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Covid restrictions tighten as omicron cases double every two to three days

BMJ 2021; 375 doi: (Published 09 December 2021) Cite this as: BMJ 2021;375:n3051

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Rapid Response:

Operation Plan B – Pre-emptive strike or premature deprivation of liberty. What’s the answer?

Dear Editor

I read with interest your coverage of tightening restrictions due to the emerging threat of Omicron. (1). The government has implemented Plan B (2) and new restrictions are coming into force. There has been criticism that this is a “diversionary tactic” (3). This is not new as the former leader of the free world was criticised (4) when air strikes were launched against Iraq in 1998 with media reporting “attacks were launched partly to divert attention from Clinton's threatened impeachment over the Monica Lewinsky affair”. The government in September set out its COVID response plan for autumn/winter 2021 (5) including the scenario when Plan B is likely to come into force. “If the data suggests the NHS is likely to come under unsustainable pressure, the Government has prepared a Plan B for England”. It went on to say, “The Government would also consider asking people once again to work from home if they can, for a limited period”.

In his oral statement (6) to the Parliament the Health Secretary made his case for enacting Plan B. Omicron is more transmissible with a doubling time 2.5 to 3 days and there could be up to 10,000 cases in the UK of Omicron. According to the estimates of UK Health Security Agency “… at the current observed doubling rate of between 2.5 and 3 days, by the end of this month infections could exceed a million”. There are also concerns regarding the potential increase in hospitalisation. According to the Prime Minister (2) “as seen in previous waves, a swift rise in cases can lead to a rapid rise in hospitalisations, which will quickly lead to pressure on the NHS. The data in South Africa is showing a rapid increase in hospitalisations”.

Currently the political atmosphere is very charged (7) and there is discontent (8) about the measures implemented as part of Plan B. However, we must remind ourselves that we are still fighting a pandemic battle and need to be united as a country to win this war on COVID. Currently our foe has a slight advantage in the form of a highly transmissible and very poorly understood new variant. According to recent reports (9) there is a sub lineage of Omicron which does not carry S Gene Target Failure and hence it will be hard to detect quickly and being referred to us Stealth Omicron (10). On a different note, UK chief veterinary officer has warned (11) of a “phenomenal level” of bird flu in the UK. There is always the risk albeit small that both human influenza and virus causing bird flu successfully mix in humans and produce a virulent new strain of influenza – and with it the likelihood of a new pandemic (12).

The media discourse over the last few days has been whether the public will obey the new rules because what happened or did not happen twelve months ago, and questions have been raised about public faith. This issues also came up in Parliament (13). Rt. Hon Mark Harper MP asked, “Why should people at home, listening to the Prime Minister and the Secretary of State, do things that people working in No.10 Downing Street are not prepared to do?”. In my humble view this is a very dangerous path to tread. It is essential for the public to have trust and faith in their leaders and the scientists who advise them. As we are dealing with an infectious disease pandemic non pharmaceutical interventions are major part of armoury and mutual trust between the government and its people is essential for success. In a free society like ours when there are infringements on personal liberty opinion will be divided (8). However, after a healthy and open debate people accept these restrictions and abide by them for the common good as we have seen previously. The government of the day also must consider not only saving lives but also livelihoods of its citizens. Already there are calls to “Reboot furlough” to save jobs in the sectors hit by Plan B (14). Latest data shows UK economy grew by 0.1% in October with a warning "steam has well and truly been taken out of the UK economic recovery" from coronavirus restrictions (15).

Despite the heated political landscape common sense should prevail. We managed the pandemic reasonably well. Our cases are stable with minimal if any restrictions until Omicron arrived on the scene. Our vaccination programme including booster achieved phenomenal coverage thanks to our beloved NHS. We have invested heavily in genomic capacity and share our expertise and resources with the wider world (16). The question we need to ask ourselves is who is likely to be affected if the rules are not followed? The simple answer is each and every one of us and our dear and near ones who will not be able to get the clinical care when we need it as the pandemic will overwhelm our NHS. The NHS is already under enormous pressure with long delays for admissions and ambulance finding hard to transfer patients into the hospitals (17).

Earlier on in the pandemic in March 2020 my call to the nation was to rekindle our war time spirit in the electronic pages of this journal (18). In my view it is the moral and legal duty of every citizen and resident on these islands to follow the rules and guidance and do our little bit to slow the spread of the virus which will give us just enough time to vaccinate our population and further strengthen our vaccine defences. To answer the question on the timing of Plan B – this is a very close call to make. We are operating in a volatile, uncertain, complex, and ambiguous landscape regarding Omicron, and my sincere hope that the government made the right call at the right time, and it will bring in the desired benefits to us all.

Dr Padmanabhan Badrinath, Lead Consultant for Health Protection & Lead for enhanced COVID Specialist Team, Public Health Suffolk, Suffolk County Council & Associate Clinical Lecturer, University of Cambridge.

Directorate of Public Health & Communities, Endeavour House, Suffolk County Council, Ipswich, IP1 2BX

Disclaimer: The views expressed here are the personal views of the author and in no way represent the views of his employer, Suffolk County Council, or the University of Cambridge.

Conflict of interest: The author works in a local authority Public Health Department and is the lead consultant for health protection and part of the local COVID specialist response.


(1) Torjesen I. Covid restrictions tighten as omicron cases double every two to three days. BMJ 2021;375: n3051. Available from:
(2) Prime Minister's Office, 10 Downing Street and The Rt Hon Boris Johnson MP. Prime Minister confirms move to Plan B in England. 8 December 2021. Available from:
(3) Rt.Hon William Wragg MP. Hansard. 8th December 2021. Available from
(4) World media troubled by Clinton's timing in airstrikes. December 18, 1998. Available from
(5) HM Government. COVID-19 RESPONSE: AUTUMN AND WINTER PLAN. September 2021. Available from
(6) Gov.UK. Health Secretary's oral statement to Parliament on COVID-19 and Plan B. 8th December 2021. Available from
(7) Sky news. COVID-19: 'Boris Johnson should resign' over alleged Christmas party says SNP. 8th December 2021. Available from:
(8) The Guardian. Government faces Tory backbench revolt over plan B Covid measures 9th December 2021. Available from
(9) Git Hub. Proposal to split B.1.1.529 to incorporate a newly characterised sibling lineage. Available from:
(10) The Guardian. Scientists find ‘stealth’ version of Omicron that may be harder to track. 7th December 2021. Available from
(11) BBC News. UK chief vet warns avian flu at phenomenal level in UK. 8th December 2021. Available from
(12) Houston M. Bird flu virus is back, should we be worried? Irish Times. 27th November 2021. Available from
(13) Rt. Hon Mark Harper MP. Hansard 8th December 2021. Available from
(14) Trade Union Congress. Reboot furlough to save jobs in sectors hit by Plan B. 8th December 2021. Available from
(15) BBC news. UK economy stutters as health sector drives growth. 10th December 2021. Available from
(16) Oliver I, Gharbia S, Hopkins S. Re: Seven days in medicine. 7th December 2021. Available from
(17) Triggle N. NHS Tracker: How is the NHS in your area coping? BBC News. 9th December 2021. Available from
(18) Badrinath P. Let us fight COVID-19 with Compassion, Optimism, Versatility, Inspiration, Determination and invoke the Blitz spirit. 15th March 2020. Available from

Competing interests: The author works in a local authority Public Health Department and is the lead consultant for health protection and part of the local COVID specialist response.

10 December 2021
Padmanabhan Badrinath
Consultant in Public Health Medicine & Associate Clinical Lecturer
Suffolk County Council & University of Cambridge
Endeavour House, Suffolk County Council, Ipswich IP1 2BX