Earlier this week, the health secretary Sajid Javid said in a Downing Street press conference that the government was not yet ready or willing to activate its Covid ‘Plan B’. His announcement came after the Scientific Advisory Group for Emergencies (Sage) argued last week that Plan B measures – such as mandatory masks, working from home and vaccine passports – should be prepared for now to reduce the need for tougher restrictions in the winter.

Both Sage and the health secretary will have been keeping a close eye on the number of Covid infections, hospitalisations and deaths, all of which have been rising steadily this month. The worry, of course, is that a surge in infections during the winter will push the health service to collapse and mean we have to lockdown once again.

But does the UK need new coronavirus restrictions? And how serious is the situation heading into the long winter months?

Currently the coronavirus situation in the UK is in flux. We’re regularly told that the R number for Covid-19 is around one, so the virus can’t be spreading too quickly. But this metric is an estimate of the situation two to three weeks ago rather than real-time information. The R number could be a lot higher now.

Who the virus is infecting could change quickly too. At the moment there has been an increase in infections among teenagers and young children, who are less at risk from severe disease. That doesn’t mean we can sit on our hands though. Last year, as predicted by scientists and medics, coronavirus infections quickly bled from younger to older age groups in winter, which meant we had to lockdown twice in quick succession. This year the simple fact remains that the coronavirus numbers are going up – and they are going to continue to do so in the coming weeks and months.

The risk of the UK needing to go into lockdown this year is still vanishingly small. It would require a torrid flu season to be layered on top of a concurrent wave of Covid-19, possibly with a sprinkling of respiratory syncytial virus. In other words, a lot of unpleasant stars would need to align before a lockdown happens.

It seems more reasonable to me to expect a wave of infections over the winter which puts pressure on the health service. When significant numbers of Covid-19 patients are admitted to hospital this not only takes up space but also causes serious infection control problems for other patients who are vulnerable to infection. The NHS works at or near capacity for most of the year and there simply isn’t much give in the system, which leaves it vulnerable to surges.

But it’s not just the NHS which could suffer. Life is for living and our society does not exist simply to support its healthcare system, like how North Korea’s raison d’etre is to prop up the Communist party. But if infections begin to rise there will also be a wave of mass sickness. Even people who are vaccinated against Covid-19 may need a week or so of bed rest after catching the disease. This would put other public services under strain too. Who will drive the buses and trains, put out fires or empty the bins if too many people are at home feeling unwell? Who will look after children when they need time off school because they’ve caught Covid-19?

Unless ministers really are indifferent to the wider toll of Covid-19, they need to stop the number of infections from getting out of control
Sectors that are struggling to hire staff could see their situation get worse this winter too. Whether it’s toilet paper or fuel, we’ve seen how willing the public are to panic buy and hoard when something is perceived to be in short supply. If the current national supply chain problems were exacerbated by high levels of sickness, we could end up seeing supermarkets shelves stripped bare and petrol stations drained in a matter of hours, without enough people to replenish them quickly.

With these factors in mind, the government is currently walking across a tightrope when it comes to Covid-19 preparations. Sajid Javid’s pronouncement at the Conservative party conference that he is ‘entitled not to listen to Sage’ might be true. But the public will be unforgiving if he fails to listen to his scientists and people end up unable to buy bread or milk.

Unless ministers really are indifferent to the wider toll of Covid-19 beyond the NHS, they need to stop the number of infections from getting out of control – and the only way to drive the numbers down further in a close to fully vaccinated society is to limit interpersonal interactions. Sure, boosters and vaccinating youngsters will help, but I don’t think that will solve the UK’s problem.

There is only one guaranteed way not to catch Covid-19, and that is to have no contact with anyone who might be infected. Quite simply, pathogens require transmission to survive. If every human of earth could isolate themselves for a fortnight, the coronavirus would simply die out.

Clearly that’s not going to happen. Instead, everything from increased hand washing and face coverings to full-blown lockdown can reduce our exposure to each other, and reduce transmission events.

The biggest problem with Covid restrictions is that nobody actually knows how effective each individual measure is. No country has imposed a single measure in isolation, and there are no controlled experiments. Claims from some people that, for instance, face coverings are our most effective measure seem far-fetched. How can a piece of cloth be more effective than avoiding other people? But if you don’t wish to hide yourself away from humanity they probably offer a degree of protection, at least to other people.

The more severe the measure the more effective it is likely to be and you don’t get much more draconian than controlling who people can associate with. Recent advice from Sage suggests that increased working from home where possible would be an effective way to take the heat out of the recent rises in infections.

This is because it substantially reduces the number of interactions with other people. But politics gets in the way and despite the government’s manifesto commitment to ‘encourage flexible working’ and to consult on making this ‘the default unless employers have good reason not to’, Number 10 currently seems more interested in pillorying private businesses about where their staff work, than protecting people from severe disease.

Assuming the government eventually have to open the Plan B locker, I expect its contents to be brought out piece by piece, rather than all at once. We’ll see lighter touch, low or no cost measures first. Face coverings will be first because they fit this bill and are also a visible sign that the government is taking coronavirus seriously. Face coverings may be more important to the public than the data supports, but they’re a quick win and give the media something to chew on.

Next will be advice to work from home when you can. Then we get to the stuff that costs real money like reducing the number of people allowed in indoor places like shops and cinemas. I suspect the government’s advisors will turn their attention to the upcoming Christmas season and the hospitality industry; we can expect to hear plenty of protest in response, but it’s an obvious place for them to go to reduce infections.

Then of course there are schools and other educational establishments. I think closing them should only be a last resort and this is only slightly more likely than a full lockdown. Closing schools not only hurts children, it also keeps parents at home and unable to work. Demands to improve ventilation in schools and elsewhere are worthy but represent longer-term projects which will be easy to do in some places, but not everywhere. It’s not going to be as simple as just opening a window. Each building will need to be properly assessed, a plan drawn up and equipment installed, anything less would be pretty pointless.

Ultimately the number of infections any country will tolerate is governed by the risk appetite of its politicians. In the UK we have become fixated on the effect that Covid-19 has on the NHS and while this is very important, in a largely vaccinated population it overlooks the more subtle but still serious effects of the disease. Instead of taking a pragmatic approach which would see restrictions used as a safety valve, the government seems intent on resisting. I do wonder if they are waiting until the public demands restrictions are put in place. What better way to dodge any future blame.

While the government isn’t currently saying ‘let the bodies pile high’, at the moment it is acting like an insolent teenager. We will have to see if we will all pay the price for its failure to put in place restrictions now.