Sir Patrick Vallance and Chris Whitty, the government’s top scientific and medical advisers, are understood to be arguing hard with ministers for tighter restrictions across England ahead of Christmas.
The pair are calling for tougher measures armed with what has been described as new modelling from experts on Sage, the government’s epidemics advisory group, showing that deaths this winter could exceed those in the spring.
Just last month, on 21 September, the pair were accused of doom-mongering when they appeared on national television as a double act, warning of the possibility of 50,000 cases and 200 Covid deaths a day by mid-October.
The measures Boris Johnson announced later that day – closing pubs at 10pm, encouraging working from home and penalties for people who break the rule of six – were supposed to prevent those numbers being reached. But they have not. Deaths have exceeded 200 and even 300 in recent days.
There is now clear evidence that the trajectory of infections, hospital admissions and deaths is rising steadily , in spite of the tier system of controls on people’s social activities.
According to some newspapers, the death toll is likely to be higher than it was in the spring. New modelling was said to predict that deaths would plateau, but at a relatively high level even though lower than earlier in the year. That plateau would continue for months. Vallance was said to be pushing for tier 3 restrictions across the whole of England before Christmas.
The existence of new modelling surprised some members of Sage – although not the conclusions that Vallance and Whitty had reached. The evidence was there in a report that Vallance himself commissioned from the Academy of Medical Sciences in July.
That report, “Preparing for a Challenging Winter 2020/21” modelled a “reasonable worst-case scenario”, in which the R – the number of people infected by each person with the virus – rose to 1.7. It estimated that almost 120,000 Covid hospital deaths between September this year and June next year, “over double the number that occurred during the first wave in spring 2020”.
In addition, it warned of further disruption of the NHS and social care, a backlog of non-Covid cases and a possible influenza epidemic. “There is a need for urgent preparation to mitigate the risks of a particularly challenging winter 2020/21,” said the report.
That preparation should have happened over the summer, said Prof Dame Anne Johnson, president elect of the Academy of Medical Sciences, who was one of the authors.
“What we suggested in the report was that the time to be really working on suppressing the virus is exactly when it is really low. Keep it down there. And of course we didn’t do that and there were a lot of reasons,” she said.
“When we came out of lockdown we went very nervously to restaurants. We continued to queue outside shops. Somehow all that effort which wasn’t necessarily about not meeting in each other’s homes –it was just about maintaining quite high levels of social distancing – a lot of people became too relaxed about that. And then additionally there were these mixed messages – eat out to help out, restart the economy. And I think people got very confused and we’re partly seeing the product of that.”
Infections began to go up again in August and people were told there were various magic bullets – the test and trace scheme or a vaccine or treatment. But, said Johnson, “as is so often the case in public health, there isn’t a magic bullet”.
Johnson does not call for more imposed restrictions. What is needed, she said, is to talk to people about what they should do and the reasons for having fewer contacts with others and staying indoors if they feel sick or have been told they were exposed to the virus. There should be consistent messaging– and the reward for compliance that brings the virus levels down might be a more normal Christmas. And there should be more attention to infection control in hospitals and care homes, as the report advised.
“I’m afraid I think we’re in for a tough winter. And we do have it in our power to try to reduce the amount of transmission, not by a magic bullet but by the small efforts of everybody, because the sum of small things can make big differences. And it’s that idea that these contributions in various spaces, health and social care, reducing infection, everybody trying to comply, as much as they can. But we have to be realistic. We’re social animals,” she said.