Following the prime-minister's statement this afternoon, please find here a provisional analysis from Scientists for Labour on the Government’s announcement of new rules for Christmas.
We have identified some major areas of concern with the suggested approach, which are presented here:
The loosening of regulations over the holiday period will (with high certainty) lead to an increase in infection rates, hospitalisations, and deaths.
We would expect to see increased cases very early in the new year, with subsequent hospitalisations observed mid-January and associated deaths in mid to late January
The consequences of any easing of restrictions will be felt for many weeks or months to come, and may be difficult to mitigate against ex post facto.
The exact level of excess mortality from Christmas easing will depend on the degree of public compliance with (or indeed over-compliance with) new government rules and an effective test, track and trace system.
In putting the responsibility for decision making onto the public, excess risk will be experienced by those with lower healthcare literacy or situational comprehension. This includes vulnerable populations: those with learning difficulties, and those with English as a poorly-spoken second language, and so on.
It is also apparent that:
The current infection rates mean that it is not reasonable to expect that complete normality will be restored by the expiry of national lockdown on December
With over a million students in the UK, their return home (regardless of other measures) has the potential to contribute to a ‘third peak’ in infection rates in mid-late December.
A ‘normal’ Christmas in 2020 would involve increases in infection rates due to mass travel, non-COVID safe practices (communal worship, time indoors with other households, alcohol induced socialising); NHS services may be further strained due to staff shortages
A fully locked-down Christmas will likely increase the burden on NHS mental health services, but would free up resources for COVID-related and other urgent appointments.
If handled poorly, the Christmas period could see a substantial increase in infections, and in later weeks, deaths. Any reduction in the provision of essential services (due to their withdrawal, or decreases in capacity due to staff self-isolation shortages), could contribute to this.
It is also likely that compliance with restrictions will not be uniform, given a loss of confidence in the government and statements in the media by individuals stating that they will not be following the rules. To account for non-compliance, the base level of restrictions will need to be tighter than they would if full compliance were observed.
It is possible to gain some insight by considering other countries, especially those with different dominant religions, who had festivals at various points through their lockdowns.
Select international examples
China – restrictions in travel helped to reduce transmission of the virus at the time of their major annual festival, the Chinese New Year celebrations. The Chinese New year is the world’s biggest annual migration, involving mass movement of people and about 3 billion separate trips. Movement is widespread across China with significant international travel [1]. The Chinese government cancelled a large proportion of the 40-day 2020 New Year celebration in January and February, with the novel coronavirus known to be spreading widely in parts of China. The impact of this has been modelled: restrictions were put in place on 23 January, two days before the start of Chinese New Year celebrations [2].
Whilst this did not completely stop the seeding of the virus from Wuhan, it did prevent large numbers of cases being transmitted from Wuhan to a wider area. Analyses suggests that effective contact tracing and social distancing measures had the greatest effect, followed by the travel restrictions. Without these measure, cases are estimated to have been 67-fold higher than was observed [3].
Saudi Arabia – significant restrictions as to who could attend the 2020 Hajj.
Over 2 million people typically travel to Mecca, in Saudi Arabia, each year for the Hajj celebrations. In 2020, only around 10000 pilgrims travelled to Mecca, with restrictions as to who was allowed to travel. These restrictions included excluding older individuals, pilgrims needing to be between 20 and 50, and they also required quarantine periods and to have had a negative polymerise chain reaction (PCR) test [4]. Modelling suggests that these restrictions prevented 127 000 new cases [5].
Israel – significant restrictions on number of worshippers and additional measures targeted at the festival period.
In Israel, Passover is celebrated in April. In 2020, the government targeted additional restrictions during the holiday period beyond those already in place [6], including no travel between cities and no visiting of other households. A key component of the celebration usually sees tens of thousands of people visiting the Western Wall (Wailing Wall), but this year, only ten people at a time were allowed to visit the site [7].
Christmas in the UK
There are multiple international precedents to suggest that additional, rather than reduced, restrictions are effective at minimising cases and deaths during religious holidays. It is also clear that the risk of super-spreading events at mass gatherings (e.g. Church Services [8]) means that it cannot be assumed that small gatherings will have a negligible effect on the infection rate and R number.
For the government to consider a relaxation (either actively or passively through non-enforcement) of regulations has the potential to be extremely dangerous. There is optimism that the latest interventions, scheduled to last until early December, may reduce transmission ahead of the Christmas period (for example with the R number being reduced below 1.0). If so, this may allow recommendations of some movement of people and limited mixing of households during the festive period. An approach involving ‘bubbles’ between two households may be an example of an acceptable strategy that respects the need for good public health but also receives compliance from the general public.
However, there are significant uncertainties around future levels of community transmission, and any relaxation of pandemic strategy cannot be guaranteed – especially many weeks beforehand. In order to maintain any progress, the ‘test and trace’ system needs urgent improvement, along with incentives to comply with self-isolation [9]. There should also be significant restrictions around international travel, given the likely impact of summer holidays on autumn transmission [10].
Other religious holidays
It is worth noting that no exemptions were made for other major religious holidays (e.g. Eid, Diwali); although these would involve far smaller fractions of the population and hence could have pose less of a risk to overall public health.
Care should be taken to ensure that Government relaxations around Christmas alone do not stoke resentment in communities who do not celebrate Christmas. These groups may be disproportionately BAME, and as such may have already been disproportionately affected by the pandemic [11].
It should also be acknowledged that those with relatives abroad are unlikely to be able to visit them (with the UK’s infection rate resulting in it having been removed from many ‘safe corridors’), contrasting with the relatively open summer holidays experienced by many. This will affect both Christians who would normally travel abroad, as well as those of other faiths.
References