July 19: Boris Johnson offers freedom day with health warning – mixed messages?

Boris Johnson will urge people today not to return to life as normal after July 19 unless they want to risk restrictions being reimposed.

Chris Smyth, Whitehall Editor http://www.thetimes.co.uk

As he confirms that all remaining limits on social contact will be lifted in England a week today, the prime minister will emphasise that “caution is absolutely vital” in the face of rising infections.

Wales is to review its restrictions on Thursday and Scotland is due to lift some restrictions on July 19 and most on August 9.

Senior scientific advisers urged people yesterday to continue to work from home over the summer and not to be “overenthusiastic about social contact” because of the risk of thousands of hospital admissions a day.

Susan Hopkins, of Public Health England, said that no one could “ringingly endorse” the decision to lift all restrictions and the country had to be braced for them to return at short notice if hospital admissions rose too much.

Johnson has dropped claims that the end of restrictions is “irreversible” after scientists warned him that the decision to open up fully was a gamble that could go wrong.

The prime minister will strike a wary tone about life after July 19 as he marks the end of lockdown measures with a plea to carry on with many habits formed during the pandemic.

A government source said that “the best way to make sure we never go back is to be cautious”.

Johnson will say that England is “tantalisingly close to the final milestone in our road map out of lockdown, but the plan to restore our freedoms must come with a warning”.

While praising the success of the vaccination programme, which has “weakened” the link between infections and hospital admissions, he will caution that “the global pandemic is not over yet”.

He will say: “Cases will rise as we unlock, so as we confirm our plans today, our message will be clear. Caution is absolutely vital and we must all take responsibility so we don’t undo our progress, ensuring we continue to protect our NHS.”

Hopkins called the decision to end restrictions now a “fine balancing act”, given that a delay could allow more people to get vaccinated, but would risk pushing an exit wave into the autumn or winter and putting even more pressure on the NHS. “I don’t think we know the right answer,” she told Times Radio.

Sajid Javid, the health secretary, has said that cases could reach 100,000 a day and Hopkins said it was “possible” that this could result in 3,000 hospital admissions a day soon afterwards.

“It will depend on the behaviour that we as individuals and the population overall, do,” she said.

There were 31,772 new cases recorded yesterday. The most recent figures for England show 461 hospital admissions on Wednesday.

Hopkins said that January’s peak of 4,000 admissions a day was “three doubling times away from where we are now, and that it was six to eight weeks potentially, unless things change, and unless we keep the transmission rate down”. Vaccination had more than halved the proportion of cases that end up in hospital but there was still a “direct relationship” between the number of cases and pressure on the NHS, she said.

At present 62 per cent of patients in hospital are under 55 as vaccines protect the elderly. Hopkins said that while vaccination had been “highly successful at reducing hospitalisations, it is not 100 per cent effective”. She said now was “not a time to be over-enthusiastic about social contact”, telling people: “We need to be careful, to keep our distance, keep social contacts low, wear masks in enclosed spaces, despite them not being legally required after July 19.”

The government will drop the recommendation to work from home next week, with ministers insisting that it will be up to businesses to decide whether staff come to the office.

Hopkins said: “Over the next four to six weeks that needs to be very cautiously implemented by businesses to keep transmission down.” She advised: “If you are able to do your business effectively from home then . . . we should try our best to do that.”

Sir David Spiegelhalter, professor of the public understanding of risk at Cambridge University, said that the proportion of people infected who ended up in hospital “has dropped a lot. It used to be in the second wave about one in ten. Now it’s about one in 40 because the cases are so much younger”.

But he told the BBC: “That would mean that a hundred thousand cases, if we got there, would be maybe 2,500 admissions a day. That’s very high.”

Spiegelhalter said that with younger people having shorter stays in wards “the actual numbers in hospital would be well below the second wave peak”.

Like it or not, rolling of the dice is under way already

It has always been, we know, a finely balanced decision (Tom Whipple writes). We are about to find out just how finely balanced. No one is pretending that the modelling accompanying England’s reopening, which is expected to be released today, will make for pleasant reading.

Of course, it never has. For six months the Scientific Advisory Group for Emergencies has been predicting that there would be a huge exit wave in the summer. The difference is that where once such predictions were treated with derision — how could we have so many cases when nearly all adults are vaccinated? — they are now treated with fatalism.

When the models are published, the key insight will not so much be in its prediction of the size of the coming wave. Everyone knows it will be big. For those who are immuno-compromised, it is clear this summer will not be one of freedom. Instead, the insight will be in the decision-making process — about how much morbidity and mortality the government is prepared to stomach, and how certain it is that both will stay within “acceptable” limits.

As Boris Johnson prepares to formally announce the lifting of all English restrictions, modellers from Warwick, the London School of Hygiene and Tropical Medicine and Imperial will have already told him how many daily Covid hospital admissions they expect. At the weekend we breached 500. A peak of 1,000 a day seems conservative; 2,000 does not seem inconceivable.

They will also have made it clear we are now rolling the dice. Many scientists vociferously oppose the nation’s acquiescence into mass infection. Others think that, with vaccination falling among the young, with the huge economic costs of social distancing, and with no plans to vaccinate children, it is our only option to reach herd immunity, and delaying opening simply delays deaths. But even that option becomes untenable if the NHS becomes overwhelmed.

In the modellers’ graphs there will be a “confidence interval”, showing the range of likely outcomes. How high will hospital admissions go? Four thousand a day was the figure that nearly toppled the NHS in January. With a backlog of other patients and an exhausted workforce, NHS leaders think even that might be too much.

Last week more than 100 scientists wrote a letter to The Lancet decrying England’s reopening plans as an unethical experiment. They predicted that it would burden the nation with long-Covid-related disability for a generation, create ideal conditions for a vaccine-escape variant, and needlessly cause hundreds, probably thousands, more deaths.

Those points are reasonable, even if some are arguable. But there is a corollary. If mass infection really is an experiment, it is one that has already begun. The relaxation on July 19 might push cases higher but our wave is well under way. If you don’t like 100,000 cases a day, it’s hard to see why 50,000 is acceptable.

If our only goal were to prevent Covid hospital cases, it is clear the best thing would be to reimpose lockdown and start vaccinating teenagers. For reasons of politics, logistics and national exhaustion, that seems highly unlikely.