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Coronavirus Plan B for Summer 2021

I have been invited to write a piece for The Conversation about the current status of COVID-19 outbreak in the UK and the perspectives for future developments. I got the following comment on my Facebook page:

My question, however, is what is the Plan B if the vaccines don’t work sufficiently well to stop outbreaks? I have yet to see any proper discussion/modelling on this – all I know is that from my own experience we simply cannot continue with endless lockdowns; the impact on mental health (particularly on students/younger generation) is very clear to see – let alone the other illnesses/deaths caused by delayed operations etc


I am not part of any government advisory group so I can only speak as an epidemiologist and a modeller. Nevertheless, here are some further thoughts on the past 18 months and the future.

Firstly, it is not lockdowns as such that cause so many problems, but their wrong application. As I said in my The Conversation article, the UK government have been applying them too late and relaxing too early, combining this with failure to apply border controls. Unfortunately, we have now to deal with a fall out of a series of bad decisions and the choice is between bad and worse options.

Secondly, vaccines do work and they work exceedingly well, although not perfectly. Were it not for the rise and spread of the Delta variant, we probably would have eliminated the virus in the UK and other developed countries. Coronavirus would then have been a bit like measles – not present, but always some threat.

Delta has changed the picture, as an excellent article in The Atlantic points out. Delta is more infectious than the original strain and even the Alpha strain, we probably are not going to ever reach herd immunity and hence it is very likely that we need to learn to “live with the virus”.

Thirdly, I might be completely wrong, but I do not expect any new significant variant to appear, spread, and achieve a significant breakthrough for the vaccines. Yes, there will be new VOC, and there might be localised epidemics, but it will be very difficult for the virus to overcome the current vaccination levels and the strength of Delta (the new variant would need to evade the vaccination, spread by vaccinated individuals, and have a higher R_0 than Delta.

Fourthly and most importantly, COVID-19 vaccines have significantly reduced the hospitalisation and death rates, perhaps to the level that might now be acceptable to society as a price for complete reopening and return to “normality”. The death of every person is a tragedy, but we continuously balance risks in our life. But we need to be very clear about what the risks are and what the costs are, to the individuals and to the society at large.

Previously, the government has been trying to balance the two – apparently incompatible – priorities – physical health vs economy and mental health – by lurching from one extreme of strict lockdowns (March-April 2020, Winter 2020-21) to another of almost complete relaxation (Summer 2020, Christmas 2020, August 2021). Now, it is possible to “flatten the death curve” with only minimal NPIs.

So what is the Plan B? A strategy from Singapore – as described in the new Reuter’s article – combines high vaccination rates (71% fully vaccinated and growing) with the cautious reopening strategy, continuing mask wearing, excellent post-infection health care, and a continuation of strict border controls – not closing, but actually implementing checks.

But the key element – which is still missing in the UK and in many other countries – is an honest dialogue between the government, public health officials and the general public. Singapore public health officials are very clear that some people will indeed continue to fall ill and possibly die. Instead, we often get slogans and confusion.