Boris Johnson’s tie was carefully tucked inside his shirt, all the better not to spread infection. He bumped elbows with nurses, rather than shook hands. But when the prime minister posed for the cameras at Hexham hospital this week, he didn’t bother with a mask. He had been wearing one when he turned up, local papers reported – just as every other visitor to the hospital must. But he shed it to do some press interviews and then emerged barefaced for his photocall. Was it just forgetfulness, or a deliberate nod to the strange minority of diehards who still enjoy watching him throw Covid caution to the wind? As ever with Johnson, it’s hard to tell cock-up from calculation. But no other living British leader would, one suspects, have failed to cover their face in a building full of sick and sometimes immune-compromised people. Hospitalisations from Covid have, thankfully, been falling recently, as booster jabs for elderly people help to tackle waning immunity, although daily figures released on Thursday recorded a surprise uptick in cases. But we are not out of the woods yet. There are even hopes of reaching some kind of “endemic equilibrium” this winter, where some people will still get infected but the vaccine is enough to hold rates in check. However, the NHS is still struggling with the long tail of the pandemic, including surging demand from people who missed out on medical care at the height of the crisis and who are now presenting as emergencies. Hospitals are so full that ambulances wait for hours outside A&E to unload their patients, while 999 operators run out of crews to send. The family of 82-year-old Margaret Root described this week how she waited almost six hours for an ambulance after having a stroke, and then another three hours just to get inside the hospital; by then it was too late to give her drugs that could have helped reverse the damage. Nine in 10 health service leaders, in a survey released this week by the NHS Confederation, said their situations were “unsustainable” – and that’s before the weather gets truly wintry, bringing with it falls on icy pavements, and pneumonia cases. Downing Street still insists there is no need to bring in tougher restrictions such as proposed Covid passports, which would force people to show proof of vaccination or negative Covid status to get into nightclubs. Ministers hastily retreated from that idea this summer after rumblings of outrage from all the usual rightwing suspects. But what’s intriguing is that Wales – which in October had the highest rates of infection of all four nations – and Scotland went ahead; and this week the Welsh scheme was extended to cover cinemas, theatres and concert halls. For a good year now, Labour-controlled Wales has been following a more cautious path than England. The jury is still out on what difference that has made; the circuit-breaker lockdown it imposed last October, at a time when Johnson was reportedly declaring that he would rather let the “bodies pile high” than impose it, didn’t stop Wales needing another lockdown later that winter. Nor did a more cautious Welsh approach to lifting restrictions this summer prevent hospitals struggling, or stop case numbers shooting up again once schools reopened. But all this has to be weighed against the great unknowable, which is how much worse things might have been had Wales not been so cautious. The one thing we know for sure is that, far from revolting against the restrictions – as some pundits never tire of predicting – if anything, Welsh voters seem reassured by them. YouGov polling this September found 67% thought their administration had handled Covid well, against only 39% thinking the same of the UK government. Wales’s soaring Covid numbers may have pushed it into hard choices that England has so far avoided, but a wise government would be watching carefully to see how these decisions play out. The Welsh scheme still allows the unvaccinated to secure a Covid pass by producing a negative lateral flow test result. But it makes socialising less spontaneous for the wilfully unjabbed – so as well as keeping infections down, it may yet help nudge vaccination rates up. In France, where a similar scheme covers everything from cafes and cinemas to shopping centres and long-distance trains, President Macron admitted the idea was “to push a maximum of you to go and get vaccinated”. The sky does not appear to have fallen in on French cafe culture, and 76% of a once vaccine-hesitant country is now jabbed. This is what grownup government looks like: different in each country, because each outbreak is different, but always responsive to the demands of the virus. What stops it happening in England is what arguably stops grownup governing from happening on all sorts of issues, to the growing alarm of some Tories watching their poll lead narrow. It’s Johnson’s longing to please the people who put him where he is now. Dancing with the one that brung ya, as Ronald Reagan used to call it, means pandering to an ideology that has been calling the shots inside the parliamentary and grassroots party since the Brexit referendum, its leading figures self-styled as the Spartans but increasingly (for a new generation of Conservatives) known by less printable names. Owen Paterson was a loyal Spartan, so Downing Street marched his reluctant colleagues up the hill to save him from being suspended over lobbying allegations, only to turn and flee when that proved workable. The self-harming trade war we are threatening to start with the EU is chiefly for the benefit of the Spartans, who were told that a hard Brexit would have serious consequences for Northern Ireland but wouldn’t listen. Spartans tend not to like facts that contradict their ideological worldview. In his book Spike, the former Sage science group adviser Jeremy Farrar recalls a Zoom meeting last autumn with Tory MPs from the lockdown-sceptic Covid Recovery Group, in which he tried to persuade them of the case for restrictions. Farrar reeled off the numbers on rising infections, hospitalisations and deaths, proof of an epidemic exploding. In return, he writes: “They asked questions like, ‘What should I say to my constituents who don’t see much Covid?’” There is, to put it mildly, a theme emerging. In the wake of the Paterson debacle – which not only trashed parliament’s reputation but started a war on Conservatives with lucrative outside interests – some Tory MPs are asking hard questions about who has the prime minister’s ear. The mask, in more than one sense, is slipping, and in future they may well push back harder when asked to do things that don’t sound right. Well, it’s progress of a kind, I suppose. What a shame that, for the sake of the rest of the country, it has come several years too late. Gaby Hinsliff is a Guardian columnist