The Omicron variant is now in Britain. Here’s how we beat it

As feared, Covid-19 is not going quietly. The arrival of the Omicron strain in Britain - with cases already identified in 

Chelmsford and in Nottingham - is clearly not the news we wanted as we prepare for the Christmas holidays. The Prime Minister will hold a press conference later today, likely to mark a distinct change in tone. For a while, it was possible to feel that our vaccine programme, supported by better treatments, mass testing and non-pharmaceutical interventions had started to defeat the virus. So, we started to turn our focus to other activities such as levelling up, addressing the NHS waiting lists, climate change, violence against women and girls, and bickering with the French.

But the surge in infection rates in continental Europe has shown that Covid-19 has not been defeated in the way we might have hoped. In the UK, the virus seems to have become endemic with around 1 in 65 infected, according to the ONS Covid Infection Survey, though the vaccine programme has resulted in a much lower level of hospitals admissions and deaths when compared with previous peaks.

The Omicron variant is potentially alarming — Covid-19 might be starting a major counterattack. Jenny Harries, the chief executive of the UK Health Security Agency, called it the ‘most significant variant that we have encountered to date.’

We still know very little, but indications suggest that the high number of mutations in this new strain could result in higher transmission, a partial breakdown of our immune protection (whether from previous infections or vaccines) and potentially a reduction in the effectiveness of some of our treatments.

The resurgence of the virus has highlighted the fundament challenge with almost all of our responses to date, namely that the virus can operate at a very different speed to our response.

One way of looking at this difference in speeds is to use the analogy of ‘dog years’. It is often said that a human year is the equivalent to seven dog years. The various mutations have shown that Covid-19 can grow and evolve more in a year than the human race can in centuries. A ‘human year’ might therefore be the equivalent of hundreds of ‘virus years’, as the virus just operates much faster. But our difficulties in dealing with the virus are compounded because our response is dependent on our social-political system — which operates in ‘government years’. ‘Government years’ are much slower than human years because of, for instance, the requirement to build consensus across departments and political groups, lack of competition for the Civil Service to push innovation in speed, and the need to ensure decisions are documented robustly in case of a future inquiry or judicial review.

It’s a pretty uneven match between Covid-19 and government. But we have shown that we can, occasionally, operate at a speed best measured in ‘virus years’. So, in the early days of the epidemic in England we built the Nightingale hospitals in days, as opposed to the decade that it would normally take. When it came to vaccines we were able to develop, test, approve, select, pre-purchase and administer over a hundred millions doses in months rather than years. And, most recently, we responded to the new variant by shutting down flights from southern Africa in hours – a step change improvement when compared to the embarrassing weeks it took to impose restrictions in response to the rise of the Delta variant earlier in the year. While we should celebrate our success in these cases, they are unfortunately the exception, rather than the rule. 

It now seems likely that we are going to need to learn to live with Covid-19 as the increased transmissibility of new strains make it very hard to suppress the virus though herd immunity, as I have discussed before. To learn to live with Covid-19, we need to learn to operate at ‘virus years’ in at least six areas.

First, we must become much faster in developing, testing, manufacturing, and administering top-up vaccines. Our vaccination programme has operated at a speed never achieved by a vaccination programme before, but it will still have taken us a year and a half to develop, test, manufacture, and vaccinate the UK. If we do really face new vaccine-busting variants, that is still too long a period of potential lockdown.

It’s technically possible to manufacture, test for safety, and distribute a new vaccine in around three months. We should target that turnaround time and establish sufficient manufacturing capacity to make enough doses for all of the UK’s population in months – a several fold increase in manufacturing capacity to what we have now. We could even train more of the population to administer a vaccine (apparently, it’s not that hard) so that each post code could have their resident ‘home-guard volunteer vaccinator’ ready to be part of a programme of delivering a million shots a day in a quicker and more cost-effective way than the current programme. We need to find a way of simplifying the administration of the pre-jab questionnaire. We might even explore whether we can identify the features of possible future vaccine busting variants so we can test and stockpile a cocktail of vaccines in case they arrive, allowing us to operate at ‘virus speed’ in our responses.

Second, we must speed up our efforts at encouraging take-up of the vaccine. Roughly 5 per cent of the over-50s still have not had two shots of the vaccine. A few of these have declined the jab for medical reasons (for instance the immunosuppressed), but the vast majority will have declined the vaccine by choice, albeit in many cases influenced by untrue anti-vax propaganda. This number is skewed towards minorities, with around 25 per cent of Blacks and 10 per cent of South Asians over 50 not being vaccinated, as measured by Oxford University’s OpenSafely. In England, this not fully-vaccinated older group is around one million individuals, a group that could be very vulnerable as higher infection rates among the young eventually find the old.

The government has tried using ambassadors such as Sir Lenny Henry and set up vaccination centres in mosques. But progress has been painfully slow. At the current rate of progress, it’s going to take over a year to close the gap for some minorities. We should learn from the likes of the Census, which seems to have achieved 97 per cent participation compared with the 80 per cent of over 12 years old who have had at least two vaccine shots. Given the number of patients who catch Covid when in hospital, we should consider whether we really need to wait until April 2022 to make vaccination compulsory for healthcare staff. Italy introduced similar regulations in weeks.

Third, we need to be much faster at stopping the import of variants from overseas. While history shows that dominant variants eventually spread globally, better border controls will give us more time to manufacture treatments, and develop and administer a vaccine should a vaccine-busting variant develop somewhere else in the world. In the last week we have stopped flights from six southern Africa countries and reimposed red-list quarantines.

We need to operate at this speed if the new variant spreads around the world – and it has already been reported in Hong Kong, Israel and Belgium. We have to be fast at recommissioning our quarantine hotels and building sufficient capacity in case we have to add more countries to the red list. We have to adopt a much more aggressive track-trace-test-and-isolate approach to all those who have arrived from southern Africa in the last weeks, using data from the passenger locator form to ensure that if the new variant has already arrived, it can be contained.

Fourth, we need to continue pushing on treatments. Operating at ‘government speed’ in April 2021, over a year after the arrival of Covid-19 in the UK, we launched our antiviral taskforce. This taskforce is bringing the focus and execution previously seen with the vaccine taskforce and building on the early UK success finding Dexamethasone. Operating almost at ‘virus speed’, orders for two new antivirals from Merck and Pfizer have already been placed. The taskforce needs to continuing operating at pace to expand the basket of available treatments, especially broad-spectrum antivirals as these are likely to work better on future variants (full disclosure, I have an investment in some vaccine, treatment and testing innovators). But we should also learn from the previous problems with manufacturing the vaccines and the unhelpful squabbles between countries on supply, by gearing up manufacturing though dedicated UK preorders.

Fifth, we need to establish a norm of using a home lateral flow test before attending mass events. We need to create a culture where it is not acceptable to attend large gatherings without having tested first, in the same way as we created a culture where it became socially less acceptable to drive drunk. A programme of self-administered mass-testing is considerably more cost effective than the eye-watering expense of test, trace and isolate.

And finally, we are going to be thoughtful about the early reintroduction of some of the Plan-B restrictions around social distancing and other non-pharmaceutical interventions. Historically we did this too slowly and so ended up needing a longer period of fuller lockdown. Instead we should try to introduce those with less pain sooner. For instance, we might want to start mandating the wearing of masks when moving inside buildings and on public transport in England, as they already have in Scotland. We might avoid super-spreading packed trains, undergrounds and offices by encouraging some working from home. We might require continental-style table service over Christmas, so as to avoid the infection sharing melee at the bar.

The Omicron variant could provide us with the jolt to get us operating at a different speed for our vaccinations, treatments, testing and non-pharmaceutical interventions. By doing that we reduce the risk of drastic further lockdowns and, importantly, are ready for what the virus next throws at us. The government might even learn to operate at a faster pace, which would put us in good stead as we set out to address some of the other challenges we face after the pandemic.