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expert reaction to editorial from the BMJ and Health Service Journal (HSJ) entitled ‘Covid 19: Christmas relaxation will overwhelm services’

An editorial from the British Medical Journal (BMJ) and Health Service Journal (HSJ) asks the UK government to abandon plans for household mixing to protect the NHS.


Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, University of Leicester, said:

“The risks around relaxing the restrictions over Christmas are very real – clearly real enough for this BMJ/HSJ Editorial to be written today.

“The knock-on effect of increased COVID-19 cases over Christmas/New Year on other health services as well as the inevitable hospitalisations and deaths due to COVID-19 itself will tax NHS services severely – even without the usual burden from seasonal flu and RSV (mirroring the Australian experience) – our only silver lining so far this season.

“I would say to everyone – can you tolerate a Zoom Christmas this year and save yourselves for a more normal Christmas next year – once everyone who needs it has been vaccinated?

“Some will need this Christmas contact more than others, I understand, but for those who can make do with a remote Christmas this year – try to do this if you can. 

“Then we can hopefully avoid another prolonged national lockdown in January – with the social, emotional and economic devastation that we know this will cause.”

“I’ve studied respiratory viruses and their transmission, epidemiology, and seasonality over the last 15-20 years in various countries around the world, and everything tells me that this Christmas relaxation is likely to be a ‘perfect storm’ for the virus if we are not careful – 3 households mixing, under the same roof, in a closed, crowded, close contact environment, with no masks, poor ventilation for 5 days – this is similar to some experimental studies that have been set up to examine how viruses can transmit.”


Prof Rowland Kao, Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, said:

“The advice of the epidemiologists for the relaxation of restrictions around Christmas was always predicated on increased restrictions prior to Christmas. These would have to be sufficient so that any increase in activity and therefore transmission risk in the Christmas period would be alleviated by the prior reduction in cases, therefore freeing up capacity in hospitals and ICU and reducing testing burdens.  Further it was expected that any relaxation could only be small, given the potential for different amounts of mixing between geographical regions and age groups posing difficult to quantify risks across the country. Given that we have not even reached those relaxations when the risks are expected to increase, the increase in cases now suggests that, those relaxations would be unwise, and indeed in many places more severe restrictions are merited. After a long year of restrictions, meeting with loved ones over the Christmas period has an extra importance, and thus any extra restrictions may seem especially hard. However, with new vaccines being deployed and  the potential for easing of restrictions on a much broader scale, efforts now will be paid off for in both keeping the most vulnerable safe, but also in making sure that a more lasting easing of restrictions comes all the sooner.”


Prof Ashley Woodcock, Professor of Respiratory Medicine at the University of Manchester, said:

“The points they make are correct.

  • The hospitals are full.
  • Staff are exhausted.
  • We have COVID plus the peak winter pressures, and for the whole winter (not a month or so like last March).

“One thing they don’t mention is that generally people pass it around within their peer group. But Christmas is uniquely designed to mix young and old. This will bring severe disease and death to the elderly (much greater than meeting within peer groups). This would be an avoidable catastrophe…. just in time for New Year.

“Instead the government should designate a day in 2021, after the vulnerable population in the UK have been vaccinated, to celebrate…irrespective of religious group.”


Prof John Edmunds, Professor in the Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, said:

“As with all public health policy the Christmas relaxation is a balance. From a purely epidemiological standpoint we should not relax our guard at Christmas, particularly as the prevalence of COVID in the community remains dangerously high. On the other hand, it is clear that many people intend to meet up with friends and family over the holiday period, so the current rules are an attempt to find a balance between the urge to see our loved ones and the need to control transmission. We should remember that just because we can meet up with two other households, it doesn’t mean that we should. So it might be best to postpone meeting up with vulnerable relatives for another month or two, when hopefully they will be protected via the vaccination programme.”


Prof James Naismith, Director of the Rosalind Franklin Institute, and University of Oxford, said:

“The warning in the BMJ is fact based and reflects an accurate assessment of what we currently know. 

“November’s national lockdown worked as expected, we saw a decline in cases. The evidence is that such national measures are more effective in the UK. There is no mystery, science tells us the more we restrict social interactions the more we reduce the viral spread. This has been proven time and time again, here, the EU, the USA and around the world. It works for flu, for the common cold and covid19.

“Just as certainly, when we loosen restrictions we increase the spread. The rise in case numbers in London is the evidence that shows the new tier 2 level is not an end point. Simply put, the increase in contact permitted at tier 2 coupled to open schools, means the virus will spread and reach the trigger for level 3. This is not the ‘fault’ of people in tier 2, its simply a feature of the virus. Tier 2 will almost always end up going to Tier 3. If we decide we do not wish cases to rise so far that it risks overwhelming the NHS, then there is no end to cycling between tier 2 and something like lockdown social restrictions until we vaccinate a significant share of the population.

“I am fully aware these lockdowns are a massive burden, they are damaging business, they are making people ill and they take from us some of the things that we value most in life (contact with friends and family). The lockdowns are particularly harsh on the young, the most deprived and the vulnerable. 

“This is the choice; social restrictions or risk overwhelming the NHS (resulting in very high death rates). 

“In a democracy, it is for politicians to make this choice, they should do so with an understanding of the current science. Fringe ideas and magical thinking will lead to disaster.

“To my regret but not surprise, the UK is now set for a third wave (in reality the continuation of the second wave) as we approach the Christmas holidays. Cases and pressure on the NHS are once again growing, an increase in deaths will tragically follow.

“Analysis of the USA’s Thanksgiving holiday (in some ways similar to Christmas) shows that travel and family reunions have indeed lead to an increase in the case load. The USA is now facing 7 day average records in positive cases, hospitalisation and deaths. This is not yet an “explosion” or a “spiral” but the holiday has made things, already grim, worse. Deaths in the USA will continue to climb in the weeks ahead.

“In the UK the outcome of the currently planned relaxation at Christmas will mainly depend on the case load on December 25th and a little bit on our individual actions. 

“The likelihood of an exponential surge due to relaxation over Christmas means that high case numbers at the start of Christmas, will make January dramatically worse. This is why restricting social activity now can give such large benefits. The sort of hyper local restrictions being discussed by some have not worked before to reduce numbers, so such suggestions can be dismissed as wishful thinking.

“As individuals, we can do things to have a safer Christmas. The safest is for everyone to stay in our own households but this may not be achievable for many of us. The single most important thing is check for symptoms every day for a week beforehand, a temperature, change in sense of smell or a persistent cough. Any symptom for you or a household member in this week, don’t mix with another household. Secondly, if the visit is short, wash your hands thoroughly, wear a mask if possible, sit apart and ventilate the room. If two households are joining a household over Christmas, it will help if everyone in the household stops all other socialising for at least 5 days beforehand and during their stay (no seeing others or no one going to an indoor venue).”  

“The New Year will bring the vaccine, doing what we can now will mean more people live to take it.”


Prof Paul Hunter, Professor in Medicine, The Norwich School of Medicine, University of East Anglia, said:

“Yes the Christmas break will almost inevitably lead to some increased transmission. But I do not think this will be as dramatic as many people are suggesting because:

1) Despite what at least one professor has said on air, being in a house with an infected person does not mean you will almost certainly pick up the infection. The secondary attack rate in household contacts is only 21% (about 1 in 5). If you stay with an infected person for less than 5 days then the risk is even less about 15% (about 1 in 8). If that person is asymptomatic then the risk is even lower (? About 5% or 1 in 20). This is the source of this data.

2) I am worried about public transport during the travel to and from your Christmas bubble. If coaches and trains get really packed then this will be a problem. It is important that the government manages this properly to avoid over-crowding on public transport.

3) If (and this is really important) but seems to have been forgotten in the current messaging.

  • If you or anyone you will be visiting has symptoms or
  • if they have had a previous positive test in the past 10 days,
  • or they have been told to self-isolate or
  • if they have been in contact with someone who has had symptoms or been test positive in the  


4) If you or someone in the group you will be visiting falls into a clinically at risk group then think carefully about whether you should meet up. If someone is in the extremely clinically vulnerable group then almost certainly DO NOT GO. But I think it is up to that person to make an informed decision. For example, if this may be that person’s last Christmas, then they may wish to choose to spend it with their loved ones even with the increased risk of acquiring a fatal infection.

5) My reasons for this are that community transmission is driven by a number of things that will be closed such as schools, hospitality venues and many other places where people may gather in large numbers, and so any increase in R from mixing in homes will be counteracted to some extent by reductions through these other transmission pathways.

6) My personal view is that the potential benefits of being able to spend some time with your loved ones for many people outweigh the risks. January is a difficult time for many people and being able to spend Christmas with your loved ones may be what helps you make it through. But of course if you can wait for a few months to meet up later in the spring, then please do.”


Dr Shaun Fitzgerald, Royal Academy of Engineering Visiting Professor at the University of Cambridge, said:

“Christmas relaxation will overwhelm services’ is certainly a headline to get our attention, and that is the point. The question we need to ask is ‘what can I do to help prevent our services being overwhelmed?’ There are lots of things, and it is important we intersect the routes of transmission as best as we can. If we elect to spend time with others, and remember there is a choice to postpone doing so until later in 2021 when hopefully more people are vaccinated, then let’s focus on preventing transmission by the aerosol, droplet and contact routes. If we spend time with others then let’s do so in a well ventilated space and let’s consider meeting outside rather than inside. Let’s wear a face covering especially if indoors, and keep a distance of 2m. We should remember to a wash and sanitise our hands. And finally, try and limit our social get-togethers; 3 households is a maximum, but if we can keep it less than that then it will help.”



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