Thu. Sep 23rd, 2021

Plans to relax Covid restrictions at Christmas must be reversed or many lives risk being lost, according to a rare joint editorial from two of the UK’s most eminent medical journals.

The government can no longer claim to be protecting the NHS if it goes ahead with “rash” plans to allow households to mix indoors over Christmas, the British Medical Journal and Health Service Journal have said.

“We believe the government is about to blunder into another major error that will cost many lives,” it says.

It warns that if current trends continue, there will be 19,000 Covid patients in English hospitals by New Year’s Eve – the same as at the peak of the first wave on 12 April. Those numbers do not factor in the impact of Christmas mixing between households and the freedom to travel to see family.

The editorial says the extra caseload of Covid-19 patients is likely to be 40 times higher than at the beginning of the second wave.

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“The new year is likely to see NHS trusts facing a stark choice: be overwhelmed or stop most elective and non-urgent work,” the editorial warned. “Rather than lifting restrictions over Christmas as currently planned, the UK should follow the more cautious examples of Germany, Italy and the Netherlands.”

The move from the journals, which cover both medics and policy and management across the health service, will increase pressure on the government to rethink of plans to allow three households to mix from 23 to 27 December.

The joint editorial, only the second joint endeavour in the titles’ 100-year histories, said it was time to rethink the Christmas restrictions in light of the current rate of infections.

France reopened non-essential shops this month, allowing Christmas shopping to begin. But an uptick in new infections since then means that while travel is permitted from 15 December, a nationwide 8pm to 7am curfew will begin then that will be lifted for 24 December, but not Christmas Day or New Year’s Eve. Bars and restaurants will not reopen until January and private gatherings are limited to six adults.

Germany extended its “lockdown lite” until early January, but amid a record surge in infections and deaths may have to shut down further before Christmas – possibly allowing people to leave home only for essential reasons and closing shops from 21 December. Private meetings are currently limited to five, a limit that should be raised to 10 from between 23 December and 1 January, but this may change.

Austria’s strict lockdown ends this month. The country is carrying out a mass programme of 10 million tests over the next fortnight with the aim of allowing more families to reunite over the festive period. Christmas markets have been cancelled.

Italy has banned inter-regional travel from 20 December to 6 January except for work, health or emergency reasons, and Italians may not leave their towns on Christmas Day, Boxing Day or New Year’s Day. Midnight mass on 24 December will be brought forward so worshippers can get home before the country’s 10pm-5am curfew, and people arriving from EU countries must present a negative test.

Spain has appealed for people to be responsible but will allow movement between regions “for family reasons” between 23 December and 6 January. Regional curfews, which range from 10pm to midnight, will be pushed back to 1.30am on 24 and 31 December, when the limit for gatherings will be raised from six to 10, a measure that will also apply on Christmas Day and New Year’s Day.

Authorities in the Netherlands have said current restrictions will not be relaxed for Christmas and may yet be strengthened if infections rise. Guests for Christmas dinner will be limited to three (excluding under-13s); cafes, bars and restaurants will remain shut except for takeaways; non-essential shops must close at 8pm and all non-essential travel is discouraged.

Belgium has said households may be in close contact with just one extra person over the Christmas period, although people living on their own will be allowed to meet two others. Fireworks are to be banned on New Year’s Eve to limit gatherings.

Poland will allow people to spend Christmas only with their immediate family, with no more than five guests to be invited to each household until at least 27 December and travel banned outside people’s home towns.

John Henley Europe correspondent

“When government devised the current plans to allow household mixing over Christmas it had assumed the Covid-19 demand on the NHS would be decreasing. But it is not, it is rising, and the emergence of a new strain of the virus has introduced further potential jeopardy,” the editorial says.

“The government was too slow to introduce restrictions in the spring and again in the autumn. It should now reverse its rash decision to allow household mixing and instead extend the tiers over the five-day Christmas period in order to bring numbers down in the advance of a likely third wave. It should also review and strengthen the tier structure, which has failed to suppress rates of infection and hospitalisation.”

The government has announced that up to three households will be able to mix indoors and stay with each other overnight from 23 to 27 December under loosened coronavirus restrictions across the UK.

Can I eat out with my Christmas bubble?

No. In a blow to pubs and restaurants, and families who like to avoid the piles of washing-up, separate households in a Christmas bubble will not be able to meet up in hospitality venues. However, members of a Christmas bubble can meet at home, in places of worship and in outdoor public places including gardens. You can continue to meet people who are not in your Christmas bubble outside your home according to the rules in the tier you are staying in. If you are living in a tier 3 area in England, pubs ands restaurants will remain closed.

Is there a limit on the number of people who can meet up as part of a bubble?

There is no maximum size for a Christmas bubble, so you don’t need to worry if you and those you join with live in large households.

If I’m already in a bubble with another household, do we count as one household or two for the new Christmas rules?

Under the rules, a support bubble will count as one household when Christmas bubbles are being formed.

Can I join more than one Christmas bubble?

No, the bubbles have to be exclusive, and they cannot change over the five-day period – so pick your households carefully. This means that you can’t mix with two households on Christmas Day, and then a different two households on Boxing Day. However, children whose parents are separated will be able to move between two Christmas bubbles so they’re able to celebrate with both parents.

Do I need to socially distance from the people in my Christmas bubble?

Bubble members will not be required to social distance while they are together, so they can hug or kiss under the mistletoe. However, people are advised to exercise caution if there are vulnerable people involved in their bubble. 

What about care home residents?

In England, some care home residents may be allowed to form a bubble with one other household, in agreement with the home and subject to individual risk assessments. In this case, social distancing should be maintained, with regular hand washing and ventilation to reduce risk. Care home residents should not form a three-household Christmas bubble at any point.

Can I travel to meet up with people in my Christmas bubble?

Individuals will be able to travel between coronavirus tiers and across the UK during the designated festive period (23 to 27 December). People will be able to travel to and from Northern Ireland for an extra day either side of that period, to allow for the extra time needed.

What if I live in a shared household?

In England, people living in shared households can split and join separate Christmas bubbles without breaking the three-household rule. So a group of, say, four young people living together would all be allowed to return home to their four separate families for Christmas and then come back to their shared home after the festive period.

Jessica Murray

NHS trusts in the most pressured regional health systems are already having to cancel almost all elective and non-urgent care because of the resurgent virus, the editorial says. “Even if NHS England succeeds in vaccinating all those ‘at risk’ by Easter, this will not be in time to prevent hospitalisation and death for many during the next few months,” it adds.

The BMJ and HSJ also criticise NHS test and trace and the government’s plan for mass testing with lateral flow tests. The tracing service “which has almost nothing to do with the NHS, continues to squander money on failure. So too does the mass testing of asymptomatic people using lateral flow tests that are not fit for purpose”, the editorial says.

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