Boris Johnson has urged significant caution as he confirmed plans for reopening in England, following warnings from government scientists that the growth in Covid infections amid mass unlocking could lead to hospitalisation rates similar to the winter peak.
Addressing a Downing Street conference, the prime minister said he would “expect and recommend” people still wear masks in crowded indoor spaces, that he was seeking a gradual return to workplaces, and that nightclubs and similar businesses shoud use Covid certificates “as a matter of social responsibility”.
Johnson said the time had come to remove virtually all statutory Covid restrictions, given the “natural firebreak” of imminent school holidays and the summer weather.
“But it is absolutely vital that we proceed now with caution, and I cannot say this powerfully or emphatically enough – this pandemic is not over,” he said. “This disease, coronavirus, continues to carry risks for you and your family. We cannot simply revert instantly on Monday 19 July to life as it was before Covid.”
Modelling released by the Scientific Advisory Group for Emergencies (Sage) highlighted the potential increase in pressures on the NHS amid fast-rising infection levels and the risks from long Covid.
At present the epidemic is growing, and infections are expected to rise further as mixing increases. But while deaths are expected to peak at far lower levels than earlier this year, the modelled scenarios suggest the NHS could still see a substantial number of hospital admissions, despite the impact of the vaccination programme.
The models, produced by a number of different academic teams, suggest there could be at least 1,000 hospitalisations a day at the peak of the current wave, assuming public behaviour does not immediately revert to how it was pre-pandemic.
However, should pre-pandemic behaviour bounce back rapidly over a month, models from researchers at the University of Warwick suggest there could be around 1,300 to 4,800 hospitalisations per day. In some scenarios, particularly where hospitalisations are lower over this summer, the experts also suggest there could be another wave in the winter.
“Most modelled scenarios have peaks lower than January 2021. However, under more pessimistic assumptions, some scenarios show a resurgence of that scale or larger. Even if lower than previous peaks, the number of admissions may become challenging for the NHS,” minutes of a Sage meeting note, adding that contingency plans should be put in place for how to respond if hospital admissions approach such levels.
But the experts stress there is uncertainty around a number of crucial factors, including how effective Covid vaccines are, the level of vaccine uptake, and how quickly public behaviour will change. Such factors matter: according to other documents, the number of infected vaccinated people who go on to be admitted to hospital would be three times higher if the vaccine is 94% effective rather than 98% effective.
The documents stress that to avoid pressure on the NHS, the priority is that return to pre-pandemic life must be a gradual process, adding that measures including working from home, masks in crowded indoor settings and improved ventilation all help to reduce spread of the virus and hence hospitalisations, while isolation of infected individuals and an effective test-and-trace system also remain important.
However, Sage adds that while hospitalisations are a key concern, they are not the only major risk, with increased cases of long Covid, workforce absences and new variants also flagged. The latter could be of global concern, the experts note.
“The combination of high prevalence and high levels of vaccination creates the conditions in which an immune escape variant is most likely to emerge,” the Sage minutes state. “The likelihood of this happening is unknown, but such a variant would present a significant risk both in the UK and internationally.”
With infection levels high, they add, testing capacity and resources to identify the variant involved may become overwhelmed, making it harder to quickly spot a new variant.
NHS bosses warned ministers that the service’s efforts to tackle its huge backlog of care would be hit, and people seeking normal care would have to wait longer, if hospitals have to focus once again on caring for an influx of Covid patients.
“The NHS will need to treat increasing numbers of Covid-19 patients in hospital at a time when the service is going full pelt to recover backlogs, is seeing record emergency care demand for this time of year, is losing significant numbers of staff to self-isolation and has much reduced capacity due to infection control”, said Chris Hopson, the chief executive of NHS Providers.
“This will inevitably mean the NHS will be unable to recover care backlogs as fast as trusts, and patients, would like and ministers should be clear about this trade off. In this context, predictions of at least 1,000 Covid-19 admissions a day from the Scientific Advisory Group for Emergencies are concerning.”