 In the last 24 hours, 49,000 new COVID cases were recorded in the UK. It's a figure that once would have shocked us, but we've become used to high rates for a while now. We also have a government telling us there's little reason to worry now that vaccines have weakened the link between infection and hospitalisation. This was Pretty Patel speaking to Andrew Ma on Sunday. I think it's important to reflect as to where we are now compared to where we were. I mean, last winter, last Christmas, I mean, it was difficult. It was absolutely difficult. Parts of the country were locked down. We were taking very, very strong measures. I think the biggest change, of course, now, Andrew, from where we were last year to this year, is that we are living with this virus. We are all living with this virus. And of course, this year has been dominated by the vaccine rollout programme, which has fundamentally shifted the landscape and where we are literally looking to, I think, the next few months on the virus. That was Pretty Patel saying rightly that the vaccines have transformed the landscape when it comes to COVID. That doesn't mean high infection rates don't come with a cost, though. 869 people have died from coronavirus in the past seven days. 7,000 are currently in hospital. Pretty Patel also rightly points out that these are nowhere near the catastrophic figures we faced last winter. Hospitalisations and deaths were way, way higher there. What we're seeing in a week we saw in a day back then. But perhaps the best comparison to present is not the UK 10 months ago, but rather our European neighbours right now. On this front, Britain has become quite the outlier and not in a good way. Over the past seven days, the UK has had an average of 620 new daily cases per million people. That's six times higher than the rate in Germany, nine times higher than the rate in France, 15 times higher than the rate in Italy, and a massive 20 times higher than the rate in Spain. This is, as you would expect, translating into higher rates of hospitalisations. Hospitalisation rates in the UK are four times higher than France, five times higher than Germany, eight times higher than Italy, and 16 times higher than Spain. This is not a graph that makes the UK look good. We're not handling this well. A similar gap can be seen when it comes to deaths as well. Daily deaths as a proportion of the population are 2.5 times higher than in Germany, in the UK, and three times higher than Spain, Italy, and France. So what is going on? Speculation has focused on the looser restrictions we have in the UK when compared to the rest of Western Europe. For example, in most of Europe mask mandates are still in place, whereas in England, many people stopped wearing them after the government made them optional. There probably is something to that. It was always stupid. We always said on this show it was stupid to end masking, which is a low cost but effective intervention. There are a few downsides. However, there is reason to think that the impact of masks might be overstated. John Byrne Murdoch at the Financial Times has pointed out that Scotland kept mask mandates in many public places, yet they have even higher rates of Covid than in England. The free charts you see here show rates of Covid in the over 60s, hospital admissions per 100,000 people, and weekly deaths per million people. In each of these respects, Scotland is having an even worse time in England. And that's with masks. So what is going on? Why are both Scotland and England doing so much worse than countries on the continent when Scotland has masks and England doesn't? One potential explanation involves looking at broader categories of behavior. Again, this is from John Byrne Murdoch in the FT. These show that while Scotland and England differ in terms of the proportion of people no longer wearing masks, in both nations, over 25% of the population are no longer avoiding large events. That's the third chart you can see there. That compares to 15% in Germany and France, and less than 10% in Spain and Italy. So you can see the real difference between England and Scotland and countries on the continent is not so much masks. It seems to be socializing, or at least socializing in large events. However, if you are a fan of nightclubs like me, other explanations for our high rates are available. That's because, as Byrne Murdoch points, out Britain's biggest problem might be something unrelated to our behavior, but rather our levels of immunity. To be precise, vaccination rates we have among children and waning immunity we have among our elderly population. On vaccinating teens, we are way behind our peers. England has vaccinated only 25% of those aged 12 to 17. In Spain, France and Italy, the corresponding figures are between 60 and 80%. On waning immunity, the problem is a little more complex. That's because on one level here, we are victims of our own prior success. We vaccinated people earlier than our neighbors, which means our collective immunity will have waned more. It's also because we used a slightly less effective vaccine, AstraZeneca, instead of the Pfizer and Moderna jabs, which were more universally used on the continent. So we now have a population which has less vaccine-induced immunity than our neighbors. Ash, I've got a tough question for you. Does this information about immunity mean that I, someone who quite likes to go out to nightclubs every now and again, am absolved from guilt? I think that you should feel very guilty for what you go up to at nightclubs, but I'm not sure how much that has to actually do with coronavirus. I think that it's, as you say, it's a combination of factors. You've got mask wearing, you've got the waning immunity that comes from having vaccinated lots of people very quickly with AstraZeneca, which we know has got diminished effectiveness when it comes to the Delta variant. We've also got low vaccination rates amongst children. And yes, we've also got people going out to nightclubs. I also think with schools now being in attendance again, and you're seeing infection rates climbing up amongst school-aged children, and of course that's an age group which has got much lower vaccination rates than the rest of the population, I don't necessarily think that nightclubs are going to be the main site that you want to tackle. Basically, I think that we need to get our heads around the fact that vaccinating children is a good thing. The risks from vaccination are relatively low. The risks from coronavirus are that much higher. And also what that does is that it prevents that first vector of infection, your snotty school-aged kid from infecting the rest of the family when they come home. But maybe I'm just saying that because I'd rather jab little Tommy in the arm and give up clubbing. I should make clear, if they decided a couple of weeks, the nightclubs have to close for a couple of months. I'm not going to be out protesting in the street. If that's the decision that's made, fine, so be it. But it does seem like there are a number of lower cost interventions that could be made first. I suppose it is worth saying that if the problem is immunity in the country, while it is disappointing and a massive shame that we dragged our feet when it came to vaccinating teenagers when they rushed ahead on the continent. And that means that way more kids have got COVID and some of them will have got long COVID. It means more people will have caught it from kids in school and that would have passed up the age groups and you will have had people hospitalised and some people dead. The fact that we are low in that respect means that maybe we can get some easy wins when we increase vaccination among those age groups. It was announced on the weekend, which is a good thing that instead of having to wait for a whole school visit from vaccinators, kids in England, it was always the case in Scotland, can just turn up to their local vaccination centre. They don't have to wait for it all to be arranged via school. So we could see a bit of an increase in the speed of vaccinating kids there. When it comes to the booster campaign, this is particularly disappointing, I think, especially compared to our rollout at the start of the year. It's been especially disappointing and I mean, I'm sure very scary for people who are extremely vulnerable. On that front, the Guardian report surveys by Blood Cancer UK and Kidney Care UK found that for both groups of patients, so that's blood cancer patients and kidney patients, between 55% and 60% had yet to be invited to get a third injection that's seen as particularly vital for conditions which affect people's immune systems as they are generally less protected by two jabs. The charity said many of those who responded were desperately worried and were struggling to get information about a third vaccination. Some people with blood cancer had resulted to go into vaccination centres without an appointment pleading for a third dose, Blood Cancer UK said. Now, this to me just seems like a massive abdication of responsibility from the state. We had a system at the start of the year where we were vaccinating 300, 400,000 people, 500,000 people a day. Now, I think we're vaccinating 150,000 people a day. And one, that means that we have higher overall rates of COVID in the country, but it also means that you've got, as those quotes there indicated, you've got lots of people who are severely vulnerable to COVID-19, who are twiddling their thumbs, waiting, they see that there are, today almost 50,000 cases of COVID in the country, but you're not going to feel safe if you have waning immunity because you got vaccinated back in January or February. And now you're just waiting to receive a letter asking you to get that vaccine. So this to me just seems like complete incompetence in the government sitting on their hands. We know we have the vaccines, right? There isn't a shortage of overall vaccines. So that to me seems no justification whatsoever that this booster campaign has been so slow. I did ask for explanations on Twitter today. So a couple that were mentioned was that, they did have to take lots of nurses and get them to do that roll out and now they're back in hospital. Although, I mean, we had more people in hospital with COVID back in January and February than we do now. So I find it a little bit inexplicable. I want to discuss one final potential explanation as to why we might have higher rates of COVID than our neighbours. It's less discussed than usual and that's because it's structural. For example, the UK has some of the lowest sick pay in Europe. That obviously means people will be less able to self isolate. So that means that even with a similar amount of restrictions, we will probably have more COVID circulating. We also, and this is something I didn't realise, have the highest levels of pension of poverty among the big European countries. As you can see here, 16% of pensioners in Britain live in poverty. That's defined as less than half the median household income or the average household income. That's higher than any of our big neighbours. We know the correlation between poverty and catching COVID and being hospitalised with COVID. Obviously, if you're short of cash, it's going to be harder for you to stay in the house. You won't have that extra money to pay for deliveries or the various insulations from the vagaries of life that a decent income provides you. And also, you're more likely to be in poor health, which means you're more likely to end up in hospital. But it does seem like we do it... This is something everyone recognises. You ask Boris Johnson that. He'll say, yes, of course, these terrible inequalities, which mean that we're harder hit by COVID. But it does seem like nothing is being done about it. And actually, we're going in the opposite direction with things like the 20-pound universal credit card. So, I mean, I'm feeling a bit depressed about this. I don't know if you've got sort of how the pandemic can be mobilised to actually fight for a more equal country instead of, you know, I'm in a zone of disappointment at the moment. I think the best realistically, you're going to get out of this Tory government when it comes to dealing with the forces behind those health care inequalities is a bit of tinkering around the edges when an issue becomes so politically toxic that they have to then, you know, make the U-turn. You saw this with free school meals, for instance. But ultimately, one of the reasons why they're never going to be able to get to the core of the issue is because that means dealing with and confronting how our economy is organised. So, there's one way of looking at health care outcomes, not just simply as a reflection of our body, but as a manifestation in the body of what we value and what we don't in society, particularly with respiratory illnesses. So a friend of mine who's a doctor and also that given the kind of poetic ways of phrasing himself, one of the things that he says is like, well, the lung is kind of the interface between the body and the rest of the world. You know, whether or not we're poor, whether or not, you know, we live in an area which has got, you know, a high amount of air pollution, whether or not we live in overcrowded accommodation. That's not a reflection of something that is within our bodies. That's a reflection of how society has decided to treat us. And so if you wanted to deal with the things which made this country so structurally vulnerable, the fact that you had a high number of elderly patients in hospitals because perhaps they couldn't afford the kind of care that they needed either at home or in a residential setting. The fact that we have so many people who are in overcrowded housing, multi-generational housing, where it's likely if a young person has got coronavirus that you're going to pass it on. The fact that we have got absolutely insulting rates of sick pay, which mean that you can't afford to take the time off if you have this virus or think you might have this virus, all of these things have added up to almost a collective clinical vulnerability for society. And we haven't dealt with any of those things and that's because this government simply won't.