New Coronavirus News from 21 Oct 2021

UK government accused of being 'willfully negligent' as Covid cases mount [CNN, 21 Oct 2021]

By Rob Picheta

London (CNN)Britain's doctors' union has accused Boris Johnson's government of being "willfully negligent" in its handling of the latest wave of the Covid-19 pandemic, as ministers refuse to introduce mitigation measures despite the country recording more than 50,000 new infections on Thursday.

The United Kingdom has recently registered far more cases than most of Europe, and its rates of hospitalizations and deaths have failed to substantially decline since the summer, when the country lifted almost all of its remaining restrictions.

On Thursday it reported 52,009 new infections, the highest mark since July.

The government has nonetheless ruled out moving to its "Plan B" approach, which would see the introduction of vaccine passports and mandates in line with many European countries.

"We are sticking with our plan," Boris Johnson said Thursday. "The numbers of infections are high but we are within the parameters of what the predictions were."

But in a scathing intervention on Wednesday, the British Medical Association (BMA) said Johnson's government "has taken its foot off the brake, giving the impression that the pandemic is behind us and that life has returned to normal."

"It is willfully negligent of the Westminster Government not to be taking any further action to reduce the spread of infection, such as mandatory mask wearing, physical distancing and ventilation requirements in high-risk settings, particularly indoor crowded spaces," it said.

"These are measures that are the norm in many other nations."

Britain's Health Secretary Sajid Javid admitted on Wednesday that cases could reach 100,000 a day this winter, but said the government would not implement its Plan B measures "at this point."

The number of patients admitted to hospitals in the UK has been steadily increasing since the beginning of October, though it remains far below the wave of infections last winter that forced a lengthy nationwide lockdown.

"Thanks to the vaccination program, yes the link between cases and hospitalizations and deaths has significantly weakened. But it's not broken," Javid said at a news conference on Wednesday. "This pandemic is not over," he added.

But the BMA said the country is "rapidly approaching a position where, yet again, the Government is delaying for too long, and equivocating over taking action."

"This is the time to learn the lessons of the past and act fast, or else we will face far more extreme measures later," the body said.

Its warning followed a similar message by the NHS Confederation, which represents providers of the country's National Health Service (NHS). Last month was the busiest September in the history of the service, according to official figures, and there are fears that the winter months will again push its hospitals towards capacity.

Almost 140,000 people have died due to Covid-19 in the UK, according to official figures, the worst death toll in western Europe and the eighth highest globally.

In July, Prime Minister Johnson controversially ended England's remaining pandemic restrictions. Pubs, bars and large events have been able to operate as normal there since, without a vaccination requirement or a requirement that people wear masks. But infections have failed to decline markedly since then and now are spiking.

Despite a swift start to vaccinating its population, the UK now has the 13th highest vaccine rate in Europe and the government has faced criticism over the speed of its booster shot program and the availability of vaccines for 12 to 17-year-olds.

Cuts to overseas aid thwart UK efforts to fight Covid pandemic [The Guardian, 21 Oct 2021]

By Patrick Wintour

Government watchdog finds £3.5bn cut has damaged attempts to tackle virus in poorer countries

Cuts to the government’s overseas aid budget of more than £3.5bn have undermined the quality of the UK’s efforts to slow the global Covid-19 pandemic, ministers’ own aid spending watchdog has found.

It is the first official UK assessment of how the cuts to the Official Development Assistance (ODA) budget have damaged the British contribution to the fight against Covid in poorer countries, with a number of such programmes having been “reduced or closed, increasing the burden on developing countries and placing vulnerable groups at increased risk”.

As a result, the Independent Commission for Aid Impact (ICAI) says, the “ability of the UK aid programme to respond flexibly to the evolving pandemic has been reduced”.

The report, looking into the first 16 months of ministers’ response to Covid, finds that from November 2020 the “scale of the budget cuts required to meet the reduction of the aid spending target from 0.7% to 0.5% of UK gross national income meant that many areas of aid spending linked to the pandemic response were affected”.

It says decisions on where to cut “were mostly taken centrally, with overseas networks and spending teams closest to the programmes providing advice. They did not always reflect the substantial volume of evidence and analysis on pandemic-related risks and vulnerabilities that had been collected”.

It points out that by March 2021, one year into the pandemic, the UN had estimated that 12 million women had seen interruption in their access to contraceptives, leading to 1.4 million unwanted pregnancies.

Yet the report points out that in April 2021 the UK government announced its decision to reduce funding by 85% to UNFPA Supplies Partnership, the UN’s flagship programme focused on expanding access to reproductive health services.

The report concludes: “Programmes that would have mitigated the long-term damage of the pandemic … have been reduced or closed, as well as long-term investments delivering good value for money, which have been ended.”

It cites a 27% decrease in funding for “social safety nets” for Syrian refugee families in Jordan as another example of a cut that went against the available guidance. The report warns that it is not yet clear how much of the vaccine help given by the UK will qualify as ODA or instead have to come from other budgets.

The report points out that as of October 2021 less than 2% of the populations in Sudan and Zambia have been vaccinated. It also says too many specialist staff were mandated to return to the UK at a time when their skills were needed. Development staff were reallocated to work on consular issues for British nationals.

The ICAI commissioner, Sir Hugh Bayley, said: “The Covid-19 pandemic has reversed development gains made in many of the world’s poorest countries, pushing an additional 97 million people into extreme poverty.

“The UK’s early aid response was strong and made an important contribution to global efforts to develop vaccines. It is important that the government now builds on this to accelerate the supply of Covid-19 vaccines to developing countries and to ensure they are used to protect the most vulnerable people.”

The report says ministers pivoted funds and rapidly allocated £733m of UK aid by mid-April 2020, making the UK one of the largest donors during the early phase of the international response.

But it says the distribution of vaccines to poor countries has been disappointing and this, coupled with the challenges of delivery within vulnerable countries, “highlights the need for the UK to continue to build on its initial investment”.

Morocco bans UK flights due to Covid cases rising [BBC News, 21 Oct 2021]

By Caroline Davies

Morocco has banned flights to and from the UK due to the coronavirus pandemic.

Several UK airlines and holiday companies have been told by the Moroccan government that flights will be suspended from 23:59 BST on Wednesday until further notice.

Flights between Morocco and Germany and the Netherlands have also been suspended.

The BBC has contacted the Moroccan embassy and tourism office, as well as the UK Foreign Office for comment.

Latest figures from the European Centre for Disease Prevention and Control said that Morocco's weekly rate of reported coronavirus cases on 14 October stood at 10.4 per 100,000 people, compared with 445.5 per 100,000 people in the UK.

On Tuesday, the UK reported 43,738 new Covid-19 infections, with new cases above 40,000 for seven days in a row. The number of patients in hospital rose by 10% in a week to 7,749 on Monday.

Another 223 deaths were recorded, the largest number since March, although daily figures are often higher on Tuesdays.

The UK government updated its advice on travel to Morocco to state that the Moroccan government has suspended direct flights between the UK and Morocco for an unspecified period of time.

UK passengers are not banned from travelling from the country, but must travel via a third country to do so.

The advice states that UK travellers will need to provide proof that they have been fully vaccinated for at least two weeks or a negative PCR test taken no more than 48 hours before boarding.

They will also be asked to present a Public Health Passenger form to the Moroccan authorities on arrival.

Airline cancellations
EasyJet has said that it was told this morning. It has cancelled its outbound flights from the UK, Germany and Netherlands to Morocco until 30 November.

The airline had two flights operating from Manchester and Gatwick to Marrakech, which it will operate as "ferry flights" for return customers due to travel back to the UK today.

It said that, ahead of receiving further guidance from the Moroccan government, it intends to fly inbound flights in the coming days as repatriation flight options.

"We are contacting all customers whose flights are cancelled with their options, which include a free of charge transfer, receiving a voucher or a refund," an EasyJet statement said.

British Airways has cancelled a flight from Heathrow to the same destination, meanwhile holiday operator Tui confirmed it had also been contacted by the Moroccan government.

Tui said: "We are contacting customers in departure date order to discuss their options, which include amending to another destination or a full refund. We would like to thank our customers for their patience and understanding during this time."

The tour operator said it currently has about 2,000 UK travellers in Morocco, but hasnot yet confirmed whether it will need to bring these passengers back early.

The flight ban will affect families in England and Wales who booked half-term holidays in Morocco for next week.

Morocco's National Office of Airports said the policy will remain in place "until further notice".
The UK's Foreign Office has updated its advice on travel to Morocco to include the latest development.

It says that passengers returning to the UK from Morocco should contact their airline or tour operator to arrange an alternative route via a third country, such as Spain or France, where flights are operating as normal.

'I don't feel confident travelling abroad'
Alison Sedgewick is currently on holiday in Agadir, off the south-western coast of Morocco, with her husband and son.

On Thursday, they were due to return from their first holiday in the two and a half years since her son was born.

"You couldn't write it… the one week we've chosen to go away and they've closed the borders while we're here," she said.

However, Ms Sedgewick added she felt hopeful that because she booked a package holiday with Tui, things would get sorted out swiftly. She said she received a "holding message" from the tour operator, telling her she will hear more information within 24 hours.

"I'm hoping it'll be a bit sooner than that because the bus to the airport is supposed to be picking us at half six tomorrow evening," she added.

While she joked that her main concern is ensuring she doesn't run out of nappies for her son, Ms Sedgewick said she did feel put off the idea of travelling during the upcoming winter months.

"We debated doing a city break in November or December but I don't feel confident travelling abroad over winter because things like this might become more common," she said.

'Not very encouraging'
Meanwhile, Peter Mercer, the owner of the Dar Zaman boutique hotel in Marrakech, said that several guests were "rushing around" and attempting to return to the UK on Wednesday before the ban came into place.

"It's going to have a major impact, not just from the UK but also the flights from Germany and the Netherlands," he said.

"It's not very encouraging because we're suddenly back to where we were in March 2020. In terms of our business model, it is worrying. People perhaps will lose faith in travel because restrictions can be imposed with little notice."

While Mr Mercer said that he agrees with the Moroccan government's actions to reduce the spread of coronavirus, he hopes any restrictions on travel will be short-term.

Fading vaccine immunity threatens Britain’s restriction-free co-existence with COVID-19 [Sydney Morning Herald, 21 Oct 2021]

By Bevan Shields

London: Fading vaccine immunity is fuelling a spike in coronavirus cases in Britain, with the country’s early rollout success now working against it.

Weeks from the onset of winter, infection and hospitalisation rates in the United Kingdom are more than six times higher than large nations in Europe, while the death rate is three times greater.

The “unusual and slightly worrying” situation, as described by Health Security Agency head Jenny Harries on Wednesday, looms as a test of the government’s determination to live with the virus and keep its economy and society functioning as normal. It will also be closely monitored by other countries that started their inoculation programs much later than the UK and might soon encounter their own waning immunity complications.

New cases hit 44,000 on Wednesday — up 16 per cent on the previous week. Most were detected in children and younger adults.

Warning daily infections could soon rise to 100,000, Health Secretary Sajid Javid resisted calls for the government to implement its “Plan B” winter contingency which would reintroduce some restrictions such as mandatory indoor mask-wearing.

“This pandemic is not over,” Javid said. “Thanks to vaccinations, the link between cases, hospitalisations and deaths has significantly weakened but it is not broken.

“We must all remember this virus must be with us for the long term, and it remains a threat to our loved ones and the progress we’ve made to getting our nation closer to normal life.”

Experts stressed the AstraZeneca, Pfizer and Moderna vaccines were still hugely effective at preventing the vast majority of hospitalisations and deaths, but there was growing evidence that protection from catching the virus wanes six months after a second shot.

The Financial Times calculated that 75 per cent of older people in the UK had gone five months since their second jab, compared to 35 per cent in Italy and France.

Mask-wearing is also much less common in Britain than on the continent. However, in Scotland, where masks are compulsory in public venues and schools, case rates are higher than in England, where face coverings are not.

Asked why it did not make sense to make masks mandatory in English venues, Javid replied: “We still feel it was the right decision to try to learn to live with this virus.”

NHS England medical director Professor Steve Powis said concerns about fading immunity should not discourage people from getting their first and second dose, and a booster shot if over 50 years of age or clinically vulnerable.

“It’s a natural phenomenon that immunity reduces over time - it will occur,” he told reporters.
“And that’s exactly why we are recommending a booster dose is an important part of our armament particularly as we go into winter.”

The UK has rolled out about 4 million booster jabs but has faced criticism it has moved too slowly on that program and the rollout of vaccines to children.

Overall, 79 per cent of people aged 12 and over in the UK have had two doses.

Eastern Europe is also battling a surge in infections, with funeral directors in Romania unable to keep up with demand. On Wednesday, Russian President Vladimir Putin endorsed a week-long workplace shutdown to curb fatalities.

The Russian government earlier announced a record 1028 deaths for the previous 24 hours, although the true figure is thought to be much higher.

Romania is registering 19 daily deaths per million people - one of the highest rates in the world and 10 times higher than the rate in Britain.

Deaths in the UK are hovering at an average of 140 per day.

As the northern winter approaches, medicos are worried about a perfect storm of high coronavirus cases, resurgent flu season and huge backlog of procedures caused by lockdowns in 2020 and 2021.

About 8000 people are in hospital with COVID - nowhere near the deadly first and second waves and well below what the government’s expert advisory committee had projected for this time of year.

Two doses of the Pfizer or AstraZeneca vaccine are estimated to be 96 per cent and 92 per cent effective against hospitalisation with the Delta variant, respectively.

Paul Moss, a professor of haematology at the University of Birmingham’s Institute of Immunology, said reinfection was “something that will have to live with society around the world”.

“What we’re seeing is that the antibody levels after the second vaccine are waning. There’s some evidence we’re seeing about a four-to-fivefold fall after the second vaccine over several months, and we are seeing a slight increase in breakthrough infections.

“But what’s relatively reassuring is protection against very severe illness and death remains very high.”

Moss said the severity of reinfection was less severe because people have built up immunity and antibodies.

Russia orders new business shut-down amid record daily COVID-19 deaths [CBS News, 21 Oct 2021]

BY MARY ILYUSHINA

Moscow — Russian President Vladimir Putin told his country's employers on Wednesday that they would have to shut down again for a week from the end of October — the most dramatic step by his government in months aimed at stemming the country's surging coronavirus epidemic. During a meeting with senior officials, Putin backed a proposal to mandate "non-working" days from October 30 until November 7.

Workers will be paid during the shutdown, Putin said, as he ordered an expansion of COVID-19 testing to try and more efficiently identify virus cases.

"Our main task now is to protect the lives of citizens and, as far as possible, minimize the spread of coronavirus infection," Putin said.

He announced the new measure shortly after Russia announced yet another record number of daily coronavirus deaths, and a day after the Kremlin accepted, for the first time, a "share of responsibility" for the country's lackluster vaccination campaign.

Only about 32% of Russia's total population is fully vaccinated against COVID-19, according to official data, despite the shots being widely available since the beginning of the year. About 57% of Americans are fully vaccinated, by comparison.

The halting uptake of vaccines in Russia has kept hospitalization and death rates high. Russia reported 34,073 new COVID-19 infections on Wednesday and set a grim new record with 1,028 fatalities. The United Kingdom, in contrast, where about 66% of the population is fully vaccinated, is still seeing very high daily case numbers — over 40,000 each day for about a week — but the daily death toll from the virus has hovered for weeks around 150.

"There is a tradition to blame the government for everything," Kremlin spokesperson Dmitry Peskov told reporters on a Tuesday conference call. "Of course, the government always feels and acknowledges its share of responsibility."

Peskov accepted that "not everything that needed to be done was done in terms of the information campaign of the lack of alternatives to and the importance of vaccination," but he added that "a more responsible approach is required from all citizens of the country."

Mistrust of the vaccines has been widespread in Russia, fueled in part by officials appearing on state television early in the pandemic and downplaying the seriousness of COVID-19.

The majority of Russia's regions have seen case numbers rise fast since September, prompting authorities to revert to stricter control measures.

During a government meeting on Tuesday, Deputy Prime Minister Tatiana Golikova appealed to Putin to make the week starting October 30 a "non-working" week, to keep people at home in a bid to slow the spread of the virus. In confirming his decision to enact the plan on Wednesday, Putin ordered officials in regions with particularly high case rates to assess the situation bring in the business closures even sooner, from October 23.

The capital accounts for 21% of Russia's more than 8 million officially reported cases.
Moscow's mayor has announced plans to reintroduce remote working, along with a vaccination mandate for workers in service industries, and other measures, from next week. All employers will be obliged to have at least 30% of their staff work from home for the next four months, until February 25, 2022, Mayor Sergey Sobyanin wrote on his website.

Employees who have been vaccinated or recovered recently from a COVID infection, along with medical and other critical workers, will be exempt from the requirements.

According to Sobyanin, the number of new cases being registered in the Moscow region since the summer has increased four-fold, and the number of hospitalizations tripled.

"I'm well aware of how tedious and uncomfortable the current restrictions are, but there's simply no other way to protect you from serious illness," he wrote, adding a targeted appeal to older Muscovites, whom he said had been reluctant to get the shots.

"Please get vaccinated. That's how you will protect your health and be able to maintain your usual lifestyle," the mayor said.

The tightening of restrictions in the capital area comes as most of Russia's federal 85 regions introduce vaccine mandates for various groups. Digital passes, to show vaccination or COVID test status via a QR code on personal phones, are also required to access many public venues across the country.

UK health experts urge government to implement covid 'Plan B' [The Washington Post, 21 Oct 2021]

By Annabelle Timsit

Public health experts in the United Kingdom are calling on the government to reintroduce some coronavirus restrictions as cases climb — far outstripping those of its Western European neighbors — despite the country’s high vaccination coverage.

The U.K.’s coronavirus case count could rise to as high as 100,000 a day, Health Secretary Sajid Javid said at a news conference Wednesday. But that was not grounds for the government to abandon its “Plan A,” he said, and impose more restrictions — at least not yet.

“We think it is the right decision to learn to live with this virus,” such as “asking people to take more responsibility” for measures such as masks and vaccinations, Javid said.

Other public health experts warn that Britain is, once more, facing a critical juncture: impose restrictions now before this wave becomes too big to contain.

“We are right on the edge — and it is the middle of October,” Matthew Taylor, chief executive of the National Health Service Confederation, a group representing the health-care systems in England, Wales and Northern Ireland, told the Guardian newspaper Tuesday. “It would require an incredible amount of luck for us not to find ourselves in the midst of a profound crisis over the next three months.”

Prime Minister Boris Johnson ended the lockdown in England on July 19, declaring it “Freedom Day.” Since then, the country has lifted most restrictions, with no legal mask requirement in most settings, including schools, and nothing approaching a universal vaccine mandate, in sharp contrast with some other European countries.

How vaccine-skeptic France and Germany came to support near-mandates
In a speech in September laying out his government’s plan for autumn and winter, Johnson said he would like things to continue that way, with an emphasis on promoting vaccinations, booster doses and frequent testing, rather than reintroducing restrictions. However, he outlined a pandemic “Plan B” that he said could be necessary if the publicly funded NHS became overwhelmed. Some restrictions could then be introduced, including advising people to work from home, legally mandating face coverings in certain settings again, and bringing about mandatory covid passports.

Now, as the United Kingdom this week recorded its highest number of deaths from the coronavirus since March, health experts are warning of a “winter crisis” and have begun urging the government to not just implement “Plan B” — but to go further with “Plan B Plus.”

The government should ensure “clear communications to the public that the level of risk has increased,” Taylor’s organization said in a news release, and call on the public to “mobilise around the NHS and do whatever they can to support frontline services this winter,” including by getting booster shots and volunteering.

“Many of these measures, particularly around mask-wearing and covid-19 certification, are already common in parts of Europe where the prevalence of the disease is lower,” the group added.

However, the government, which has been keen to reopen the economy, has insisted that its approach is working. Business Secretary Kwasi Kwarteng said Wednesday that it was not the time for Plan B, adding: “What we want to do is manage the situation as it is — we don’t want to go back into lockdown and further restrictions. I would rule that out.”

The Cabinet Office said in an emailed statement: “The vaccination programme has significantly weakened the link between cases, hospitalisations and deaths and will continue to be our first line of defence against COVID-19.”

“We always knew the coming months would be challenging, which is why we set out our plan for Autumn and Winter last month.”

UK faces calls for ‘Plan B’ with virus cases high and rising
Daily case numbers are the highest they have been since July — 49,156 people were reported to have tested positive for the coronavirus in Britain on Monday. And “the problem is a lot worse than the daily figures suggest,” said Robert West, a professor of health psychology at University College London who is part of the government’s Scientific Pandemic Insights Group on Behaviors.

This is because not everyone who has contracted the virus is aware of it, particularly if they do not have symptoms, and some people may test positive but not report their result to public health bodies. The Office for National Statistics estimates that the true number of infections in England, in the week ending on Oct. 9, was closer to 1 in 60 people in the country.

And while hospitalizations and deaths remain low, they are climbing. According to the government, in the United Kingdom as a whole, 954 people were recorded to have died of covid-19 in the past seven days, a 21 percent week-on-week increase, while 6,074 people were reported to have been admitted to a hospital because of covid-19 in the seven days leading up to Saturday, an 11 percent week-on-week increase.

Experts say three major trends may have led Britain to this point: loosened public health restrictions, the relative success of vaccination campaigns and the natural evolution of the virus.

The government went into “an explicitly post-pandemic mode” and did not do enough to mitigate risks after Johnson ended lockdown, said Danny Altmann, professor of immunology at Imperial College London. This created a “perfect storm” once the more contagious delta variant began to spread, while schools reopened, immunity from the coronavirus vaccines began to diminish and the weather got cooler.

The success of the country’s vaccination program may also be a factor in the rising number of cases right now. While much is still unknown about how coronavirus vaccines work, studies suggest their efficacy could be reduced over time. Because many people were vaccinated early, immunity to infections could be going down around now, said West, of University College London, just as people begin to spend more time indoors, potentially increasing transmission.
The virus mutates naturally over time, so some of the rising cases could also be explained by “basic biology and timeline,” Altmann said. “Not only were we early, we were also at the front of the queue for importation of delta variant, so we’ve had much longer for it to percolate,” he said, adding that the same is true for AY4.2, a new variant sometimes known as “delta plus” that is “expanding” in England, according to the latest official analysis.

What we know about the delta-plus coronavirus variant
And while nearly 79 percent of those older than 12 have been fully vaccinated, efforts to vaccinate school-age children have progressed more slowly — even though infections are rising in that age group. The latest official data shows an estimated 8.9 percent of children in England in what roughly translates to sixth to 10th grade were infected.

While the government has remained reluctant to reintroduce covid restrictions, it has said it will keep “a very close eye” on case numbers.

It has delayed implementing covid measures in the past, partly out of concern that the public would not comply, according to a recent scathing review of the British response to the pandemic. In that review, lawmakers concluded that the government underestimated people’s willingness to comply with restrictions and erred in delaying a lockdown as a result.
Now, some health experts say the public would be willing to accept more restrictions again if they are sold as common-sense measures.

Research shows most people would be willing to start wearing masks again “if you make it very clear in your communications why and when to do it,” West said.

Altmann had a more blunt assessment: “I don’t understand how people can get bored of avoiding death.”

UK reports almost 50000 new COVID cases, 179 deaths [Reuters UK, 21 Oct 2021]

by Michael Holden & Estelle Shirbon

LONDON, Oct 20 (Reuters) - Britain reported 49,139 new COVID-19 cases on Wednesday and 179 more deaths within 28 days of a positive test, official data showed.

The number of new cases has been rising rapidly, with infections in the last seven days up 17% compared to the week before.

Deep within the UK’s shocking Covid data, there may be reasons for optimism [The Guardian, 21 Oct 2021]

By Ian Sample

Analysis: soaring cases in schools are adding to the pool of the immune – which could soon see some community infections fall

It is hard to be upbeat about the latest numbers. The government’s Covid dashboard is awash with red and upward-pointing arrows. New cases have climbed 17% on the week. Hospital admissions are up 11% and deaths have increased by 21%. This is not where we wanted to be nearly two years into the pandemic – and 10 months into the most successful mass vaccination campaign in the history of the NHS.

So is this what we have to get used to? Nearly 1,000 hospital admissions a day, and nearly 1,000 deaths a week? There are so many forces at work in a pandemic, operating on different timescales, pushing in opposite directions, that reliable predictions are a fantasy. But delve into the data and there are, perhaps, some reasons for optimism.

With so many adults well protected after vaccination, infection, or both, the primary driver for the UK epidemic is the infection rate among schoolchildren. Data from the Office for National Statistics show that cases soared in secondary schools when they reopened after the summer.
This was bound to happen: in England at least, protective measures in schools were minimal; the decision to vaccinate healthy children came later than elsewhere, and the process has been difficult and slow.

The ONS estimates that for the week ending 9 October, 8.1% of children in school years 7 to 11 would have tested positive for coronavirus. This equates to about 5% becoming infected every week and adding to the pool of the immune. Before schools went back after the summer, a substantial minority of children in London may have had antibodies to the virus. With natural infections building on that immunity for weeks, cases may soon start to fall. And since schoolchildren are seeding infections into the community, national cases may follow suit.

But England is not London, and not all children are equally protected. In London, fresh cases of Covid are barely increasing, suggesting the capital may be close to a peak – at least for now. In the south-west, where immunity in children is thought to have been much lower before schools went back, cases are rising fast. If herd immunity starts to drive cases down, it will happen city by city, region by region, not in a coordinated wave across the UK. As ever, other factors muddy the waters, not least mixing patterns among adults. In London, for example, home-working rates are far higher than in many other places, keeping exposure levels down.

One question modellers are keen to answer is how much can Scotland tell us. When secondary schools in Scotland opened in mid- to late August, the percentage of students testing positive rose sharply. Depending on the age group, the rates peaked at 8%-10% before cases started to fall. At the same time, in early September, national cases fell sharply. Daily cases in Scotland more than halved in a month.

England may follow suit in the weeks ahead, but there is uncertainty. Scotland was faster to vaccinate schoolchildren, so their immunity before returning to school may have been higher than for children in England. If the tide has started to turn in teenagers in England, the first sign may be a slowing of infections in the ONS data this Friday.

Not that that will be the end of it. Vaccines are good at preventing severe disease but do far less to stop the virus from spreading, and immunity is steadily waning, especially in vulnerable people. Meanwhile, children are the only ones close to pre-epidemic levels of contact with others. Adults have not returned to anything like previous levels of mixing, though it is starting to increase. To top it all, as Chris Whitty, England’s chief medical officer, would say, “winter is coming”. All could drive further waves in infections.

John Edmunds, a member of Sage and professor in the faculty of epidemiology and population health at the London School of Hygiene & Tropical Medicine, said while the epidemic has looked relatively stable over the past few months, “this has masked large changes under the surface, with rises and falls in levels of immunity in different age groups being generated by different processes – levels of immunity are rapidly increasing in children due to sky-high infection rates, whereas immunity is falling in older age groups who were vaccinated earlier in the year”.

He added: “How these dynamics play out is very difficult to predict right now, but it is clear that speeding up the vaccine rollout in children and boosters in adults will help both in the short and longer term.”

New Coronavirus News from 20 Oct 2021

New COVID-19 subvariant is spreading in the UK: What we know [KXAN.com, 20 Oct 2021]

by: Michael Bartiromo

(NEXSTAR) – A new offshoot of the COVID-19 delta variant was responsible for approximately 6% of cases in the United Kingdom as of late September, according to officials with the U.K. Health Security Agency.

The subvariant, known as AY.4.2, is not yet a variant of concern (VOC) or even a variant of interest (VOI), though officials confirmed that cases appeared to be on an “increasing” trajectory in an Oct. 15 report.

FDA authorizes Moderna and J&J booster shots, OKs mix and match
“A Delta sublineage newly designated as AY.4.2 is noted to be expanding in England,” the UK Health Security Agency wrote in its report. “It is now a signal in monitoring and assessment has commenced.”

Researchers have determined that AY.4.2 contains two spike mutations — A222V and Y145H — that have already been observed in other variants. Neither of those mutations, however, had been observed in any variant deemed to be a VOC, or variant of concern.

Commenting on the mutations, Prof. Francois Balloux of the UCL Genetics Institute in London told the U.K.’s Science Media Centre that the presence of both A222V and Y145H does not necessarily mean AY.4.2 is more transmissible than other variants, though he said it’s possible.

“Neither mutation is a priori an obvious candidate for increased viral transmissibility, but we have learnt that mutations can have different, sometimes unexpected, effects in different strains,” said Balloux on Tuesday.

On Twitter, Balloux further noted that AY.4.2 might actually be “intrinsically more transmissible,” citing its unchanged trajectory of rising cases, as well as the areas of the UK where cases have been observed. (Infections don’t seem “region-specific,” he said).

Outside of the U.K. and Denmark, cases of AY.4.2 currently appear to be rarer, though reports indicate cases have now been observed in the U.S., Canada, and Israel.

Still, concerns are rising in the U.S. Former FDA commissioner Scott Gottlieb tweeted on Sunday that “urgent research” is needed to determine the transmissibility of the subvariant, as well as its possible resistance to vaccines.

“This is not a cause for immediate concern but a reminder that we need robust systems to identify, characterize new variants,” Gottlieb added. “This needs to be a coordinated, global priority for COVID, same as similar international efforts have become standard practice in influenza.”

Remarking on the release of the U.K. Health Security Agency’s findings, a representative for the prime minister has said the government is also “keeping a very close eye on” the numbers.
“There’s no evidence [to suggest increased transmissibility], but as you would expect, we’re monitoring it closely and won’t hesitate to take action if necessary,” the representative told Sky News.

White House details plans to vaccinate 28M children age 5-11
While it’s unclear for certain whether the AY.4.2 subvariant is more transmissible, U.K. health officials are investigating the possibility of transmissibility and immunity-evading traits.

Balloux, for one, does not yet believe AY.4.2 is an “obvious” candidate for elevation to a VOC.

“The emergence of yet another more transmissible strain would be suboptimal,” he told the Science Media Centre. “Though, this is not a situation comparable to the emergence of Alpha and Delta that were far more transmissible (50% or more) than any strain in circulation at the time. Here we are dealing with a potential small increase in transmissibility that would not have a comparable impact on the pandemic.”

As U.K. Covid Cases Surge, Israel Offers Lesson in Boosters [Bloomberg, 20 Oct 2021]

By Gwen Ackerman

As Covid-19 cases soar again in the U.K., officials could look to a country that’s moved past a similar crisis for a possible roadmap.

The search for answers in Israel may be useful, health experts say, because both countries were among the fastest in the world with their vaccination programs, yet were similarly quick to lift lockdown restrictions. And just as Israel experienced a spike in cases in June, so the U.K. is now, having just reported the biggest single daily jump in infections in three months.

Booster Dose Slashes Rates of Covid Infection in Israeli Study
Israel’s response to its renewed outbreak was to roll out an aggressive booster program, a decision that appears to have quelled the worst of the outbreak within weeks.

And while there are too many other variables to draw hard-and-fast conclusions -- from vaccine type and timings to age-group prioritizing, social-distancing rules and mask-wearing -- it may offer one stand-out lesson for the U.K: People should get their boosters.

Another Shot
Cases dropped after the booster shot was rolled out

“Israel was the first country to have a mass vaccination campaign and it was the first to experience the full impact of waning immunity” and the mass susceptibility that followed, said Ran Balicer, the Tel Avi-based chairman of Israel’s national Covid-19 advisory team. Other countries that vaccinated later will go through the same thing, “unless they use the lessons learned here and consider the booster campaign,” he said.

Standing Out
U.K. case rate is far higher than other major European countries

Britain has a booster program that began in late September. It’s open to people 50 and older, and is focusing on the elderly in that age group, as well as other vulnerable people. In Israel, the rollout extended to people 12 and above within weeks of its Aug. 1 launch.

U.K. to Begin Covid Booster Drive for Over-50s Next Week (2)

The surge in infections in the U.K. has left the country behind other major European nations, in terms of both case rate and deaths, according to Bloomberg’s tracker.

“We’re starting to see indications that hospitalizations and death rates are increasing,” U.K Prime Minister Boris Johnson’s official spokesman, Max Blain, told reporters on Tuesday.
“Clearly we are keeping a very close eye on rising case rates. The most important message for the public to understand is the vital importance of the booster program.”

The latest Covid updates
Make sense of the headlines and the outbreak's global response with the Coronavirus Daily.

Last month, U.K. ministers unveiled a contingency plan if cases surge, including measures such as mandatory face masks, vaccine certificates and advice to work from home. The National Health Service Confederation, which speaks for the health care system, has urged the government to enact that plan “without delay,” but on Wednesday, Business Secretary Kwasi Kwarteng told Times Radio that the time hadn’t come for that.

U.K. Expands Vaccine Access for Children After Surge in Schools
In Israel, officials are optimistic that they’re putting the delta wave behind. Serious coronavirus cases continue to drop now that almost 3.9 million people out of an eligible 5.2 million have received a third dose.

“It’s possible to say, cautiously, that we are quelling the fourth wave, the delta wave, but it’s not over until it’s over,” Prime Minister Naftali Bennett said Sunday.

A new Delta descendant is rising in the UK. Here's what to know [CNN, 20 Oct 2021]

By Tara John

This is the weekly edition of CNN's coronavirus newsletter. Look out for your roundup every Wednesday. If you haven't subscribed yet, sign up here.

(CNN)British and international authorities are closely monitoring a subtype of the Delta variant that is causing a growing number of infections in the United Kingdom.

This descendant of the Delta variant, known as AY.4.2, accounted for an estimated 6% of cases in the week of September 27 -- the last week with complete sequencing data -- and is "on an increasing trajectory," a report by the UK Health Security Agency said.

Little is known about AY.4.2. Some experts have suggested it could be slightly more transmissible than the original Delta variant, though that has not yet been confirmed. While it accounts for a growing number of infections, it is not yet classified in the UK as a "variant of concern." It currently remains rare beyond Britain, with a small number of cases being recorded in Denmark and the US, expert Francois Balloux told the Science Media Center (SMC) on Tuesday.

"As AY.4.2 is still at fairly low frequency, a 10% increase its transmissibility could have caused only a small number of additional cases. As such it hasn't been driving the recent increase in case numbers in the UK," Balloux, Professor of Computational Systems Biology and Director at the UCL Genetics Institute, told the SMC.

While new variants have repeatedly overtaken one another to become the dominant strain globally in the past year, experts say it is too soon to know whether AY.4.2 will become significant. In the UK, "Delta very rapidly in a matter of weeks" outpaced the Alpha variant by the summer, Deepti Gurdasani, a senior epidemiology lecturer at Queen Mary University of London, told CNN. "That's not what we're seeing here, we're seeing sort of a slow increase in proportion that suggests that it's not hugely more transmissible, it might be slightly more transmissible.

Balloux agreed, telling SMC that "this [is] not a situation comparable to the emergence of Alpha and Delta that were far more transmissible (50% or more) than any strain in circulation at the time. Here we are dealing with a potential small increase in transmissibility that would not have a comparable impact on the pandemic."

AY.4.2 has caught the attention of public health experts across the pond. In a series of tweets Sunday, former US Food and Drug Administration Commissioner Dr. Scott Gottlieb called for "urgent research" into this Delta offshoot and said it was a "reminder that we need robust systems to identify, characterize new variants."

The emergence of AY.4.2 in Britain, however, points to what scientists have warned throughout the pandemic: soaring transmission can create new variants. The UK has had the highest rate of daily Covid-19 cases and deaths per million people in Western Europe since most pandemic restrictions were dropped in the summer. On Tuesday, it reported 223 Covid-19 deaths, the highest daily figure since early March, and health leaders are urging the government to reintroduce measures such as mask mandates in enclosed spaces to help ease the pressure on the health system.

The "whole problem with this approach to living with the virus and allowing between 30,000 to 50,000 cases a day -- which has been the UK's case rate since [the summer] -- is the [virus's] evolution will continue ... we need to suppress cases and suppress the virus," Gurdasani said.
YOU ASKED. WE ANSWERED.

Q: When vaccinated people die from Covid-19, how do you explain that vaccines are still worth taking?

A: We need to start with science and what the research shows, according to CNN Medical Analyst Dr. Leana Wen. The Covid-19 vaccines are extraordinarily effective in preventing illness and especially severe disease, she said.

The most recent data from the US Centers for Disease Control and Prevention (CDC) shows that they reduce the likelihood of testing positive for Covid-19 by six-fold and the likelihood of death by 11-fold, she added.

"That means that if you are vaccinated, you are six times less likely to get Covid-19 than someone who's unvaccinated. And you are 11 times less likely to die from Covid-19 compared to an unvaccinated person. That's really excellent," she said.

"However, the Covid-19 vaccines do not protect you 100%. No vaccine does, just likely virtually no medical treatment is 100% effective. That doesn't mean the vaccine doesn't work, or that you shouldn't take it."

Send your questions here. Are you a health care worker fighting Covid-19? Message us on WhatsApp about the challenges you're facing: [phone].

READS OF THE WEEK
Why Colin Powell's cancer likely reduced his protection from the Covid-19 vaccine
Colin Powell, the first Black US secretary of state, died Monday from complications of Covid-19. Experts say his death shows how important it is for more people to get vaccinated and stop the spread of the virus, Jen Christensen reports.

Powell was fully vaccinated, but a source close to the matter confirmed to CNN he had multiple myeloma, a type of blood cancer that would have affected his immune response to the vaccine, and made it difficult to fight the virus. Peggy Cifrino, Powell's chief of staff, said Powell, 84, also had Parkinson's disease, a neurodegenerative disorder.

Although the Covid-19 vaccines provide strong protection against severe disease and death in healthy people, multiple myeloma patients are among the immunocompromised groups who may not respond as well, studies have shown. One study published in Nature in July showed that only 45% of multiple myeloma patients developed an adequate response to the vaccine, while 22% had a partial response. One-third had no response.

Despite Powell representing a high-risk population group, some conservative media figures have dishonestly seized on his death to cast doubt on the effectiveness of Covid-19 vaccines, Oliver Darcy writes.

These doctors are spreading misinfo about vaccines
Dr. Christiane Northrup was a frequent guest on The Oprah Winfrey Show -- an Ivy League-educated obstetrician-gynecologist who often spoke about women's health and holistic medicine. She was a media darling, and in 2013 made Reader's Digest's annual list of the 100 most trusted people in America.

But Northrup is also among a small group of doctors who have emerged as a huge source of misinformation -- whether as social-media influencers or family doctors meeting with patients in person -- about Covid-19 vaccines, which have thus far proven the most effective weapon against the deadliest pandemic in 100 years, Rob Kuznia, Scott Bronstein, Curt Devine and Drew Griffin report.

Moscow orders unvaccinated over-60s to stay home for 4 months
Millions of Russians face strict new Covid-19 restrictions from this week, after a slow vaccination drive, an overwhelmed health care system, and widespread mistrust in government combined to plunge the country into its most deadly phase of the pandemic to date, Anna Chernova and Rob Picheta report.

On Tuesday, Moscow's mayor ordered all unvaccinated residents over 60, as well as unvaccinated people "suffering from chronic diseases," to remain home for four months until late February as the city grapples with a growing crisis.

The national government has also proposed introducing a non-working week at the start of November, but senior figures have started openly admitting that the situation is dire as Russians head towards a bleak winter.

Russia has recorded its highest numbers of daily cases and deaths multiple times in recent days, and registered 1,002 official fatalities on Sunday -- the first time the country has crossed the four-digit deaths barrier so far.

Experts point towards a lagging vaccination program and a failure in government messaging as factors behind the surge, which is now threatening to deluge hospitals across the country.
"I think the country is now falling into disaster," Vasily Vlassov, a Russian epidemiologist and former adviser to the World Health Organization (WHO), told CNN.

TOP TIP
The test-to-stay approach in US schools
The CDC is working with select school districts across the nation to evaluate the practice of the test-to-stay approach.

This type of policy would prioritize testing to monitor students who may have been exposed to Covid-19, allowing students to continue to attend classes if they test negative, instead of having to quarantine. But there are many health experts who agree that quarantines are still necessary.

In an email to CNN, CDC said it views test-to-stay as a "promising practice" and that it's "working with multiple jurisdictions implementing test to stay to evaluate the effectiveness of this strategy." But it's not clear when that guidance could be available. Read more about it here.

UK health minister says Covid cases may hit 100,000 a day in winter, no contingency measures for now [CNBC, 20 Oct 2021]

By Sam Meredith

LONDON — U.K. Health Secretary Sajid Javid on Wednesday said that the government won’t be implementing the so-called plan B strategy of its fall-winter Covid plan, defying warnings from health leaders that the country risks “stumbling into a winter crisis.”

“We are looking closely at the data and we won’t be implementing our plan B of contingency measures at this point,” Javid said, speaking at the government’s first coronavirus news conference in more than a month.

“But we will be staying vigilant, preparing for all eventualities while strengthening our vital defenses that can help us fight back against this virus.”

Javid said the NHS was “performing with distinction,” acknowledging that the health service was seeing greater pressure but rejected the suggestion that it was unsustainable.

“We will do what it takes to make sure that this pressure doesn’t become unsustainable and that we don’t allow the NHS to become overwhelmed.”

Javid said that winter poses the “greatest threat” to the recovery from Covid, adding that cases could yet climb as high as 100,000 per day.

It comes shortly after the National Health Service Confederation, which represents organizations across the U.K. health-care sector, warned some Covid restrictions must be reintroduced “without delay” if the government is to keep people healthy and prevent hospitals from becoming overwhelmed this winter.

This is because the NHS is seeing a “worrying” increase in Covid cases in hospitals and the community as it prepares for a busy winter period, they added.

The U.K. recorded 49,139 new Covid cases on Wednesday, according to the latest government data, and 179 deaths within 28 days of a positive test.

The seven-day average of new Covid cases in the U.K. has jumped from around 34,000 at the beginning of October. Meanwhile, the number of people in the hospital who have Covid has surged by 11% in a week.

To date, the U.K. has recorded more than 8.5 million Covid cases and 139,265 deaths, according to data compiled by Johns Hopkins University. The U.K. ranks among the countries with the highest death tolls worldwide.

Making matters worse, potentially, is a new mutation of the delta variant that British experts are watching closely.

Downing Street said earlier this week that it was closely monitoring rising cases, but the Cabinet had not yet discussed contingency measures.

Business Secretary Kwasi Kwarteng told Sky News on Wednesday that it was not yet time for the government’s so-called Plan B strategy, saying the focus should be on administering more booster shots instead.

Kwarteng also ruled out the prospect of another national lockdown.

Rising cases across Europe
Officials from the World Health Organization on Wednesday noted the rise in cases across Europe, including in the U.K., blaming it at least in part on the easing of Covid restrictions.

“The Northern Hemisphere is heading into another winter, and just need to be a little concerned about that uptick across Europe as we enter the late, late, deep autumn,” Dr. Mike Ryan, head of the WHO’s emergencies programs, said in a Q&A. “As societies are opening up, we’re seeing those numbers rise, and in a number of countries, we’re already seeing the health system begin to come under pressure, we’re seeing the number of available ICU beds decreasing.”

Last month, the government outlined its fall-winter plan for tackling the coronavirus crisis, setting out a series of measures designed to avert the need for more lockdowns. These include vaccine uptake, test, trace and isolate, supporting the NHS and social care, government guidance and communication, and embracing an international approach to the pandemic.

If the NHS was deemed to be at risk of coming under unsustainable pressure, Javid said those contingency measures could kick in across England. That includes the possibility of making masks mandatory in certain settings, vaccine passports for events and encouraging remote working.

Health and care policy is devolved across the U.K., with different provisions made in Wales, Scotland and Northern Ireland.

The UK has more new Covid-19 cases than France, Germany, Italy and Spain combined [CNN, 20 Oct 2021]

By Rob Picheta

London (CNN)Last December, as the first of several worrying Covid-19 variants ripped through the United Kingdom, Prime Minister Boris Johnson made the unwelcome decision to cancel Christmas plans for millions of Brits.

"We are sacrificing our chance to see loved ones this Christmas, so we have a better chance of protecting their lives so we can see them at future Christmases," Johnson said, taking a potentially career-defining step that he had ruled out just days earlier.

Ten months later, the UK's attitude towards Covid-19 has changed beyond recognition.
Virtually all of England's restrictions were lifted in July, with the events and hospitality sectors returning to full capacity as Johnson urged Britons to "begin to learn to live with this virus."

But the Delta variant -- more transmissible still than the Alpha strain which wrecked last year's festivities -- has not gone away.

The country has quietly endured stubbornly high cases, hospitalizations and deaths when compared to the rest of Europe. Britain has registered nearly half a million cases in the past two weeks -- and almost 50,000 on Monday -- more than France, Germany, Italy and Spain combined. The UK reported 223 deaths on Tuesday, the highest daily figure since early March.

Johnson has strayed from much of the European Union in his approach; while a number of countries on the continent have introduced vaccine passports, England halted its original plan to do so. Mask-wearing and social distancing and other measures are no longer required by law in Britain.

That contrasts with far stricter measures in several European nations, where proof of vaccination or a negative test are needed to visits bars and restaurants or work in several fields, including healthcare.

Hospitals in Britain are now close to buckling once again under the strain of new admissions.
And the country's early vaccination success risks being undone by a stuttering rollout of booster shots and shots for children.

"Exceptional policies lead to exceptional outcomes," Deepti Gurdasani, an epidemiologist at Queen Mary University in London, told CNN. "It's very predictable. This is a consequence of opening everything up."

"We're approaching winter, and things are only going to get worse," she added.

Some things may yet shut back down; Johnson's spokesperson admitted on Monday that a "challenging" winter lies ahead, and the Prime Minister has refused to rule out a return of mask mandates or stronger restrictions to protect the country's National Health Service (NHS) in the coming weeks.

But experts -- including Johnson's own health care chiefs -- are clamoring for a more urgent change in approach.

The NHS Confederation, which represents providers of the service, urged the government on Wednesday to move to its "Plan B" raft of measures, which would include European-style vaccination passes and more mask mandates. But the government has ruled out that move for now, only insisting it was closely watching the case figures.

"There's a whole series of ways (in which) we're out of line with western Europe and the rest of the world," said Martin McKee, professor of European Public Health at the London School of Hygiene & Tropical Medicine.

"We've seen in other European countries that collective measures make a big difference," he said. "We should be asking ourselves: Are we right? (Because) there's no evidence that we are."
A stuttering vaccine rollout

The driver behind Britain's renewed optimism in the new year was its vaccination program, which outpaced most countries in its initial scale and set the narrative for what Johnson portrayed as Britain's triumphant emergence from the pandemic.

But the country is struggling to repeat those early successes as it attempts to vaccinate adolescents and roll out booster shots to elderly and at-risk people.

"England's booster rollout is failing to keep pace with the rollout of first and second vaccine doses," John Roberts, a consultant at the Covid-19 Actuaries Response group which tracks vaccination figures, warned in a statement on Monday.

More than a month after booster shots began, less than half of twice-vaccinated over-80s have received a top-up. "It's clear that accelerating the booster rollout is vital to reduce the pressure on health services and minimise Covid-related deaths this autumn and winter," he said.

The group estimated that, at current pace, the 22 million people that make up the country's higher-risk groups won't be triple-vaccinated until late January, despite initial government promises that the program would protect people for the winter.

Vaccines continue to reduce the number of Covid-19 patients who need hospital treatment, but waning immunity makes the pace of the rollout particularly important. The majority of over-40s in Britain were originally vaccinated with the partially homegrown Oxford-AstraZeneca vaccine, whose efficacy against the Delta variant has been shown to be lower than Pfizer and Moderna's shots.

A preprint of a study by Public Health England (PHE) found that the shot's protection against infection fell from 66.7% to 47% after 20 weeks, compared to a drop from 90% to 70% for the Pfizer vaccine. Separate PHE research found that AstraZeneca's efficacy against hospitalization from Delta slipped from just above 90% to just under 80% after 140 days, while its efficacy against death remained close to 90%. Pfizer remained above 90% in both metrics.

Many experts blame the lack of momentum in the UK's vaccination drive on months' worth of positive reassurances from Johnson's government.

"All of the government's messaging and actions suggest that we're out of danger," Gurdasani said.

"There's been a lot of messaging that the pandemic is essentially over, so a lot of people are thinking: "why bother?" added McKee.

There are concerns too at the other end of the age spectrum, as the NHS works to vaccinate over-12s and avoid a repeat of the rampant transmission in schools that disrupted much of the summer term in June and July.

That program suffered a false start amid conflicting early advice from the country's scientific bodies; whereas France, for example, began vaccinating under-18s in June, the British government only green lit the move in September.

1.2 million teenagers have now been given one dose of a vaccine and just 260,000 have seen two doses in England.

"The problem is not that adolescents don't want to take it. There are many who are desperate to get it, but are not being offered it at school yet," Gurdasani said.

Schools have complained about a lack of vaccinating staff, and England's delay in allowing adolescents to visit national vaccine centers has seen it fall behind Scotland in inoculating the age group.

"There's a loss of direction here," McKee said. "It's not clear who's in charge."

Britain's hospitals brace for a bleak winter
Britain's Covid-19 rates soar above much of Europe's, but its mitigation measures remain minimal.

"The government is totally dependent on the vaccination program, which is now going on in a very half-hearted way," McKee said. "There really needs to be an urgent review of where we are different from other countries, and an assessment: should we be different? What is the rationale?"

McKee joined many experts in calling for a package of measures that mirror the continent.

Several European countries, including France and Italy, have rolled out Covid-19 passes and required vaccination for healthcare workers, while many more still employ mask mandates in crowded spaces that the UK does not.

Johnson, by contrast, has walked back initial plans to introduce similar measures. "Vaccine passes have an important role to play; the French and the Italian experience show that they do," McKee said. Cases have remained low in both countries since the measures were introduced.

Health care is devolved in the UK and vaccine passes have been announced in Wales and Scotland. Johnson is meanwhile keeping them in reserve under its "Plan B" scenario for England -- but with such high infection rates every day, many wonder why Plan A is still in effect.

"We have extremely high infection rates in children (and) they've spilled over into the elderly population," Gurdasani said. "We're approaching winter, and things are only going to get worse."

Covid fatigue amongst the public is another challenge. Mass events are underway with no vaccination requirements and little trace of the pandemic still remains on British high streets during busy periods.

Just 40% of Britons still regularly practice social distancing, compared to 62% in mid-July and 85% in April, according to the Office for National Statistics. The same recurring study has also found a gradual decline in mask-wearing.

For some, that trend is alarming. "We've had 30 to 40,000 cases every day for months now. There's no other country that's tolerating that ... (but) it's been normalized" in the UK, Gurdasani said.

The steady stream of hospitalizations has not dramatically surged in the past two months, but has not noticeably declined either; official figures show more than 700 new patients entering facilities every day.

That leaves hospitals, already struggling to work through a backlog of treatments that were delayed during the pandemic, anxiously awaiting another winter surge.

Last week, NHS England said more people were waiting for treatment than at any time since it started keeping records -- 5.7 million -- while health care staff battled the busiest September on record this year.

"There is no doubt the NHS is running hot, with the highest ever number of patients seen in A&E in September, 14-times as many covid patients in hospital compared to the same month last year and record 999 ambulance calls," Professor Stephen Powis, the NHS national medical director, said of the figures.

Which direction the winter takes is still not inevitable. "There's so many unknowns," McKee said, noting that previous anticipated spikes in infections this year have not materialized.

But experts and hospital staff fear a further strain. "It's not a place where most healthcare workers want to be," added Gurdasani. "It really scares me that we're in this place ahead of the winter."

And, as the year winds down, the nature of Britain's second pandemic Christmas remains unclear.