Blackburn with Darwen Council public health director

THE government is going to have to make a very difficult decision soon about what sort of Christmas we can all have.

The potential release of the Pfizer BionTech and maybe also Moderna vaccinations in December is good news for us all. They shine a light on the pathway out of the pandemic and promise some end to the continued controls on all our lives. But the path is not going to be a short one. We are all going to need to manage our expectations about just when we will be ‘free’.

SAGE (the government’s Scientific Advisory Committee for Emergencies) has just published its six-month predictions for the pandemic. This suggests that after the lockdown, cases may plateau but at a much higher rate than the summer.

Population immunity will slowly rise in the new year with any potential vaccination programme, but this will have very minimal impact on cases until well past spring and early summer.

We will need to keep R below one until herd immunity is reached. This is only realistically achievable by mid-late summer at best and until then, we will require a continued mix of high control/high compliance with current control measures. Herd immunity for Covid will require 60 per cent of us to be immune but to achieve this we will probably need to vaccinate at least 70 per cent of the population – starting with the most vulnerable.

Continued pressures on the NHS and adult social care and on East Lancashire Hospitals Trust in particular are likely to continue for a prolonged time period – although they may fall from the current rate depending on the final effects of this second lockdown and continued tier control measures.

The SAGE report concludes: “The decline in infection rates seen after cases plateau will be slow, driven by gradual accumulation of population immunity - potentially leading to a long, relatively flat plateau of relatively high incidence unless measures are further intensified to drive incidence down”

This is going to make government decisions about Christmas difficult. The British Medical Association has warned this week that a ban on mixing between more than two households and travel between areas with different ‘tiers’ will be necessary over Christmas and on into next year until herd immunity is reached.

The epidemiology currently suggests that if we allow even limited social mixing at Christmas, the consequent ‘surge demand’ on the NHS from newly-infected residents will be significant. A surge of patients will arrive in hospitals, adult social care and GP practices somewhere between week two and three of January and week four of February.

Government can let us have a big family Christmas and there is no doubt that all of our families both need it and want it. But we must be honest with ourselves. For many of us, the real cost of a big family Christmas may involve much more than we planned for.