Will the U.K. Face a Winter Covid Surge?

I’m slightly surprised to be writing this post as to my mind the answer is obvious – of course the U.K. will face a winter Covid surge. It’s winter. That’s what happens in winter; the dominant respiratory virus surges and, most years, taxes the capacity of the health service. The only question is how big it will be – unusually large like 2020-21, or unusually small like 2019-2020 before Covid hit? It’s worth remembering that more people died in England and Wales per head of population in 2008 (once adjusted for age etc.) and every year prior to it than died in 2020 or 2021, many of them succumbing during the winter flu season, as the chart below from the Institute and Faculty of Actuaries shows. In other words, there’s a winter surge in deaths-by-virus every year, and I see no reason why 2021-22 will be any different.

Standardised mortality rates (SMRs) in England and Wales

As I see it, the only realistic way there would not be a Covid surge on some scale is if another influenza-like virus takes over, which seems unlikely right now as flu is almost nowhere to be seen.

Nonetheless, I am writing this post, and that’s because some people seem to think that this year it’s not going to happen. Dr Sebastian Rushworth argues that places hit hard already, such as Sweden, New York and Lombardy, have developed enough immunity to avoid “another big wave” altogether. Andrew Lilico in the Telegraph maintains that owing to “infection saturation” and vaccine third doses, “for us, the Covid crisis is over”. Even the usual doom-mongers at SAGE are predicting a decline in hospitalisations and deaths in December, according to new modelling released on Friday. A decline in flu-like hospitalisations and deaths in December? Whoever heard of such a thing?

I freely admit that the winter surge may, because of acquired immunity, be relatively small in places like the U.K. which have already faced widespread exposure. Perhaps that’s all that Sebastian Rushworth and Andrew Lilico mean, and in which case our positions are not so far apart. But will it really be a non-event, as SAGE at least appears to be implying, so that Covid deaths decline during the winter and don’t put any further pressure on the health service?

Looking across to America, we can see that the summer and autumn Delta surge has seamlessly moved into a new winter surge in the more northerly states, including highly vaccinated New England in the north east. Southern states hard-hit by Delta already, such as Florida, South Carolina, Georgia, Mississippi, Louisiana and Texas, are not yet seeing a new rise, though there is an uptick in Arkansas, Kansas, New Mexico and Arizona that may be ominous. In the north east at least, then, the indication is that, as in Europe, vaccination does not protect from the winter spike, though whether prior high exposure, as in some of the southern states, keeps it muted remains to be seen.

My expectation remains that the U.K. will experience a winter Covid surge in December that causes a peak in hospitalisations and deaths in January, as happens most winter flu seasons, including last year. My prediction is that our acquired immunity will keep this down below last year’s level, perhaps to around 60%, but this is really just a guesstimate.

With restrictions returning and vaccine mandates being reinforced across Europe as the autumn tilts into winter, it’s important to be clear that the U.K. remaining restriction-free must not depend on there being no winter surge or heightened seasonal pressure on the health service. My fear is that these rosy predictions of no-winter-surge make us hostage to fortune, or rather to near-certainty, as when the almost inevitable surge does appear the pressure to respond as per the rest of Europe – because ‘look, our cases and hospitalisations are now going up as well’ – will be irresistible.

The health service was not overwhelmed last winter – at peak Covid-occupancy in England on January 18th, 10% of the NHS’s 85,802 beds remained unoccupied, while Covid patients occupied just 31% of beds. Hospitals coped by triggering their winter capacity-expansion plans and, if necessary, they will do the same this year.

There continues to be no evidence that general lockdown restrictions make any significant impact on Covid infections or deaths, or that they are worth the immense costs and harms they impose on society.

Naturally, I hope the optimists are right, and I will certainly be glad to raise a glass to their foresightedness if they are. But in the likely event they are not, we are in desperate need of a new tune to sing. As a society we must learn to turn our back on the baleful lockdownism that has characterised the pandemic so far, and find another way of responding to the acute hospital pressures, which are, after all, a normal winter occurrence.

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