NN Comment: Plan B is needed now to slow Covid rates

By not adopting Plan B, we are again in danger of not intervening fast enough

By Dr Stephen O’Brien

Today we hear from visiting professor at Northampton University Dr Stephen O’Brien about why the government should now move to Plan B to tackle rising Covid rates

The coronavirus pandemic is a public health crisis the likes of which none of us have seen in our lifetime. There is no doubt that it has had an enormous impact on all of us, with the UK subjected to social restrictions aimed at containing the pandemic. Whilst those restrictions have certainly helped to manage the spread of the virus they have also had a massive toll on our psychological health, our social lives and importantly the UK economy. 

The real pandemic game changer was the development and subsequent roll out of effective vaccines which ultimately allowed all restrictions in England to be lifted in July. At that time the decision to open up was met with a mixed reaction. Many welcomed the move while others remained anxious about what the future could hold.

Roll forward three months and those anxieties are at the forefront of current political debate. This anxiety has been fuelled by rising case rates currently touching 50,000 cases per day and rising numbers of people being admitted to hospital (up 19 per cent in the last 7 days) and deaths (up 12 per cent in the last 7 days). 

As part of the government’s Winter Covid Management Strategy two plans are outlined that are critical in managing virus spread. Plan A, which is in force at the moment, emphasises a defence plan against the virus through pharmaceutical interventions: vaccines, antivirals and disease modifying therapeutics. It restates the continuing importance of identifying and isolating positive cases to limit transmission through a Test, Trace and Isolate strategy. 

The plan aims to support the NHS and social care to manage pressures and enable routine services to recover. It further advises people on how to protect themselves using clear guidance and communications, and finally adopts an international approach, helping to vaccinate the world and manage the risks at our borders. However, scientists and leading health professionals are expressing concerns that Plan A is simply not enough to stem the rising tide of infections, hospitalisations and deaths as we approach the winter months.

The Winter Plan does have a second set of interventions, Plan B, which could be imposed if Plan A was seen to be ineffective. It is this judgement that is currently exercising us all. The critical assessment in terms of implementing Plan B is whether the NHS is experiencing unsustainable pressure.

The government stated last week that it believes it is not - something that is countered by NHS organisations themselves who believe the pressure is now unsustainable as they struggle to manage a mix of Covid admissions, winter flu, other winter respiratory disease, the backlog of work created by the pandemic and a shortage of critical frontline staff to deliver services. 

In itself, Plan B offers a limited range of additional measures that can be introduced well short of a full lockdown. This includes; communicating clearly and urgently to the public that the level of risk has increased, and with it the need to behave more cautiously, legally mandating face coverings in certain settings, considering asking people once again to work from home if they can for a limited period and finally introducing mandatory vaccine-only COVID-status certification (passports) in certain settings.

In comparison to other countries in Europe the UK is certainly an outlier when it comes to these additional measures and many argue that this is demonstrated in their lower case rates and better outcomes. Given the limited measures in Plan B it seems odd that our government is loath to introduce it. It appears that this is primarily driven by the inherent ideological position of the Conservative Party for whom personal freedom and responsibility is so important.

The government is continuing to emphasise the important message about the vaccination programme and the need for all who are eligible to get the primary course of two jabs and a booster vaccination to enhance protections over the winter. The importance of the vaccine is primarily in protecting people from serious illness reducing hospital admissions and mortality, with research also indicating that the vaccine can reduce onward transmission by up to 50 per cent. With such good vaccination outcomes, it is argued that the most vulnerable are now protected and there is no need to introduce any further restrictions. In essence they argue that the situation remains manageable. 

However, I would argue that reducing case rates is important for several other reasons. Given that the current UK rates of infection are rising and may continue to rise, indeed the health secretary indicated they could get as high as 100,000 per day, the following key issues need to be considered.

  • Rising infection rates will inevitably lead to increased hospitalisation and deaths. A tragedy for all those families involved.

  • Increased bed occupancy with Covid will inevitably have knock on negative effects on the provision of other vital NHS services.

  •  Rising case rates could result in unsustainable pressure on the NHS given normal winter pressures, Covid, Flu, The Covid backlog, staffing levels and Covid exhaustion.

  • Increasing disruption to Schools/Education and the economy through lost days (isolation)

  • Rising infection rates provide an environment within which the opportunity for the virus to mutate increases. The possible emergence of a variant of concern also increases. This is important because a variant of concern may be more transmissible, change the clinical disease presentation, escape immunity derived by natural infection and decrease the effectiveness of vaccination and other public health measures.

  • Anyone infected with the virus is at risk of developing long term debilitation: Long Covid with potential devastating effects on individuals and pressure on future health and social care services. 

So what is likely to happen over the next weeks and months? I would argue that the data are trending in the wrong direction and if the reproductive number (R) creeps above 1.0, and there is evidence that this is already the case, then case rates will continue to rise. The vaccination programme will remain our front-line defence, but other mitigations will be required to suppress the transmission of the virus during the winter months. 

The words of Patrick Vallance the Chief Scientific Officer for England should be heeded. He suggests you “Go earlier, faster and harder” than you might think to control the pandemic spread. I’m convinced from the historical management of this crisis in the UK that we have been found wanting on all three of these pieces of advice. 

By not adopting Plan B at this juncture we are again in danger of not intervening fast enough and making things worse in the future. In my opinion it is not a simple choice between Plan A or B, it is a case of needing both. We owe it to every individual in this country and our struggling NHS to do so now.

Dr Stephen O’Brien is a visiting professor and executive project manager for the Faculty of Health, Education and Society at The University of Northampton