Removing all restrictions clearly isn’t guided by the science – Experts.

The views of experts and health professionals on the government reducing the self-isolation period, on whether the pandemic is, at last, coming to an end, and whether it is the right time to stop all COVID restrictions.

WHAT THE EXPERTS SAY...

... on how the self-isolation period works in England and the new stay-at-home guidance.

Professor Mike Tildesley, Professor in Infectious Disease Modelling at the University of Warwick, a Member of the Scientific Pandemic Influenza Modelling group (Spi-M) of SAGE:

“It is a big change, we do need to remember that from an epidemiological perspective any relaxation in testing like that is going to have an increased risk attached to it, but of course, I totally understand it’s a practical thing.

“We’re seeing an awful lot of absences, and it’s particularly concerning in healthcare at the moment actually, so if we can reduce the isolation period then that will allow more people to get back to work.

“Of course, important to remember that is done with two negative tests – so you can’t come out of isolation until the sixth day with a second negative test. And if you don’t get a negative test, you have to stay in isolation potentially even until day 10. So, hopefully, that mitigates some of the risks.”

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Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, Respiratory Sciences, University of Leicester:

“This study just confirms what we knew already – using an alternative method – that there is often a long tail of virus shedding – which can extend beyond 10 days in a few people (at least 10%).

“The main message is that any minimum duration of isolation (and it has just been reduced to 5 days in the UK) will pose a risk of allowing virus shedding to continue, albeit it at progressively decreasing viral loads.

“But now with a well-vaccinated population, those lower levels of virus may be neutralised by existing vaccine-induced (or naturally-acquired) antibody responses in most people exposed to it – and pose less of a threat (though not zero) to others.”

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Professor Lorna Harries, Professor of Molecular Genetics at the University of Exeter Medical School:

“Our data suggest that after five days, about one in three people could potentially remain infectious for COVID-19; a figure that is backed up by the UK Health and Safety Authority’s own data.

“Our data arise from research which uses a newly adapted test which can detect whether the virus is potentially still active. We applied that test to samples from 176 people in Exeter who had tested positive on standard PCR tests. Our data show that at five days, 30 per cent of people still exhibited clinically-relevant levels of potentially active virus, meaning they may still be infectious.

“Deciding an isolation period is obviously a delicate balance between mitigating transmission and keeping society functional. However, this new move underlines the critical need to encourage people do those lateral flow tests, and abide by the outcome, to help mitigate the risk. Our government urgently need to ensure adequate supplies of lateral flow tests are available. Special care should be taken in vulnerable settings such as care homes, as older people with perhaps waning vaccine immunity may be much more at risk.”

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Professor Lawrence Young, Virologist and Professor of Molecular Oncology, Warwick Medical School, University of Warwick:

“The study shows that in a small selected group of individuals, 4 of the 32 had high levels of this RNA consistent with ongoing virus replication for more than 10 days. This means that these individuals are very likely to have remained contagious beyond 10 days and could have transmitted the virus to others.

“It does confirm previous observations that the infectious period varies from person-to-person and that some individuals can continue to be infectious for long periods.

“A recent study from Japan of 21 hospitalised cases with omicron infection has shown that peak infectiousness occurs at 3 to 6 days after diagnosis or symptom onset but found that no infectious virus was detected after 10 days in these vaccinated individuals.

“Recent analysis from UKHSA suggests that the window between infection and infectiousness (the incubation period) may be shorter for omicron as compared to delta and this could mean that the infectious period is also shorter. Nevertheless, this current study reinforces concerns that reducing the self-isolation period to 5 days will increase the risk of highly infectious people spreading infection as they return to work or school.”

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WHAT THE EXPERTS SAY...

... on whether getting COVID-19 has now simply become inevitable.

Dr Paul A. Offit, Director of the Vaccine Education Center and Professor of Pediatrics in the Division of Infectious Diseases at the Children’s Hospital of Philadelphia:

“I don’t plan on getting infected with Omicron. I’m vaccinated; because I’m over 65, I’m boosted. I wear a mask whenever I’m in public and indoors around people I don’t know. And I have no intentions of being infected with this virus.

“This virus does things no other respiratory virus does. You can have strokes, heart attacks, kidney disease, liver disease, and then whatever Long COVID is.”

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Dr Eric Topol, Professor of Molecular Medicine, Founder and Director of the Scripps Research Translational Institute, Editor-in-Chief of Medscape:

“There is reason why we think Long COVID could be worse with omicron. First is most cases of Long COVID occur after mild infection. Second is due to omicron’s immune evasiveness, which may make it harder to clear.

“Right now we should plan for the worst for Long COVID. This whole idea of accepting millions of infections a day as inevitable ignores Long COVID. The last point about vaccines protecting against Long COVID, it might halve the risk but that’s still questionable.”

“This is a real-deal virus where there’s unpredictability. Some people can get very sick. Some people can get long COVID. Some people unwittingly will then get immunocompromised people sick, leading to hospitalization and death.

“There’s too many liabilities, too many uncertainties and unpredictabilities when you get a virus with this known profile that can be very severe and lethal still.”

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WHAT THE EXPERTS SAY...

... on whether the pandemic is, at last, coming to an end, and whether it is the time now to stop restrictions.

Professor Mike Tildesley, Professor in Infectious Disease Modelling at the University of Warwick, a Member of the Scientific Pandemic Influenza Modelling group (Spi-M) of SAGE:

“We have had very, very high case numbers throughout late December and early January – we peaked about 200,000 at one point. We do now seem to be a little bit beyond that.

“Hospital admissions are still relatively high albeit there is some evidence that maybe they’re plateauing or possibly going down in London, which is cautiously good news.

“I would say we probably need about an extra week of data to really see the effect of children going back to school – we’re still only two weeks since children went back to school – but if we still see that over the next week or so, I’d be pretty confident that we are seeing this wave turning around.

“A while ago I did say probably January is going to be a little bit rocky, if this wave starts to turn around and hopefully as we get towards the warmer weather we can start to see restrictions removed and we can have more of a discussion about what living with Covid is going to be like and hopefully we won’t see a return to restrictions as we get further through the year.”

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Professor Azra Ghani, Infectious Disease Epidemiologist, Professor of Infectious Disease Epidemiology & Mathematical modeller at Imperial College London:

“The widespread availability of lateral flow tests that enable self-isolation has undoubtedly been one of our strongest responses to the Covid-19 pandemic. We should therefore see this as an opportunity to enhance our public health response to other serious diseases rather than to downgrade our Covid response.

“Such an approach would, in addition to saving lives, reduce the annual winter burden of respiratory illnesses on the NHS, freeing up space and resources to focus on other health needs.”

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Dr David Nabarro, WHO Director-General’s Special Envoy on COVID-19 Preparedness and Response, Co-Director and Chair of Global Health at the Institute of Global Health Innovation, Imperial College London:

“Looking at it from a UK point of view, there does appear to be light at the end of the tunnel… I think that it’s going to be bumpy before we get to the end.

“So, even though it’s possible to start imagining that the end of the pandemic is not far away, just everybody be ready for the possibility that there will be more variations and mutations coming along, or that there will be further challenges, other surges of even Omicron coming.

“We’re going to have children acting as vectors of the virus for some time to come.

“Do what you can to stop transmitting it. Do what you can to protect others from being affected by it. It’s not the common cold.

“I know people would like it to be but it’s a virus that has still some really unpleasant features. Let’s do our best to protect people from it if we possibly can.”

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Professor Andrew Hayward, co-director of the UCL Institute of Epidemiology and Health Care, a member of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag):

“It doesn’t do the virus any good to become increasingly severe. In fact, it looks like the omicron variant, by becoming more transmissible, that it’s also become less severe, and we would hope that’s the general direction of travel.

“The pandemic will end and we will move to a situation where we are living with the virus continuing to transmit but causing much less disruption.

“It will tend to, I think, settle into a seasonal pattern – we may still get quite big winters of infection but not the sort of level where we can justify wholesale societal closedown. So, I think it is genuinely an optimistic picture, but we are still not quite there yet.”

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Professor Rowland Kao, Epidemiologist, Chair of Veterinary Epidemiology & Data Science at the University of Edinburgh:

“Speaking purely from an epidemiological point of view, you would always prefer these things (restrictions being removed) to be done gradually. The fact they’re doing everything at once means it’s going to be a little bit difficult to tell what’s going on and obviously increases the potential for increases.

“We do still have a large number of people in hospitals. We do still have a large number of people with severe illnesses. We would not like to see those go up if possible.

“We always have to counterbalance that with the other affects the restrictions themselves have.”

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Pat Cullen, Royal College of Nursing’s General Secretary and Chief Executive:

“The Prime Minister’s decision to loosen the restrictions may have relieved the pressure from his backbenchers but will do nothing to relieve the pressure on the NHS.

“We can’t rely on the vaccine alone when the situation is still so precariously balanced.

“Time will tell whether dropping other measures when the pressure on health and social care services remains unrelenting was wise – particularly when thousands of unvaccinated nursing staff are facing the sack.

“Ministers should adopt a cautious approach. The Government will regret sending the wrong signal to the public for political expediency.

“With so many COVID-19 patients still in hospital, it would be very premature to conclude this wave is over. That is not what our members are telling us.”

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Professor Devi Sridhar, Professor & Chair of Global Public Health at the Edinburgh University Medical School:

“We still need to test. We still need to vaccinate and combat misinformation. We need to encourage people to wear medical-grade masks such as N95s in crowded and indoor settings. Employers need to recognise and support employees who have been identified as in a shielding group. We also need to review isolation and other policies so they remain safe, but are less disruptive to the functioning of society.

“Public health is not about one disease; it is broadly about wellbeing, which includes mental health and being able to pay the rent, feed your family, stay warm through winter and have a meaningful role in society.

“But now, two years into this pandemic, we need to find a better way of living alongside Sars-CoV-2 using the tools we have. We have created ways to minimise the impact of Covid-19. And 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.”

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Matthew Taylor, chief executive of the NHS Confederation:

The decision to lift restrictions is “a trade-off.”

“We will have greater freedoms but the cost – at least in the short term – will be that more people are likely to get sick with COVID, and that the health service will continue to have to deal with the extra burdens that this creates.”

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Professor Christina Pagel, Director of University College London’s clinical operational research unit, member of Independent Sage:

“The release of all measures right now (especially masks, especially schools) is only to protect himself (Boris Johnson) and his job.

“Boris Johnson has zero interest in protecting others from getting sick, needing hospital or dying. Or protecting businesses, schools, NHS from disruption.

“Where is the longer-term plan for actually making our environments safer to enable us to mix more safely? e.g. cleaner indoor air? better building design for all new builds?

“We need to take positive steps to enable a return to normal – not just pretend that COVID has gone away.”

“There is no public health justification for removing work from home where possible or mask requirements when we are at very high cases and high hospitalisations. Plus we have to make schools safer, not less safe, including clean air and offer vaccines to 5-11-years old, in whom cases are shooting up.”

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Professor Claire Horwell, Professor of Geohealth, Director of the Institute of Hazard, Risk and Resilience at Durham University:

“Boris Johnson’s easing of restrictions is in stark contrast to what other countries are doing to control Omicron.

“With daily Covid-19 case numbers in the UK still above 100,000, and a daily average of more than 250 deaths within 28 days of a positive test, our situation is among the worst in the world. Though our case numbers are indeed falling, this may well be partly due to the measures imposed in plan B, such as wearing face masks and working from home. There is a risk that the removal of these measures could reverse this trend.”

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Professor Stephen Reicher, Professor of Social Psychology, School of Psychology & Neuroscience, University of St Andrews, Member of the Scientific Advisory Group for Emergencies (SAGE) subcommittee on behavioural science:

“Yes, there is good news. Yes, we are over the Omicron peak in terms of infections (though not hospitalisations and deaths) BUT “OVER THE PEAK” IS NOT THE SAME AS “ALL OVER”. Infection rates are still incredibly high. The NHS under huge stress. Hundreds of thousands off school.

“While we no longer need stringent restrictions, it’s wrong to remove everything now and add to the number of infections and the load on services. As infections rise amongst younger unvaccinated children, it is particularly mad to remove the few remaining protections in schools.

“Instead of taking away masks we should be adding ventilation to classrooms and making sure as few children as possible have their education disrupted by infection – something that should have been done long ago.

“In the end, today’s announcement by the Prime Minister has far less to do with the science and keeping us safe than trying to placate a few Tory MPs who might otherwise be writing their letters to the 1922 Committee demanding his resignation.”

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Dr Simon Williams, Senior Lecturer in People and Organisation, Swansea University:

“From a behavioural perspective, there are a couple of problems with the government’s proposals. Throughout the pandemic there has been a feeling amongst many that there have been ‘mixed messages’ – often a result of policies and messages not matching up, and because the four UK nations have adopted different approaches and timelines. For example, the problem with the general advice to ‘be cautious’ is that it is too vague and conflicts with the message that is sent by the removal of all policy measures and protections. Also, as we saw in the summer, simply suggesting that people wear facemasks in certain settings, is likely to result in a substantial drop off in mask-wearing. It is also a problem where different countries in the UK put forward different policies and messages on things like masks and self-isolation requirements. Differences between messages and policies within and across countries can prove very confusing.”

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Dr Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, past Chair of the BMA Public Health Medicine Committee:

“The Omicron wave may now be peaking, but case numbers remain very high.

“The strong desire to return to normal is understandable, but we should be cautious. Many people are still susceptible to Covid-19 and highly vulnerable. It may be reasonable to relax some of the non-pharmaceutical interventions, but some – such as the legal obligation to wear a well-fitting, good quality mask in indoor public spaces and public transport – should remain wherever the incidence exceeds 10 cases per 100k population per week: and legislation / regulation to improve air quality in schools, workplaces and public spaces should be introduced.

“SARS-CoV-2 has not gone away. It will continue to mutate, to become more infectious and to evade immunity from previous infection or vaccination. There is no guarantee that they won’t be more virulent (causing more severe disease and deaths). We may also see further waves of infection from existing variants as our immunity wanes.

“Things are looking a lot better, but we’re still a long way from the end of the pandemic.”

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Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton:

“The UK will have a long backlog of consequences to address that have emerged from previous decision-making, but there may at least be a component of looking forward, rather than back. This includes the huge waiting list for both urgent and routine healthcare, that could not be addressed before due to the consequences of ‘too much covid’.

“A pandemic is, by definition, a global problem. The world at large is struggling with this fire-fighting phase of the pandemic response. The emergence of new variants is full of uncertainty, and there’s a fair chance we will soon see another variant. The impact of that may be minimal, or it may reduce the effectiveness of the vaccines that we have, and may require further timely decision-making to reduce its impact.

“‘Learning to live with the virus’ must also include ‘learning when to do something about it’. The pandemic is certainly not, in any way whatsoever, ‘over’.  The best we can say is that the UK is seeing shoots of recovery, but there must be no complacency in our pandemic response policies going forward.”

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Dr Chaand Nagpaul, Chair of the Council of the British Medical Association:

“This decision (removing restrictions) clearly is not guided by the data. When Plan B was introduced in December, there were 7,373 patients in hospital in the UK – the latest data this week shows there are 18,979. Case rates too are nearly twice as many.

“Removing all restrictions risks a rebound in the number of infections across society, would inevitably increase hospitalisation rates, further destabilise patient care and drive up staff absences and the number of people with long COVID.

“Today’s announcement from the prime minister risks creating a false sense of security when the levels of infection and illness remain high, and the NHS is still under crippling pressure.

“The pressures on the NHS are clear for everyone to see. We have a record backlog of 6m patients at a time when hospitals are cancelling operations, trusts are declaring critical incidents and ambulance delays are jeopardising public safety.

“Removing effective infection control measures like mask-wearing on public transport and indoor crowded spaces will inevitably increase transmission and place the public at greater risk, especially for those who are vulnerable.

“It is vital that the government acts according to the data. We recognise the implications of restrictions on our society, but equally, we have seen the impact of the failure to control the virus on the economy, business and education.

“The announcement by the PM that he will seek to end self-isolation rules is premature, especially given the statement by the WHO today that the pandemic is far from over amidst high global case rates and the risk of new variants emerging.”

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Dr Stephen Griffin, Virologist, Associate Professor in the School of Medicine, University of Leeds:

“It is striking that the Government are so adept at moving to reduce restrictions early when they have repeatedly failed to act in a timely fashion to prevent now five consecutive waves of SARS-CoV2 resulting in profound human and economic cost.

“There is a mistaken notion that the virus is somehow evolving to become less virulent, more transmissible, and this is being inaccurately lauded as endemicity by various parties. Endemic, sadly, does not mean benign, as sufferers of Malaria, TB, HIV, and Lassa fever might tell you. Variola (smallpox) and polio were endemic prior to eradication efforts.

“The use of the term endemic should be done in the correct context and bearing in mind that endemicity can run at very high prevalence of infection. Viruses do not evolve to become less virulent, necessarily, they evolve to ensure they can thrive and transmit effectively – the fact that severe COVID ensues after the virus has moved on to the next person means that severity is simply not a relevant evolutionary pressure for SARS-CoV2. Endemicity happens once our immunity as a population balances out the inherent ability of the virus to transmit, so prevalence remains at predictable levels… I challenge anyone to find an example of this in recent times.

“The fact is that all VOCs to date have arisen independently in evolutionary terms, and primarily from countries with low vaccine coverage – Omicron, therefore, cannot be used to set a trajectory for how SARS-CoV2 will behave in the future, and while there exists exponential growth and ongoing evolution across the planet, the pandemic cannot be over. The UK does not exist in a vacuum and we now make little effort to prevent importation, or indeed export of infections.

“The NHS remains on a “war footing”, we have similar numbers in hospital now as we saw in spring and autumn of 2020, and the deaths and morbidity associated with the omicron wave are still being counted in their thousands.

“Our understaffed, exhausted NHS workforce are being asked to catch up on 2020/21, address standard winter pressures, in addition to dealing with Omicron.

“We are also seeing the highest admissions of juveniles to hospital that’s ever occurred, but again this is dismissed because they’re mainly on the wards rather than in PICU. However, severe cases and deaths are sadly increasing. Infections are already growing in primary schools where minimal provision of mitigations is being made, no masks are worn, plus we are seemingly endlessly waiting for a decision on whether the UK might follow the rest of the planet and protect this group with safe, effective vaccines.

“The reason I am so aghast at the haste in which restrictions are being dropped is that our outlook could, and should be positive due to our vaccines. However, without the patience required to bring the current wave under control and to ensure that our vaccines are as widespread as possible, it remains the case that the majority are moving ahead at the expense of a considerable minority, numbering in the millions. Vulnerable people have equal rights to a full and fulfilling life, yet whilst prevalence remains high this is simply not possible. I urge the government to reconsider this action and to have the patience to – THIS time – get proper control of the virus such that we can all move forwards together. Endemicity is indeed a likely future for SARS-CoV2, but the level at which that exists and the people that it affects, remains very much within our control.”

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Going Further:

• Stay at home: guidance for households with possible or confirmed coronavirus (COVID-19) infection | UKHSA

Sources

• Text: This piece was first published in PMP Magazine on 21 January 2022.
• Cover: Flickr/Number 10 - Andrew Parsons. - PM Boris Johnson arrives at Huddesfield train station. | 18 November 2021. (Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)