Lockdown ruled out, for today

The cabinet has decided not to impose fresh restrictions – yet – to combat the spread of the Omicron variant.

Discussions went on for three hours this afternoon, and the upshot is that those ministers opposed to limiting indoor mixing and restrictions on hospitality prevailed. The Chancellor Rishi Sunak fears the economic impact, and several of his colleagues have doubts about the validity of the modelling claiming to show that the NHS is about to be overwhelmed.

Boris Johnson has not ruled out imposing tighter Covid restrictions, possibly once Christmas is done. He warned that the government “will have to reserve the possibility of taking further action”, as cases of Omicron continue to surge. 

“The arguments either way are finely balanced” the Prime Minister said, as ministers wrapped up their virtual cabinet meeting earlier this afternoon. It seems the cabinet may meet again as early as tomorrow.

Labour said the situation illustrated Johnson’s weakness, because pressure from cabinet members and at least 100 Conservative MPs opposed to further lockdowns or anything like it had made him powerless to act.

It is an obvious line of attack, and just what an opposition would say when gifted the opportunity by Tory rebellions and rows over rule-breaking in Number 10, but the projections are disputed and the path of Omicron is still genuinely unclear.

Some scientists are urging the government to impose tighter measures, with the Scientific Advisory Group for Emergencies (SAGE) predicting that, without intervention beyond Plan B, hospital admissions could reach 3,000 a day in the coming weeks, or even higher at the peak. For context, the previous winter daily peak came with hospitalisations reaching 3,768.

But how much would reimposing further restrictions really help to alleviate the current situation and at what cost in terms of social harms?

The UK Health Security Agency (UKHSA) estimates Britain will be dealing with the acute stage of the Omicron surge for four to eight weeks.

It is highly unlikely that the spread of Omicron can be stopped. It is moving fast. The rationale for tighter measures is that it will delay its spread. This might flatten the peak and alleviate pressure on hospitals.

Yet, if tougher measures will simply extend the wave, and delay deaths and serious illnesses, can they really be justified at this point in the pandemic when the economic and social costs are so high?

Professor Paul Hunter, an expert in infectious diseases at the University of East Anglia, is dubious. A delay is crucial “if you are waiting for vaccines or better treatments. But it’s hard to see the argument for that now,” he says, especially given the wider impact on the economy, education and mental health.  

It is also worth pointing out that modelling the government is attempting to base its decisions on is decidedly vague. For instance, there is a huge disparity between the best and worst case scenarios laid out in the modelling published by the London School of Hygiene & Tropical Medicine at the weekend. The best would mean admissions peak at just over half the level of last winter, the worst would see them edge towards double.

Ministers always focus on the worst case scenario when looking at modelling, says Professor Carl Heneghan, director of the Centre of Evidence Based Medicine in Oxford. But some of these gloomy predictions, he argues, have already being disproved: the number of people testing positive has gone up by about 50 per cent in a week rather than doubling every two days.

In the UK, there is no sign of a sharp increase in severe illness or deaths from Covid since Omicron took hold. And on hospital admissions, are these incidental cases? That is winter admissions for other conditions, with patients also testing positive for Covid because there is a lot of Omicron around. It is too early to draw any conclusions given the two-week lag from someone getting sick with Covid to requiring hospital treatment.

In South Africa, however, where the strain was first detected on 8 November, encouraging evidence continues to emerge.

According to age-controlled data on Omicron severity from the South African health ministry from 17th December, hospital admissions are starting to rise slightly but at a much lower rate than during previous waves. Crucially, across all ages, deaths among hospitalised patients are two thirds lower during this current wave.

It is difficult to gauge if this reduced severity is because of the intrinsic virulence of the Omicron strain, or if it’s due to higher levels of prior immunity in the population (thanks to vaccination and natural infection).

Either way, it is encouraging news: so far, the rapid increase in cases has not transferred proportionally into hospitalisations and deaths.