Ditching England’s Covid restrictions is a dangerous experiment
On Monday, Boris Johnson announced a move to stage 4 easing of lockdown in England on 19 July, meaning all mandatory restrictions are to be dropped, and become a matter of personal responsibility.
The prime minister’s messaging was inconsistent, outlining a “careful and a balanced decision” of easing further in a surging pandemic, when “50,000 cases detected per day (are expected) by the 19th”, with “rising hospital admissions”. He spoke of the need to “reconcile ourselves sadly to more deaths from Covid”. The argument for opening on 19 July was equally confused and opaque, suggesting if not now, when? If we delayed this to winter “the virus would have an advantage”, so if we didn’t open up now, we couldn’t open up this year at all.
Do these “now or never” arguments hold any water? Surely delaying this step until many more people are vaccinated would ensure that the public were far less exposed than now. So, if step 4 was delayed to allow more people to get vaccinated, why then have we abandoned 50% of our population, who are either partly vaccinated or not at all? Especially when many more would have been vaccinated in the coming weeks. Rather we have chosen a strategy of allowing mass infection, which in effect means just under half our population will now be exposed to infection, and all its impacts, rather than be protected through vaccines.
This narrative probably draws on modelling from Imperial College, suggesting that delaying reopening could lead to more deaths over winter. But the reasons for this are not the ones outlined by government. The paper clarifies that this may happen due to waning immunity among vulnerable people (likely to be made worse by the arrival of the Delta variant), and lack of vaccination in children when schools reopen, alongside seasonal effects. This could mean high transmission driven by children at a point when immunity among vulnerable people is waning. It also makes clear that this could be offset with booster doses, and vaccinating children, which were not considered in this model, or by our government.
Rather we are presented with two bad options: open up in the middle of a surging pandemic accepting millions more will get infected, or delay until winter, when more people may die due to waning immunity in vulnerable people, and unvaccinated children spreading infection. Implied in this strategy is the lack of a plan for boosters or childhood vaccination, which could protect vulnerable people and children. The assumption that we will be in a better position to deal with this in winter if we open up now also makes no sense unless it invokes a significant proportion of children developing immunity through natural infection (rather than vaccination) by the winter.
The government has also created a false open up v lockdown dichotomy, which absolves it of blame for not resourcing simple but effective measures such as ventilation in schools and workplaces; fixing a broken test and trace system; and supporting people who are isolating – measures that don’t involve restrictions at all, and have been used by many countries which have not had to impose national lock
downs at any point.
The briefing made clear that how people protect themselves and others now is a matter of personal responsibility. This is a complete abdication of government responsibility. Given the prime minister has withdrawn work from home guidance and left this in the hands of employers, how does he expect clinically vulnerable or unvaccinated people who may be forced back into workplaces to protect themselves on transport and at work, where no one will be required to wear masks. How can children, including those who are clinically vulnerable, with no option of vaccination, and crowded into classrooms of 30 without sufficient ventilation or masks, protect themselves? And how can their parents?
So what is likely to happen under the current strategy? Vaccinations have weakened the link between cases and hospitalisations but this is far from broken. Hospitalisations are rising, and putting pressure on an NHS devastated by delayed action in the last two waves of the pandemic, with millions now waiting for routine care. The government focus on hospitalisations rather than transmission allows it to ignore cases completely until they reach levels seen in January. Given hospitalisation rates are severalfold lower now than prior to the start of the vaccination programme, this would mean a much higher level of daily cases would be tolerated before any action was taken. Implicit in this strategy is that cases don’t matter. Indeed, MPs have suggested cases should not even be publicly reported any more.
This strategy is dangerous and reckless. Contrary to suggestions by the health secretary, Sajid Javid, Covid-19 is not at all like the flu. Over the course of the UK pandemic, an estimated 2 million people have developed long Covid. Currently, almost 1 million people are living with long Covid – the consequences of the government strategy to ignore transmission. Of these, twothirds report an impact on their dayto-day activities and lives and almost 400,000 have been ill for more than a year. Most of these are young people. We also know now that Covid-19 is not only a respiratory disease. It has longterm impacts on many body systems, including the brain, even in those with mild symptoms on infection. Ignoring transmission has created a generation with debilitating chronic disease.
Infections are now surging among young people. Given the current doubling of cases every nine days, Independent Sage predicts that we are on track to see 90,000 daily cases by 19 July, with one million new infections occurring by then. Patrick Vallance said yesterday that one in 210 people are currently thought to be infected in the UK, translating to 250,000 people currently infected with SarsCoV-2. Considering that 13% of people develop symptoms lasting 12 weeks or more, infections from this week alone will result in 32,500 more people with long Covid. Without protection from vaccine immunity in our young people, these numbers will continue to rise until millions more are infected, with hundreds of thousands developing chronic diseases we don’t yet understand or have treatments for.
Transmission will also mean new opportunities for the virus to adapt. Allowing transmission to continue among young people while vaccinating older populations provides the best conditions for virus adaptation towards vaccine escape. We are undertaking a mass experiment that could undo the gains made through vaccines not just in the UK, but also globally.
The impact of these policies, will be felt most by people who are vulnerable, disadvantaged, marginalised or young. Herd immunity by infection is an active choice being made here. One that will lead to thousands of our young people becoming disabled, with future impacts we don’t even fully understand. At a point in time when safe and effective vaccines are available for most. Why?
Dr Deepti Gurdasani is a clinical epidemiologist and senior lecturer in machine learning at Queen Mary University of London