Coronavirus cases have surged in Bolton, raising the possibility of a new local lockdown. This is not the first time the town in Greater Manchester has faced local restrictions and the area has been a bellwether for a national lockdown in the past. However, the rapid spread of the India variant and the vaccine rollout are new factors.

Why is the government not ruling out a local lockdown in Bolton?

Bolton has the highest case rate in England with 275 cases per 100,000 residents in the week to 12 May – more than 10 times the country-wide rate.

Prof Paul Hunter, a professor of medicine at the University of East Anglia who specialises in infectious diseases, said: “The big anxiety at the moment is that this [India] variant does seem to be pretty much in most parts of the UK now. The issue is always going to be how much more rapidly will it take off in these other areas, and that is the big uncertainty.”

On Sunday, the health secretary, Matt Hancock, appeared to link rising case rates in Bolton with vaccine hesitancy, but No 10 later downplayed these comments and said hesitancy remained very low throughout the UK.

Bolton’s vaccination rate among over-40s is in line with the national average of 89.8% although there are differences locally.

The rise in cases has not yet translated into a rise in hospital admissions and previously there has been a 10-day lag between cases and hospitalisations.

When was Bolton’s last local lockdown and how high were cases then?

Bolton has had some form of restriction in place for almost 10 months. The first began on 31 July when the case rate was 20 per 100,000 population. When restrictions were eased on 3 October the rate was 249 per 100,000.

A week later Bolton went into tier 2, by which point cases had risen to 336 per 100,000. By 23 October they had risen a further 65%, at which time tier 3 restrictions were imposed. Cases plateaued but only shortly before England entered a second national lockdown.

Another local lockdown in December also failed to stop a rise in cases.

Have other local lockdowns worked?

Local lockdowns were not completely effective last year. Cases doubled in the majority of English towns and cities where long-term lockdowns were in place, according to analysis in late September 2020. However, experts say timing, decisive action and enforcement are critical in making restrictions effective.

Prof Lawrence Young, a virologist at the University of Warwick, said: “The effectiveness of local lockdowns remains controversial, particularly the three-tier system introduced into England last October. Where local lockdowns have been effective, they have been accompanied by rigorous testing, tracing and isolation.

“The key to the success of local lockdowns appears to be going in early when just a few cases are detected and enforcing hard restrictions to prevent person-to-person virus transmission. Given that the Indian variant has already now been detected in 86 local councils, any local lockdowns may well be a case of shutting the stable door after the horse has bolted.”

How are conditions different now?

The gamechanger between now and the last lockdown is vaccination. Almost 37 million people in England have had their first vaccination and 20 million have received both doses.

Hunter says vaccines will make things a lot easier: “We almost certainly won’t achieve herd immunity but vaccines are enabling us to do two things – they’re reducing the probability of severe disease in people who are infected and they’re going a long way to reducing transmission and reducing the reproduction rate.”

Another consideration is that the case rate is lower in those age groups who have already been offered their first vaccines: among under-40s in England the case rate is 2.3 times higher than among those aged 40-plus, a ratio reflected in Bolton. This is an important distinction as, to date, hospitalisations and deaths have been less severe in younger age groups.

This content first appear on the guardian

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