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England is about to take a big gamble.

On Monday, July 19, the country is lifting all restrictions related to the pandemic. People will be able to go to nightclubs or gather in groups as large as they want. They will not be legally forced to wear masks in any way and will be able to stop social distancing. The government called the media coverage “Liberty Day” and said that lifting security measures would be irreversible.

At the same time, cases of coronavirus are increasing rapidly in the UK. It registered more than 50,000 new cases on Friday, and the health minister says He said the daily number of new infections could rise to over 100,000 over the summer.

In theory, fully reopening during a surge in situations sounds like a combustible mix. But the UK government is betting it won’t be like the others this time around because of the vaccination programme.

When multiple overlapping, complex factors are involved, it’s extremely difficult to predict what will happen next, the researchers say. So let’s examine what we know, what we don’t know, and what we should watch out for in the coming weeks.

What we know: vaccines work

The UK’s vaccination program is still ongoing, but has so far been widely successful. In total, 52% of the adult population is fully vaccinated, and approximately 87% of adults have received their first dose (this includes 52% who have received both doses). Only 6% of Brits are hesitant to shoot. Office of National Statistics.

But there are still plenty of reasons to be nervous. The vaccine launch is months away from fully vaccinating the entire adult population. Young people are particularly vulnerable; Those over the age of 18 have just started getting their first dose, and only a quarter of 18- to 39-year-olds have received both vaccines. And unlike the US and most of Europe, the UK has not started vaccinating children.

“It’s dangerous,” says evolutionary virologist Emilia Skirmuntt. We urgently need to vaccinate young people, especially before they go back to school in September.”

This is important because the currently overwhelmingly dominant strain of covid-19 in the UK is the Delta variant. While fully vaccinated people have relatively little reason to worry about Delta, Pfizer and AstraZeneca vaccines provide over 90% efficacy against hospitalization. Public Health England—Delta variant is bad news for those who have only had one shorted or not vaccinated.

It is around 60% more contagious and almost twice as likely to be hospitalized than the Alpha variant, which was previously dominant in the UK. Scotland’s public health agency. He says a single dose of the AstraZeneca or Pfizer vaccine is only 33% effective against the Delta variant, compared to 50% for Alpha. Public Health England.

“This reopening will cause a lot of preventable damage,” says Deepti Gurdasani, clinical epidemiologist at Queen Mary, University of London. “We must stop slacking until all adults and adolescents are offered both doses of the vaccine.”

What we don’t know: when will cases peak

It is clear that the UK is experiencing another wave of pandemics. What we don’t know is how bad the situation will get or how lifting restrictions will change that. Even the best experts in the field cannot say for sure.

“It’s very difficult to know what’s going to happen after 19 July,” says Graham Medley, professor of infectious disease modeling at the London School of Hygiene & Tropical Medicine and head of SPI-M, a UK consulting group of scientists. on government pandemic modeling

Much depends on the behavior of the public and this is known to be very difficult to predict. While some will relish their newfound freedom (a trend that was fully displayed in the final of the European football championships last weekend), others will be much more cautious.

Many people are frustrated by the discarding of masks, one of the most basic and effective public health measures. An Ipsos Mori survey It found that the vast majority of British people plan to continue wearing masks in stores and on public transport. If people follow suit, this could help curb the epidemic somewhat: Israel, which also has high vaccination rates, had to reintroduce mask-wearing indoors last month due to the sharp rise in cases.

Regardless, it’s very likely that cases will continue to rise for at least a few more days, if not weeks. That means more hospitalizations and deaths are inevitable, according to Medley. The real question is how high this wave will go.

In a webinar on Thursday, the UK’s chief medical officer, Dr Chris Whitty, said the country “could see some pretty frightening numbers” and “could get into trouble again surprisingly quickly”.

But the government seems to be betting that not all numbers are equally frightening. He hopes hospitalizations remain low enough to prevent the National Health Service from being completely overwhelmed. It assumes that the link between cases and hospitalization rates has weakened, if not broken.

“This wave is very different from previous ones,” says Oliver Geffen Obregon, a UK-based epidemiologist who works with the World Health Organization: the vaccine programme.

But not everyone agrees. NHS bosses already sound the alarm over capacity and over 1,200 scientists signed a letter Lancet He argues that the UK should care about the huge increase in infections, regardless of death and hospitalization rates.

Epidemiologist Gurdasani is one of them.

“Cases matter,” he says, pointing to two main dangers: the increased chance that large numbers of people will develop long-term covid, and the risk of new, vaccine-escaped variants.

What we know: more people will get long-term covid

The UK already has a significant long-term covid problem. According to one large study, more than two million adults may already have or have had complications that persist for 12 weeks or longer. study From Imperial College London. But long covid was poorly understood, with more than 200 symptoms ranging from fatigue to shortness of breath to memory problems, according to the largest study published recently. Lancet.

According to the study, about one in 10 people who get covid-19 go on to develop long-term covid. WHO. This means that if one million more people in the UK contract covid during this wave (a favorable scenario by most estimates), there could be another 100,000 with long-term problems.

Whitty is worried. “I think we’re going to get a significant longer duration of covid, especially at younger ages, when vaccination rates are much lower now,” he said. I said on 6th of July

This can put enormous pressure on the NHS, businesses and society in general, causing indescribable misery for many individuals.

“Some symptoms can last for years, and we have a good chance of exposing an entire generation to very poor health for the rest of their lives,” says Skirmuntt.

What we don’t know: If all of this could give rise to another dangerous variant

The great fear for many experts is that this approach of the government creates an ideal breeding ground for a vaccine-resistant variant to emerge.

On July 5, Steve Peterson, co-director of the University of Liverpool’s Center for Genomic Research, summed up the concerns in a tweet: “Allowing a virus to pass through a partially vaccinated population is the experiment I’m going to do to evolve into a fully immune-escaping virus.”