England is getting ready for the big gamble.
On Monday, July 19, the country waived all remaining restrictions related to the pandemic. People will be able to go to nightclubs or gather in groups as much as they want. They will not be legally forced to wear masks at all and can stop social distancing. The government, given media coverage, called it “Freedom Day” and said the lifting of security measures would be irreversible.
At the same time, cases of coronavirus are rapidly increasing in the UK. On Friday, it recorded more than 50,000 new cases and his health minister says so that the daily number of new infections during the summer could rise to over 100,000.
In theory, full opening during a crash in cases sounds like a flammable mixture. But the UK government is betting it won’t be like the others this time because of its vaccination program.
Researchers say it is extremely difficult to predict what will happen next, with multiple overlaps of complex factors. So let’s examine what we know, what we don’t know and what we have to watch out for in the coming weeks.
What we do know: vaccines work
The British vaccination program is still ongoing, but has been successful so far. Overall, 52% of the adult population was fully vaccinated, and about 87% of adults received the first dose (this includes 52% who had both doses). Only 6% of Britons are hesitant to get a shot, according to Office for National Statistics.
Still, there are still a lot of reasons to be nervous. The earth is several months away from the complete inoculation of the entire adult population. Young people are particularly vulnerable; those over 18 were just starting to receive the first doses, and only a quarter of 18- to 39-year-olds had both shots. And unlike the US and most of Europe, the UK has not started vaccinating children.
“It’s dangerous,” says evolutionary virologist Emilia Skirmuntt. “We need to vaccinate teenagers urgently, especially before they return to school in September.”
This is important because the predominantly dominant strain of covid-19 in the UK is currently the delta variant. Although fully vaccinated people have relatively little reason to worry about delta – given that Pfizer and AstraZeneca vaccines offer over 90% efficacy against hospitalization, data from English Public Health– The variant is bad news for those who have only been shot once or have not been vaccinated.
It is approximately 60% more transmissible than the alpha variant, which was previously dominant in the UK, and is almost twice as likely to lead to hospitalization, according to Scottish Public Health Authority. A single dose of AstraZeneca or Pfizer is only 33% effective against the delta variant, compared to 50% for alpha, according to data from English Public Health.
“This reopening will lead to a lot of avoidable damage,” says Deepti Gurdasani, a clinical epidemiologist at Queen Mary University of London. “We should stop giving up until both adults and adolescents are offered both doses of the vaccine.”
What we don’t know: when the cases will peak
It is clear that the UK is experiencing another wave of pandemics. What we don’t know is just how bad it will get – or how lifting the restrictions will change that. Even top experts in the field cannot say for sure.
“It’s hard to know what will happen after July 19,” says Graham Medley, a professor of infectious disease modeling at the London School of Hygiene and Tropical Medicine and chairman of SPI-M, a group of scientists advising the UK government on pandemic modeling.
Much depends on the behavior of the public, and this is known to be very inconvenient to predict. While some will enjoy the newly discovered liberties with gusto (a trend that was fully demonstrated last weekend during the European Football Championship final), others will be far more cautious.
Many people are frustrated with leaving masks, one of the most basic and effective public health measures. Ipsos Mori survey found that the vast majority of Britons plan to continue wearing masks in shops and on public transport. If people continue with this, it could help combat the spread to some extent: Israel, which also has high vaccination rates, had to re-impose wearing masks indoors last month due to a sharp rise in cases.
Regardless, it is very likely that the cases will grow for at least a few days, if not a few weeks. And that means more hospitalizations and deaths are inevitable, according to Medley. The big question is how high that wave is getting.
At a webinar on Thursday, Chris Whitty, chief medical officer for England, said the country could see “pretty frightening numbers” again and “get into trouble again suddenly quickly”.
But the government seems to be betting that not all numbers are equally intimidating. He hopes hospitalizations will remain low enough to prevent the National Health Service from being fully mastered. The link between cases and hospitalization rates is assumed to be weakened, if not broken.
“This wave is very different from previous ones,” says Oliver Geffen Obregon, a UK-based epidemiologist who has worked with the World Health Organization. “The proportion of hospitalizations is significantly lower compared to similar points on the epidemic curve before the vaccination program.”
But not everyone agrees. NHS bosses already are sounding the alarm over capacity, and more than 1,200 scientists signed the letter Lancet arguing that Britain should worry about a large increase in infections, regardless of mortality rates and hospitalizations.
Gurdasani, an epidemiologist, is one of them.
“Cases are important,” she says, pointing to two main dangers: the increased chance of large numbers of people developing long-term cravings and the risk of new versions avoiding the vaccine.
What we do know: more people will enjoy it for a long time
The UK already has a significant problem with the long covid. More than two million adults may already have – or have had – complications lasting 12 weeks or more, according to the major study at Imperial College London. But long kovid is poorly understood, with more than 200 symptoms ranging from fatigue to shortness of breath to memory problems, according to the largest study to date, recently published in Lancet.
Approximately one in 10 those who catch covid-19 continue to develop long covid, according to WHO. This means that if another million people in the UK get sick during this wave – a likely scenario by most estimates – there could be another 100,000 people with long-term problems.
Whitty is worried. “I think we’ll get a much longer talk length, especially at younger ages where vaccination rates are currently much lower,” he said July 6.
This could put tremendous pressure on the NHS, businesses and society in general, not to mention causing immense misery to a huge number of individuals.
“Some symptoms can last for years, and there is a chance that we will expose an entire generation to very poor health for the rest of our lives,” says Skirmuntt.
What we don’t know: could all this produce another dangerous variant
The great fear for many experts is that the government’s approach creates an ideal fertile ground for the emergence of a vaccine-resistant variant.
On July 5, Steve Paterson, co-director of the Center for Genomic Research at the University of Liverpool, summed up the concern in a tweet: “Passing the virus through a partially vaccinated population is just an experiment I would take to evolve a virus that can escape immunity. “