Although the eradication of SARS-CoV-2 would be nice, most people accept we’ll have to live with the virus for some time, almost as we do with the flu. But a variant from India is now forcing the U.K. to define just what “living with it” means.
It comes as England reaches another milestone on its roadmap to unlocking. From Monday, people can mix inside homes (up to six people or two households); pubs and restaurants will be able to serve customers indoors. Hotels are reopening, as well cinemas, theaters and concert halls. School children no longer have to wear masks.
Those reopenings will go ahead, but the phase after that suddenly looks a little less certain. There are several strains fueling India’s rampant Covid crisis, but the variant formally known as B.1.617.2 is the one casting a shadow over Britain’s plans to end most restrictions from June 21.
The official number of cases of the variant in the U.K., at 1,300, looks low enough to wonder what the fuss is about. There are more than 200,000 cases of the dominant variant in Britain — the Kent variant, also known as B.1.1.7, which Public Health England estimates is up to 50% more infectious than the original strain. And while there were concerns about variants from South Africa and Brazil, neither has derailed the country’s reopening plans.
But numbers of cases tied to the Indian variant have doubled in the past week — and current figures are likely gross underestimates, since it takes a couple of weeks for positive cases to show up in the data. The variant is now evident in most regions of the U.K. (with signs of an exponential rise in Scotland), and there is every likelihood that it will spread further. The question is whether that poses a significant risk to life.
For Prime Minister Boris Johnson, this must feel like déjà vu. He told people to plan for a merry Christmas of family gatherings after a second national lockdown, only to U-turn when the Kent variant grew rampant. In January he put the country into another state of cryogenic suspension.
And yet there are reasons to be hopeful that this time will be different.
First, some 90% of people over the age of 40 in England have now had a first vaccine dose. A new analysis by Public Health England suggests that by the end of April, vaccines had saved almost 12,000 lives and prevented around 33,000 hospital admissions.
So far the cases are largely among people who haven’t yet been vaccinated. And those who are getting the variant after being vaccinated seem to be getting a much milder form of Covid. In the northern town of Bolton, which has seen a concentration of the Indian variant, rates of infection have increased far more sharply in the under-60s group than in the over 60s, which has a higher vaccination rate. Even in India, it seems that vaccination is affording some protection against the variant.
Second, it’s not clear yet whether the new variant is intrinsically more transmissible than the other ones circulating. If transmissibility is higher, then the expectation is that the Indian variant will supersede the other strains. That doesn’t seem to be the case so far.
Paul Hunter, a professor of medicine at the University of East Anglia, speaking to the BBC on Friday, said early indications suggest that the Indian variant is not as resistant to vaccines as the South African variant, but is more resistant than the Kent variant.
A third reason for hope: We have better detection now. The widespread availability of rapid testing can help identify clusters of cases. The government has also put in place surge testing, even going door to door to test people in some places with a high concentration of the new strain. And now the U.K. is seeking to reduce the time between first and second vaccinations for more vulnerable people. (There’s currently a lag of up to 12 weeks.) Although this may accelerate vaccinations in worrying hotspots, it will also mean taking supply from elsewhere.
The current reopening roadmap remains dependent on four tests: the continued rapid rollout of vaccinations and continued effectiveness of vaccines, as well as the infection rate and presence of new variants. If the India variant does continue to increase at the same rate, there will be a large number of infections by June. Johnson faces pressure to stay the course, but he’s well-placed to resist it given his parliamentary majority and recent election boost.
Another key indicator should be hospitalizations. As of May 6, there were fewer than 1,000 hospital beds occupied by Covid patients; and only 144 were beds with ventilators. Keeping those numbers low is critical, not least because the NHS has a huge backlog of non-Covid cases to clear through.
Epidemiologists have been warning that a third wave of some kind is likely and we may now be facing it. Unlike previous waves, we have better defenses and more experience with adaptation. Nothing is certain with this virus, but the odds look better this time around.- Bloomberg