away, each wave brings it into focus. Can't see any easy answer. Like others I felt the first lockdown was the right thing to try; the second lockdown was necessary but botched - partly because the trade-off was a bit harder to justify; another lockdown now feels to me like it would be deeply unpopular and unobserved by more than ever. 

[AJM]

If you're thinking I would have argued we would have been better off with restrictions over the summer, I wouldn't. Costs in the summer (more deaths) versus a mix of pluses and minuses pre Omicron (a health service run more ragged versus more population immunity such that cases were basically flat with few restrictions required).

But over the summer we weren't (with hindsight, obviously there was a range of views at the time - I'm acknowledging having the hindsight, not claiming foresight) letting cases run to the level where we fundamentally broke healthcare.

In terms of lockdowns - in general I tend to think the way out is a lot of population immunity - boosters for those for whom the risk to society of natural infection is too great, some kind of mix elsewhere.  I think it's arguable that point was being approached with Delta. In an ideal world you wouldn't need restrictions if you could get enough immunity. Either way, in the current situation with the booster:cases race I do think some sort of stronger control measures than current feel a fairly logical sell because you have a booster timetable and you have a clear need.

But more widely I guess I don't think a no lockdown scenario is actually believable. If you really get a decent wodge of serious infections from a huge number of cases - if you were really busting through healthcare limits, ambulances weren't coming, A&E was unavailable, whatever... Lots of people would be genuinely sick. You'd have pingdemic and more levels of staff shortage but with no magic wand of "ah you don't have to isolate" to make it go away - we essentially had to start waiving the rules in some sectors, which you can't do if people are actually sick and unable to work rather than being prevented from doing so by an isolation order you can just magic away. People wouldn't be going out, hospitality gets screwed, schools would probably stop functioning (combination of staff absence and parents withdrawing kids), employers of parents get hit by the consequences - the economy gets fucked whichever way but if it's a proper lockdown at least there's some state support. Some of a lockdown is driven by the state but if things go south enough I suspect there's enough voluntary lockdown the public could enter into that you get all the deaths and the economy gets screwed as well. And that's without even allowing for the government caving in at a certain level of chaos and locking down just far too late. Essentially I think you can run hot up to a point but if it's serious enough then after that one way or another it's a lockdown early or a lockdown late, and early is probably more ordered, better supported and kills fewer people.

[mrjonathanr]

The current conservative party view does puzzle me a bit. They obviously have this really strong streak of libertarianism and low restrictions and low intervention going through them.

Not low restriction/low intervention when it comes to restricting the right to protest, or disregarding legal judgment, or stripping UK citizens of their citizenship, or attacking the human rights act as Raab announced yesterday. Not freedom loving at all in fact.

Just hypocritical posturing and delusional babble such as showing evidence you don’t have Covid to protect others being tantamount to Nazi despotism.

Essentially I think you can run hot up to a point but if it's serious enough then after that one way or another it's a lockdown early or a lockdown late, and early is probably more ordered, better supported and kills fewer people.

Yes.

[IanP]

The current conservative party view does puzzle me a bit. They obviously have this really strong streak of libertarianism and low restrictions and low intervention going through them.

Not low restriction/low intervention when it comes to restricting the right to protest, or disregarding legal judgment, or stripping UK citizens of their citizenship, or attacking the human rights act as Raab announced yesterday. Not freedom loving at all in fact.

Just hypocritical posturing and delusional babble such as showing evidence you don’t have Covid to protect others being tantamount to Nazi despotism.

Absolutely, and you can add voter id to that list as well.

[Nigel]

I am not denying your maths in the slightest ; but the reason this has become such an interesting and complicated question is that it isn't about maths anymore, it's a much broader picture that will require trade offs.

To be clear on the maths, the modelling which Gov is using from LSHTM is summarised here https://www.lshtm.ac.uk/newsevents/news/2021/modelling-potential-impact-omicron-england , full paper here: https://cmmid.github.io/topics/covid19/reports/omicron_england/report_11_dec_2021.pdf

I've snipped the relevant summary on hospitalisations from within the document:

"For our most optimistic scenario (low immune escape and highly effective booster vaccines), an
Omicron epidemic without the introduction of additional control measures may not exceed the
peak levels of hospitalisations recorded in January 2021. However, for our most pessimistic
scenario (high immune escape and less effective booster vaccines), we project that
hospitalisations and potentially deaths will exceed the peak levels recorded in January 2021."

My note - by "exceed" they mean roughly double the Jan 2021 peak, in terms of hospitalisations. By "additional control measures" they mean on top of recent announcements - the model already includes for masks in shops (30th Nov) and "Plan B" (12th Dec to 30th April).

If you want graphs then here they are:



Look at the red graphs. These are the ones Gov are worried about. They do not look good. *If* this model is correct then even a layman can see that more likely than not this wave will be worse than the one earlier this year in terms of hospitalisations. Deaths will be similar or less.

[Nigel]

Clicked post too soon!

What the above means is that arguably it is still a question of maths I'm afraid. The million dollar question which I don't know the answer to is actually "how many admissions is too many"? Basically when does the health sytem become overwhelmed?

Yes there will be "trade offs" while we adapt to living with the virus, but as things stand we might be trading a functioning healthcare system. That is a big risk. Too big for a sensible (!) government.

So in light of that will there be more restrictions? Well it hasn't been mentioned anywhere in the media AFAIK but the model goes on to look at the affect of the re-introduction of lockdown measures in 4 steps, which are reversals of the steps out of lockdown from this spring. So reversals of the following: https://www.theguardian.com/uk-news/2021/apr/01/step-by-step-englands-roadmap-for-easing-covid-lockdown

All of these are based on extra controls coming in on 2nd Jan 2022. Add that to the fact that I picked up Grant Shapps on R4 yesterday quite specifically and precisely say that he "was confident no further measures (Plan C) will be required this year". "This year" is over in 2 weeks. Don't book anything for January....

[TobyD]

Whatever any further measures involve, they are likely to be pretty light touch and advisory rather than restrictions I reckon.
I don't think Johnson has the political authority to get another lockdown through unless we're actually knee deep in the s*** already.

[abarro81]

Don't book anything for January....

We're supposed to go away in early Feb but are already wondering whether Mar might be a better bet!

[AJM]

Don't book anything for January....

We're supposed to go away in early Feb but are already wondering whether Mar might be a better bet!

And there's me wondering what sort of shape France will be in at Easter!

[abarro81]

Well April it is then...    Why do covid waves have to coincide with periods where it's horrible to be in the UK! 

[AJM]

Well April it is then...    Why do covid waves have to coincide with periods where it's horrible to be in the UK! 

Hah! Don't hold me to it!

I suppose I was thinking that France, as much of western Europe, were struggling with Delta - as in despite having a stronger control environment than UK with a reasonably restrictive covid passport they had cases doubling about every ten days. I can't remember whether they strengthened their restrictions pre Omicron as Germany/Austria did, or whether it just looked like they were probably going to have to. And I can't remember how bad their actual deaths per case figures looked.

Either way, Omicron probably hits them less hard in the short term - we were more reliant on immunity to manage Delta, which Omicron partially sidesteps, whereas they were more reliant on controls which will hinder both D and O. But in the medium term, I think they had lower old age vaccine take-up, less natural immunity, and I think are still behind us on boosters (although their control measures maybe gives them space to catch up), so if they were struggling with D it feels likely that once O gets going - a bit later for them, but probably inevitable - they're going to struggle with that too without tougher control measures than just the ones they had in the autumn.

However, whether that's a big deal or not I don't know and I also suspect that your tolerance of faff on a longer trip without children would be higher than the level of inconvenience that would be worthwhile for a week's trip with young children in tow, which is what we had planned.

[Nigel]

Whatever any further measures involve, they are likely to be pretty light touch and advisory rather than restrictions I reckon.
I don't think Johnson has the political authority to get another lockdown through unless we're actually knee deep in the s*** already.

Agreed, for now.

The thing is that because of the newness of the situation and the uncertainty in the models we won't know if we're knee deep in the shit or not until it happens (around New Year). And whatever happens, it is already getting baked in and will happen incredibly quickly. So quickly that I don't think its wise to predict anything politically. For e.g. there is a scenario where the most pessimistic model is the reality, half the country has covid and is defacto locked down anyway, including most MPs so they can't even return to vote on anything! Or it might all be "fine" in the end, which still means similar-ish to last year i.e. hardly a popularity boost. Or anything in between. All we can say with certainty is that if further restrictions are needed then they will pass with Boris as the head of a Tory + Labour coalition (as per the votes this week) which will probably be the end of him. If he hasn't gone already after Shropshire today? Or more party photos? Anything can happen! Whatever it is I expect it won't be boring.

Nugget from Whitty in select committee earlier:

“The numbers in hospital over a short period could be very high indeed. This will be happening at a time when a very significant number of staff are going to be off ill, isolating or caring. So you’re going to have both a reduction in supply and an increase in demand in the health service over a very short time period, and that really is the reason why we’re all taking this extremely seriously,” Whitty said.

“One risk that is going to happen irrespective is, because of the steepness of this, even if this ended up in a situation where boosters do hold this to a large degree for a lots of people … a lot of people will simultaneously fall ill and be unwell, isolating or caring for others at the same time across the whole economy.”

From full article https://www.theguardian.com/world/2021/dec/16/omicron-could-lead-to-record-daily-covid-hospitalisations-chris-whitty-mps-told

[battery]

Maybe I've missed something, maybe I'm being dense, maybe my rose tinted glasses are turned up too high or maybe I'm a friggin genius....

The main focus of the strategies to fight covid are to stop the healthcare system from collapsing (the health care system that was already creaking before the pandemic) so surely the way out of it in the long term is to properly support the NHS. Investment and resources to make staffing levels safe and sustainable and beds available.

??

[petejh]

If the modelled outcomes for greatly increased hospitalisations over a short time period actually happen, then that would be the kind of situation for which opening Nightingale wards in high demand areas was designed for, no? Haven't heard much about them being opened for this wave, since they shut following seemingly not much usage during the first wave. Staffing issues?

Well April it is then...    Why do covid waves have to coincide with periods where it's horrible to be in the UK! 

Supposed to be heading to the Pyrenees on Dec 27th for some ski-touring.. Just waiting now for Spain to follow France's lead.

[Paul B]

Supposed to be heading to the Pyrenees on Dec 27th for some ski-touring.. Just waiting now for Spain to follow France's lead.

I'd get your money back; I've engineered a month off between jobs so it's clearly going to be DIY for me! #firstworldproblems