Scientists and health bodies are calling for tighter coronavirus restrictions in England as cases continue to rise and hospitals report mounting pressure. Issuing a warning ahead of a government review of the tier system in England on Wednesday, the Independent Sage group of experts said that unless the whole country was immediately put under lockdown, there could be ‘tens of thousands’ of avoidable deaths. NHS Providers, which represents members within NHS hospitals, mental health, community and ambulance services in England, also called for tier 4 restrictions to be further extended across the country. The calls come in the same week that the number of patients in hospital with Covid in England surpassed the peak in the first wave, with 20,426 people in hospital with the disease on the 28 December, and numbers expected to rise further as cases climb. On Tuesday, coronavirus cases reached a new record high, with 53,135 cases reported in the UK and 47,164 cases in England. The seven-day average rate for London as a whole to the 24 December was 807.6 per 100,000 population, twice that of the rate for England, while Thurrock, in Essex, had more than 1,300 cases per 100,000 population for the same period. Christina Pagel, professor of operational research at University College London and a member of Independent Sage, said things were as bad as they had ever been. “The frightening thing is that they are going to continue to get worse,” she said. “Action is needed now to avoid the collapse of the NHS in a few weeks. It is that serious.” The group warns that with the emergence of a new UK variant of the virus, which is estimated to be 56% more transmissible than previous variants, the situation has taken a turn for the worse and that the current tier system is not sufficient even in places where the new variant is rare. “The very rapid rise of cases in London, the south-east and east of England under restrictions that previously kept growth much slower, highlights the need for a radical rethink of how we deal with Covid-19 going forward,” the Independent Sage group wrote in an emergency statement, adding that cases were rising, albeit more slowly, across all English regions. The deputy chief executive of NHS Providers, Saffron Cordery, said pressures on the NHS were rising at an unsustainable rate in some parts of the country. “Thankfully, trusts in other areas have been helping out,” she said. “But with the virus spreading fast alongside mounting winter pressures, the options are narrowing.” Matt Hancock, the health secretary, is due to address the Commons on Wednesday afternoon, following a Tuesday evening meeting of the government’s Covid-O committee, chaired by Boris Johnson. With ministers under pressure to take action to stem infections amid surging coronavirus cases, some locations in the Midlands and further north could be moved into tier 4. “We urgently need to get ahead of the outbreak,” said Cordery. “The Covid-19 tier review offers an opportunity to do that. It will require difficult decisions, moving millions more people to the highest level.” Cordery added that while such rules will impact peoples’ livelihoods, wellbeing and the economy, the cost of not going further will be heavy. The Independent Sage group has called for a national lockdown and the closure of schools for at least a month for most children, along with other demands including a plan to scale up the vaccination programme and tougher measures for those travelling to and from the UK. It said it was necessary because cases had continued to grow since early December in areas under tier 2 and 3 restrictions, while even the tighter tier 4 restrictions – introduced in areas where the new variant is common – did not appear, as yet, to be slowing the spread of the virus. The group said cases in current tier 4 areas had risen four-fold since lockdown. With the incubation period for the virus lasting up to 14 days, and delays in getting tests and results over Christmas, the impact of tier 4 might not yet be fully apparent, but the group said the signs were concerning. “It is now over 10 days since tier 4 was imposed on London, Kent and parts of [eastern] England. If cases in these areas do not level and reduce soon, then we cannot expect tier 4 to be enough to contain Covid-19 in England,” they warned. Among the evidence to support their calls, the group point to an analysis of the spread of the new, highly transmissible coronavirus variant by experts at the London School of Hygiene and Tropical Medicine, released this month, which warned that even if the whole of England were placed under tier 4 restrictions on Boxing Day until the end of January, the R value would not fall below 1. The study, yet to be peer-reviewed, also warned that without a substantial vaccine roll-out and tighter regulations the death toll of 2020 could be surpassed within the first six months of 2021. According to the Mirror, a Whitehall source has said the tier 4 rules do not appear to be working, adding that the government could introduce “another level […] like a tier 5”. While no details have been released as to what such a tier could look like, or whether it would even be called “tier 5”, one possibility is that the tighter measures could include closing schools for most pupils and moving education online. “I can’t see any other option for getting the virus under control,” said Prof Susan Michie, a member of the government’s Covid-19 behavioural science team that feeds into Sage, as well as the Independent Sage group of experts – although she noted that she had not heard any direct evidence that the government was planning such a move . Schools closed for most pupils during the first lockdown in the spring, while the other restrictions included the edict to venture outside only once a day for exercise, leave home only for essentials, and for all non-essential shops and places of worship to close.