On 19th July, the British government abandoned many of the precautions in place to reduce the spread of coronavirus on what some of the press inappropriately insisted on calling ‘freedom day’. Limits on how many people could meet, social distancing and mandatory use of masks were dropped. Nightclubs were allowed to reopen, pubs and restaurants no longer had to offer table service only and limits were lifted for numbers at weddings, funerals, concerts, theatres, sports events and church services. From mid-August, most Covid restrictions in schools will end, including ‘bubbles’, and fully vaccinated adults will not need to self-isolate after contact with a positive case. Guidance recommending against travel to amber list countries was removed, and those visiting were no longer expected to self isolate on return.
Had the war been won?
Reading the above it would be tempting to think that the ‘war against coronavirus’ in the UK had been won. However, numbers of new cases and hospital admissions told a quite different story, prompting rising concern among the scientific community long before restrictions were lifted. Writing in the medical journal The Lancet, Deepti Gurdasani and colleagues branded the decision to lift restrictions as dangerous and premature. An end to the pandemic should mean that enough of the population are immune to SARS-CoV-2 to prevent an exponential increase in infections with the huge pressure that this exerts on the NHS and the risk to many of death and chronic illness. In fact, in early July it was estimated that there were still 17 million people with no protection against the virus.
Indeed, the Health Secretary, Sajid Javid, was confidently predicting a rapid rise in case numbers to as high as 100,000/day. Soon afterwards, having developed infection himself despite being vaccinated, he fatuously and insensitively tweeted that people should not “cower” from infection. This not only led to swift condemnation by those who had lost relatives but also called seriously into question his soundness of judgment and his understanding of the seriousness of the disease.
A return to herd immunity
At the start of the pandemic, the UK government initially considered letting infection spread until herd immunity was achieved. While this is denied, video evidence confirmation from the Chief Scientific Adviser is freely available. The most obvious explanation for the recent lifting of restrictions is that the government now feels that herd immunity can be achieved through a combination of both vaccination and natural infection, rather than waiting for greater vaccine coverage to be rolled out. The consequence would be a huge rise in infections among the predominantly as yet unvaccinated younger population. This was justified by arguing that vaccines had “broken the link between infection and mortality” and that catching the virus if you were relatively young and healthy did not much matter.
However, the link between virus and death has been weakened rather than broken and infection can be a serious matter resulting not only in sudden illness requiring hospital admission but also long term problems in many who become ill. Around 10% of patients have symptoms three months after being infected and long Covid can affect the whole spectrum of people with Covid-19, from those with very mild acute disease to the most severe forms. The risk of this approach is therefore clear – exponential growth of the delta variant leaving hundreds of thousands of people with long term chronic health problems, increasing pressure on the NHS, and preventable deaths.
Storing up trouble for the future
Allowing transmission of the virus over the summer may also create a reservoir of infection that will accelerate spread when schools and universities reopen in the autumn. Modelling suggests that another effect could be to increase the likelihood of vaccine resistant variants. This would put all at risk, including those vaccinated, both in the UK and globally. An increase in hospital admissions will apply further pressure on health services struggling to cope and on exhausted staff. Catching up with the backlog of work will also become even more challenging. As always, it is the deprived communities who are more exposed to and more at risk from Covid-19 that will be disproportionately affected.
The authors of the letter to The Lancet described the government approach as a “dangerous and unethical experiment” as well as branding it illogical. They suggested an alternative approach of delaying relaxation of restrictions while pushing up vaccination rates, investing in adequate ventilation in schools and workplaces, continuing to follow WHO guidance including mask wearing in indoor spaces, having effective border quarantine processes and ensuring that ‘find, test, trace support’ systems worked. The latter must include doing something about statutory sick pay in the UK, which at £95.85 a week is almost the lowest anywhere in the industrialised world, and means around a quarter of the British workforce face poverty by falling ill.
Taking the batteries from the smoke alarm – a novel approach to fire fighting
Just as England was about to lift restrictions, new infection rates had climbed to one of the highest in the world with 54,674 new cases in the UK on 17th July. Not surprisingly, more people were being asked to isolate through contact with infected cases, more than half a million in the first week of July (a 46% rise on the previous week). Most of the press chose to call this a ‘pingdemic’ and blame it on the NHS contact tracing app rather than the huge rise in infection brought about by government strategy. Meanwhile, the lamentably expensive and largely useless privatised ‘test and trace’ continued to underperform, with only a minority of those with Covid symptoms coming forward for testing, mainly due to lack of financial support.
There followed calls for the sensitivity of the contact tracing app to be reduced and for key workers to continue to work provided they had negative daily lateral flow tests, a negative PCR test and had been double vaccinated. Much confusion then followed in terms of just who were key workers, would they still have to isolate when not at work, and what about risk to fellow workers who had not been in contact with infection? In addition, health staff told not to isolate would inevitably come into contact with vulnerable patients. While ministers are fans of lateral flow tests, it should be noted that the US Food and Drug Agency takes a different view and warned the public to stop using the Innova SARS-CoV-2 antigen rapid qualitative test for detecting infection, suggesting the tests should be destroyed and binned or returned to the manufacturer.
Despite a symptomatic Sajid Javid testing positive and being in face to face meetings with the prime minister and chancellor, both suddenly claimed to be part of a ‘pilot scheme’ that allowed them not to isolate. A hostile public response, including from many of the around 1 million people estimated to have been told to self isolate, prompted a rapid U-turn. Among accusations of ‘one rule for them, another for the rest’ Johnson spent ‘freedom day’ isolating in 10 Downing Street. This meant we were spared him declaring victory over the virus day “by summoning the spirit of Churchill with appropriately stirring rhetoric . . at an historic venue associated with the wartime leader”.
Time will tell which way the numbers go
Modelling of what might happen after lifting restrictions suggested that Covid cases could rise as high as 200,000 a day with up to 2,000 hospital admissions and 100-200 deaths each day. By 26th July, daily infections had fallen from over 50,000 to the lowest in three weeks (24,950 cases) but hospital in patient numbers had risen to above 5,000 for the first time since mid-March and deaths were up by 50%. The seven-day average for hospital admissions had increased by 26% over the previous week, with a 31% rise in Intensive Care Unit bed occupancy. Since a June 1st with no coronavirus deaths, 1,114 were reported over the next four weeks. NHS providers warned the government that the NHS was as stretched as it was at the height of the pandemic in January.
With the closure of schools, numbers of children tested fell, possibly contributing to falling case numbers. Good weather also meant more people were outside and the spread of virus may have reduced. At the time of writing (end of July) It is certainly too early to conclude that a level of herd immunity has now been reached. Effects of lifting restrictions on the 19th July will take time to become apparent and a surge in cases remains possible in September (if not before) when schools reopen. There is general agreement that considerable uncertainty must remain about what will happen in the coming months.
Overseas observers looked on with incredulity at the July 19th lifting of restrictions, pointing out that the prime minister had clearly abandoned any claim to be basing actions on ‘data not dates’ given the skyrocketing of delta variant cases. A professor of infectious disease from Harvard commented: “Yes, vaccines make it much less likely you’ll get infected or ill; but if the virus isn’t there, it definitely can’t infect you”. Only half the UK population was fully immunised, vaccine uptake was slowing, and there were many who were unable to benefit from vaccination including those with immuno-suppression or those struggling with vaccine access.
Prof Robert West of the government’s Scientific Advisory Group for Emergencies behavioural sciences subgroup, described the government approach as getting “as many people infected as quickly as possible, while using rhetoric about caution as a way of putting the blame on the public for the consequences”. In effect, a very strong signal had been sent out that the Covid crisis was now less serious, with the overall message being that actions by the public – not only mask wearing, but also distancing and avoiding crowded places – were no longer required.
The possibility of the UK becoming a breeding ground for new vaccine-resistant variants and exporting them to the rest of the globe caused alarm among 1,200 world scientists. Prof Michael Baker from New Zealand remarked: “we have always looked to the UK for leadership when it comes to scientific expertise, which is why it’s so remarkable that it is not even following basic public health principles”. Clinical epidemiologist Deepti Gurdasani commented: “Let’s be under no illusions – we are in a country where our government is taking steps to maximally expose our young to a virus that causes chronic illness in many. Our government is ending all protections for our children including isolation of contacts of cases in schools and bubbles”. Others warned that the British government’s approach would be imitated, for political expediency, by authorities elsewhere.
Coercion and vaccine passports – an assault on civil liberties
Care home staff will be expected to have vaccination against Covid-19, with expansion of compulsory vaccination against both Covid-19 and flu for all health and care workers. Care home staff that refuse will be dismissed without compensation and barred from their occupation. There is a lot more to safety in care homes than vaccination, including adequate staffing levels, training equipment, cleanliness, personal protective equipment, risk assessment, and consultation with staff and residents. The government has also overestimated the number of care staff who have not had vaccination. Respect and professionalisation of care staff would do more to boost vaccine uptake.
Nightclubs have been identified internationally as particularly dangerous environments for spreading the virus. By the end of September, vaccine certificates will be mandatory for entry into nightclubs and other venues where large crowds gather. This is more about coercing the young to be vaccinated rather than a serious approach to persuading people of the benefits. Critics asked why, if it was safe to go to a nightclub from July 19th, would it require full vaccination from the end of September? Big Brother Watch has highlighted problems of vaccine passports/COVID status certificates and mass testing of asymptomatic people – that there is insufficient evidence that vaccinations prevent transmission of the virus; there is no evidence to support the use of mass testing in people without symptoms or exposure to an infectious person (false positive tests hamper public health efforts and unfairly exclude healthy individuals from public life).
Further, the use of immunity as a condition for work, travel or leisure rights raises serious legal and ethical issues and would risk incentivising healthy people to contract the virus in attempting to access equal socio-economic opportunities. As COVID-status certificates do not reduce community risks, they should not play a role in reopening the economy. COVID-status certificates would create a two-tier society, in which minority ethnic groups, migrants, poorer people and people with lower education would be disproportionately represented. The best way to ensure marginalised groups are included in public health measures is to create an enabling, not a punitive, environment.
The current UK government strategy for managing coronavirus remains deeply flawed. Despite rising infection rate, restrictions known to reduce the spread of virus were abandoned on July 19th exposing many millions of unprotected individuals to risk of developing Covid-19. Ministers chose to abdicate responsibility for this by leaving the public to decide how to behave. Apart from a recent reduction in number of daily new cases, it is clear that hospital admissions and deaths have been increasing. Lifting of restrictions should have been delayed until a much greater proportion of the population were vaccinated, up to around the 85% mark needed for herd immunity to be achieved. The government has capitulated to its critics who declare mask wearing an infringement of liberty, insist Covid-19 is no worse than flu and see a disconnect between the economy and the health of the people. It is principally the young and the poor who are being sacrificed.
While only time will tell, there is every possibility that cases will once again surge over the coming months, with the added risk of the emergence of vaccine resistant variants. The government has failed to learn lessons from the pandemic so far, is still failing to adopt basic public health measures, has long since abandoned the science and is now taking a huge gamble. More than ever, it no longer deserves to be in power.