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Researchers react to Boris Johnson’s forthcoming “living with Covid” strategy
UK prime minister Boris Johnson is expected to further lift Covid-19 restrictions this week as part of his government’s “plan for living with Covid”.
The announcements are to ready England for a “move away from government intervention to personal responsibility”.
“We need to learn to live with this virus and continue to protect ourselves without restricting our freedoms,” Johnson said ahead of the announcements.
“Thanks to our successful vaccination programme and the sheer magnitude of people who have come forward to be jabbed, we are now in a position to set out our plan for living with Covid this week.”
Johnson is expected to largely axe free community testing for Covid and drop the legal requirement to self-isolate for people with Covid, which has left many experts uneasy.
“If the legal requirement for self-isolation is removed, and if the testing regime is to be dismantled in the face of high levels of infection, this would inevitably increase the spread of the virus,” said Lawrence Young, professor of molecular oncology, at the University of Warwick.
“Learning to live with Covid doesn’t mean ignoring the virus and hoping it will go away. We need to live safely with Covid, and that means retaining basic surveillance, as well as case isolation.”
Michael Head, senior research fellow in global health at the University of Southampton, said “the UK government response overall has been typified by a ‘too little, too late’ or ‘too much, too soon’ agenda.
“For example, too late to put interventions in place, or too soon with lifting those restrictions, when just a few weeks more would be eminently more sensible.
“Here, we have the latest in a long line of reckless policies.”
“There are still hundreds of Covid-19 deaths a week, with tens of thousands of new cases every day, and over 1,000 people being admitted with Covid-19 to hospital every day,” said Head. “There appears to be little to no consideration of vulnerable populations, who either cannot be vaccinated or generate a reduced immune response to the Covid-19 vaccines.”
Testing
“We need to maintain our test and trace capacity and do everything to protect those who are most vulnerable,” said Young. “You can’t control virus infection if you don’t know where the virus is and how it is spreading.”
“Key to this is maintaining free access to lateral flow tests (LFTs) for all those with symptoms, and maintaining the ONS [Office for National Statistics] Infection Survey as a way of monitoring community infection and the arrival and spread of new variants.”
Simon Williams, lecturer in psychology at Swansea University, echoed this, saying the government should “rethink keeping free lateral flow tests”.
“With testing, reducing people’s opportunities and capabilities to test easily will lead to a reduction in the behaviour,” he said. “Having to pay for free tests will disproportionately affect those on the lowest incomes, who, because of the lower vaccination uptake within their communities, and because their jobs are often higher-contact, have been most affected by Covid.”
Head said it would be “a ridiculous move” to cut free tests as “few people will take tests if they have to pay, and thus surveillance will suffer”.
He added that “the surveillance must be bolstered by continuation of the ONS surveys, since this will be our most reliable way of measuring prevalence in the population. This will contribute to our early warning system against any waning of immunity and future spikes in new cases.”
But Sheila Bird, formerly programme leader at the MRC Biostatistics Unit at the University of Cambridge, noted that “lateral flow device (LFD) antigen tests have not been free. They have been paid for by thee and me, out of the public purse”.
Going forward she said the government and Medicines and Healthcare products Regulatory Authority need to put into the public domain all evidence held for different LFTs’ “sensitivity for asymptomatic testing, or explain why such data are lacking”.
She said robust and cost-efficient polymerase chain reaction tests and genomic surveillance remain “essential going forward”.
Legal requirement to self-isolate
“I, like many in public health and healthcare, feel it is too early to remove this protection,” Simon Williams, lecturer in psychology at Swansea University, said of the mooted removal of the legal requirement to self-isolate.
“One reason why it is too early is because we don’t know how people are going to behave in the absence of this legislation—we don’t know how many people are going to voluntarily self-isolate if they feel unwell with symptoms which may be related to Covid.”
“It is reasonable to expect that removing rules will likely lead to a decrease in a behaviour, including self-isolation. We see this with mask-wearing.
“We don’t want to throw the baby out with the bathwater, and self-isolation remains an important way to protect ourselves and others, as we continue, cautiously, to put the past two years behind us and get on with our lives.”
Simon Clarke, associate professor in cellular microbiology at the University of Reading, said, “The government’s move towards abandoning compulsory isolation might be politically brave but it could end up exposing a lack of defences against even this wave, let alone any new, more dangerous variants.”
He noted a “common misconception” that the virus will definitely become less lethal over time, whereas “nobody knows what the Covid-19 weather has in store for us”.
“This is not a move motivated by data, despite what ministers will doubtless say,” he said. “Comment and insight from the chief medical officer or chief scientific advisor are notable by their absence.”
But Robert Dingwall, professor of sociology at Nottingham Trent University, said that “socio-legal change of this kind is not a cliff edge, as we saw with Freedom Day last summer”.
“Large numbers of people are not going to start changing their behaviour overnight, but behaviour will gradually shift, as it did last year. Creative compliance will come out of the shadows as people decide what precautionary measures suit their own lives, circumstances and tolerance of risk.”
Head added that “keeping some measures in place, including for example the requirement to wear masks in indoor spaces and the requirement to self-isolate, for a few more weeks would be helpful”, and that “supporting people to stay at home when they test positive is vital”.