Covid: The UK is Europe's virus hotspot - does it matter?

With the news dominated by other issues, it has gone almost unnoticed that the UK now has one of the highest rates of Covid infection in Europe. But, as winter fast approaches, how worried should we be?

The rates certainly look troubling. Only a handful of countries, including Romania and Serbia, have higher infection levels than the UK. And compared with the big nations in western Europe, the numbers are significantly higher.

There is a variety of reasons for this. The UK - or rather England - was the first nation in Europe to fully unlock when it ended most Covid restrictions on 19 July. It was not until late August that an EU country - Denmark - followed suit.

Others, such as Norway, have only taken this step in recent weeks, while many have retained a significant number of measures, such as limits on large gatherings, Covid passports to enter bars and restaurants, social distancing and mandatory mask-wearing.

For example, in Germany and Italy there are still restrictions on large crowds at events like football matches. And in a number of nations, such as Spain, social distancing remains in schools as does wearing masks from the age of six.

So it is hardly surprising a virus that thrives on human contact has taken off in the UK compared with the rest of Europe.

Another factor is vaccination. At the start of the year and into the spring, the UK was leading the way on vaccination. But not any more, with the likes of Spain, Portugal and France all having administered more doses per head of population.

A big reason for this is that many nations have started vaccinating under-16s, whereas this is only just getting going in the UK.

But when it comes to protecting people from serious illness - older people and those with health conditions - the UK has similar high levels of vaccine uptake.

And that protection means the gap in the numbers dying is much smaller.

There are currently just over 100 deaths a day on average linked to Covid. That may sound a lot, but it is similar to what happens in a bad flu season for months on end.

Of course, death should not be the only measure. Every day there are about 700 people being admitted into hospital with Covid. For some, the road to recovery will be long and arduous.

There is also then the risk of "long Covid" among those who have not become severely ill. The idea of persistent symptoms after a viral infection is not unique to Covid - it also happens with flu. But given we are still learning about Covid and it appears to happen more often, there are some who argue this warrants more action to contain spread.

Prof Christina Pagel and Prof Martin McKee, both of whom are members of Independent Sage, a self-appointed group of experts which has been critical of the approach taken by the government, wrote in the Guardian this week about the benefits of the "vaccine-plus" approaches taken on mainland Europe.

But extra measures do come with a cost, so for others it comes back to trade-offs. Prof Mike Tildesley, an expert in infectious disease modelling at the University of Warwick, believes there needs to be a debate about what is an "acceptable" level of Covid or we could find ourselves relying on extra measures long-term. "Covid is here to stay - we need to discuss what we are willing to live with."

But it is not just where we are at, it's where we are heading that matters. There has always been variation in rates across Europe as a result of different approaches and being at different stages of the pandemic.

The UK was hit by the more infectious variants Alpha and then Delta before other parts of Europe. Back in early spring, for example, the UK had one of the lowest rates in Europe because our Alpha wave had passed and Europe's was in full swing.

With Covid the situation can change quickly. And as the chart on deaths above illustrates, this may already be happening. The UK death rate is falling - an achievement in itself given how open society is and a sign that the virus has been brought under some control. If nothing else really rapid surges in infection should be a thing of the past because of the amount of immunity in the population most experts agree.

The epidemic here is largely being fuelled by high rates in teenagers - and, in particular, those under the age of 16 who have not had a chance to get vaccinated over the summer, unlike many of their peers elsewhere in Europe.

Children are, of course, at very low risk of serious illness. So the concern has always been that infections in the young could spread into older age groups.

But the early signs are that that is not happening - and the rise in children may have peaked. Prof Tildesley says he is "cautiously optimistic" about the data although he says it is quite possible rates in teenagers will remain high for a little while.

When this wave in teenagers ends, through a combination of natural immunity and the vaccination programme that is clicking into gear, we could actually start to see a sustained fall in infections as winter approaches.

That, after all, was always the argument the government and its senior scientists - Prof Chris Whitty and Sir Patrick Vallance - made when they decided to unlock on 19 July - that is was better to have our "exit wave" before winter really hit.

Prof Neil Ferguson, one of the senior scientists advising ministers, said this week there was a lot of uncertainty about what would happen next, but a sustained decline from this point on was possible. "It's not guaranteed we will see a winter wave," he told MPs on the All-Party Parliamentary Group on Coronavirus.

But the problem, he said, was there was "limited headroom" in the NHS to cope with even a little surge. And that is one of the big risks with the government's approach.

The NHS has, compared with other nations, much less capacity to absorb extra demand.

And this winter that will not just come from Covid. Lockdowns and social distancing meant the traditional winter viruses were largely absent last year. That will have led to less immunity across the population, prompting fears they could rebound back in a big way.

A virus called RSV, which can cause 30,000 admissions every winter among the under-fives - six times what we have seen so far in that age group from Covid - is already circulating at very high levels. The flu season is just beginning.

It will not take much for the situation to unravel.

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