From vaccine roll out in January to abolishing tiers by Easter – how 2021 is the year we’ll defeat Covid

A COVID vaccine has changed everything – finally giving a silver lining to the end of this pandemic.

The roll-out of both the Pfizer and Oxford jab spells the end of the restrictions that have crippled the economy and people's mental health.



But change won't happen quickly, officials warn, and there is still room for more lockdowns.

Professor Jonathan Van-Tam, England's Deputy Chief Medical Officer, said we couldn't yet have a "massive party, throw our masks and hand sanitiser away and say it's behind us like the end of the war".

Dashing hopes of a speedy rollout for the whole nation, the top professor also said it will take "months not weeks" and warned that low uptake of the jab will "almost certainly make restrictions last longer".

Behaviour over the Christmas break will also have a “big impact” on how long it takes for life to return to normal, the lead researcher behind the Oxford jab has warned.

Sarah Gilbert, professor of vaccinology at the University of Oxford, said life could be “more or less” back to normal by next summer – but that depends on the severity of the outbreak in the new year.

But Prime Minister Boris Johnson says he has "high hopes" the vaccine would allow life to return to normal.

And the Health Secretary Matt Hancock said 2021 would give us a "summer we can enjoy".

So given the prospects of mass vaccination in Britain, how could 2021 pan out?

THE NEW YEAR

Before the majority of the population can get vaccinated, there is the winter to get through.

Professor Chris Whitty, the Chief Medical Officer for England, said this month that “for the next three months, I want to be very clear, we will not have sufficient protection”.

The PM said that it will be “long, cold months” before even all the most vulnerable are protected from the virus.

“So it’s all the more vital that as we celebrate this scientific achievement we are not carried away with over-optimism or fall into the naive belief that the struggle is over,” he told a press conference on December 2.

For now England is in a tiered system which restricts social contacts depending on how many cases there are in each area.

NHS bosses warned Boris Johnson that any relaxation of restrictions in England’s tier system may trigger a third wave.

And that would come at the busiest time of the year for hospitals, in January and February.

Prof Hunter said there are "big uncertainties" about the implications of having allowed families in some areas to get together for Christmas Day. 

He said: “Some increase in transmission is almost inevitable.

“Because schools are closed and many leisure venues will also be closed a Christmas surge should be containable. Clearly by January 14th, we will know who was right.”

Prof Hunter said: “After the start of the year we will start to see gradual relaxation of the restrictions probably starting by the end of January.”

This might look like a nationwide lift of certain rules, such as the 11pm curfew on pubs.

Or areas may be moved down the tier levels, with ministers reviewing whether areas need to move up or down the ranks every 14 days.

But Liam Smeeth, a professor of clinical epidemiology, London School of Hygiene and Tropical Medicine, said he thinks "a further circuit breaker in January or possibly February is likely to be needed", given the festive period.

The PM has said the legislation of the tiered system has a “sunset" clause – or expiry date – of February 3 – which is when MPs have the ability to vote it out.

SRING

Prof Hunter said if we relax too much in December and January, the epidemic will grow again and it will "elongate the crippling restrictions into the spring".

However, he said: “I am actually quite optimistic that by spring the worst will be behind us, providing we hold our nerve for the next six to eight weeks.”

Mass vaccinations will be in full swing across the UK by the spring time thanks to the approval of the Oxford and AstraZeneca vaccine this week.

Health Secretary Matt Hancock said the UK now has enough doses ordered to vaccinate the entire population.

He also said that the vaccine would mean the day on which restrictions are lifted can be brought forward.

 

NHS boss Simon Stevens said that the bulk of jabs for at-risk people who need it most will be done by April.

And the Chief Scientific Advisor, Sir Patrick Vallance, said on "V-day": "I would expect spring time, April, something like that, you would start to see some return towards normality."

Prof Hunter said: “As we move into spring and as vaccines are more widely taken up, I suspect that we will see more authorities moving into lower tiers and perhaps the appearance of a new Tier zero."

Currently only the Isle of Scilly is in Tier 1, the lowest level of restrictions that allows indoor mixing with other households.

Millions were plunged into Tier 3 and 4 restrictions from midnight – forcing pubs and shops to close for three quarters of the country.

Local authorities can apply for rapid coronavirus tests to screen thousands of people in order to speed up the process of moving out of Tier 3.

Mass testing did wonders for Liverpool, the city used for a pilot study of the "lateral flow tests".

How are the tiers decided?

Decisions on tiers are made by ministers based on public health recommendations informed by the following factors:

  • Case detection rate (in all age groups and, in particular, amongst the over 60s);
  • How quickly case rates are rising or falling;
  • Positivity in the general population;
  • Pressure on the NHS – including current and projected (3-4 weeks out) NHS capacity – including admissions, general/acute/ICU bed occupancy, staff absences; and
  • Local context and exceptional circumstances such as a local but contained outbreak.


Mr Johnson and his sidekick Professor Whitty have visions of Easter becoming the first opportunity to come out the worst Covid-19 restrictions. 

This optimism was further bolstered after the vaccine was approved, with Education Secretary Gavin Williamson saying Covid-19 will be defeated by the spring.

Mr Johnson said it was now “sure and certain” that life could start returning to normal in 2021, possibly by the spring.

But a combination of community testing, vaccines and social distancing measures were still necessary, he said.

“As we do all this we are no longer resting on the mere hope that we can return to normal next year, in the spring, but rather the sure and certain knowledge that we will succeed and together reclaim our lives and all the things about our lives that we love,” he said.

If MPs vote to keep the tier system, it will stay in place until the end of March.

SUMMER

Ministers have not given much indication of what they expect to happen from Easter onwards, but the general tone is promising.

The Health Secretary Matt Hancock said on BBC Breakfast on December 2, after the vaccine was approved: “I’m confident now with the news today that from spring, from Easter onwards, things are going to be better and we’re going to have a summer next year that everybody can enjoy.”

He even admitted a few days later he had already booked a holiday to Cornwall for summer 2021, saying: “I do have high confidence that the summer of 2021 will be a bright one without the sort of restrictions."

The Government’s coronavirus vaccine tsar has also predicted Britons will be able to go abroad on summer holidays next year.

Kate Bingham said that while the virus would never completely disappear, by the summer of 2021 “we should be in a much better place to get on planes”.

Prof McKee said: “I suspect we will be able to put the more severe restrictions behind us by next summer.”

With the potential of scrapping social distancing, it gives hope for gatherings of more than just a couple of dozen.

Next summer will be a “different world” for weddings and the event industry, Boris Johnson said on December 3.

Dr Scally said: "The ability to run major events involving large crowds will very much depend upon the level of cases being found in the community. "

He said there will be people who cannot get it due to clinical reasons, for example pregnant women.

There will also be those who chose not to take it, up to one quarter according to recent surveys.

"Thus, there will be plenty of opportunities for the virus to spread amongst the community", Dr Scally said.

Prof Hunter also said that as we move into summer, "we get better at spotting super spreader events early”.

This suggests events that give the virus the chance to spread rapidly, such as concerts, festivals and football matches, might still be dangerous territory.

However, ministers hope the rapid Covid tests will offer the return of "mass gatherings", by making sure those going are negative on the day of the event.

In the summer of this year, coronavirus cases dropped to their lowest levels, with single figure daily deaths. 

Experts say the virus is less able to spread in the summer climate; the heat and sunlight kills the virus, and people spend more time outside. 

However, the four months of restrictions from March to July probably contributed to the record low R rate. 

A YEAR’S TIME

It’s difficult to predict what state the UK and the rest of the world will be in by this time next year because it rests so heavily on what happens now.

Even if all goes swimmingly well, Prof Hunter said: “I'm quite convinced we will be seeing cases this time next year. Not so many I hope, or hospitalisations and deaths. But it will still be around.”

Prof Smeeth said ideally most of the population will be immunised by a vaccine by next winter.

"Life won’t ever be the same as it was before Covid-19, but it will feel a whole lot better than now", he said.

Of the other seven vaccine candidates under the Government's belt, the ones from Oxford University and Moderna are most likely to be approved next.

IN THE FUTURE

The World Health Organisation, echoed by a slew of experts, have said the virus is going to be with humanity forever – even if a vaccine is found, because it is so established now. 

On December 2, Prof Van-Tam admitted "we will never eradicate coronavirus", but urged Brits to take the jab if they want their dreams of a return to normal life to come true.

He added: "I think we may get to a point where coronavirus becomes a seasonal problem – I don't want to join too many parallels with flu – but possibly that is the kind of way we would learn to live it."

But in the absence of a vaccine, the disease would likely have become milder over time as people develop some natural immunity towards it.  

Like other coronaviruses, SARS-CoV-2 will most likely be seen as a cause of the common cold.

The "pandemic" tag will probably be dropped once enough immunity from vaccination has built up and the virus no longer remains a global threat – which will happen "in due course", Prof McKee said.

Experts suspect that mask wearing will remain prevalent, even if mandatory laws are dropped.

Dr Head said: “There may be some need for longer-term infection control measures, such as continuing to wear masks when entering a higher-risk environment such as hospitals."

Prof Hunter said: “It wouldn't surprise me even if face as rules are lifted, people will continue to wear them because they feel safer.”

Dr McKee said “we may never go back to exactly the same situation as before” in various aspects of life.

He said: “People have realised the benefits of working from home and not travelling to meetings that can be held on Zoom."

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