Is this the right time to remove all Covid restrictions?
It is likely that all protective measures against coronavirus will be removed in England next week. It’s a decision that seems driven more by politics than science.
A generous way of describing the UK government’s pandemic strategy is “experimental”. While much of the world believed lockdowns were the only realistic way to stop the spread of Covid-19 in March 2020, Britain remained determined to follow an ambitious path to simply ‘flatten the curve’ and heading for herd immunity – until it reverses that direction too late to prevent tens of thousands of deaths. In July 2021, the government chose, in the face of extensive scientific advice, to relax all of its mitigation measures, allowing a significant reservoir of virus to remain in circulation until the outbreak of Omicron, partially escaping to vaccines, hit last fall. Only the relative softness of this variant – something no one could have confidently predicted in advance – saved the country from the worst forecast.
Now the government is proudly proclaiming that, most likely from February 24, England will be one of the first nations to remove all protective measures against Covid-19. (That’s a more honest framework than talking about “removing restrictions.”) Even the current five-day self-isolation of infected people will no longer be compulsory – and it seems likely that free Covid tests, both by PCR and by self-administration lateral flow tests, will soon be completed. Prime Minister Boris Johnson is expected to confirm changes to self-isolation rules when presenting the Government’s “Living with Covid” strategy to the House of Commons on February 21. It’s yet another bet.
But is the decision to speed up the easing (originally scheduled for March 24) just a political ploy to boost Johnson’s falling popularity following the lockdown party scandals? It doesn’t matter the answer; the mere fact that the question is widely asked, and that many suspect that this next step is indeed designed as a distraction from the Prime Minister’s political woes, shows how little confidence remains that the government’s pandemic policy has anything to do with science.
This mistrust is only reinforced by the fact that Chief Medical Officer Chris Whitty and Chief Scientific Adviser Patrick Vallance – who have laid out the scientific case with charts and statistics at press briefings on previous major policy decisions – are on this occasion untraceable. It is tempting to conclude that they cannot bring themselves to offer any credibility to the decision. Again, whether this is true or not doesn’t matter; nothing speaks so clearly about the malfunctioning of the scientific advisory machinery as the silence of the chief scientists here. It is simply appalling that the public is being asked to trust this most untrustworthy government on such an important decision without any indication of the scientific position behind it. It turns out that John Edmunds of the Scientific Advisory Group for Emergencies (Sage) has indicated that removing the self-isolation rules was not even discussed by Sage. This flies in the face of conventional wisdom about how science policy advice should work, which warns that the public should not be kept in the dark about it.
The most immediate question is whether, for whatever reason, the decision is the right one. While the right-wing libertarian press is keen to portray this as a bold government move to free us from the tyranny of containment-obsessed scientists, the truth is there is widespread recognition among experts that it is time to restore some normalcy in our lives. Lives. For most people, a combination of vaccines and boosters plus the reduced virulence of Omicron (studies suggest the risk of hospitalization after infection is 15-80% lower than Delta) means it there is very little danger of being infected. Public health experts such as Devi Sridhar of the University of Edinburgh, who has previously criticized the government’s lax protective measures, agree that, as she said, “now is the time to start recovering and to heal as a society and move forward, treating this virus as we do other infectious disease threats. That, Sridhar says, includes a willingness to reconsider mask and isolation requirements.
But the bland phrase “learning to live with the virus”, so often repeated by Johnson and his ministers, does not do justice to what is involved in adapting society to an endemic future (a situation which, with the current high and changing levels of infection we have certainly not yet reached). The rhetoric of freedom rings hollow for the many who remain, despite vaccines, very vulnerable to Covid, and which currently seem to be considered a mere inconvenience to the official narrative. The potentially imminent removal of free testing and the need to self-isolate is a double kick in the teeth for these people, of whom there are an estimated 3.7 million in the UK. Not only will infected people be free to go out and infect others, but they will have no easy way of knowing if they pose such a risk.
If you want to know the scientific point of view on this, look at the declaration of the SPI-B behavioral science group that advises Sage. He says that :
Removing free access to testing will make it harder for people with symptoms of Covid-19 to confirm infection and take steps (including self-isolation) to reduce transmission to others. Especially in the short term, these changes can increase anxiety in some people and limit their social participation outside the home, especially those who are or live with a clinically vulnerable person.
Although the disappearance of free testing has yet to be confirmed by the government – Health Secretary Sajid Javid only says the decision is “under review” – it is widely anticipated. SPI-B member Susan Michie, from University College London, said such a move would be “a regressive step”. Equally alarming are rumors that infection statistics currently collected by random sampling by the Office for National Statistics (ONS) will no longer be compiled from April, making it very difficult to assess the extent of Covid day to day in the country.
And if the self-isolation requirements are lifted, the SPI-B statement says: “This will have a disproportionate impact on vulnerable segments of the population, for example those who face greater pressure to work outside. away from home when they are sick due to financial hardship, precarious employment, or family responsibilities.
The group adds that public messaging “should continue to emphasize the importance of continued adherence to specific protective measures as well as the rationale for lifting restrictions.” So far, it seems clear that public messaging will instead focus on the “new freedoms” and the debt of gratitude we owe the government for granting them.
Scottish Health Secretary Humza Yousaf questioned the proposed changes, saying: “Free testing and the obligation to self-isolate if you test positive are effective in tackling the virus and should remain for as long as recommend it the advice of public health experts.” (All the more reason, then, why we need to know what this advice actually is.)
This is, of course, a complicated phase of the pandemic. It cannot simply be declared over by executive order, nor (despite what Johnson asserted in January) is it not clear that we are still entering an endemic phase. While much of the world remains without good access to vaccines, the possibility of a more dangerous variant emerging still cannot be ruled out. Indeed, the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) under Sage has recently notified that Omicron’s relative mildness is likely a fluke, not an indication of a longer-term trend, and that there is a “realistic possibility” of a more virulent variant to come. Moreover, even if vaccines have done wonders to loosen the link between infections and death, Covid-19 is not a passing discomfort for some: the burden of the pandemic for long-term illnesses and disability n is not yet sufficiently recognized.
Yet, individual risk levels vary widely, and there are valid questions about whether uniform protective measures are warranted. Isolation requirements can create economic hardship for adults and educational hardship for children. There is also a discussion to be had about how best to maintain mass testing in the future. The truth is that testing in the UK has been more extensive than in many other countries – genomic sequencing of viral samples from tests, for example, was key to identifying and tracking new variants. This infrastructure is worth celebrating, and also worth preserving, but of course it is expensive and all of it is unlikely to be needed indefinitely. One of the simplest tools is the sewage infection population test. This survey and the ONS surveys are relatively cheap, and it would be a false economy to let them expire.
Another contentious issue is the use of face masks. Here, there is not much to debate, or should be: beyond the possible case of classrooms, nothing prevents us from continuing to apply for the moment a such a simple, discreet and cheap public health measure, aside from the fact that some of the government’s supporters (and MPs) take offense to it. Simply put, any remaining requirement to wear masks in public places would be seen as undermining the “purity” of the “freedom” promised by the government.
The UK is not alone in considering ending almost all protective measures. Denmark did so at the start of February, and Norway has now followed suit. It is too early to say what the effects will be, although in Denmark infections and deaths have increased since the start of the month. Both countries, however, have had a considerably less deadly pandemic than the UK.
Such differences that exist between most scientists and public health officials on the way forward are a matter of detail: should we retain this or that particular protective or surveillance capacity? Most seem to agree that it is time for more change, but also that a strategy for moving safely into endemic Covid must be nuanced and recognize the various challenges and risks that people will face. We need a smart approach. Instead, we seem to be eyeing even more triumphant rhetoric about “freedom-loving Britain”, accompanied by the suggestion that vaccines have defeated the virus. There is no “follow the science” on this.