This 12 months, it's safer to have fun on Zoom. insta_photos/Shutterstock

In early November, the UK authorities put England into its second coronavirus lockdown. With rising infections nationally, strained well being providers and the specter of but extra deaths, the UK prime minister, Boris Johnson, stated: “There isn’t a various”.

An necessary issue within the determination to lock down in November was the hope that restrictions could possibly be eased in time for Christmas. However though the federal government has set out its plan for popping out of lockdown on December 2 and launched a brand new tier system for that point, the circumstances are usually not beneficial. Certainly, many areas in England will likely be positioned in tier three restrictions – the best attainable degree – instantly.

No matter tier, between December 23 and 27, folks in England will be capable of kind “bubbles” of three households who’re permitted to collect over Christmas, mixing indoors and probably staying in a single day.

Easy methods to determine which tier is correct

The federal government has had a troublesome determination to make between controlling the unfold of the virus and limiting the financial harm attributable to restrictions. Elevate restrictions too quickly and also you threat escalating infections in a matter of weeks that require the re-imposition of these restrictions. Certainly, authorities scientific advisers have warned that though tier three restrictions would possibly sluggish the epidemic, they will not be sufficient to push it into decline.

When contemplating whether or not restrictions may be lifted for any given space, there are two key issues. First, what are the epidemic traits? In epidemiological phrases, that is summarised by the replica quantity, or R quantity, which supplies an thought of whether or not onward transmission of the virus may be sustained in the long term, and the lowercase r quantity, or progress price, which signifies whether or not the epidemic is rising or shrinking. However an infection traits are extra difficult than simply the R and r numbers.

We need to know not simply what number of new circumstances of infections are occurring, but additionally the place they’re taking place, which age teams they’re affecting and wherein environments (similar to workplaces, care properties or hospitals). If epidemic traits are persistently on the decline, this provides some reassurance that present measures are working and infections are being contained adequately. Unstable or rising traits, nevertheless, could be trigger for concern as that tells us the state of affairs isn’t absolutely underneath management.

The second consideration is the quantity of infections – that’s, simply how many individuals are contaminated at present. Every contaminated particular person is a possible infector of another person. On November 20, 664,700 folks in England have been estimated to be contaminated with COVID-19. So even when an infection traits have been on the decline, if there’s a giant pool of contaminated folks out locally, the probability of additional unfold is there, particularly if restrictions are lifted and social mixing is allowed. To make issues worse, the epidemic will begin from a excessive base and is prone to rise even additional.

The opposite motive why the quantity of infections issues has to do with the feasibility of containment. If the variety of infections is low, well being safety interventions such because the NHS Check and Hint service and mass testing are extra seemingly to have the ability to include the infections, as it will be simpler for the groups concerned to analyze a lot of the circumstances and handle outbreaks successfully. However when the quantity of infections is excessive, that is prone to breach the capability of even the best check and hint system. It doesn’t assist that the English check and hint system is at present underperforming.

We all know that social mixing is what drives infections. And enjoyable restrictions is prone to result in a rebound within the variety of social contacts that takes place. The extra mixing that occurs, the extra alternatives there are for infections to unfold. We additionally know from expertise that many COVID-19 outbreaks may be traced to households.

Must you keep house for Christmas?

If December 25 held no cultural significance, it’s extremely seemingly that the present restrictions wouldn’t be eased because the circumstances for doing so simply aren’t there. Nevertheless, within the UK and different western nations, this nationwide vacation is a crucial a part of the nationwide psyche. The festive season is a time for households to congregate, often in crowded properties, for extended intervals. Sadly, these are the very circumstances related to an infection transmission, which might result in superspreader occasions.

The Christmas season can be related to mass migration throughout the nation that would improve illness transmission and will probably switch infections from areas of excessive incidence to low incidence communities. It entails the blending of younger and previous, which carries the danger of transmission to aged kinfolk who’re extra susceptible to the intense penalties of the an infection, together with demise.

The federal government subsequently wants to contemplate what the price of enjoyable COVID-19 restrictions for Christmas is likely to be. It’s prone to drive up the variety of infections, and in flip hospitalisation figures and mortality charges a number of weeks later. It dangers compromising England’s containment of the epidemic, resulting in additional restrictions, and even one other lockdown, weeks later. All of this could have critical societal and financial repercussions.

It’s no exaggeration to say that the chance to satisfy family and friends on Christmas Day would possibly imply having to bury the identical folks weeks later. With the promise of safety that vaccinations deliver, the comfort of restrictions for the vacations appears an pointless threat to take proper now. No matter what tier system applies to your native space, it will be clever to remain inside your individual family for Christmas this 12 months.

Andrew Lee has beforehand obtained analysis funding from the Nationwide Institute for Well being Analysis. He’s a member of the UK School of Public Well being and the Royal Society for Public Well being.