The wording of the four home nations’ chief medical officers joint statement on Sunday was undramatic but still ominous. “Transmission of Covid-19 is already high in the community, mainly still driven by Delta, but the emergence of Omicron adds additional and rapidly increasing risk to the public and healthcare services.”
Given that “vaccine protection against symptomatic disease from Omicron is reduced … hospitalisations from Omicron are already occurring and these are likely to increase rapidly”, they added.
The growing threat means the urgent twin imperatives of all policy now are to save lives and prevent the NHS becoming overwhelmed by what Boris Johnson in his televised address called “the tidal wave of Omicron coming”. The UK Health Security Agency has already warned that the new variant could produce 1m infections a day by New Year’s Eve.
Johnson’s message and tone made clear the urgency of the threat. He made clear that vaccination is the main – in reality the sole – meaningful tactic the government has chosen to pursue both outcomes, given another lockdown or anything resembling it is for now not on the cards.
As the prime minister said: “To hit the pace we need, we’ll need to match the NHS’s best vaccination day yet – and then beat it day after day. This will require an extraordinary effort.” In simple terms that means doing 1m or more boosters a day from now on, especially as he brought the deadline for everyone in England to have been offered a top-up from 31 January to 31 December. Bear in mind that the record number of jabs administered in one day across the UK to date was 844,285 on 20 March and that the most since the booster rollout began in September was 699,192 on 10 November.
For an NHS already under the most intense pressure it has ever faced, this is a massive task. It means that for an undetermined period GPs and their teams will have to provide less of the care they usually give to patients as delivering huge numbers of boosters becomes their top priority. Hospitals will also come under more strain once Omicron leads to more people being admitted who are seriously ill.
As Johnson acknowledged, the “extraordinary effort” will come at a price. “As we focus on boosters and make this new target achievable, it will mean some other appointments will need to be postponed until the New Year. But if we don’t do this now, the wave of Omicron could be so big that cancellations and disruptions, like the loss of cancer appointments, would be even greater next year.”
He did not quantify how many fewer GP consultations, operations and outpatient appointments will now not happen in the weeks ahead. It is impossible to know what those numbers will be. But given GPs see more than 20m patients a month, they will be measured in the many millions. The backlog of people awaiting hospital care in England is already just shy of 6 million. The widespread cancellation of hip and knee replacements, cataract removals and other planned operations will send that soaring. This is a strategy of short-term pain for long-term gain.
The initial reaction from NHS bosses was one of support. As one official said: “NHS leaders will be fine with the plan as they recognise that the likely pressures from Omicron could be very serious. But they will need the PM and ministers to make clear that the number one and number two priorities are delivering the booster – and first and second doses to those who haven’t been jabbed – and dealing with medical emergencies. That means non-urgent ops and so on will likely be pushed back but hopefully this is for a specific period of time as we race to get as many people jabbed as possible.”
Hospital bosses are acutely aware of the terrible human cost of the huge backlog of people waiting for planned care, mainly surgery – anxiety, pain, inability to lead a normal life and in some cases less chance of surviving their illness – and have made strenuous efforts this year to perform as many non-urgent operations as possible. They will hate to have to start cancelling surgery again, especially as no one will be able to give patients affected any real sense of when they will finally be treated. But they will have to do it. GPs will feel the same about putting such a large amount of normal care on hold for patients but again have no choice.
But medical need does not magically disappear, though. The next few weeks, possibly months, are going to be tough for anyone who relies on the health service as well as those who work in it. Both will hope that the sacrifices involved turn out to be worth it.
