Medical Centre

Over the last few weeks, the United Kingdom has experienced a record number of covid-19 infections, driven by the rapid spread of the Omicron coronavirus variant, with the daily reported case numbers approaching 200,000 on some days. This has placed considerable pressure on the NHS through a combination of people seriously ill from covid-19 and staff absences. Other parts of the economy such as public transport have also been badly affected by staff absences.

A sustained period of high infection rates would be very damaging for the UK. But there are now signs that the number of covid-19 cases in London – the first area of the UK to face the wave of infection from Omicron – may have peaked. In which case, a similar pattern of declining case numbers may be seen in other parts of the UK later this month.

There were several factors that drove the early increase in Omicron cases in London. London is the UK’s main international travel hub with the UK’s busiest airports located nearby. Overseas travellers who are infected with a new coronavirus variant are more likely to arrive in the London region than in other parts of the UK. London also has a very large number of international visitors – for activities such as work, study, tourism, leisure, and sports events. London is the also UK’s largest city and is very densely populated, with many overcrowded households, often with people from three or more generations living together, which makes infections more likely to spread, including to clinically vulnerable groups who will be at much greater risk of adverse outcomes such as hospitalisation.

London also has a lower covid-19 vaccination uptake than other parts of the UK. Around 20% of people aged 12 and over in London remain unvaccinated, compared to a national average of about 10%. Although vaccines provide less protection from symptomatic infection with Omicron than from the previously dominant Delta variant, they do still provide good protection from serious illness, particularly in people who have had  their booster vaccination. The lower vaccination rate will lead to infections from Omicron spreading more quickly in areas such as London; as well as increasing the likelihood of severe disease. This would in turn increase hospital admissions from covid-19 and pressures across the NHS in London.

After increasing vary rapidly in London, the Omicron wave now shows signs of abating with the number of covid-19 cases and hospital admission dropping in recent days. We can’t confirm yet that the drop will continue; and nor what the impact will be of schools, universities and workplaces reopening. But if the decline is sustained, other parts of the UK can also expect to see similar falls later this month with case numbers dropping first, followed by a drop in hospital admissions after a lag period. This means that the outcome of the Omicron wave well may be less severe than predicted in the more pessimistic government models, particularly in the areas of the UK with the highest vaccination rates.

However, we can’t yet relax our covid-19 control measures. The number of covid-19 cases in the UK will remain high – compared to previous waves – for some time. The NHS will continue to be under pressure, perhaps for many months, trying to cope with the impact of covid-19 on top of the usual winter pressures that it faces each year whilst also trying to deal with the backlog of work that has built up during the pandemic. The NHS will also continue to be affected by staff shortages due to illness. Although the government may wish to declare “victory” against Omicron and end its Plan B measures later in January, it should refrain from doing so. The public also need to continue to practise good infection control measures, building on the “Three C Approach” to personal safety limit the impact of covid-19.

Measures such as wearing face masks in indoor settings should remain in place, with the government and public health agencies encouraging people to use well-fitting FFP2 masks that provide better protection for the wearer, rather than loosely fitting surgical or cloth masks. More targeted use also needs to be made of publicly-funded lateral-flow tests. Finally, the covid-19 vaccination drive must continue – for those who are currently unvaccinated as well as for those who are now eligible for a booster vaccine. A high uptake of booster vaccines will protect against serious illness and buy time until modified vaccines that target Omicron become available later this year.

In conclusion, the experience of London offers some positive news for the rest of the UK and for the government. But we must remain cautious and continue with our covid-19 control measures until infection rates are substantially lower than they are now. We also need to be fully prepared to deliver another booster vaccination programme later this year, whilst also continuing to target the 10% of people aged 12 in the UK and over who remain unvaccinated.

A version of this article was first published in the British Medical Journal.

Read London is an important barometer for the omicron wave in the United Kingdom in full

Why are some scientists concerned about the new Covid variant that has been found in France?

Whenever a new variant of the coronavirus that causes Covid-19 is identified, there are always concerns that it may prove to be more infectious than previous variants and spread quickly in the population. We saw this previously with the Alpha, Delta and Omicron variants, each of which spread rapidly in the UK, leading to waves of infection that put a lot of pressure on the NHS.

Should we be worried, and why?

The B.1.640.2 variant was first identified over a month ago and so far, it has not caused the massive global spike in Covid-19 cases we have seen with the Omicron variant. There is now very good identification of variants in many countries, so that the spread of a new variant can be monitored. If a variant is spreading rapidly, the World Health Organization will label it as a Variant of interest (VOI) or a Variant of Concern (VOC) depending on its severity. This has not happened yet with B.1.640.2. We should remain cautious, monitor the spread of any new variant, including B.1.640.2, but not get over-anxious.

Both Omicron and the new variant appear to have emerged in Africa, which has the lowest vaccination rate. Is that the reason?

Variants can emerge anywhere. The Alpha variant was first identified in the South-East of England and the Delta variant was first identified in India.

Will it become normal for variants to emerge and spread around the world like Omicron?

The coronavirus that causes Covid-19 will mutate constantly. Most mutations are of no great consequence but occasionally a mutation will appear that can cause a wave of infections – such as the Alpha, Delta and Omicron variants. We may well see other variants emerge and spread around the world in the future.

Are variants getting milder, or is it possible that another variant will be deadlier?

There is no guarantee that a variant will be milder. The Alpha and Delta variants were shown to be more likely to cause a serious illness that the original version of the Coronavirus. In the case of Omicron, the evidence thus far shows that it generally causes a milder illness than other variants. However, because of the very large number of Omicron cases, some people will still have a serious illness.

Could Omicron bring about the end of the coronavirus pandemic?

It’s unlikely that Omicron will bring an end to the Coronavirus pandemic. However, with updated vaccines that can target a new variant such as Omicron and antiviral drugs that can be used early in an illness, we can suppress the severity of disease caused by Covid-19 and allow people to live more normally.

If the world has to live with Covid, what might that look like?

This will vary from country to country. In the UK, high levels of vaccination – including with a modified booster vaccine later this year to target Omicron if the government approves this – combined with antiviral drugs will allow our society to function more normally. Countries with low vaccination rates and weak health services are still likely to face large waves of infection. It’s possible that we will need regular vaccinations – as for flu – to allow us to live with Covid-19. It is also always possible that a variant will emerge against which vaccines are less effective. But the good news is that vaccine manufacturers can modify their vaccines quickly if this happens.

Why is the booster important for Omicron?

The immunity provided by Covid-19 vaccines weakens after a few months. A booster vaccine substantially increase people’s protection from serious illness, including from Omicron. Ensuring that people are fully vaccinated with three doses of vaccine will reduce the number of people who are seriously from Covid-19, and keep down pressures on the NHS.

A version of this article was first published in the Daily Mirror.

Read Questions and Answers About New Variants of SARS-CoV-2 in full

Lateral flow tests are now being used by many members of the public. In this blog, I answer some of the common questions that people ask about these tests, which I was asked to comment on for articles for the Guardian Newspaper and VICE UK.

How do lateral flow tests work and how reliable are they?

Lateral flow test (LFTs) work by detecting the proteins on the surface of the SARS-CoV-2 virus that is the cause of Covid-19. They can be carried out at home and don’t require a laboratory to process the test, unlike PCR tests. They also give a result very quickly, typically within 30 minutes. They are less accurate than PCR tests, which is why PCR tests are recommended for people with symptoms.

Studies show widely varying estimates of the accuracy of LFTs, typically detecting between 40%-90% of people who have Covid-19 in different studies. We can’t just take an average of these studies to determine the accuracy of the tests as this will depend on a range of factors – such as the type of people in the study, what stage of illness they were at, what specific test was used, and how well the test was carried out.

We do know that carrying out the test correctly is very important. It’s essential therefore to read the instruction leaflet that comes with the test and to watch one of the NHS videos that explain how to carry out a lateral flow test to learn the correct technique.

How do I carry out a lateral flow test?

Before you start, read the instructions that came with the test. If your test needs a throat swab, open your mouth wide and rub the swab over your tonsils (or where they would have been if you have had a tonsillectomy). Put the same swab inside your nose (about 2.5 cm / one inch up or until you feel resistance). If your test requires only a nose swab, put the swab inside your nose (about 2.5 cm / one inch).

After you have done this, put the end of the swab into the tube so it’s in the liquid, then squeeze the liquid from the tube onto the test strip and read the test result once the waiting time advised in the instruction leaflet has passed. Once you have the result, record this via the reporting website. This is important as it allows the government and the NHS to monitor Covid-19 infections in the UK.

Full instructions on how to carry out the test are available on the NHS Website. There are also several NHS videos available online that show people how to use the tests properly.

People online have had negative lateral flows but positive PCRs – why is this? Should I get a PCR instead?

Lateral flow tests and PCR tests work in different ways. Lateral flow tests detect some of the proteins in the virus, can be carried out at home and give a result quickly. PCR tests detect the genetic material (RNA) in the virus and require a laboratory to do this. The result of a PCR test takes longer to come back but it will pick up more infections than a lateral flow test because the test has a higher sensitivity than a lateral flow test.

Because lateral flow tests are not as accurate as PCR tests, they can sometimes be negative in people with symptoms when the subsequent PCR test is positive. If you have symptoms of a possible Covid-19 infection, you should always get a PCR test and not rely on a lateral flow test. If you don’t have symptoms, a lateral flow test is sufficient. PCR tests should be reserved for people with symptoms of a possible Covid-19 infection to avoid overloading government laboratories with unnecessary test requests. (UPDATE: From 11 January, most people with a positive lateral flow test do not need to take a confirmatory PCR test to confirm they have Covid-19).

What are the symptoms of a Covid-19 infection?

When Covid-19 first arrived in the UK in early 2020, the main symptoms people were asked to look out for were a high temperature, a new continuous cough, or a loss or change to their sense of smell or taste. Now that so many people in the UK have some immunity because of vaccination or a previous Covid-19 infection, they may get other symptoms when infected – such as a headache, runny nose, sore throat, or sneezing. So even if you think you might just have a cold, you should still get a PCR test.

How long before meeting family/friends should you take one, and does taking multiple LFTs increase their accuracy?

The test should be done on the day of the meeting. One test is sufficient. Although you can carry out more than one test a day, there is a shortage of tests in many parts of England. If the tests are over-used, this will lead to further supply problems – including for key workers such as NHS staff who are required to test regularly for employment purposes.

Does the thickness of the ‘test’ line on an LFT give any indication of how infectious you are? (if it’s a weak line, does that mean you are hardly shedding any virus? Does a thick one mean you are really infectious?)

The test is designed to tell you if you may be infected and is not designed to estimate how infectious you may be. You shouldn’t therefore use the thickness of the line to try to estimate your infectivity. At a time when the prevalence of Covid-19 in the UK is so high, a positive test means that you are very likely to be infected and you should isolate until you get the result of a PCR test; and then isolate further if this is positive.

If you are still testing positive on an LFT after 10 days’ isolation, are you still infectious and do you still need to isolate? (MIT medical journal says: “But what if someone still tests positive after 10 days? This is very common. People who have tested positive for COVID-19 are very likely to continue to test positive after 10 days. But they are not contagious.”)

There is no need to keep on testing repeatedly if you have had a positive LFT result and this is then confirmed by a PCR test. You should complete your period of isolation and, if in England, carry out any required LFTs as advised by NHS Test and Trace. In England, people who are fully vaccinated can now carry out LFTs on day 6 and day 7 of their isolation period and come out of isolation if both these tests negative. Unvaccinated people will need to continue to isolate for 10 days. Test results can sometimes remain positive for a period after day 10 of isolation ends but this not necessarily mean you are still infectious. (UPDATE: From 17 January 2022, the isolation period in England was reduced to five days if the lateral flow tests are negative on day 5 and day 6).

If you’ve tested positive, including for Omicron, does that mean you won’t get it again?

Reinfections can occur after a previous Covid-19 infection. These are more common with Omicron which a recent study from Imperial College London showed was over 5-times more likely to cause a reinfection than the Delta variant. These reinfections will have been in people who have had an infection with a variant such as Delta, Alpha or the original version of SARS-CoV-2. Because Omicron infections have only occurred recently in the UK, we don’t yet know how prone people who have had an Omicron infection will be to a repeat infection.

Read Questions and Answers about Lateral Flow Tests for Covid-19 in full

In an article for VICE UK, I answer questions from Darcey Edkins about staying safe this Christmas in the midst of a wave of Covid-19 infections driven by the Omicron SARS-CoV-2 variant. We cover topics such as the Three C Approach to personal safety, why you should wear a well-fitting FFP2 mask, and testing for Covid-19.

Given the scientific data out there, is it safe to travel home for Christmas right now?

There is currently a high level of Covid-19 in the UK so you need to take appropriate precautions when travelling such as adopting the “Three C Approach” to reduce the risk of infection to you. This means: Avoid closed spaces; Avoid crowded spaces; Avoid getting too close to other people when outside your household. When you travel home, you should use a good quality FFP2 face mask to protect yourself better if you are on public transport or enter places such as bus, train and service stations. You can test yourself before you travel with a lateral flow test. If you have symptoms, you should not travel until you hear that your PCR test is negative.

I have seen people saying that lateral flows are not reliable – how much can I rely on them to make a call on whether I am COVID-negative?

Lateral flow tests will detect the majority of people with Covid-19 but they are not as accurate as PCR tests (which are processed in a laboratory). The accuracy of a lateral flow test can improved if it is carried out correctly. Lateral flow tests will detect infections from the Omicron variant.

Before you start, read the instructions that came with the test. If your test needs a throat swab, open your mouth wide and rub the swab over your tonsils (or where they would have been if you have had a tonsillectomy). Put the same swab inside your nose (about 2.5 cm up or until you feel resistance). If your test requires only a nose swab, put the swab inside your nose (about 2.5 cm).

After you have done this, put the end of the swab into the tube so it’s in the liquid, then squeeze the liquid from the tube onto the test strip and read the test result once the waiting time advised in the instruction leaflet has passed. Once you have the result, report this via the website. This is important as it allows the government and the NHS to monitor Covid-19 infections in the UK.

Full instructions on how to carry out the test are available on the NHS Website. There are also several NHS videos available online that show people how to use the tests properly.

People online have had negative lateral flows but positive PCRs – why is this? Should I get a PCR ahead of travelling home?

Lateral flow tests and PCR tests work in different ways. Lateral flow tests detect some of the proteins in the virus, can be carried out at home and give a result quickly. PCR tests detect the genetic material (RNA) in the virus and require a laboratory to do this. The result of a PCR test takes longer to come back but it will pick up more infections than a lateral flow test because the test has a higher sensitivity than a lateral flow test.

Because lateral flow tests are not as accurate as PCR tests, they can sometimes be negative in people with symptoms when the subsequent PCR test is positive. If you have symptoms of a possible Covid-19 infection, you should always get a PCR test and not rely on a lateral flow test. If you don’t have symptoms, a lateral flow test is sufficient. PCR tests should be reserved for people with symptoms of a possible Covid-19 infection to avoid overloading government laboratories with unnecessary test requests.

When Covid-19 first arrived in the UK in early 2020, the main symptoms people were asked to look out for were a high temperature, a new continuous cough, or a loss or change to their sense of smell or taste. Now that so many people in the UK have some immunity because of vaccination or a previous Covid-19 infection, they may get other symptoms when infected – such as a headache, runny nose, sore throat, or sneezing. So even if you think you might just have a cold, you should still get a PCR test.

Is there any other precautionary stuff I can do to ensure I don’t give COVID to my loved ones this Christmas?

People who are unvaccinated are more likely to become infected with Covid-19 and transmit infection to others. To protect yourself and others, ensure you are vaccinated – including with a booster. Your friends and family members should also ensure they are fully vaccinated. Another step you can take to reduce the risk of infection is to test for Covid-19 before you all meet up and then once or twice each week.

Good ventilation will also reduce the risk of infection as will limiting the size of the gathering. For ventilation to work best, you need a good flow of air in and out of the room you are in. This would mean opening at least one window and the door to the room. The more air that flows through the room, the quicker any virus that is in the air will disperse, thereby reducing the risk of infection. If you want to measure the quality of air in a room, you can use a carbon dioxide monitor. Higher levels of carbon dioxide indicate poorer air quality and are a sign that you need to open more windows to improve ventilation.

Regarding the number of people you have in a room, there is no “right” number. The more people who are in a room, the more likely it is that one will have a Covid-19 infection. But other factors also important – such as the size of the room and its ventilation, whether all the people are fully vaccinated, and whether they have all carried out a recent lateral flow test to check their infection status.

When you are outside in places such as public transport and shops, you should wear a good-fitting mask. Higher specification FFP2 masks provide better protection from infection than the cloth masks and surgical masks you see many people wearing. Good hygiene is also important.

Should I be testing every day I’m home for Christmas, just to be sure? Should I be testing multiple times a day?

Testing every day is not a good use of lateral flow tests. Some people do carry out more than one test per day but this will lead to tests running out very quickly as the supply of tests in the UK  is limited and there are not enough tests available for everyone to do this. You should test before you meet up and then once or twice weekly. There is no need to carry out multiple tests on the same day. There is currently a shortage of lateral flow tests in many parts of England and they should be used sensibly. We also need to ensure that key workers such as NHS staff have sufficient tests for their own use. If you have symptoms, you should get a PCR test and wait for the result rather than carrying out multiple lateral flow tests.

Read Should You Even Be Travelling Home for Christmas? in full

Several patients have asked me if lateral flow devices (LFDs) will detect Omicron infections. These are the rapid tests that people can use to check for Covid-19 infection while they are asymptotic. NHS staff are required to use these tests regularly if they are in patient-facing roles.

Short Answer: Yes. The UK HSA has confirmed this in an initial laboratory evaluation of the LFDs currently used in the UK. The data from the initial samples in the HSA study show a similar sensitivity for the detection of Covid-19 from Omicron to that seen for previous strains of SARS-CoV-2 including Delta, which has been the predominant strain in the UK from May to December 2021.

All LFDs approved for use within the UK specifically detect the nucleocapsid protein of SARS-CoV-2 using a combination of 2 or more different antibodies, each targeting a distinct epitope. Full details of the study are available on pages 14-16 of the HAS study. Finally, remember that LFDs are not 100% sensitive and won’t detect some infections. Full details of the study are available on pages 14-16 of the HSA report.

If you have symptoms of a possible Covid-19 infection, get a PCR test. Irrespective of your test result, continue to practise good infection control measures such as wearing a face mask and avoiding higher risk venues such s very crowded indoor spaces with poor ventilation.

Read Detecting Covid-19 infections from Omicron using lateral flow devices in full

The UK is facing a surge in Covid-19 infections from the Omicron variant of SARS-CoV-2 coronavirus with a record number of Covid-19 cases (78,610) reported in the UK today. Cases of Covid-19 due to Omicron will soon account for most infections in the UK. Omicron has proved to be highly infectious – more so than other variants of SARS-CoV-2 – and is also able to evade vaccines better than other variants. To protect yourself, and reduce the risk of infection to you and others remember the three C approach to personal safety:

– Avoid closed spaces

– Avoid crowded spaces

– Avoid getting too close to other people when outside your household

These are simple and effective messages that need to be disseminated and adopted widely.

Remember also to get vaccinated – including with a booster as well as your first two doses – and to wear a good quality FFP2 mask when in indoor spaces outside your home. Three doses of vaccines provide much better protection against symptomatic Covid-19 infection than one or two doses. Test regularly with lateral flow devices. These don’t pick up all infections but can help identify the people who may be most infectious.

Finally, remember to improve ventilation whenever you are indoors, particularly with people from outside your household. The virus that causes Covid-19 (SARS-CoV-2) is airborne. Good ventilation can help  disperse the virus and reduce the concentration in the air, thereby lowering the risk of infection.

When vaccination, testing and ventilation are combined with wearing a higher quality face mask and adopting the 3C approach, you are reducing the risks of infection for you and the people close to you when you follow this guidance.

Read The Three C Approach to Personal Safety During the Covid-19 Pandemic in full

The number of Covid-19 cases in the UK has increased in recent weeks to an average of around 50,000 per day. The number of cases caused by the Omicron variant, although currently small, is doubling about every three days. If this increase continues, Omicron will replace Delta as the most common variant of the Coronavirus in the UK within a few weeks. This is concerning because it looks like our current vaccines may be less effective against the Omicron variant than against the Delta variant. The good news though is that three doses of a vaccine (the first two doses followed by a booster dose) should continue to provide good protection from serious illness, even if current Covid-19 vaccines are a little less effective against Omicron. To help counter the threat from Omicron and limit the pressures on the NHS, the government is introducing new measures in England to reduce the risk of infection. As well as following the new rules, you should also ensure you are fully vaccinated – including receiving a booster vaccine – and use lateral flow test before attending events or meeting others from outside your household. Some people with weak immune systems will need four vaccinations before they are fully vaccinated. And remember that if at any point you develop symptoms of a possible Covid-19 infection, get a PCR test and isolate until you get the result of the test.

I’m having my family over for Christmas dinner, but some of them are unvaccinated. What should I do?

People who are unvaccinated are more likely to become infected with Covid-19 and transmit infection to others. If you have vulnerable family members – such as elderly relatives – joining you for your Christmas dinner, my advice would be for your unvaccinated relatives not to attend. If they do attend, you should aim to reduce the risk of infection by asking them to carry out a lateral flow test before they visit. You should also improve the ventilation in your house as this will also reduce the risk of infection.

My elderly mother missed Christmas last year. Can she come round this year?

People from different households can mix indoors this year, so your mother can come round. Ideally, everyone eligible for a vaccine who is present should be fully vaccinated (including boosters) and take a lateral flow event before your mother arrives. Children under 12 are not currently eligible for a vaccine. They should also take a lateral flow test as there is currently a high Covid-19 infection rate in children.

I’ve booked to go with my family of four to a West End musical over Christmas. Can we still go?

Theatres remain open. You will be required to wear a mask whilst in the theatre. Currently, a COVID pass is not needed for entry to a theatre but it is a good idea for everyone to carry out a lateral flow test before leaving home for the theatre.

My work is throwing a big Christmas party for all 50 employees. Will it still go ahead, and if so, will it be safe to go?

Christmas parties can still go ahead but many employers are cancelling them because of the risk of infection in crowded, indoor settings; particularly where ventilation is poor. A COVID pass is not required for entry to the party but if the event does go ahead, ideally, everyone attending should ideally be fully vaccinated and take a lateral flow test before the event. If you are clinically vulnerable through age or a medical condition, or live with someone who is clinically vulnerable, my advice would be not to attend the event even if fully vaccinated because of the risks from a breakthrough infection.

My department is planning a Christmas lunch with around 15 people. Is that still allowed? What precautions should we take?

Christmas lunches organised by employers can go ahead. Everyone attending should aim to be fully vaccinated and take a lateral flow test before the event. People who are clinically vulnerable – or live with someone who is clinically vulnerable – should consider missing the event.

Will my kids’ school Christmas play still be allowed to happen, and if so, what extra restrictions might there be?

School Christmas plays can go ahead. However, many schools are limiting the number of people who can join the event, meaning that parents may not be able to attend. If you are allowed to attend, you should wear a face mask and take lateral flow test before attending. Ensure that you are also fully vaccinated.

What precautions should I take when I go Christmas shopping?

Wear a face mask whilst indoors and on public transport. An FFP2 mask provides greater protection and many public health specialists advise the use of these rather than standard surgical masks. Wash your hands or use had sanitiser before and after leaving shops.

Is it safe for my children to have friends around to play over the Christmas holidays?

Children can have their friends round. A lateral flow test for everyone can help in reducing the risk of infection. Ventilation can also help reduce infection risk. Younger children (under 12) are not currently eligible for a Covid-19 vaccination.

What will happen to the Christmas Eve midnight mass we all normally go to?

Religious events can still go ahead and are exempt from the from requirements to use the NHS COVID Pass. A face mask will be required whilst indoors in the church. To reduce the risk of infection further, everyone attending should be fully vaccinated and take a lateral flow test before attending.

Will me and my mates still be able to have our traditional festive drinks evening at the pub?

You can still have your festive drinks with your friends. As the venue is likely to have less than 500 people, the NHS Covid Pass in not needed to enter. A face mask is not required either. You should remember however that indoor events like this carry a risk of infection because the venue may be crowded and social distancing will not be possible. Ensure you are fully vaccinated and use a lateral flow test before the drinks event.

A version of this article was first published in the Daily Mirror.

Read Staying safe this Christmas in the midst of an Omicron Covid-19 wave in full

We all want to avoid another lockdown. We need sustainable public health interventions that will keep Covid-19 cases, hospitalisations and deaths at an acceptable level, and get us through the winter. What could this mean in practice?

1. The most important public health intervention to control Covid-19 is our vaccination programme. This has slowed down in recent months. Also, in effect, it has split into four distinct programmes:

– a programme aimed at people 16 and over. This has almost stopped, with around 10% of adults in the UK still unvaccinated (higher in London).

– a third primary dose programme aimed at people with weak immune systems. This has been poorly planned and implemented by NHS England and has caused a lot of confusion.

– a booster dose programme. This is going OK but could be speeded up to provide more protection for key groups of people before the full onset of winter.

– a programme for 12-15 year olds. This has got off to a very slow start in England.

Speeding up all these vaccination programmes is essential and is our best defence against Covid-19.

2. Try to reduce social contacts; for example, by asking staff to work from home where possible. The government has been encouraging people to “get back into the office” but I think we should be cautious over the winter.

3. Face masks. The government needs to reconsider its policy. In my view, face masks should be required in settings such as shops and public transport.

4. Vaccine mandates / vaccine passports / negative test results. Many European countries require these for entry to higher risk settings such as nightclubs, bars and indoor events. No vaccine is 100% effective but the fact is that an unvaccinated person is much more likely to become infected and transmit infection to others than a vaccinated person. The government has flipped-flopped on this policy (currently against) but have said they may reconsider.

Effective measures now can help bring Covid-19 under control, protect public health, keep pressures on the NHS manageable, and get us through the Winter.

Read What can we do to reduce the risk of another lockdown this Winter? in full