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There have been several media reports suggesting what the Prime Minister Boris Johnson is set to announce about lifting restrictions on July 19th ahead of the Downing Street press conference this evening.
Comments on facemasks:
Prof Robert Dingwall, Professor of Sociology, Nottingham Trent University, said:
“The benefits of masks have always been uncertain because the quality of the evidence in both directions is so weak. Any benefit has probably been quite small – or it would have been obvious even from weak studies – and needs to be offset by the psychological impact on population fear and anxiety , on children’s learning and interactions with adults, on people with communication issues, and on the substantial number of adults who cannot wear masks because of underlying health conditions or other disorders, including previous trauma from assaults or abuse.
“In my opinion it is a positive step to make mask wearing voluntary. No government can know all the circumstances of individual immunity and context. It is much better to focus on advice, guidance and education so that people can adapt their behaviour to the actual risks that they are encountering rather than having a one-size-fits-all approach. However, it is important that the messages also give equal attention to those contexts that are essentially safe, like almost anywhere outdoors or well-ventilated indoor spaces like supermarkets. The government ‘s behavioural scientists must now work to defuse the fears they have amplified for the last 15 months.”
Dr Laurence Aitchison, Lecturer in Machine Learning and Computational Neuroscience, Department of Computer Science, University of Bristol, said:
“Our research has shown mask-wearing reduces the spread of COVID-19 by around 25 per cent if everyone wears them1. At a time when mask-wearing is decreasing and mask mandates are being lifted, the findings confirm that masks do indeed have a strong impact on lowering transmission of the virus and remain an important measure in our response against it. As people are now used to wearing them, it’s a simple thing everyone can do to continue managing risk while also resuming normal activities.”
Comments on lifting restrictions in general:
Prof Richard Tedder, Senior Research Investigator in Medical Virology, Imperial College London, said:
“Without doubt this epidemic of coronavirus in the UK has driven pain to many people and exposed the fragility and fault-lines of our complex society. That said, there has to be whatever the financial costs, a recognition that we are on a very difficult balancing act, even with the extensive and laudable rollout of vaccines to people in this country. My reason for saying so is that vaccines are currently being used to prevent illness in people rather than the usual primary aims of a vaccine which is to prevent infection in the first place.
“Using these vaccines in the present way to “ free up our behaviour” comes with the very real risk of facilitating the escape of variants which will be even more resistant to vaccines and potentially more infectious. Failing to recognise this is playing with fire. The repeated mantra “look at the infection rate, and the low disease rate” is truly dangerous. This coronavirus will exploit the current rates of infection in the face of partial immunity, by definition partial immunity is the continuing infections which occur in people following a full course of immunisation. As these infections occur and the virus replicates in somebody in spite of immunisation, natural evolution of the infecting virus will select for variants which both escape immune system and which are likely to be more easily transmitted. Sadly this may have happened already in Israel. This view of the inherent danger in facilitating a very real increase of the infection rate in this country is likely to be held by professional medical virologists across the UK. I would hope the Health Secretary will listen to this view and involve those who have had decades of experience in medical virology. I am sure we as a cadre will do anything we can to help contain and defeat this virus.”
Prof Dominic Wilkinson, Professor of Medical Ethics, University of Oxford. UK Pandemic ethics accelerator, said:
“Data suggest that the vaccination programme is reducing the death and hospitalization from COVID-19. This means that the benefit of continuing with public health restrictions aimed at reducing transmission (such as mask mandates or social distancing) is now far smaller than it was at the beginning of the pandemic.
“The key issue is one of proportionality. Public health restrictions that reduce transmission have costs, and not just for freedom. The lockdowns have been effective, but they have also had huge impacts on healthcare, education, and the economy. Restrictions will only continue to be proportionate if their public health benefits are still sufficient to outweigh these costs.
“Some have claimed that the government is not ‘following the science’ in planning to relax the rules. However, science cannot tell us when to unlock. That depends on what we choose to prioritise. Like all major policy decisions during this pandemic, decisions about relaxing restrictions are not purely scientific. These are ethical questions.”
Dr Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, Immediate past Chair of the BMA Public Health Medicine Committee, said:
“It is widely expected that the Prime Minister will today announce that there will be “an end to lockdown”, “freedom day”, in two weeks’ time, on 19 July. There has been much speculation about the detail, with several ministers declaring that they will refuse to wear a mask if it is no longer legally required. Before considering whether any – and if so, which – restrictions (sometimes referred to as NPIs – non pharmaceutical interventions) it might be appropriate to continue after that date, let’s look at what has changed.
“On the one hand, we are now experiencing yet another wave of Covid-19 infection, despite manifold restrictions. Case numbers around the country are well above 100 new cases per day per 100,000 population (https://coronavirus.data.gov.uk/‘s UK summary currently shows the overall rate to be 214.4 per 100,000). Case numbers in children and young people have risen particularly dramatically.
“Yet, on the other hand, a large proportion of the people most at risk have already been vaccinated with at least one, if not two doses of a Covid-19 vaccine; and the available vaccines are all >90% effective at preventing disease severe enough to require hospital admission, so the rate of hospital admission and death has not increased in the way that it did in previous waves of infection.
“We now know a lot more about how the virus transmits than we did 15 months ago (and should consider what we already knew but did not implement).
“We now know, for example:
“With vaccination having partially broken the link between infection and hospitalisation, the risks are much lower than they were in previous waves. But younger people are still at risk. It seems that about 1% of children who are infected are ill enough to require hospital admission; and many children and young people suffer “long covid”. We know that the infection can damage the lungs, brain, and other organs; and such damage may cause long-term or permanent impairment. Young people may carry such impairment for the rest of their lives. This harms them directly, and there is a substantial cost to society if people require more care, and are less able to contribute (through work and taxes, volunteering, informal caring and so on) for the rest of their lives. It is far too soon to be sure of the extent of the long-term harms; and this should require a degree of caution.
“Given that children and young people can be severely affected by Covid-19, and are likely to spread the disease to vulnerable people if infected, there should be no relaxation to the current Covid-19 regulations until after the start of school summer holidays, and until then, schools should continue to take steps to minimize transmission. I am not sure if the current arrangements are (or ever were) as effective as they need to be, and the schools arrangements should be reviewed if there is any chance that case numbers will remain or high (above 10) or rise above this level when schools go back after the summer.
“Of course we want society – and the economy – to get back to something like a pre-Covid normal.
“This means that we should consider the costs and effects of any interventions, and set these against the burden of disease if we don’t maintain or introduce them. Any remaining restrictions should be proportionate.
“It is worth comparing the UK approach to the approach in other countries. I have close links to Germany, and I’m aware that in many areas restrictions are linked closely to incidence rates. In Baden-Württemberg, for example, they use four incidence levels: <10, 10-35, 35-50, and >50 per 100,000 population.1 2 Restrictions recently increased in some areas because the incidence rose to just over 10. (In contrast the UK incidence is well over 100, closer to 400 in some areas.) Regulations relating to carbon dioxide monitoring are used in various countries to ensure adequate ventilation, such as in Belgium.3 We should consider following these examples in the UK.
“Given the decreased effect of case numbers on hospitalisation and deaths, it may nevertheless be appropriate to lift many of the restrictions now in the UK, even with our high case numbers. When we get the case numbers down much lower – below about 10 cases per 100,000 population – we will be able to relax the population-wide restrictions completely (while maintaining legally mandated, supported, and enforced quarantine/isolation for cases and contacts at high risk of becoming cases).
“When rates are this low (<10/100k), the risk of becoming infectious will be very much lower, and the low number of cases will allow proper contact tracing, identifying the likely source[s] and isolating them and their contacts until we can be sure they’re not infectious.
“We can be far more relaxed about outdoor events – outdoor transmission rates are extremely low. And we can be more relaxed about well-ventilated indoor spaces, using carbon dioxide monitoring to ensure adequate ventilation.
“Easing handwashing/sanitizing regulations is probably sensible in any case; we don’t have to be quite as obsessive about it (although of course requirements relating to food hygiene etc. must remain).
“Many people who are infected and infectious will be asymptomatic or have only minor symptoms. They won’t know that they are infectious. Masks provide good source control if properly worn, so in high risk settings, while case numbers remain high, people should continue to be obliged to wear a mask to protect others.
“Where there are effective and relatively non-intrusive mitigations – like continuing with (rigorously enforced) mask mandates in indoor spaces where the carbon dioxide levels can’t be kept low enough (eg public transport), we should keep on with them until infection rates are very much lower – below 10 per 100,000 population.
“It is not a huge imposition to require mask-wearing in high-risk settings such as crowded, poorly ventilated public spaces such as public transport, and while case numbers remain high, this must continue. Anybody who refuses the minor imposition of wearing a mask in such places is placing vulnerable people at risk, effectively barring them from entering such spaces – and if you can’t travel on public transport, that is a massive imposition. Allowing people to make their own choices on this is, effectively, handing control of the safety of such spaces over to the least informed, least caring and indeed the most callous members of society. It remains entirely proportionate, while case numbers are above 10 per 100,000 population per day, to require – and rigorously enforce – mask wearing in such spaces.
“Government ministers who have declared that they will not show consideration to vulnerable people by wearing a mask – and thereby encouraged others in this approach – have been hugely irresponsible, and shown a gross failure of leadership.”
References
Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:
“Most of Europe and the USA allow fully vaccinated contacts to not have to isolate after being identified as a contact. Travel poses much less risk than being a household contact.
“Mask wearing costs nothing in many inside places and maintaining distancing again can be done easily so no reason to stop.
“Outside is much safer so many (but not all) mass events and music festivals can be managed with COVID certificates on entry to reduce risk
“COVID will be around for years to come so we need to learn to live with it.”
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“The COVID vaccines give us a clear route to resolving the dreadful toll of this pandemic. However, the impatience with which restrictions are due to be relaxed is likely, in my view, to greatly amplify the number of infections we see caused by the delta variant, and so cause unnecessary harm along this road. Whilst the link between infections and severe disease has indeed been weakened by vaccinating the older members of the population, it most certainly has not been broken, and a strong link to morbidity remains. It’s difficult to imagine a series of measures that might favour the spread of the virus more, and as this happens we will sadly see rising hospitalisations, severe disease and long COVID in the young and unvaccinated.
“I am also concerned that the notion of allowing personal discretion to guide the implementation of what restrictions remain will be ineffectual, and represents an abdication of responsibility from the government; one is reminded of the somewhat pointless “stay alert” message. Whilst the majority of people will, I hope, continue to act responsibly, the principle of altruism will be undone by a minority that do not. Moreover, several of the announcements seem ideologically driven, rather than having any basis in either public health or economic benefit – masks being the prime example of tokenism that will likely actually cost us dear. I completely understand that the public, myself included, are exhausted by lockdowns and restrictions, with the majority of those worst affected being those least able to cope in terms of either health or wealth. However, the reason we have had such prolonged and harsh measures in place is due to the failures of policies that managed the implementation and relaxation of previous measures. The vaccines may allow the government to now behave similarly without quite such dire consequences, but they should acknowledged that this plan comes with a cost that will sadly not be applied evenly to UK society.”
Prof Paul Hunter, Professor in Medicine, University of East Anglia, said:
“The first thing to say is that there is a general consensus that COVID will never go away. Our grandchildren’s grandchildren will be getting infected with SARS-CoV-2. But in the not too distant future SARS-CoV-2 will probably just be another cause of the common cold that we catch every few years, more frequently in children than in adults. Indeed it is interesting that the symptom profile of cases is now changing, resembling less the COVID disease of last year and looking more like a common cold. We can see this for the other human coronaviruses. The most recent of which to enter human society was Coronavirus OC43 probably in around 1890. So if it is inevitable that we are all going to catch SARS-CoV-2 repeatedly for the rest of our lives whether or not we have had vaccine, this issue becomes not whether it is safe to lift all restrictions but when would it be safest to lift all restrictions?
“If we do this on 19th July then we have to summer ahead, schools will be closed and the vast majority of adults have completed a course of immunization within the past six months. If we wait till the autumn then schools will be back so increasing transmission, vaccine immunity against infection may be starting to wain ahead of the autumn booster campaign and other seasonal respiratory infections may be starting to increase. We do know that if you catch influenza at around the time of your COVID infection then that about doubles your risk of dying. It is likely that we will have a worse than normal influenza season as we return to normal maybe this winter, maybe next.
“So even though case numbers are rising quite rapidly at present, possibly as a consequence of celebrations around the Euros, I still think it would be safer to lift restrictions now than in the autumn. The disease burden associated with a larger peak during the summer would likely be less than one during the winter.
“I am quite happy with the thought of allowing fully vaccinated adults to avoid self-isolation if they are a contact of an infected person or have returned from an amber-list country. This is not risk free but the additional risk to public health of this relaxation is unlikely to be great. Double vaccinated people are less likely to get an infection and even if infected are less likely to infect others.
“I also feel okay with facemask wearing becoming optional. I do think that some people will probably feel less anxious by wearing them and that is OK. What I would say is that if you are in a vulnerable group and are going into a crowded indoor environment then it is sensible to still wear one COVID is common in the community, at least whilst infection rates are high. Also if you are visiting a very vulnerable individual indoors when COVID is common in the community then I would wear one for their protection, even though I have been fully vaccinated.
“As for signing into venues via a QR code, I don’t think the evidence this practice has contributed a great deal to the control of the epidemic is there anyway and so I do think this should stop.
“The school bubble system may have had some value but if we accept that we are all going to get repeated SARS-CoV-2 infections throughout life and we are unlikely to vaccinate children under 11 and may not vaccinated children from 11 to 16 (JCVI cannot decide this at present) then all this can be said to be doing is delaying the inevitable. This is causing considerable disruption for relatively little benefit. So no school bubbles. Even relying on daily testing of asymptomatic individuals is open to debate. There have been strong criticisms about the value of asymptomatic testing from people who I think are credible experts. Personally I would exclude children with symptoms from school and maybe test them but otherwise I think we should pretty much go back to normal in the autumn term.
“Of course we have seen new issues appear during the course of this epidemic and so no one can be certain of the challenges over coming months, but we will eventually come into an equilibrium with this virus as we have with all the other endemic respiratory infections.”
Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, University of Leicester, said:
“We understand that we need to relax restrictions to open up the economy and education.
“But the virus is still spreading in the form of the delta variant and hospitalisations are rising gradually.
“There are several unknowns to deal with here:
– in those who have had previous infection or vaccination, we are still not sure whether long COVID is still a complication of those with these breakthrough infections
– we are not sure how effective and how long natural and vaccine-induced immunity lasts against the different variants – and whether the incidence and severity of long COVID complications may differ between variants
– ongoing replication that does not lead to hospitalisations and deaths, still allows the virus to mutate and generate new variants in the community – even without the international importation of new variants
– and vaccine escape variants are more likely to arise in a partially immune population as some people lose their vaccine-induced immunity over time as their antibody levels fall – though T cell immunity may blunt this to some degree. Third dose boosters will help with this.
– opening international travel again will likely import new variants that may start to replicate in the UK population – and may recombine with existing variants here
“So for all these reasons, maintaining some (even if voluntary) level of personal restrictions (e.g. masking indoors, on public transport) may be wise to at least slow down all of these processes above.
“We’re not entirely clear how COVID-19 will combine with flu and other seasonal respiratory viruses, if these return once all restrictions are lifted – but this will not be good.
“Similarly, these seasonal respiratory viruses combined with the usual cold winter exacerbations of chronic diseases – diabetes, hypertension, chronic heart, lung, kidney, neurological conditions – will be demanding for the NHS.
“But all of this is part of the process in ‘learning to live with the virus’ – and, as with flu, unfortunately, there will be casualties on the way.”
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Prof Dominic Wilkinson: “No conflicts of interest.”
Dr Peter English: “No conflicts of interest to declare.”
None others received.