What is plan C and which Covid restrictions could come next?

Instead of a spike in the next few weeks we might be looking at a lower, longer hump of cases over January and February. We should still expect more people to need hospital beds, but the hope is that admissions will be spread out enough so that the NHS can cope.

What is plan C and when will it come in?
Right now, there is no official plan C. The government’s winter plan said it was very unlikely that more cautious behaviour and increased vaccination would not be enough — except in the case of a dangerous new variant. Now that Omicron is here, officials are scrambling to come up with a second back-up.

What measures could be considered as part of plan C?
Masks and ventilation Masks and ventilation reduce the risk that an infected person will spread the virus. But there is little further scope for compulsory masks — requiring them while moving about in hospitality is likely to be marginal when people spend most of their time eating and drinking with their face uncovered. Requiring them for pupils in class comes at a heavy cost to education. Beyond that reducing people’s social contacts is the best way of slowing infection. The difficulty is doing in this in a way that causes the least disruption to people’s lives.

Check-ins at pubs and restaurants Requiring people to check in at hospitality venues has been suggested, ostensibly to reduce the risk of super-spreading events. But the main gain would be to require people to start using the NHS app again, and so isolate if they came into contact with an infectious person.

Ten-day isolation for contacts of all confirmed Covid cases, not just Omicron cases Requiring contacts of cases infected with all Covid variants to stay at home would have a big impact on spread. One government scientific adviser described the summer “pingdemic” as “better than a lockdown” in bringing down cases.

Vaccine passports for pubs Extending certification to hospitality and entertainment venues, so that only those who had been vaccinated or tested negative would be allowed in, is one leading option being considered. While limited use of vaccine passports in Scotland and Wales, similar to England’s plan B, has not shown a huge impact, France has shown that requiring for more or less any public space can drive up vaccination rates and so protect people against serious illness. However, if Omicron evades jabs to the degree thought likely, vaccine passports would have less effect in actually controlling spread. They could even help it to spread if it means less of the Delta variant around to compete with.

So should we require negative tests for public places?
Increasingly, government scientific advisers believe that lateral flow tests are a highly effective way of finding the people most likely to be infectious. They appear to work just as well in detecting Omicron.

Requiring people to prove they are negative before going to pubs, theatres and other indoor spaces would be a hassle, but highly effective. One government adviser says that “keeping hospitality open and full, but demanding testing and app usage would have a very beneficial effect”.

How controversial will this be?
Very. Tory MPs and businesses hated the pingdemic, with the unpredictable and disruptive staff absences that result. Large numbers of backbenchers also have principled objections to vaccine passports, and Boris Johnson has talked of his own discomfort at the idea of “papers for the pub”.

Is Omicron milder than Delta and are we overreacting?
There are early indications that it may cause less severe disease. Many in South Africa have only mild symptoms and no one in Britain is known to have been admitted to hospital with Omicron. But most cases so far are in the under-50s, who are less likely to get severely ill, and most only caught the variant a week or two ago, when hospitalisation typically takes longer. Only when enough vulnerable people have caught the disease long enough ago can we be sure.

So if it is milder can we relax?
Unfortunately not. No one expects Omicron never to lead to hospital and the speed at which it is spreading means huge numbers of cases are likely, meaning a significant number of admissions. Professor John Edmunds of the Scientific Advisory Group for Emergencies says it is “crazy” to think Omicron is good news even it is milder. Even if it is half as likely to cause hospitalisation, he points out, at the current rate of spread this means it will only take two or three days longer for the NHS to be overwhelmed.

Will household mixing be allowed under Plan C and could hospitality close?
These are really the only other sure-fire ways of reducing cases. But after the gruelling experience of last winter, few want to go back to such draconian measures if there is any alternative. There is a reasonable chance that plan B will work and we will not be faced with this choice. But if we are, expect principled arguments about vaccine passports and practical complaints about a pingdemic to be overruled.

What about restrictions on care homes?
Care home residents will be only be allowed three visitors under new measures that are expected to come into force on Wednesday, 15 December. The Department of Health and Social Care said the move would “balance the current Covid-19 risk and the need to keep people safe in line with clinical advice”. Testing of staff and residents will also increase.