After well over a year of varying degrees of coronavirus rules, the prime minister will announce next week whether England’s last remaining restrictions will be lifted on 21 June.
Step four of the roadmap out of lockdown involves the removal of social contact limits, including mask wearing and working from home, as well as the opening of nightclubs and large events.
The government has outlined four data areas it will consider when taking each step of the roadmap – but measuring whether the country has met the relevant criteria is problematic because the targets ministers set are vague.
1. The risk from new ‘variants of concern’
Fewer people with coronavirus are being to admitted to hospital. The data shows on average just three in every 100 people infected are admitted each day.
This is the lowest rate since data became available since the end of last summer.
But hospital admissions have started to increase in recent weeks.
Cases and hospital admissions have ticked higher in recent weeks after falling for months.
The number of new patients each day has gone up by 30%, from 75 in mid-May to 100 at the beginning of June.
The rise in hospital admissions began two weeks after the increase in cases, mostly caused by the spread of the Delta variant (B.1.617.2), first detected in India.
The increase has been been driven by the North West, which accounted for one in four new admissions in the last two weeks.
The region also has more than half of all Delta cases sequenced in England, according to data from Wellcome Sanger Institute.
The rise of cases and admissions in England is not as fast as in September (darkest shade), the start of the second wave when a similar number of daily cases were recorded.
But in the North West, cases and hospital admissions are increasing faster than the national average, although the growth remains slower than it was at the start of last autumn.
Public Health England has said people with the Delta variant (first detected in India) are 2.5 times more likely to be admitted to hospital than people with the Alpha variant (or Kent), which was previously dominant in the UK.
There is also evidence that Delta is spreading faster than Alpha. Professor Neil Ferguson of Imperial College London, the former government adviser whose modelling has been influential in Whitehall since the pandemic began, has suggested it is 60% more transmissible.
Delta (B.1.617.2) became the dominant strain in England in just over a month after it was first detected. And it now accounts for upwards of 91% of new COVID-19 cases in the UK.
The variant is dominant in a third of England’s local authorities. More than half of cases sequenced in 80 out of 244 areas in the week ending 29 May were Delta.
2. Vaccines reduce hospital admissions and deaths
Vaccines are proving they reduce hospitalisations and deaths, but there is uncertainty about how effective they are against the Delta variant.
According to PHE, B.1.617.2 reduces the effectiveness of the jab among people who’ve received just one dose, but protection is higher amongst those fully vaccinated.
Two-thirds of people admitted to hospital with the Delta variant so far have not received a vaccine at all, according to figures released by the health secretary.
Of 126 people recently admitted, 83 were unvaccinated, 28 had received one dose, and just three had both, he said.
Data shows that the increase in admissions has been driven by younger groups with lower vaccination rates.
Since mid-May, the number of people aged 18 to 64 admitted to hospital has slowly gone up by 45%, from 42 to 61 daily admissions.
Only 35% of this age group has been fully vaccinated.
In contrast, almost all of those aged 80 and over have received two doses.
Admissions of the oldest and most vulnerable continue to fall. They’re down by 40%, from 11 people admitted daily in mid-May to seven in June.
In younger groups – where fewer people have had two doses – admissions are rising. However, the increase has been slower than in September (darkest line).
In regions with large numbers of the Delta variant, such as the North West, daily hospital admissions are rising faster in younger age groups than the national average.
3. Vaccine programme continues ‘successfully’
Vaccines minister Nadhim Zahawi wants everyone in the top nine priority groups to be fully vaccinated by 21 June.
That includes everyone aged over 50, as well as health workers and the clinically vulnerable.
As of 6 June, 86% of over-50s had received two doses. But vaccination rates vary throughout the country.
Richmondshire in North Yorkshire, an area within Chancellor Rishi Sunak’s constituency, has one of the lowest vaccination rates for second doses outside London, alongside Eden and Slough. In all three areas, three quarters of over-50s had been given their second dose.
The 18 areas with the lowest second dose rates in England are in London, with just under two in three over-50s receiving a second jab in the borough of Tower Hamlets and Camden.
The number of people being vaccinated has risen sharply in the most recent week. But it’s thought it takes around two weeks from injection to when the vaccine becomes fully effective.
Even if all over-50s are given two doses by 21 June, experts say a delay might be necessary.
4. Infection rates do not put ‘unsustainable pressure’ on the NHS
The last of the four tests the government will consider is whether infection rates risk a surge in hospitalisations which would put unsustainable pressure on the NHS.
Professor Sir David King, a former chief scientific adviser to the government, has told Sky News there is “evidence of another wave appearing”.
Researchers from the University of Warwick, whose members are part of a group that advises the government, have projected that the 21 June reopening would increase transmission and therefore hospital admissions.
Their model also considered a variant 40% more transmissible than Alpha and found it could result in a peak of 6,000 hospital admissions per day, assuming full relaxation. Admissions could go up to 10,000 per day if the variant was 50% more transmissible.
This assumed immunity either due to vaccination or natural infection still holds.
Prof Ferguson has said vaccines have lowered the risk to life in a third wave, but that the future is still uncertain.
Prof Ferguson said: “It’s well within possibility that we could see another third wave at least comparable in terms of hospitalisations. I think deaths probably would be lower, the vaccines are having a highly protective effect.
“Still, it could be quite worrying. But there is a lot of uncertainty.”
The problem for the government is the timing of the Delta variant.
Even some of its own scientific advisors have argued that they need more time to assess Delta’s impact and allow a greater proportion of adults to have received both doses of a vaccine.
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