As Britain emerges from the Omicron wave, ministers are thrashing out a “living safely with Covid” plan for England expected to be announced next week. The strategy should see freedoms expanded back towards pre-pandemic norms in an attempt to readjust people’s attitudes towards coronavirus.
The decisions taken this weekend in Whitehall will have major repercussions for public health across the country. While vaccines have drastically blunted Covid hospitalisations and deaths, and restrictions came with significant downsides, lifting further measures is unlikely to come without a cost – particularly for those in vulnerable groups.
Here we take a look at what could change, and the potential implications:
Testing
Free home-delivered lateral flow tests (LFTs) for all are likely to be scrapped, possibly within weeks. Ministers are divided over when the tests, designed for people who do not have Covid symptoms, should be wound down – with “hawks” pushing for a reigning in of billions of pounds in public spending while “doves” believe mass surveillance of the virus should continue.
Discussions are also under way about when over the next month advice should be rescinded for people in schools and universities to get tested twice a week. Those with Covid symptoms may be moved off PCR tests, which are also likely to cease being free at some point in March, and on to LFTs.
About 1.3 million of the country’s most vulnerable people will probably continue to get free access to tests.
Some scientists have raised concerns at the proposals, pointing out that reducing PCR testing may compromise the UK’s capacity to spot and monitor new variants. They also worry about the availability of LFTs being reduced because of their importance for detecting Covid outbreaks and letting people manage the risk of spreading the virus to vulnerable contacts.
“If testing is not free, people won’t do it,” said Dr Julian Tang, a clinical virologist at the University of Leicester, adding that would mean relying on hospital tests and so-called “sentinel testing networks” to track the virus, as is the case for flu. Tang said he believed the virus is likely to evolve to become milder, but added: “On the way, there may be the occasional more virulent variant that causes more hospitalisation briefly before dying out – as we have seen with Beta, Gamma, Lambda, Mu variants.”
Isolating
Johnson announced in his final Commons appearance before recess that the legal requirement for anyone with Covid to isolate was expected to end a month earlier than the planned date of 24 March.
Contact tracing will also likely be scaled back, along with an end to “support payments” worth £500 for low-income workers who would struggle to afford missing work by isolating.
According to a paper from behavioural scientists advising the government, withdrawing testing and making isolation voluntary might give some the message it is acceptable to socialise with others despite being infected or having symptoms.
The scientists warned that removing restrictions would disproportionately impact vulnerable sections of the population such as those in precarious employment.
While Downing Street has stressed “we would never recommend anyone goes to work when they have an infectious disease”, this may not have much effect: that advice is often unheeded.
Prof Susan Michie, director of the UCL Centre for Behaviour Change and part of the writing group for the paper, said: “We need to change our whole culture to be more oriented to health and safety, with presenteeism at work disapproved of and people told by employers to stay at home if unwell or likely to be infectious.”
Though a surge in cases may not be as alarming as it once was, experts warn that the high prevalence of Covid means an uptick could see hospitalisations quickly reach levels seen over the festive period, putting more pressure on the NHS when waiting lists are already at a record high.
Vaccines
Driving up the level of jabs administered to help increase the population’s immunity will remain a key priority for the government. So far, around a third of people over the age of 12 have still not had a Covid booster.
According to the UK Health Security Agency, protection against death in over-50s was about 60% 25 weeks past the second vaccine dose, while two weeks after a booster dose it was about 95%. Two jabs offered 25-35% protection against hospitalisation after 25 weeks, compared with about 75% 10 to 14 weeks after a Pfizer booster.
However the World Health Organization has warned that offering further boosters of the original Covid jabs is not a “viable strategy” against new variants. Instead, it has stressed the importance of developing vaccines that do a better job at preventing transmission, and which elicit a broad, long-lasting immune response.
Experts are divided about the best route to take when it comes to vaccinations, not least because of a lack of data on the benefits of repeated mRNA boosters.
Ministers are also understood to be keen to help make more use of antiviral treatments – currently available to about 1.3 million people – to help treat those who catch Covid and limit the risk of severe illness developing.
Travel
While most of the toughest travel restrictions have already been scrapped, the currently empty “red list” will remain in reserve should ministers need to use it again to redirect all arrivals from a particular country into hotel quarantine.
For now, unvaccinated people will continue to need to continue to take a Covid test before they travel to England and another within two days of arrival. The passenger locator form will remain mandatory, but be “simplified” and could be scrapped later in the year.
Dr Michael Head, senior research fellow in global health at Southampton University, said the success of vaccines in reducing both symptomatic infection and onward transmission has been pivotal.
Masks
Since plan B was scrapped in England a month ago, masks have returned to being optional rather than mandatory on most public transport and in shops. Some services, such as Transport for London, still require face coverings to be worn.
Ministers are still discussing what should happen in healthcare settings like hospitals and care homes, the last remaining places where masks are mandatory.
Michie said that for masks, as with other measures, removing legal requirements wrongly signalled that the risk was not great or that the measures were not effective enough. “The extent to which they will be retained will depend on the messaging from government and other institutions,” she said.
Shielding
The government ended shielding advice for people previously considered to be clinically extremely vulnerable in September 2021. Further specialist advice for those people, which included suggestions such as asking home visitors to wear face coverings and avoiding enclosed crowded space, also looks set to be withdrawn.
Baroness Brinton, a Liberal Democrat peer who is clinically extremely vulnerable, said she was “utterly astonished” that the reported change had received little publicity. “It’s all part of the prime minister’s tactic of pretending the pandemic’s over, while making no mention of the millions of clinically vulnerable people who will suffer as a result,” she told the i.
