On Monday the government announced its “living with Covid” strategy, including a phasing-out of free access to rapid lateral flow tests, reduced access to the more accurate PCR tests for most of those with symptoms, an end to legal requirements to self-isolate and an end to financial support for those on low incomes needing to self-isolate.
Announcing the changes, which will come into force on Thursday, Boris Johnson said the time to “compel” people was over. Now “people will be asked to exercise personal responsibility” to look after each other, he said.
Health and education leaders and scientists are concerned about the wisdom of phasing out both testing and self-isolation measures at this stage of the pandemic – but given that it is happening, what will the shift in policy mean in practice? What will things look like in the UK over the next year, and how will it affect our ability to deal with Covid-19?
Supporters of relaxing the measures have often appealed to individual responsibility – whether that’s to voluntarily self-isolate if positive, or to assess our own appetite for risk and behave accordingly. But this misses the point: there is a limit to what the individual can do with a highly infectious disease.
Many might choose to isolate if positive, but that relies on knowing you are positive in the first place, on being able to resist pressure from employers to go in to work, and on being able to afford to stay home (both financially and practically). All three aspects will become much more difficult from now on, and will necessarily put others at risk.
And measures individuals can take to protect themselves, such as reducing social contact or wearing high-quality filtering masks (such as the FFP2 grade), depend on knowing what the risk of social contact will be. The government indicated some aspects of Covid surveillance will remain, but with less reliable local data on infections and not having the ability to ask others to test before meeting, such personal choices are taken away from individuals.
Once infected, lack of testing will ultimately reduce timely access to antivirals to prevent severe illness (which need to be taken as soon as possible after infection) and to long-term care if long Covid develops.
The Sage group believes that part of the reason the peaks in July with Delta and this winter with Omicron were not higher is because people voluntarily restricted their behaviour over and above what was required by legislation. However, this “responsible” behaviour on the part of the public as a whole relies on everyone being able to see that there’s a potential problem. As testing, surveillance and reporting of infection rates are scaled back, this will be much more difficult, and it will be much less likely that enough people will change their behaviour at the same time to dampen down future waves.
Almost a year ago I wrote about the danger of Covid becoming a disease of poverty. Under the new policies this danger is exacerbated. A vicious cycle will come into play: those in more deprived areas will be less able to afford to test; less able to afford to voluntarily self-isolate; more likely to live in poor, overcrowded housing and more likely to be exposed outside the home thus more likely to infect others; less likely to be vaccinated but more likely to be in existing ill-health, and so more likely to fall seriously ill and die from Covid and develop long Covid. Ill-health then worsens families’ financial situation again and the cycle perpetuates.
Despite the constant comparison to the flu, coronavirus is more infectious than flu and has worse health outcomes (both in terms of death and long-term ill-health). Simply adding it to our population without any policy adaptation may return us to what feels like normal life – but it will be a shorter and sicker one.
There is also no doubt that Omicron is not the last variant. As the virus continues to mutate, vaccine efficacy against infection wanes and public health measures are abandoned, it is likely that many people will catch it once or twice a year. This is likely to ultimately reduce overall life expectancy, where the steady gains seen over the last 70 years had already stalled between 2011 and 2018.
Sudden waves of infection, like those seen last December and January, will put pressure on the NHS as we add a whole new disease to already challenging winter season. A sizeable percentage of the workforce getting sick at once will also – again – cause significant disruption across education, hospitality, transport and other work places.
As for any communal problem, lasting remedies must be communal ones. Societies around the world did just this when they tackled passive smoking through anti-smoking legislation, pollution through environmental legislation and car accidents by drink-driving and road safety legislation.
For coronavirus, this means research into better vaccines and treatments, understanding and preventing long Covid, infrastructure investment to support cleaner air, tackling inequalities across their whole range to improve population resilience, and a well-oiled national and global public health strategy that can spring into action when needed. The latter three will be effective against any future airborne pandemics.
If we don’t want a world with more illness and death, we need to actively do something to prevent it.
Christina Pagel is director of UCL’s Clinical Operational Research Unit, which applies advanced analytical methods to problems in healthcare
