Plan B

8th December 2021

UK COVID Deaths – Daily 161 / 7-Day average 121

Total UK COVID Deaths within 28 days – 145,987

Total UK Deaths with COVID-19 on the death certificate – 170,001 (up to 26 Nov)

James Cook Hospital – Total COVID deaths – 716

All COVID cases within South Tees Hospitals Trust – 56

James Cook Critical Care

COVID cases – 6 (5 ventilated)

Non-COVID cases – 46 (26 ventilated)

It’s been quite a day for COVID-related news. The big banner headline is that Plan B will shortly be implemented and it’s all Omicron’s fault. Plan B involves advising the public to work from home where possible, more mask-wearing and the use of the NHS COVID pass for entry into large venues such as nightclubs.

Restrictions have been reintroduced following the discovery that the number of cases due to the highly-infectious Omicron variant is doubling every two to three days. There is no doubt that we will see infections soar over the next few weeks and that Omicron will quickly replace the Delta variant as the top dog.

The other big story is the continued furore regarding the Downing Street Christmas Party. The party in question was held last December, at a time when Christmas gatherings were banned in London and in many other parts of the country. The Government has insisted that no rules were broken during the ‘small, socially-distanced, cheese-and-wine, definitely-not-a-party, business meeting’ but no-one believes a word of it. The irony of instructing the public to follow the rules whilst simultaneously defending breaking them seems completely lost on the Prime Minister.

The final piece of news is that, from today, the booster vaccination programme is now open to those over 40. The time period between the second and third doses was shortened last month from six to five months and has now been shortened further to three months. Boosting the booster programme aims to protect as many people as possible from the imminent wave of Omicron infections and reduce pressure on the health service.

What isn’t yet clear is just how many hospital admissions we might expect to see. The first laboratory study from South Africa confirms, as suspected, that Omicron is able to evade vaccines better than the Delta variant. The study found that in those who had been vaccinated with two doses of the Pfizer vaccine, exposure to the Omicron variant produced neutralising antibody levels that were 25 times lower when compared to the original ‘Wuhan’ strain. To put this in perspective, exposure to the Delta variant produces five times fewer neutralising antibodies than infection with the original strain.

To be honest, whilst this isn’t great news, it is better than many people expected. What is reassuring is that Omicron’s many mutations have not occurred in the part of the virus that is targeted by T-cells and so there is a hope that the T-cell immunity produced by previous infection or vaccination will be left intact, helping to maintain protection against severe illness.

Even more reassuring is the finding that a booster dose of the Pfizer vaccine may restore this lost protection. A third dose provides a similar level of neutralizing antibodies against Omicron that you see after two doses against other variants. A third dose also serves to further boost your existing T-cell immunity.

So, the best current prediction suggests that, whilst vaccination may not offer much protection against mild disease, a booster dose should offer very good protection against severe disease. So, if you haven’t had one yet, you need to quickly move ‘booster vaccine’ to the top of your Christmas list.

At the hospital, things have remained relatively calm. The number of COVID infections on Teesside is still lower than the national average and the number of COVID patients being admitted to the hospital has been slowly decreasing. The number of Critical Care patients, both COVID and non-COVID, has not changed much over the past fortnight and, if it weren’t for Omicron, we might even be relaxing a little bit.

We all know we are not in for a happy New Year. How soon and how fast hospital admissions will rise is unclear at the moment. Fortunately, Omicron does not appear to cause more severe disease than its Delta counterpart and there are signs that it may even be milder. Unfortunately, a more infectious, less severe disease can still wreak havoc. As Joseph Stalin used to say, “quantity has a quality all of its own.”