A modest recalibration of the government’s Covid strategy would lift pressure on the NHS. But the PM will wait until he has absolutely no other option
Early on Friday morning, I woke up with an unaccountable urge to go all the way to Barnard Castle to check my eyesight. And we all know what that means.
Sure enough, a couple of lateral flow tests later – the two lines on each strip telling their own story – I realised that, after 19 months of scrupulously observing lockdowns, tiering systems, the “rule of six”, social distancing, bubbling, and all the rest of it, I had been caught by Covid. And I will admit that I felt – well – a bit cheated.
This moment of self-indulgence and wounded pride passed soon enough. Apart from my strange desire to travel 260 miles north in search of optometric reassurance, I was fortunate enough to be asymptomatic. I am double vaccinated (thank you, AstraZeneca, and the team at Downham Health and Leisure Centre), which means that the Delta variant, or perhaps its new mutation, AY.4.2, had infected me, but was not killing me. This strikes me as a distinction we should dwell upon more often, and with more gratitude: the “not dying thanks to the jab” business, I mean. To cap it all, I am lucky enough to have a job that means I can work from home.
And – in any case – might the government be about to advise me to do just that, yet again? In the past few days it has been hard to avoid the increasingly heated row over whether and when ministers should implement so-called “plan B” in its Covid strategy.
On Thursday, the UK reported 52,000 new coronavirus cases, the highest tally since mid-July and the superspreader gatherings of the Euros. We have reached the point where the UK is recording around seven times as many cases as our western European neighbours; six times more hospitalisations; and (in spite of the vaccine roll-out) three times as many fatalities.
In the light of this surge, Boris Johnson’s government is – according to the British Medical Association – acting with “wilful negligence” by refusing to reintroduce minimal safety measures: mandatory mask-wearing in specific locations, vaccine passports at crowded events, and guidance to work from home if possible. On Wednesday, Matthew Taylor, chief executive of the NHS Confederation which represents healthcare bodies, said that “[t]he message from health leaders is clear – it is better to act now rather than later.”
On the same day, Sajid Javid, the health secretary, conceded that new case numbers might reach 100,000 a day, that “this pandemic is not over”, and that he would do “what it takes” to protect the NHS. He did not believe, however, that “the pressures currently faced by the NHS are unsustainable.” On the BBC’s Andrew Marr Show yesterday, Javid’s successor as chancellor, Rishi Sunak, stuck to the same line. The situation was under review, but present Covid data “does not suggest that we should be immediately moving to plan B”.
Covid data, of course, is only part of the story. Because, by design, there is so little slack in the NHS’s capacity, it takes very little to overheat the system. As one senior ICU specialist told me: “What we’re seeing is a lot of cancer, cardiac and respiratory cases coming in – people who have stayed away because of the pandemic. There’s an undoubted spike in RSV [respiratory syncytial virus] and flu. And because people aren’t dying of Covid quickly like they were last year, they’re staying longer in ICU or high dependency beds, and getting better – which is great, of course, but also a big new factor in terms of pressure.”
As for A&E, Dr Katherine Henderson, president of the Royal College of Emergency Medicine, was unambiguous in her remarks yesterday to Sky’s Trevor Phillips. “We’re already struggling to cope – this is not something that is coming in the next couple of months. We’re already in a terrible place, where we have got large queues of ambulances with vulnerable people waiting in those ambulances to be offloaded into departments, and other patients at home waiting to be picked up by the ambulance.”
This week, as part of his Budget and Spending Review, Sunak promises the NHS a “game-changing investment” (though, so meaninglessly boosterish has political language become under this government, one wonders if there is any other kind now). There is also a fresh sense of urgency around the vaccine programme – symbolised by the return of the senior official Emily Lawson from Number 10 to NHS England to oversee the rollout of booster jabs. To date, only half of the ten million eligible in England to receive a third dose have come forward for the supplementary injection (though Saturday was the most successful booster day so far, with 325,140 vaccines administered).
In his recent book, The Resilient Society, the Princeton economist, Markus K. Brunnermeier, describes the “last mile phenomenon” that often afflicts health initiatives: “A resilient public health strategy might fail because people find it hard to carry through until the end of a pandemic. As populations become careless, strategic complementarities can reverse. As some neighbours become less concerned about the virus, others might relax their own precautions too.”
As Brunnermeier puts it, “aggregated fear and anxiety” are frequently replaced as time passes by a blend of fatigue (people have simply had enough of restrictions) and the optimism bias that makes individuals expect that they will be spared bad outcomes.
In the case of those reluctant to get booster shots – or indeed hesitant about vaccination of any sort – this is a dangerous combination: exasperation with the pandemic as a whole (will this never end?) combined with an irrational sense of personal immunity (I’m obviously not going to get the virus now).
Bear in mind that less than a year has passed since 90-year-old Margaret Keenan became the first person in the world, on 8 December at University Hospital, Coventry, to receive the Pfizer-BioNTech vaccine outside a trial. In less than a year, a degree of complacency has entered our collective attitude to the jab, as though it were an Instagram fad rather than a historic medical achievement. And that is a complacency which – it should be obvious – we can ill afford (for the record: Ms Keenan herself got her third shot on 24 September).
In the campaign to restore dynamism to the vaccination programme, the signals sent by public figures are of the greatest importance. Which is why the images of maskless Conservatives on the Commons front bench are a messaging disaster.
It is precisely at this moment, when wearing a mask has become a matter of personal responsibility, that we need to see those who govern us erring on the side of caution. They need to demonstrate that their own exercise of freedom is responsible and prudent, and, in deed as well as in word, that they fully grasp Javid’s point that “this pandemic is not over”.
What, then, is the public to make of Jacob Rees-Mogg’s extraordinary argument that Tory MPs don’t have to wear masks because they “know each other”? This would seem to mark a spectacular development in contemporary epidemiology – namely, that being the member of the same political party or social class confers immunity from pathogen transmission. The potential, when you think about it, is limitless: “No need to worry, doctor. I was in the same house at Eton as Binkie, and we were in the same production at Balliol of Pirates of Penzance, so there’s absolutely no danger of him giving me Ebola.”
Meanwhile, back on planet Earth, the real puzzle is why Number 10 is so reluctant to implement plan B immediately. The proposed measures, after all, represent an inconvenience rather than a serious programme of social restriction. The economic impact of the plan ought to be minimal.
True, there are plenty of latter-day Tony Hancocks who – when they hear that proof of vaccination or a recent negative test might be temporarily necessary at certain venues – lament that Magna Carta died in vain. But, as long as the requirement is time-limited, it really is a small price to pay for continued access to night-clubs, concerts and sporting events.
Yesterday’s Observer disclosed that the UK Health Security Agency contacted local authorities on Friday to establish their position regarding “immediate rollout of the winter plan – plan B”. Every minister, official, and public health administrator I have spoken to expects the plan, “or some version of it”, to be announced soon. So why the delay?
The answer is psychological and political, rather than clinical. We know now that the prime minister is and has always been violently opposed to lockdowns – that, according to his former chief adviser Dominic Cummings, Johnson allegedly said in his study after agreeing to the second, he would rather see the “bodies pile high” than announce a third (though he went on to do exactly that on 5 January).
Plan B is, of course, nothing close to a lockdown. But it still offends the core principle of the roadmap to liberty that the PM unveiled in February – namely, that the relaxation of restrictions should be “irreversible”. As one who knows him well puts it: “Never forget that Boris cares most about winning. And ‘plan B’ sounds like something a loser would have to do.”
More specifically, Johnson is frantic that Covid should not interfere more than it already has with Cop 26, which opens in Glasgow on Sunday. According to a source connected with the summit preparations: “He sees this like his second Olympics – like London 2012 all over again. He wants to be the ringmaster of the world. And he doesn’t want bloody Covid getting in the way.”
Whatever Cop achieves – and one hopes that it achieves a lot – you can be sure the occasion will be nothing like an Olympic festival. This is gritty diplomacy, all-night drafting and redrafting, and hard-nosed trading of the toughest kind – not the Queen pretending to parachute into London Stadium, Usain Bolt ruling the world, or Team GB winning 29 gold medals. But is it not revealing that the PM sees this global gathering on the future of the planet as another exercise in personal choreography?
In a sense, none of this should surprise us. For 19 months, we have witnessed a government that resists measures until the very last moment – and then imposes restrictions that, only days before, it has scorned as wholly unnecessary. In the words of one senior public health official: “He absolutely needs to be seen as defiant until he is forced into it. That’s the way he works.” So why, by implication, expect him to change the formula now?
One reason, you might think, is the report, published on 12 October, of the joint inquiry by the Commons Health and Social Care and Science and Technology Select Committees, which described the “decisions on lockdowns and social distancing during the early weeks of the pandemic” as “as one of the most important public health failures the United Kingdom has ever experienced”.
Where is the accountability in response to that extraordinary verdict? Where is the humility, the change of trajectory, the mature recognition of mistakes made and lessons learned? Nowhere, of course, because that is not how populist politics works.
A mature government would not feel the slightest embarrassment about recalibrating its pandemic strategy to match the needs of a difficult winter. Such amendments, after all, are the essence of nuanced public policy.
But, in our infantilised political culture, a modest change of plan represents, absurdly, a defeat, a punctured ego, a ruined performance. It is implemented as late as possible, grudgingly and in a spirit of impatience. Though the pandemic is not yet done with us, we have been implicitly encouraged by this government of enablers to act like children in the back of the car: are we there yet?
Well, we’re not – and it does nobody any favours to pretend otherwise. The question is not: when should we implement plan B? (Answer: yesterday). The question is: why is this government making such a big deal of it? Plans B, C, D, and E…get used to them, because they’re coming. Pathogens don’t give a damn about political pride.