Will we get a big revamp of the UK’s traffic light system on Thursday?

Whatever happened to Grant Shapps’ end of July review?

The UK government has promised a more comprehensive review of their traffic light system which governs restrictions on travel at “the end of July”. Travellers and travel companies alike are hoping for a relaxation and a simplification of the system, so that the second half of the summer can be saved.

It is August and the end of July has come and gone. We know that the the government is due to announce its regular three weekly changes to the country classifications on Thursday. Could we get bigger changes?

The change that would make the biggest difference would be a relaxation of the onerous testing system. Let’s look at that first.

The case for reform of the testing regime

The UK is still forcing people travelling to the UK to take about 160,000 pre-departure tests a week, plus the same number of “Day 2” PCR tests after arrival. Unvaccinated travellers from amber list countries need to take a further “Day 8” test and, if they want to stop quarantining early, pay for another “Day 5” test. This is costing travellers tens of millions of pounds a week and the data show that it isn’t delivering very much.

For the first three weeks of July, just 7,000 people tested positive in the arrivals testing programme. Only 354 of the positive Day 2 tests were able to be sequenced, an incredibly low rate given that they aim to sequence all of the positive samples. That is almost certainly driven by the fact that everybody testing positive on arrival will already have tested negative before departure. That means they are likely to be very recently infected, or the more sensitive PCR test used on arrival is picking up very low viral load cases missed by lateral flow tests used on departure. Increasingly, they will almost all be fully vaccinated too. All of these factors will tend to mean viral loads that are so low as to make sequencing impossible. In any case, in the most recent data, none of those sequenced samples were found to be anything different from the Alpha and Delta variants that we already have.

The whole system is a colossal waste of money and a pointless inconvenience to travellers at this point. The Day 2 PCR test in particular for fully vaccinated people arriving from low risk countries makes no sense at all.

Do I expect it to get simplified on Thursday? No, but it should be.

Let’s turn to things that are more likely to change. The country classifications which get reviewed every three weeks.

Any green countries which might get downgraded?

When I tried to “reverse engineer” the thresholds for green status in this article, I came up with thresholds for case rates of 20 weekly cases per 100,000 and a test positivity of 1.5% or less. Leaving aside the countries which are on the green list where we don’t have any data (like the Antarctic and the Falkland Islands), there are four current green list countries where case numbers or test positivity has crept back above those thresholds. Antigua and Barbuda, Barbados, Bulgaria and Croatia are all above 20. But since they are only marginally above, I don’t expect them to be downgraded. The worst that seems likely is that they get put on the “Green Watchlist”, if that is still a thing.

Green list candidates

There have been media reports that up to 77 countries were being considered for possible green list status. I can’t see very many making it through that review process, unless the government has decided to raise its thresholds significantly. That is possible of course, as part of the “end of July review”.

If they haven’t moved the goal posts, there are eight amber list countries that meet the case rate, test positivity and level of testing thresholds that might previously have qualified them for the coveted green list status.

Five of them met these tests at the last review too: Canada, Hungary, Poland, Romania and Slovakia. They didn’t make the green list last time, but perhaps a country needs to meet the tests at two successive reviews? Case numbers in Slovakia, Romania and Canada have been rising recently, so maybe that will rule them out.

The first of the three other candidates is Bhutan, where case numbers have fallen. The other two countries are ones which I had previously ruled out based on the lack of testing statistics: Equatorial Guinea and Gabon. We now have some testing data, so perhaps that will bring them into consideration.

Poland and Hungary seem to be the best bets for green out of this bunch, but I could make a case for any of them.

What about the Amber Plus list?

As I set out in my last post, I think the creation of the Amber Plus list in order to deal with a perceived threat from the Beta variant in France, was fundamentally misconceived and based on flawed data. In any case, Beta cases in France have continued to decline. In the second half of July, only 1.5% of cases were Beta variant, compared to about 3% at the last review.

I never believed the scare stories about Spain potentially being added to the amber plus list, since the data didn’t support that. It supports it even less now. The most recent weekly variant report from Spain showed that only 6 Beta cases had been detected out of 468 samples - a little over 1% and declining fast in the face of the Delta variant.

The government should consign the amber plus list to the dustbin of history. Let’s hope they do.

Red list countries

I think this is the most interesting and difficult to predict category. The red list has been something of a black hole. Once a country falls into it, it seems impossible for it ever to escape. Is that about to change?

The government says the list is defined by countries “presenting a high public health risk to the UK from known variants of concern (VOC), known high-risk variants under investigation (VUI) or as a result of very high in-country or territory prevalence of COVID-19”.

Let’s deal with just the second part first, “very high prevalence”.

Red list changes based on prevalence

There are eight European countries that have case rates that might have been considered high enough for the red list in the past. I’m not going to list them, as I don’t see any real risk of the UK putting European countries onto the red list when their case rates are no higher than recent figures in the UK. I’ve shown them on the following chart, along with the UK as a reference point.

Outside of Europe, there are a few more amber list countries with high prevalence figures. Once again though, they are not that different to recent UK levels. None of them have high travel to the UK, combined with a large number of people testing positive on arrival. That’s the profile which seems to have prompted red list treatment in the past. For example, Fiji has the highest case rate but there were only 10 arrivals from there in the first three weeks of July.

So, I can’t see much likelihood of additions to the red list based purely on high prevalence.

What about the other direction? Countries that were put on the red list because of high prevalence at the time, but where rates have come down.

There are 28 countries on the red list where we have data for case rates and they are relatively low. For 12 of these, we either have no data on testing rates, or it is really low, so the government may not trust the data. But that still leaves 16 countries with testing data and case rates considerably below the UK. Could some of these finally escape?

To answer that question we need to look at the other main reason they might be on the list. Variants.

Which countries deserve to be rated red based on variant concerns?

Let’s go through the 16 red list countries which don’t seem to belong there based on prevalence data alone.

In the latest batch of arrivals testing data which the government published, they made an interesting modification to what they report for the identification of variants. They now split the numbers into “Variants of Concern (VOCs) with widespread community transmission in the UK (Alpha and Delta)” and “Other VOCs & VUIs”. That’s a pretty strong hint that they have stopped caring about Delta, which makes sense as all of the cases in the UK are Delta now.

We know they still seem sensitive to Beta cases, given what they did to France. Quite why is unclear, as there is plenty of evidence that Delta outcompetes it, even in a highly vaccinated population. Here’s a chart of worldwide prevalence from outbreak.info, which seems to show that the variant is dying out in the face of Delta.

Unless the government decides to stop worrying about Beta, three of the 17 “captive countries” seem doomed to stay red, since they have significant Beta prevalence. They are Pakistan, Qatar and Rwanda.

The other big variant of concern is Gamma. Like Beta, that is also dying out on a global basis (see next chart). But if Gamma is “still a thing” as far as the red list is concerned, then Brazil, Chile, Peru and Uruguay will remain red, at least for now.

That leaves us with Bahrain, Bolivia, Cape Verde, Dominican Republic, Uganda, the UAE and Zambia. Most of these are lacking in data on variants, so they may be red on a precautionary basis. But three stand out: Bahrain, India and the UAE. In all three countries the dominant strain is Delta and if Delta has been downgraded as a threat by the UK, perhaps these three will finally get put back to amber.

What about Turkey?

I know that if I don’t mention it, I will get asked about Turkey. On almost every metric, it deserves to be amber, but the case rate has begun to climb again in recent weeks as the Delta variant takes hold. It is still lower than in the UK, but the direction of travel might make the UK hold back from taking it off the red list for the moment.

What I think should get announced

I’ve learnt my lesson. I’m not going to try and predict what will be announced on Thursday. The government has a nasty habit of not following logic. But I will say what I think should happen.

Poland and Hungary at least should get moved from amber to green and up to six other countries could join them.

The amber plus category should be uninvented and France moved back to amber.

Bahrain, India and the UAE should go from red to amber. Turkey could escape too, but might need to wait until case number start coming down again.

I think there is a strong case for ceasing to worry about both Beta and Gamma. We already have a much scarier variant. In which case Pakistan, Qatar, Rwanda, Brazil, Chile, Peru and Uruguay should all go to amber. But that would be a brave step, given the sensitivity about the “V word”, so I don’t expect it to happen.

It is becoming increasingly urgent to start to dismantle the excessively burdensome testing regime. Recent changes which allow fully vaccinated people to avoid quarantine and the “Day 8” test from amber list countries were a big step forward. But continuing to require both pre-departure and post-arrivals tests for travel from low risk countries is no longer justified by any rational assessment of risk. The excuse of needing PCR tests on arrival to track variants doesn’t hold water, given how few sequences are successfully carried out. Maybe it makes sense to keep them for high risk countries, but at the moment they are needed even from green list countries. Madness.

It could be argued that it would be premature to take big steps to bring travel back to normality, but as Boris Johnson said about the ending of legal restrictions on July 19th, “if not now, then when?”