14 December 2020updated 28 Aug 2021 8:44pm

As London enters tier three, household mixing over Christmas could prove disastrous

Data on Covid-19 infections and hospitalisations suggests the second national lockdown was ended too early.

An ambulance crosses Westminster Bridge in London. (Photo By Alex Davidson/Getty Images)

The mood around England’s Covid-19 epidemic has grown significantly more sombre in recent days. Confirmed case numbers have reached levels not seen since late November, with London a particular concern.

The capital has now been placed in tier three – the most restrictive regional level – hospitalisations are rising; schools in Greenwich have been forced to close early for Christmas because of soaring case rates; and NHS Providers has warned of the danger of a third wave of the virus. All this only nine days before restrictions are due to be relaxed for the Christmas period (23-27 December).

If it was possible to be cautiously positive a week ago, with cases and hospitalisations down from their mid-November peaks and the Pfizer-BioNTech vaccine being rolled out, the coming weeks may prove just how fragile that optimism was.

Given the impending Christmas exodus of Londoners to family homes across the country, the increase in confirmed cases in the capital is troubling. London initially avoided the ultra-high case rates that afflicted northern regions during the second wave, but it now has the highest rate of any English region.

Within London there is significant variation in case rates across boroughs: Havering has one of the highest case rates in the UK at 471 per 100,000 people in the latest available week. East London boroughs tend to record higher rates, with Newham, Barking and Dagenham, Redbridge and Waltham Forest all seeing case rates in excess of 300 per 100,000 people in the latest week of data.

But the biggest concern is that cases are rising in all 32 boroughs. A third of the capital has seen cases increase by more than 40 per cent in the past week with the increase as high as 74 per cent in Enfield.

The government’s scoring system for determining tiers uses five key metrics: case rates and whether they are increasing, case rates among the over-60s, hospitalisation levels and test positivity rates.

London is doing badly on nearly all these measures with the latest test positivity rate data from NHS Test and Trace showing that nearly one in eight pillar 1 and pillar 2 tests (those conducted in hospitals and in the community) in east London are returning positive results. That is a rate of around 12.5 per cent, compared to an average of 5.6 per cent across all local authorities in England.

Breaking case figures down by age shows that London also has a problem with increasing rates among older sections of the population. Rates are highest among school-age children and young adults but are increasing among all age groups.

This, unfortunately, means that hospitalisations and deaths are also likely to see corresponding increases in London in the coming weeks. Although hospitalisation rates are far off the levels experienced during the first wave of the virus, rates in London are also rising, with more than 2,000 Covid patients currently in hospital.

But the shape of London’s case rate and hospitalisation curve also shows that it’s premature to use the term “third wave” when describing the current situation. The city, along with the south-east and the east of England, is still very much in its second wave of cases.

While these key metrics have declined in regions away from the capital, their levels are such that the second wave cannot be said to have faded in the manner of the first. The chart below shows hospitalisation levels across England’s regions during the two national lockdowns. When national restrictions from the first lockdown were eventually eased in early July, hospitalisation levels were close to zero, but this was not the case when the second national lockdown ended earlier this month.

There are some key differences between the situation today and that in July, but it’s difficult to avoid the sense that national restrictions ended too early on the second occasion.

The situation in Wales may serve as a useful barometer for what could happen in England, and it doesn’t augur well. The devolved Labour administration instituted a “firebreak” national lockdown for 17 days from 23 October. As with the second national lockdown in England, this resulted in a decrease in cases but, as in England, cases started to rise again a few weeks later and are now 62 per cent higher on a weekly basis than they were when the firebreak was introduced. The number of Covid-19 patients in Wales has also continued to increase to the point where there are now 40 per cent more patients in Welsh hospitals than there were at the peak of the first wave.

If England does follow Wales’ path then the plan to allow travel and household mixing over Christmas could prove disastrous, with those in areas with high case rates spreading the virus around the country. The vaccine roll-out has provided cause for hope, but few people will have received both doses by Christmas and it isn’t hard to foresee a scenario in which cases spread rapidly across the UK, leading to large increases in hospitalisations at the time of year when the NHS is under the most stress.