Prof Dominic Harrison: the possible impact of Plan B relaxation across the North of England

The Omicron situation is improving across Lancashire – but it’s ‘not all over’ yet.

Confirmed Covid-19 case rates and hospitalisations have been falling across both the UK and Lancashire over the past seven days – but the rate of decline is slowing. Lancashire case rates peaked around the 6^th January with most local authority areas in London and the South East region peaking 7 to 10 days earlier. One consequence of this difference is that relaxing Plan B measures opens up the north of England to higher transmission risks at an earlier stage in the Omicron wave than the south of England. This will give us a higher risk of transmission rates ‘re-igniting’.

UK Health Security Agency modelling suggests that lifting Plan B control measures so quickly after the ‘peak’ may mean that the decline in Omicron case rates may stall, and we might plateau at a still high case rate for a number of weeks. The risks of this were underlined earlier this week as the national data revealed that two English regions to have an early Omicron wave, the Eastern region and the South East region, now have case rates rising again.

For Lancashire, whilst adult rates are showing a broadly consistent decline, Covid infections in 5 to 9 year olds continue to rise, and rates for other school-aged children are showing a plateauing of cases. Rates for the parents of primary school aged children, those aged 30-45, are much higher than the rest of the adult population. This is probably an indicator that the continued rise in primary school-aged children is generating a lot of household transmission and clustering of cases – something we have seen with each previous Covid wave.

UK decision making on whether or not to vaccinate 5 to 11 year olds seems to have stalled, despite the fact that the Medicines & Healthcare Regulatory Agency (MHRA) approved Pfizer/BioNTech vaccine for 5 to 11 year olds in December 2021.  The European Medicines Agency (EMA) approved the use of the Pfizer vaccine for children aged 5 to 11 in November and roll-out in some EU countries had already begun in December. It is very hard to justify this delay in the UK. Primary school-aged children, teachers and their families are currently paying a high price of the absence of vaccine protection in younger children, with disrupted learning and family life and a continued risk of Long Covid effects in a small minority of those infected.  The Lancashire local authorities are taking local ‘school specific action’ where outbreaks are exceptional, significant or persistent, but we are required to follow general Department for Education policy on the lifting of Plan B measures in education settings.

The overall Omicron case data is telling us that whilst the consequences of the Omicron wave may slowly subside, the relaxation of Plan B measures so rapidly after the peak, may be rather a gamble. Even if the decision turns out to have positive results in general, some may still end up paying a higher price than others for the wager. At the moment that looks like local authorities in the north of England and all families with primary school-aged children.

The government may publish a national strategy for ‘Living safely with Covid’ in March this year. Let’s hope it states that, in future, Covid risk management is to be localised; with delegated local risk assessment informed by local authority public health advice, agreed with local communities and signed off by their elected representatives in partnership with the local NHS.

Over-centralised decision making for managing the Covid pandemic has consistently exacerbated local risk, and it has created a disproportionately negative impact on the health and economic wellbeing of many northern towns.