It is probable that all protective measures against coronavirus will be scrapped in England next week. It’s a decision that seems driven more by politics than science.
A generous way to describe the UK government’s pandemic strategy is “experimental.” While much of the world felt that lockdowns were the only realistic way to arrest the spread of Covid-19 in March 2020, Britain stayed intent on navigating an ambitious course to simply “flatten the curve” and steer towards herd immunity—until it reversed that direction too late to prevent tens of thousands of deaths. In July 2021 the government opted, in the face of much scientific advice, to relax all its mitigation measures, permitting a substantial reservoir of the virus to remain in circulation until the partially vaccine-evading Omicron surge hit last autumn. Only the relative mildness of that variant—something no one could have confidently predicted in advance—saved the country from the worst of the forecasts.
Now the government proudly proclaims that, most likely from 24th February, England will be one of the first nations to remove all protective measures against Covid-19. (That’s a more honest framing than talk about “removing restrictions.”) Even the current five-day self-isolation of infected individuals will no longer be mandated—and it seems likely that free Covid testing, both by PCR and by self-administered lateral flow tests, will soon be ended. Prime Minister Boris Johnson is expected to confirm the changes to self-isolation rules when the government’s “Living with Covid” strategy is presented to the House of Commons on 21st February. It’s yet another gamble.
But is the decision to accelerate the relaxation (originally planned for 24th March) merely a political ploy to boost Johnson’s plummeting popularity in the wake of the lockdown party scandals? It really doesn’t matter much what the answer is; the mere fact that the question is being 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 trust remains that the government’s pandemic policy has anything to do with science.
That distrust is only heightened by the fact that chief medical officer Chris Whitty and chief scientific adviser Patrick Vallance—who have laid out the scientific case with graphs and statistics in press briefings about previous major policy decisions—are on this occasion nowhere to be seen. It’s tempting to conclude that they can’t bring themselves to offer any credibility to the decision. Again, whether or not that is true is beside the point; nothing speaks quite so clearly of the dysfunction in the science advisory machinery than the silence of the chief scientists here. It is simply appalling that the public is being asked to trust this most untrustworthy of governments on such a significant decision without any indication of the scientific position behind it. As it happens, John Edmunds of the Scientific Advisory Group for Emergencies (Sage) has indicated that the removal of self-isolation rules hasn’t even been discussed by Sage. This flies in the face of conventional wisdom about how science policy advice should work, which cautions that the public should not be kept in the dark about it.
The more immediate question is whether, regardless of the reasons for it, the decision is the right one. While the libertarian right-wing press is keen to present this as a bold governmental move to free us from the tyranny of lockdown-obsessed scientists, the truth is that there is a general recognition among experts that it is time to restore some normality to our lives. For most people, a combination of vaccines and boosters along with Omicron’s reduced virulence (studies suggest the risk of hospitalisation after infection is between 15 and 80 per cent lower than for Delta) means that there is very little danger from being infected. Public health experts such as Devi Sridhar of Edinburgh University, who has previously criticised the laxity of the government’s protective measures, agree that, as she put it, “now is the time to start to recover and heal as a society and move forward, treating this virus like we do other infectious disease threats.” That, Sridhar says, includes a readiness to reconsider requirements on masks and isolation.
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 entailed in accommodating society to a future of endemicity (a situation that, with current high and changing levels of infection, we certainly haven’t reached yet). The rhetoric of freedom rings hollow for the many people who remain, despite the vaccines, highly vulnerable to Covid, and who currently seem to be regarded as a mere inconvenience to the official narrative. The potentially imminent removal of both free testing and the need to self-isolate is a double kick in the teeth for such people, of whom there are an estimated 3.7m in the UK. Not only will infected individuals be free to go out and infect others, but they will have no easy way to find out if they pose such a risk.
If you want to know the scientific view on this, look at the statement from the SPI-B behavioural science group that advises Sage. It says that:
Removal of free access to testing will make it more difficult for people experiencing Covid-19 symptoms to confirm infection and take actions (including self-isolation) to reduce transmission to others. Especially in the short term, these changes may increase anxiety among some people and limit their social participation outside the home, particularly those who are, or who live with, someone who is clinically vulnerable.
Although the demise of free testing has not yet been confirmed by the government—Health Secretary Sajid Javid says only that the decision is “under review”—it is widely anticipated. SPI-B member Susan Michie of University College London says that such a move would be “a regressive step.” Just as alarming are rumours that the infection statistics currently collected through random sampling by the Office for National Statistics (ONS) will no longer be compiled from April, making it very hard to assess the extent of Covid day to day in the nation.
And if requirements of self-isolation are lifted, the SPI-B statement says that: “This will disproportionately impact vulnerable sections of the population, for example those who face greater pressure to work outside the home when ill because of financial hardship, precarious employment, or caring responsibilities.”
The group adds that public messaging “should continue to set out the importance of continued adherence to specific protective measures as well as the rationale for lifting restrictions.” So far, it seems clear that the public messaging will focus instead on the “new freedoms” and the debt of gratitude we owe to the government for awarding them.
Scotland’s health secretary Humza Yousaf has questioned the proposed changes, saying: “Free tests and being required to isolate when testing positive are effective in addressing the virus and should remain for as long as the expert public health advice recommends.” (All the more reason, then, why we need to know what that advice actually is.)
This is, to be sure, a complicated phase in the pandemic. It cannot simply be declared over by fiat, nor (despite what Johnson claimed in January) is it clear that we are yet entering an endemic stage. While much of the world remains without good access to vaccines, the chance of a more dangerous variant emerging still can’t be ruled out. Indeed, the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) that reports to Sage has recently warned that the relative mildness of Omicron is probably a fluke, not an indication of a longer-term trend, and that there is a “realistic possibility” of a more virulent variant yet to come. Besides, even if vaccines have done wonders to loosen the link between infections and deaths, Covid-19 is no passing malaise for some: the burden of the pandemic for long-term illness and disability is still not sufficiently recognised.
Yet degrees of individual risk vary widely, and there are valid questions about whether one-size-fits-all protective measures are warranted. Isolation requirements can create economic difficulties for adults and educational ones for children. There is also a discussion to be had about the best way to sustain mass testing into 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 vital for identifying and tracking new variants. This infrastructure is worth celebrating, and also worth preserving—but of course it is costly and not all of it is likely to be needed indefinitely. One of the simplest tools is population testing of infections in sewage wastewater. Both this and the ONS surveys are relatively cheap, and it would be a false economy to let them lapse.
Another contentious issue is the use of face masks. Here there’s little to debate, or should be: beyond the possible case of school classrooms, there are no arguments against continuing to apply such a simple, unobtrusive and cheap public-health measure for the time being, aside from the fact that some of the government’s supporters (and MPs) feel affronted by it. Simply put, any remaining mandating of masks in public places would be considered to compromise the “purity” of the government’s promised “freedom.”
The UK is not alone in considering an end to pretty much all protective measures. Denmark did so from the start of February, and Norway has now followed suit. It’s too early to say what the effects will be, although in Denmark infections and deaths have climbed since the start of the month. Both countries have experienced a considerably less lethal pandemic than the UK, however.
Such differences that exist among most scientists and public-health officials about the road ahead are a matter of detail: need we retain this or that particular protection or monitoring capability? Most seem agreed that it is time for more change, but also that a strategy for moving safely towards endemic Covid must be nuanced and recognise the diverse challenges and risks people will face. We need a smart approach. Instead, we seem to be contemplating yet more triumphant rhetoric about “freedom-loving Britain,” accompanied by the suggestion that the vaccines have vanquished the virus. There’s no “following the science” about that.
