Two fans of Manchester City soccer club stand out for wearing face masks during the Premier League match between Manchester City and Burnley on October 16, 2021.
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LONDON — When the Covid-19 pandemic swept the globe in 2020, the U.K. was hit hard, reporting some of the highest cases numbers and fatalities in Europe. A speedy vaccination program managed to turn things around, however, and brought cases under control.
Now the situation looks dramatically different. The country is recording close to 50,000 new Covid cases a day — meaning it has one of the worst daily infection rates in the world.
On Monday, 49,156 new cases were recorded, marking the highest number in three months and taking the total number of cases to over 8.4 million in the U.K. The country also reported 45 new deaths within 28 days of a positive test, bringing the total number of fatalities to 138,629 — one of the highest death tolls in the world.
Meanwhile, hospitalizations and deaths have been steadily increasing since the summer when Covid restrictions in England were lifted on July 19. Pubs, restaurants and nightclubs reopened and mask-wearing became (for the most part) voluntary.
Read more: England takes leap into the unknown, lifting Covid rules as cases surge
Thankfully, the numbers of hospitalizations and deaths have been rising at a much slower rate than earlier in the pandemic, largely due to Covid vaccines being highly effective at preventing severe infection, hospitalization and deaths.
Nonetheless, healthcare professionals in the country’s National Health Service are warning of a tough winter ahead.
What’s going on?
Experts say there are a variety of reasons for the U.K.’s steep Covid numbers — ranging from the half-hearted mask adoption (even when masks are required, such as on public transport, the rule is rarely enforced) to large indoor gatherings that have allowed the virus to spread.
The U.K.’s hesitation in vaccinating younger teenagers, something that other countries in Europe and the U.S. did much earlier, and the return to schools in September, have also been cited as reasons for the sharp rise in cases, although the boom in infections among 0-18 year olds is now ebbing as infections rise in their parents’ generation, data shows.
People seen dining outdoors in Soho in London in September 2021. Since Covid restrictions were lifted in the U.K., people have flocked back to streets, shops and public spaces.
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Perhaps most ironically, the U.K.’s early vaccination rollout — which began in December 2020 and was one of the first in the world — is also seen as contributing to its high case rate now.
That’s because we now know — due to an increasing body of data — that immunity in vaccinated people wanes after about six months. The spread of the much more infectious delta Covid variant in the spring and summer is also seen as a factor that has diminished vaccine efficacy.
Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, tweeted his assessment of the U.K.’s situation on Saturday, stating: “Why does the UK currently have 6-fold hospital admissions and a 3-fold higher death rate compared with Europe? Among [the] possible explanations, two that stand out are less use of mitigation measures and less vaccination of kids, age 12-17.”
He noted that reliance on the AstraZeneca vaccine (where effectiveness has been found to decline slightly more over time than the Pfizer vaccine) as another possible contributing factor.
While, “another potential explanation is that the U.K. vaccinated earlier than rest of Europe, and therefore has manifest more waning of protection, especially among older people,” he noted. On a more positive note, Topol noted that “the U.K. has done far better than the U.S. for uncoupling cases from hospitalizations and deaths.”
In light of what we know about waning immunity, the U.K. (like Israel, the U.S. and other countries in Europe) decided in September to roll out booster shots to the over-50s, medical staff and anyone with underlying health conditions.
Those who received their second dose at least six months ago are being asked to come forward first. Currently around 6.5 million people in England are eligible for a booster, with the NHS so far having administered around 3.6 million booster shots, data shows.
Experts have called on the government to ramp up vaccinations in unvaccinated groups, mainly in young people, and to roll out boosters faster. They have also warned against complacency this winter or a reliance on a controversial “herd immunity” strategy.
“The U.K. seems to be slowly waking up to the fact that Covid cases are too high, but the reality is they’ve been soaring for months and many countries have put us on their red list,” Tim Spector, a professor of genetic epidemiology at King’s College London and lead scientist on the ZOE COVID Study app, which collects and analyses Covid data, noted last week.
“Infections remain high in young people, and look to be spilling over into the 35-55 year olds. If these increases creep into the over 55s it could spell disaster for the NHS this winter,” he noted. “With cases so high, it’s clear that herd immunity isn’t happening, and the risk is most people continue to believe they are safe if they have had Covid or a vaccine … We need to be doing all we can to get everyone double vaccinated and stop waiting for herd immunity to happen through natural infection.”
There are also growing concerns about a descendent of the delta Covid variant that is being identified in an increasing number of U.K. Covid cases, with some suggesting it could be another possible factor in rising case numbers.
Last Friday, the U.K.’s Health Security Agency issued a report in which it said “a delta sublineage newly designated as AY.4.2 is noted to be expanding in England” and that it was monitoring the subtype.
“This sublineage is currently increasing in frequency. It includes spike mutations A222V and Y145H. In the week beginning 27 September 2021 (the last week with complete sequencing data), this sublineage accounted for approximately 6% of all sequences generated, on an increasing trajectory. This estimate may be imprecise … Further assessment is underway,” it noted.
Former U.S. Food and Drug Administration commissioner Scott Gottlieb also tweeted about the subtype at the weekend.
“U.K. reported its biggest one-day Covid case increase in 3 months just as the new delta variant AY.4 with the S:Y145H mutation in the spike reaches 8% of UK sequenced cases,” Dr. Gottlieb wrote. “We need urgent research to figure out if this delta plus is more transmissible, has partial immune evasion?”
The delta subtype, known formally as AY.4.2, is reported to be 10-15% more transmissible than the standard delta variant, but it is too early to say for certain whether it has been causing a spike in cases in the U.K.
Professor of immunology at Imperial College London, Danny Altmann, told CNBC on Monday that the subtype “needs to be monitored and, so far as possible, carefully controlled.”
“Because delta has now been the dominant mutant in several regions for some six months and not been displaced by any other variants, the hope has been that delta perhaps represented [the] peak mutation performance achievable by the virus. AY.4 may be starting to raise doubts about this assertion,” he warned.
The U.K. has often been seen as a harbinger of things to come for other countries during the pandemic, give the fact that the alpha variant was first discovered in Britain; it then became a dominant strain of the virus globally.
The same thing subsequently happened with the even more infectious delta variant, which was first found in India but then took hold in the U.K. before spreading around the world.