When will restrictions finally end?

[ChrisC]

A major contributor to current hospitalisation levels is the existence of treatments we didn't have in the first lockdown. People are surviving the disease in much higher proportions than they did back in March - thus inevitably involving a longer hospital stay than dying...

We have rather made a rod for our own backs by failing to explain this to the public. People are no less afraid (and thus just as supportive of restrictions), even though you are now much less likely to suffer serious consequences.

Whilst I don’t doubt what you say is true, it is understandable that people are no less afraid when they see the current figures for daily deaths over these last few days. I know it’s made me think a little bit more seriously about where I go and what I do. No point walking into trouble.

 

[brad465]

A major contributor to current hospitalisation levels is the existence of treatments we didn't have in the first lockdown. People are surviving the disease in much higher proportions than they did back in March - thus inevitably involving a longer hospital stay than dying...

We have rather made a rod for our own backs by failing to explain this to the public. People are no less afraid (and thus just as supportive of restrictions), even though you are now much less likely to suffer serious consequences.

Hopefully the longer hospital stays' issue will change with the two new treatments that have come into play which have been found to reduce intensive care stays by as much as a week.

 

[duncanp]

I’m not expecting much easement of restrictions for social gatherings until after 14th March (Mothering Sunday). The rise infections caused by Lots of people meeting up that day last year was one of the triggers of the first lockdown.
Though education and business activities could be eased before this.

Last year, Mother's Day was on March 22nd, two days after pubs and restaurants were closed, and one day before the lockdown started. So I can't see that Mother's day was not one of the main triggers for the first lockdown.

I would expect to see some easing of restrictions in February, if the vaccination target has been met, or is close to being met, and the figures for cases, hospitalisations and deaths have stabilised.

What could happen is the whole country is moved down to Tier 3, the main effect of which will be to see non essential shops and leisure centres re-open.

Then some time in March, on or near the time of the budget, or perhaps the anniversary of pubs being closed, the whole country is moved to Tier 2, possibly with a change to the definition of Tier 2 to allow pubs to open without having to serve meals.

Then Tier 1 could come after Easter, to precede the current end date for the furlough scheme.

The all remaining restrictions could be eased in stages over the summer.

I also hope we learn the lessons of this year, and make sure that school pupils, students and staff are prioritised for vaccination over the summer, so that there is no repeat of the situation where a return to education in the autumn is a trigger for a new wave of cases.

 

[hwl]

That would allow us to sustain rather higher infection levels than now, especially with these drugs shortening the ICU stay.
That would mean the wave would burn out fairly quickly simply because it would run out of people to infect.

We are at 1-in-45 now, at double that it's going to run out of targets quite quickly.

Even if reinfection becomes an issue it would buy us several months at least whilst we are still going to be administering ~2m doses a week.

Be interesting to see what a study of vaccination priorities optimising for reduced ICU-days occupied would look like.

Probably something like first dose only till a good proportion of the 18-64 group are covered but that could create a large problem later on with the gap between jabs at 3+ months. (We have no data on transmission reduction which should be a nice bonus when we have decent overall vaccination levels)
With the Moderna vaccine authorised and the US already looking at 12-18 age group usage that could be very useful for secondary schools post April.

There is also a circa 2 week time lag post vaccination before they show effectiveness (of any kind) but some in the government seem not to get this (Gove seems to be on the ball and gets the data)

Realistically there are still going to be large "tail" that cause problems for the NHS for 8-12 weeks longer than the most optimistic in government reckon. We just need to make sure it is a tail...

It looks like the government has just focused on the 65 age group as being the only problem and hoping the rest sorts itself.

I also suspect than many in government haven't got their head around the impact of the new variant being more transmissible and how this has changed all previous planning and assumptions.

Last year, Mother's Day was on March 22nd, two days after pubs and restaurants were closed, and one day before the lockdown started. So I can't see that Mother's day was not one of the main triggers for the first lockdown.

I would expect to see some easing of restrictions in February, if the vaccination target has been met, or is close to being met, and the figures for cases, hospitalisations and deaths have stabilised.

BoJo has already said schools back first.
The effect of vaccination and their strategy will be reduction seen in deaths first, then hospitalisation later and cases after that

What could happen is the whole country is moved down to Tier 3, the main effect of which will be to see non essential shops and leisure centres re-open.

I'd expect some places with better looking numbers and lower proportion of new stain cases to be released and some places will be deep trouble for quite while so one size fits all probably won't happen. e.g. Scilly Isles and Scottish Islands released first

Then some time in March, on or near the time of the budget, or perhaps the anniversary of pubs being closed, the whole country is moved to Tier 2, possibly with a change to the definition of Tier 2 to allow pubs to open without having to serve meals.

Then Tier 1 could come after Easter, to precede the current end date for the furlough scheme.

I'd expect some of the relaxation to take place weeks later than that.

The all remaining restrictions could be eased in stages over the summer.

Agreed

I also hope we learn the lessons of this year, and make sure that school pupils, students and staff are prioritised for vaccination over the summer, so that there is no repeat of the situation where a return to education in the autumn is a trigger for a new wave of cases.

Agreed. School pupils would need school age trials as US are doing with Moderna currently (12-18). [Pfizer is 16+]

Hopefully the longer hospital stays' issue will change with the two new treatments that have come into play which have been found to reduce intensive care stays by as much as a week.

The new treatments will help but the longer ICU etc stays in younger age groups is mostly due to those in older age groups passing away far more quickly resulting in the stay in the older age groups being lower for that reason.

 

[brad465]

Clearly Mother's Day is important to you, and therefore I understand your frustration. I don't think I've ever heard it mentioned by anybody else though in the context of last year or this. I dearly love my mother but I don't think I've seen her on Mother's Day for 25 years. Is it really a big thing?

Actually I don't take it too seriously, but I'm thinking more in the mind of what the general population might think, where once we come across key occasions that couldn't be celebrated last year and can't be properly celebrated again, more of the population will be questioning how long this can go on for. The rollout of a vaccine will enhance those thoughts. Mothers day is perhaps a smallish one, Easter a bit more so, but these will also be triggers for questioning the key events in the summer that boost seasonal tourist incomes and wellbeing, which for many can't survive 2 years in a row out of action.

 

[PTR 444]

My estimate, based on no evidence other than reading the news, is:

1) restrictions eased w/c 22 Feb. (Schools back, some other easements)
2) back into Tiers a couple of weeks later
3) most of country back to Tier 1 (or less) by easter

1. Agree with you there, although I can see secondaries and colleges remaining closed for another couple of weeks to reduce transmission.
2. I think this would be more likely to happen towards the end of March (first lockdown anniversary perhaps).
3. This could be possible as long as transmission is very low.

If things go really well, I think that a tier 0 should be introduced later in April or May which would allow the following freedoms:

• Rule of 6 increased to rule of 30.
• Wearing face masks indoors no longer mandatory.
• Up to 10,000 spectators allowed at sporting events.
• Concerts and festivals allowed to go ahead with mass testing and maximum capacity of 10,000.

 

[HSTEd]

The new treatments will help but the longer ICU etc stays in younger age groups is mostly due to those in older age groups passing away far more quickly resulting in the stay in the older age groups being lower for that reason.

If ICU beds are limiting then it is a big deal

But honestly I expect ICU to be swamped anyway, at which point I am not convinced that diverting doses to medical staff is a good move.
A few more doctors and nurses (even if they instruct vaccinated staff to ignore any COVID symptoms and not self isolate before a test result) will make no difference.

Those millions of doses could save tens of thousands of people ending up there in the first place

 

[HST43257]

I’d restructure the tiers like this after this lockdown ends in February/March. No area would start any lower than tier 3. I’d also try to make it so larger areas were together in the same tier, for example all of Yorkshire as 1 tier. This is so you don’t have a situation like we’ve just had where York had a large spike as Tier 3 residents in the rest of Yorkshire came to York, which was in Tier 2.


Tier 1

• Rule of 6 indoors and outdoors
• Pubs and Restaurants open with alcohol sales , with max. 2 households in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 10,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 2

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open without alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 5,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 3

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open for meals with no alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed but advised against
• Schools open at a level that enables Social Distancing
• Non Essential Shops open
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 4

• No indoor meeting outside of support bubble - Rule of 2 outdoors
• Pubs and Restaurants open for Takeaway and Delivery only
• Essential Travel only
• Schools open at a level that enables Social Distancing
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 5

• No meeting of people allowed indoors or outdoors outside of support bubble
• Pubs and Restaurants closed
• Essential Travel only
• Schools closed with exceptions
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

 

[DB]

I’d restructure the tiers like this after this lockdown ends in February/March.


Tier 1

• Rule of 6 indoors and outdoors
• Pubs and Restaurants open with alcohol sales , with max. 2 households in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 10,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 2

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open without alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 5,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 3

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open for meals with no alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed
• Schools open at a level that enables Social Distancing
• Non Essential Shops open
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 4

• No indoor meeting outside of support bubble - Rule of 2 outdoors
• Pubs and Restaurants open for Takeaway and Delivery only
• Essential Travel only
• Schools open at a level that enables Social Distancing
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 5

• No meeting of people allowed indoors or outdoors outside of support bubble
• Pubs and Restaurants closed
• Essential Travel only
• Schools closed with exceptions
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

No.

We don't need a load of variations on confusing rules, with poiticians moving areas between tiers every five minutes and businesses not knowing whether they would be ordered to close with no notice - as would happen.

At most, a restriction on gatherings above a specified number, for a short time - that should be it.

The furlough scheme has to be rolled back, and that cannot happen until businesses can operate normally.

 

[yorksrob]

I’d restructure the tiers like this after this lockdown ends in February/March. No area would start any lower than tier 3. I’d also try to make it so larger areas were together in the same tier, for example all of Yorkshire as 1 tier. This is so you don’t have a situation like we’ve just had where York had a large spike as Tier 3 residents in the rest of Yorkshire came to York, which was in Tier 2.


Tier 1

• Rule of 6 indoors and outdoors
• Pubs and Restaurants open with alcohol sales , with max. 2 households in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 10,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 2

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open without alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 5,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 3

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open for meals with no alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed but advised against
• Schools open at a level that enables Social Distancing
• Non Essential Shops open
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 4

• No indoor meeting outside of support bubble - Rule of 2 outdoors
• Pubs and Restaurants open for Takeaway and Delivery only
• Essential Travel only
• Schools open at a level that enables Social Distancing
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 5

• No meeting of people allowed indoors or outdoors outside of support bubble
• Pubs and Restaurants closed
• Essential Travel only
• Schools closed with exceptions
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

I think that for anything short of full lockdown, pubs should be allowed to serve beer in a socially distanced setting. The variation should perhaps be in how many households are allowed to meet.

 

[HST43257]

I think that for anything short of full lockdown, pubs should be allowed to serve beer in a socially distanced setting. The variation should perhaps be in how many households are allowed to meet.

You’re probably right, though I’d be tempted to limit it to 1-2 pints per person or something. If people are getting drunk then social distancing will most likely be forgotten.

 

[bengley]

You’re probably right, though I’d be tempted to limit it to 1-2 pints per person or something. If people are getting drunk then social distancing will most likely be forgotten.

Lol 1-2 pints per person....

No.

 

[yorksrob]

You’re probably right, though I’d be tempted to limit it to 1-2 pints per person or something. If people are getting drunk then social distancing will most likely be forgotten.

Lol 1-2 pints per person....

No.

Maybe until they start singing !

 

[52290]

You’re probably right, though I’d be tempted to limit it to 1-2 pints per person or something. If people are getting drunk then social distancing will most likely be forgotten.

If you're drinking Thwaites Mild at 3.3% abv then you will be nowhere near drunk after two pints but you might be after two pints of Robinsons Old Tom at 8.5%.

 

[Bald Rick]

You’re probably right, though I’d be tempted to limit it to 1-2 pints per person or something. If people are getting drunk then social distancing will most likely be forgotten.

Mine’s a Chablis. 2 pints please.

 

[hwl]

Mine’s a Chablis. 2 pints please.

We used to do this for student curry house visits, far easier to win downing contests with white wine than beer (especially lager)

 

[Bald Rick]

1) Agree they will get the schools back after half term but will be testing pupils first to minimise schools case rates. They are non realising the scale of impact of schools and other education on spread so not much wriggle room for much else unless in more rural settings

Others - it will be a while longer I think, as above 40% of current hospitalisations are in the 18-64 age groups that groups will be unvaccinated and if restrictions are reduced more likely to go out and transmit or catch it. Most have focused on the 65+ age group with ~60% of hospitalisations as the major issue but that still leaves another big one.
Agree on the tapering back down through tiers when it does happen. I can see them wanting to avoid large events for quite a while.

Is there any data on the pre-existing conditionof those admitted to hospital in the 18-64 age group? I can’t find any for admissions, only for deaths. That shows that of the 50,000 or so people who have died in hospital from Covid 19 (up to 31 December), only 394 (0.8%) were under 60 and had no underlying health condition. If hospital admissions follow a similar proportion, the vaccination of those in that age group with existing health conditions should go some way to solving this. They are the 6th priority, and would be donein late Feb - mid March; add a couple of weeks for immunity to build, another couple for that to feed through into reduced illness, and that’s Easter...

We used to do this for student curry house visits, far easier to win downing contests with white wine than beer (especially lager)

Me too! And, oddly, hangovers not as bad.

 

[DB]

but you might be after two pints of Robinsons Old Tom at 8.5%.

Or some of that frankly revolting stuff with very high ABV which Brewdog produces!

 

[duncanp]

Lol 1-2 pints per person....

No.

1 - 2 pints in the first pub,

then another 2 pints in the second one,

then another 2 pints in the third one......

 

[Ianno87]

You’re probably right, though I’d be tempted to limit it to 1-2 pints per person or something. If people are getting drunk then social distancing will most likely be forgotten.

Lol 1-2 pints per person....

No.

1 - 2 pints in the first pub,

then another 2 pints in the second one,

then another 2 pints in the third one......

Exactly, imposing a pint limit simply encourages turnover of customers and thus more transmission.

 

[Yew]

You’re probably right, though I’d be tempted to limit it to 1-2 pints per person or something. If people are getting drunk then social distancing will most likely be forgotten.

Is there any evidence that more drinks increases spread?

1 - 2 pints in the first pub,

then another 2 pints in the second one,

then another 2 pints in the third one......

Easy obvious solutions have easy and obvious problems.

 

[Bald Rick]

1 - 2 pints in the first pub,

then another 2 pints in the second one,

then another 2 pints in the third one......

Not of Chablis. That would hurt.

 

[duncanp]

Exactly, imposing a pint limit simply encourages turnover of customers and thus more transmission.

And imposing a time limit encourages people to drink faster.

It would be better, when pubs do reopen, to have some general advice about limiting the number of different pubs you visit, and perhaps try to encourage people to visit at less busy times.

 

[takno]

I’d restructure the tiers like this after this lockdown ends in February/March. No area would start any lower than tier 3. I’d also try to make it so larger areas were together in the same tier, for example all of Yorkshire as 1 tier. This is so you don’t have a situation like we’ve just had where York had a large spike as Tier 3 residents in the rest of Yorkshire came to York, which was in Tier 2.


Tier 1

• Rule of 6 indoors and outdoors
• Pubs and Restaurants open with alcohol sales , with max. 2 households in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 10,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 2

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open without alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 5,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 3

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open for meals with no alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed but advised against
• Schools open at a level that enables Social Distancing
• Non Essential Shops open
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 4

• No indoor meeting outside of support bubble - Rule of 2 outdoors
• Pubs and Restaurants open for Takeaway and Delivery only
• Essential Travel only
• Schools open at a level that enables Social Distancing
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 5

• No meeting of people allowed indoors or outdoors outside of support bubble
• Pubs and Restaurants closed
• Essential Travel only
• Schools closed with exceptions
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

Great. Another list of pointless rules without any justification or basis. I might skip reading this one if it's all the same, since I'm never even going to have to live under it

 

[Mag_seven]

No fans allowed at spotting events

Have you designed this with enthusiasts in mind?

 

[hwl]

Is there any data on the pre-existing condition of those admitted to hospital in the 18-64 age group? I can’t find any for admissions, only for deaths. That shows that of the 50,000 or so people who have died in hospital from Covid 19 (up to 31 December), only 394 (0.8%) were under 60 and had no underlying health condition. If hospital admissions follow a similar proportion, the vaccination of those in that age group with existing health conditions should go some way to solving this. They are the 6th priority, and would be done in late Feb - mid March; add a couple of weeks for immunity to build, another couple for that to feed through into reduced illness, and that’s Easter...

Not sure but I'll enquire with a few doctors I know running covid critical wards.
The general picture I'm getting deaths are very correlated with underlying conditions but the definition of an underlying condition is low so the that the this may not be that meaningful (half of 50 year olds would have at least one).

The is some interesting research that suggested lots of ICU admissions were genetically linked:

Covid: Genes hold clues to why some people get severely ill

A study has identified genes that provide clues about why some people get seriously ill from Covid-19.

www.bbc.co.uk

A previous study had noticed an increased rate of serious cases with the same (genetic) IL6 receptor issues seen in some rheumatoid arthritis cases which lead to the trials of IL6 antagonists Tocilizumab and Sarilumab that were reported this week to cut death rates in ICU by 8.5% or a quarter of overall ICU deaths

Two more life-saving Covid drugs discovered

The drugs, which save an extra life for every 12 intensive care patients treated, can be used immediately, say experts.

www.bbc.co.uk

Me too! And, oddly, hangovers not as bad.

Indeed

 

[NorthOxonian]

The is some interesting research that suggested lots of ICU admissions were genetically linked:

Covid: Genes hold clues to why some people get severely ill

A study has identified genes that provide clues about why some people get seriously ill from Covid-19.

www.bbc.co.uk

Is it possible to screen people for the genes which have are most linked to risk of ICU admission, and bump those up the priority list for the vaccine?

 

[HLE]

I’d restructure the tiers like this after this lockdown ends in February/March. No area would start any lower than tier 3. I’d also try to make it so larger areas were together in the same tier, for example all of Yorkshire as 1 tier. This is so you don’t have a situation like we’ve just had where York had a large spike as Tier 3 residents in the rest of Yorkshire came to York, which was in Tier 2.


Tier 1

• Rule of 6 indoors and outdoors
• Pubs and Restaurants open with alcohol sales , with max. 2 households in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 10,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 2

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open without alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed
• Schools fully open
• Non Essential Shops open
• Leisure Facilities open
• 5,000 Fans/Half capacity (whichever is lower) allowed at sporting events

Tier 3

• No indoor meeting outside of support bubble - Rule of 6 outdoors
• Pubs and Restaurants open for meals with no alcohol sales, with max. 1 household in a booking
• Non Essential Travel allowed but advised against
• Schools open at a level that enables Social Distancing
• Non Essential Shops open
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 4

• No indoor meeting outside of support bubble - Rule of 2 outdoors
• Pubs and Restaurants open for Takeaway and Delivery only
• Essential Travel only
• Schools open at a level that enables Social Distancing
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

Tier 5

• No meeting of people allowed indoors or outdoors outside of support bubble
• Pubs and Restaurants closed
• Essential Travel only
• Schools closed with exceptions
• Non Essential Shops closed
• Leisure Facilities closed
• No fans allowed at spotting events

So you'd have leisuire facilities closed (assume golf courses, tennis clubs included in that) but open indoor facilties like pubs and card shops? Assume that's a typo, if not that's absurd logic.

 

[hwl]

Is it possible to screen people for the genes which have are most linked to risk of ICU admission, and bump those up the priority list for the vaccine?

Not at anywhere near the rate we would need to do it. We haven't even worked out all the genes to look for yet. Some of it is at the level of :

The Genomicc study - and several others - has revealed a cluster of genes on chromosome 3 strongly linked to severe symptoms. However, the biology underpinning this is not yet understood.

And we are theoretically better at it that almost all other countries.

15% alone were related to 1 gene which controls Interferon, which the Southampton Uni spinout has been working on.

 

[Richard Scott]

Indeed, I know of three households that have had an infected person in them isolating and no other members of the household have caught it (tested negative)

On speaking to my neighbour's that's happened in at least three households around here.