On my 40th birthday late last year, during the autumn restrictions, I was allowed to meet one person, outside. I sat on a park bench on my 40th, drinking cans of beer with an old friend. That whole period feels like a strange dream.
By contrast, on Sunday I spent eight hours in a central London bar playing nerdy wargames in a tournament. When you’re surrounded by about 30 increasingly stressed men, on a warm day in a smallish, un-air-conditioned room, you become intensely aware of the limits of social distancing. I’ll find out whether I caught Covid soon enough, but the fact that it was possible to do it shows how different life is now.
There’s something worth noting, though. The current seven-day rolling average of deaths is at about 120. For context, that’s about what it was in the middle of October last year, two weeks before we went into that second lockdown. It’s about eight times what it was this time last year. As this thread from the Bristol University mathematician Oliver Johnson points out, in September 2020 the prediction that we would reach 200 deaths a day in November was met with horror and, in some cases, disbelief. But at the present rate of growth, we’ll be at 200 a day by November again, and no one seems to be all that concerned.
Crucially, too, at that rate of growth we could end up at 2,000 hospitalisations a day — about half the January 2021 peak. If that were to happen, we probably won’t see hospitals running out of oxygen, like we did during the first two waves. But we might see it getting harder to access routine care. I spoke to one ophthalmologist earlier this year, and he said that quite a few patients suffered avoidable, but irreversible, sight loss because the sheer weight of Covid cases meant their treatment had to be delayed. That’s a microcosm of the health service in general: for comparison, 2017/18, the worst winter for excess deaths in the last half-century, saw a peak of about 1,000 hospitalisations and about 50 deaths a day, and that led to tens of thousands of hospital appointments being cancelled.
Maybe I’m misremembering, but my sense is that we were a lot more anxious last year than we are now. I don’t think there were many wargaming tournaments taking place, for one thing. Thousands of people cheered Emma Raducanu on as she won the US Open at the weekend; in 2020, it was played in front of empty stadiums.
We’re heading into winter again, and things will probably get worse — Boris Johnson is announcing plans for the coming months today — yet there remains a relatively carefree air. So why aren’t we more worried? And should we be?
There’s one obvious reason why we’re not all freaking out, and that is that we’re tired and bored and aren’t really paying attention. The news isn’t really reporting the numbers any more.
But there are also real differences between now and last year, mainly driven by immunity, particularly vaccines. Adam Kucharski, a mathematical epidemiologist at the London School of Hygiene and Tropical Medicine, told me that while “normalisation” has been part of it — “numbers that were massive don’t feel so massive” — there are also other things at work.
Some of it is pretty obvious. “The pool of susceptibility is very different,” he says. At the start of the pandemic, and in the second wave, there was the potential for a huge amount of devastation — “hundreds of thousands of deaths, millions of hospitalisations”. We “hit the pause button” with lockdowns and other restrictions, but that was just pushing them into the future; the potential was still there.
Now, that pool of susceptibility is much smaller. Around 90% of all over-16s in the UK are vaccinated, and about seven million people have had Covid. Those people are much less likely to die than they were a year ago. Even if we completely let Covid rip through the population, it couldn’t do as much damage.
This is because the vaccines work, really quite well. If you look at how deaths are distributed (p33), around 16% of Covid fatalities among the over-80s are in not-fully-vaccinated people, despite around 95% of that age group being vaccinated: having the vaccine makes you much less likely to get very ill.
Also, the shape of the curve is very different this time around. We’re at 120 deaths a day, but the growth rate is about 7% a week. There’s this neat trick for working out compound growth: if you divide 70 by the percentage weekly growth, you get the (rough) doubling time. So it will take about 10 weeks for deaths to double. By comparison, deaths were going up 50% a week for periods in autumn and winter, doubling about every 10 days.
That’s, again, because of vaccinations. We’re living amazingly open lives at the moment — bars and theatres open, schools open, masks not compulsory — but the numbers of cases, and hospitalisations, and deaths, have crept up rather than shot up. “It’s been at a plateau for a long time,” says Kucharski. “Last year it was a firehose; you start to open up and cases go up.” Vaccines work against infection as well, so even though we’re pretty much wide open, vaccination is keeping growth slow.
After a few months of this, we now have a sense of what living with Covid feels like. Before, there weren’t “flat” periods. Either Covid numbers were going up, as they were in spring 2020 and autumn and winter, or we’d locked down and they were declining again. There was never stability. Now, even in our quite open society, even with full football stadiums and shops, numbers are going up only slowly, because we’re less likely to get infected and less likely to get ill if we do.
The question, of course, is what to do next. Because while the numbers may be rising slowly, they are still going up.
Maybe that doesn’t matter and we don’t need to stop them. “The optimistic reading is that we now have so much immunity that it’ll peak on its own,” says Oliver Johnson. And there are hints that case numbers have begun to come down. But if it doesn’t, if it carries on as it is, then we’ll have 250 or so deaths a day by the middle of November, and the NHS under severe pressure.
The three things we should have learnt about Covid by now are, one, that it is quite hard to predict but that looking at percentage growth rates and extrapolating them into the future is a good start; two, that you need to prepare for the tail risks; and three, that doing things earlier rather than later is often a good idea.
Luckily, things are still moving relatively slowly. “If it’s a car crash,” says Johnson, “it’s a very very slow-motion car crash. There are opportunities to turn it around.”
And we probably won’t need the stringent restrictions we used in the last two waves to turn it around, because the immunity in the population has made it harder for the disease to spread. “We have different levers we can pull now,” says Kucharski. “We can keep testing, we can use vaccine certification, we can reintroduce masks or ask people to work from home.” Given the slow growth, a combination of things like those — and vaccinations for the under-16s, announced this week, and booster jabs for the elderly, which are expected to be announced soon – might be enough to slow the growth to zero, to a truly flat epidemic.
But whatever we do, we’ll probably need to do it sooner rather than later: the Government’s bloody silly “irreversible” comment notwithstanding, introducing less stringent measures now could avoid us having to do more stringent ones later. “If hospitalisations creep up and creep up,” says Kucharski, “then if we tighten up, it could leave us with a flat epidemic at a higher plateau.” If the numbers have already doubled once or twice from where they are, that “would not leave us somewhere where we want the NHS to be over the winter”. The growth has been slower than it was, but in absolute terms, we are at a much higher level than we were this time last year, meaning that we have “less wiggle room” ahead of the winter surge in pressure on the NHS.
Going out to restaurants, meeting people, sending my kids to school or to their gymnastics class and football — all that stuff of life is great and important. I want to have as much of it as possible over the winter. So we need to start talking about some relatively minor adjustments – stuff like bringing back masks in shops, encouraging working from home where possible, backing proper vaccination certificates. I prefer the world where I can play silly nerdy games in sweaty rooms, even if I lose all my games and come dead last, to the world where I sit on a park bench in the cold for two birthdays in a row.