What happens if coronavirus cases stop falling or start going up?

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Coronavirus numbers in Wales have been heading in the right direction for months.

Though cases and positivity are still higher than the lowest points last summer and Cardiff and Swansea numbers are refusing to drop below 30, the overall picture is bright.

Helped by the vaccine hospital admissions and bed occupancy due to Covid are at the lowest levels since the first lockdown over a year ago and the economy is starting to reopen.

However,  in all likelihood there is going to be a third wave . And the prospect of that, and the associated rise in cases, presents quite a lot of uncertainty because of the vaccine. In previous waves, more cases have always meant more hospital admissions and more deaths. However, with the vaccine the direct link between cases and deaths may not be as strong.

Martin Michaelis, is a professor of molecular medicine at the University of Kent .

He said: “The vaccine roll-out is a great success. At this moment in time, the case rates are associated with fewer hospital admissions than they used to be. This is probably because the majority of the most vulnerable individuals have been vaccinated and Covid-19 now predominantly spreads among lower risk groups.”

Unfortunately because the vaccine is new and there is the possibility of more variants evolving, it is hard to know how the increase in cases will play out long time.

“We cannot predict how the situation will further develop,” said Professor Michaelis.

“There are ongoing concerns about new virus variants that are not covered by the vaccines. The South African B.1.351 variant is known to bypass at least in part immunity provided by vaccination and previous infections with other variants. This South African variant has now been detected in a substantial number of individuals in London.

“Hence, there is a continuous danger that such new variants emerge in the UK or are imported, which could in an extreme scenario undo our vaccine efforts. Such variants can be much better controlled when the overall COVID-19 numbers are low. Therefore, the case numbers will remain relevant.”

So what will the Welsh Government do if cases start going up again?

This is the question on everyone’s lips as we start to get our freedoms restored.

Will the Welsh Government issue a halt to the lifting of restrictions if cases start to go up?

Well they have already shown some inclination to tweak the plan once the vaccine role out s completed.

Their Covid Control Plan states: “We will need to revisit this framework again once the vaccine has been rolled out to all eligible adults – the target date for the offer to be made is the end of July.

“This will allow us to take stock of the impact of vaccinations and variants in circulation and reassess whether any changes are needed to the controls – and how we move in and out of the alert levels – during the autumn and winter to keep Wales safe.”

It is important to bear in mind that by the time cases start to rise again there will have been a senedd election so it may no longer be Mark Drakeford calling the shots in Cardiff Bay.

If the cases need to be brought under control, lockdowns are really the only option available to any new administration.

Professor Michaelis said: “Once the number of cases starts rising again, probably due to the spread of a new virus variant, we will be in exactly the same situation as we were before the last lockdown. Restrictions will need to be re-introduced and if they do not curb the spread, lockdowns will be required.

“So far, lockdowns have been the only effective way to reduce Covid-19 numbers, not only in the UK but also globally. Therefore, novel measures will need to be developed, if we want to stop Covid-19 spread in the future without lockdowns. How these measures could look like is currently difficult to predict.”

However according to Dr Philip Anyanwu , an epidemiologist and lecturer in public health from Cardiff Universities School of Medicine, there are steps that politicians can take to reduce the likelihood of a large outbreak.

“On easing Covid response measures, such as the lockdown, we anticipate the number of cases might increase (whether this increase persists to reverse the current trend will depend on different factors).

“Given this expectation, as lockdown is eased in Wales, decision-makers should intensity other Covid response measures (such as increased testing, quarantining, test and contact tracing, social distancing, vaccination among others) to avoid a reversal.

“The benefits and implications of local lockdowns should be weighed against other alternative measures to reduce local transmission. Early detection and action to suppress the increasing number of Covid-19 cases in local areas could help avoid local lockdowns.”

In January a WalesOnline analysis of Wales contact tracing system found that it had very little chance of success unless case numbers stayed very low. You can read the full analysis here.

There is going to be a real uncertainty facing the new Welsh Government over the impact immunity in the population will have.

“An increasing amount of immunity is associated with a reduced virus spread,” said Professor Michaelis. “It is not clear to which extent individuals who previously had Covid-19 or who have been vaccinated can still transmit the virus. Nevertheless, it would be unreasonable to assume that they would transmit it in the same way as unvaccinated individuals who have never been in contact with the virus. Individuals who are immune to the virus have antibodies and immune cells that prevent the virus from replicating. This means that even if there is some level of virus replication, it will be lower than in a person who is not immune.

“If we look at the current infection and hospitalisation numbers, a smaller fraction of those infected ends up in hospital than before. The most plausible explanation for this is that the most vulnerable have been vaccinated and that Covid- 19 spreads among individuals, who are less likely to develop severe disease. However, this only works as long as there are no new variants that are not covered by immunity provided by vaccinations and previous infections.



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