‘Freedom to spread virus’ day
On 19th July the government abandoned many of the precautions in place to reduce the spread of coronavirus. 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. Guidance recommending against travel to amber list countries was removed, and people visiting were no longer expected to self isolate on return.
Had the war been won?
It would be tempting to think that the ‘war against coronavirus’ in the UK had been won. However, writing in the medical journal The Lancet, clinical epidemiologist and senior lecturer in machine learning at Queen Mary University of London Deepti Gurdasani and colleagues branded the decision to lift restrictions as dangerous and premature. They 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 covid case numbers to as high as 100,000/day. Soon afterwards, having developed infection himself (despite double vaccination), he tweeted that people should not “cower” from infection, leading to swift condemnation by those who had lost relatives.
A return to herd immunity
At the start of the pandemic government initially considered letting infection spread until “herd” immunity was achieved; despite denials, video evidence confirmation from the Chief Scientific Adviser is freely available. The government now appears to feel that population immunity can be achieved through a combination of both vaccination and natural infection rather than waiting for greater vaccine coverage to be rolled out. This risks a huge rise in infections among the predominantly as yet unvaccinated younger population, justified by official claims 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 ill health in many who become infected. Around 10% of patients still have symptoms three months afterwards, 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.
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 become even more challenging. As always, it is deprived communities that 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 illogical and a “dangerous and unethical experiment”. 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, implementing effective border quarantine processes and ensuring that ‘find, test, trace, support’ systems worked. The latter requires an increase in statutory sick pay in the UK, which at £95.85 a week is almost the lowest anywhere in the industrialised world, meaning around a quarter of the British workforce face poverty just by falling ill.
Rising infections – government shift blame to the app
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 seeing it as a consequence of government strategy. Meanwhile, the largely useless privatised ‘test and trace’ continued to underperform with only a minority of those with Covid symptoms coming forward for testing.
There followed calls for the sensitivity of the contact tracing app to be reduced (now implemented) 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? 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 them (too many false positive results in people who don’t have infection), suggesting the tests should be returned to the manufacturer.
Despite the prime minster and chancellor being in face to face contact with a symptomatic and test positive Sajid Javid, both claimed to be part of a ‘pilot scheme’ that allowed them not to isolate. A hostile public response prompted a rapid u-turn. Among accusations of ‘one rule for them’, Johnson spent ‘freedom day’ isolating at Chequers. On the positive side, 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 test positive 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%, with 131 on 27th July. 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 apparent falling case numbers. Good weather and more people outside may have reduced the spread of virus. At the time of writing (end of July) It is certainly too early to conclude that population 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.
Overseas observers looked on with incredulity at the July 19th lifting of restrictions. A Harvard professor 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 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 any event, 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. Professor 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”. 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 plans for the 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. There is, however, a lot more to safety in care homes than vaccination, including adequate staffing levels, training, equipment, cleanliness, personal protective equipment, and risk assessment. The government has also exaggerated the number of care staff who have not had vaccination.
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 than a serious approach to persuading people of the benefits. Big Brother Watch has highlighted problems of vaccine passports/COVID status certificates and mass testing of asymptomatic people - insufficient evidence that vaccinations prevent transmission of the virus; no evidence to support the use of mass testing in people without symptoms or exposure to an infectious person.
Further, the use of immunity as a condition for work, travel or leisure rights raises serious legal and ethical issues and risks 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 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, with ministers abdicating 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 restrictions should have been delayed until a much greater proportion of the population were vaccinated. 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 not learned lessons from the pandemic so far, is still failing to adopt basic public health measures, has long since abandoned following the science and is now taking a huge gamble. It is also eroding our civil liberties, and more than ever, it no longer deserves to be in power. Campaigners should insist that the government follow ‘data not dates’ and listens to experts in public health. ‘Test and trace’ still needs to be linked with ‘isolate and support’ and brought back under local public health control. As the preliminary findings from our People’s Covid Inquiry stated, there is still time for a coherent policy of elimination of community spread of the virus, this is the time to invest in the NHS and a public health and care sector, and an independent Judicial Inquiry is urgently needed to guide further action.
This article was written by Keep Our NHS Public co-chair Dr John Puntis.