image source, AFP
The government 'England ' s approach is clear - it will try to rely almost entirely on vaccines to protect the country from Covid this winter.
The winter plan published on Wednesday indicates that vaccines, including the rollout of boosters and jabs for children, are Plan A.
There is a Plan B, however. This includes greater use of blankets. Faces, Covid Passports and Work-from-Home Orders - a "lockdown lite " as it has been dubbed.
What are the chances of avoidingter that?
The trigger is the pressure on the NHS
The government has a criterion for moving to Plan B - unsustainable pressure on the NHS. However, the plan does not explain exactly what this entails.
Currently, 7% of hospital beds are occupied by Covid patients. It may not seem like much - but hospitals are running at near full capacity, so Covid cases quickly impact other care.
The amount of non-urgent treatment being given is already close to 'one-fifth less than normal levels.
And if Covid admissions continue to rise or other respiratory illnesses take off, that will mean more rationing - from delayed knee and hip replacements to people waiting longer for an ambulance.
None of this is unusual - it happens every winter. But this year it could be on a whole different scale.
Currently the numbers at the hospital are quite flat, however. They have not increased than a fifth in six weeks.
If this trajectory remains constant, it will certainly put hospitals under pressure - but it would be difficult to argue that the pressure from Covid was unsustainable.
There is enormous uncertainty about Covid
Infection levels may increase, however. The number of cases has skyrocketed since the rapid rise stopped in mid-July.
Essentially, the epidemic is stable. This is a pretty remarkable achievement given how contagious the Delta variant is and the fact that society is totally open.
This suggests that we are on the verge of emerging from the pandemic. But, as the Prime Minister and leading scientists have repeatedly emphasized this week, it is not completely over.
A model suggests infection rates could rise so much that admissions could reach 7,000 per day in England by mid-October, nearly 10 times what they are now. However, most experts don't think this is a realistic scenario.
The main drivers of what's to come Next are immunity levels and the amount of people mixed up.
With the end of summer and the return to work and school, contact levels may increase and these contacts may increasingly be indoors, where the virus is more easily spread . To counter this, immunity levels need to increase.
And while vaccines are incredibly effective at reducing the risk of people getting seriously ill and dying, they're not perfect. And over time, their effectiveness may decrease.
This is where boosters come in. Strengthening protection in those over 50 and young adults with health problems could help. a crucial difference.
Much more than immunizing healthy 12-15 year olds, also announced this week, who are much less likely to get seriously ill.
What is also essential,however, that is to get over the five million adults who have not even received a single dose of vaccine.
If immunity cannot prevent admissions in the hospital, this is where Plan B comes in. The measures may not seem important given the nature of previous blockages. But they are based on the assumption that if infection levels take off, growth will not be as fast as it was last winter and therefore relatively minor changes, such as labor. at home, can make a big difference.
With so many unknowns, it's hard to predict what will happen next. "There is enormous uncertainty, " says Professor Graham Medley, who chairs the government's modeling committee.
He doesn't think we'll see the big pushes that marked the first waves and would lead to huge growth in hospital admissions.
But he also does not thinks that there will be a significant reduction in infection levels. "I don't think anyone is expecting it ", he adds.
The rebound of other viruses is also a factor
However, it is not just about Covid. Experts have warned that normal winter viruses are likely to return.
Last year, viruses such as the flu were barely seen, due to lockdowns and social distancing.
But it lowered our immunity to them - and prevented some young children from developing any immunity.
A virus called RSV - the leading cause of hospitalization of children under age five for respiratory disease - already circulating at very high levels.
And if the flu follows suit, the number of admissions for other respiratory viruses could easily exceed those currently seen for Covid - around 750 per day.
Professor Dame Anne Johnson, president of the Academy of Medical Sciences, says the conditions are "ripe " for this to happen.
But she thinks the government is right in trying to find a balance that "maximizes risk reduction while minimizing impacts on our lives ".
Ministers, she said, must be prepared to act if the need arises. Right now it is about predicting the worst, while hoping for the best.
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