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The Prime Minister has announced the easing of England’s Plan B restrictions from next week.
Dr Simon Williams, Senior Lecturer in People and Organisation, Swansea University, said:
“The rapid drop in Covid rates over the past couple of weeks in the UK has rightly been met with optimism – and relief – by many. The data suggest that we are past the Omicron peak, and that we have ‘turned the corner’ and are nearly in a new phase of genuinely being able to live alongside the virus. The rapid decline in rates has been aided by the actions of the British public, many of whom have been quick to take up their booster offer, and who have reduced their mobility and mixing over the festive period.
“Even at the start of the Omicron wave, when rates were starting to rise rapidly, and concerns were raised over how this might translate into higher numbers of hospitalisations, we were seeing much more ‘variant fatigue’ than with earlier waves. That is, many people were feeling that Omicron is ‘another variant’, and that we should ‘start living’ with Covid. And so, there is a general feeling amongst many in the public that mandated measures shouldn’t be in place longer than necessary.
“As such, many of the proposed measures are in line with both data on Covid rates, and with public opinion, that focuses more on individual responsibility than on policy measures. For example, removing Covid passes should rates continue to decline makes sense, especially given how divisive they have been. There is no scientific consensus, and a general lack of evidence, that Covid passes have worked to reduce transmission, and so their removal, provided rates continue to decline, make sense. There has throughout the pandemic generally been majority support in favour of their use, however, public support of measures like covid passes are always conditional on how much risk or threat people feel that Covid poses. Due to the rapid declines, and hospitalisation rates have been lower than many feared, many people will now likely feel Covid poses much less of a risk compared to a month ago. As such, public support for such measures would likely be less now.
“As the government mention, caution is still important, since, despite the positive trend, rates are still high.
“However, 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”.
Dr Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, past Chair of the BMA Public Health Medicine Committee, said:
“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 popn 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.”
Professor Dame Anne Johnson PMedSci, President of the Academy of Medical Sciences said:
“It’s encouraging to see in the latest ONS figures that the numbers of COVID-19 cases are falling. However, we’re still seeing an infection level of 1 in 20.
“We should all remember that even as restrictions are relaxed, everyone can still take measures to manage the risk of infection, both to themselves and to those around them who may be more vulnerable.
“Wearing a mask in crowded indoor spaces, as is still advised, is a sensible and important measure to reduce the risk of COVID-19 infection. I would also encourage everyone to stay up to date with their COVID-19, and other, vaccinations.
“It is difficult to predict what the removal of Plan B measures means for levels of COVID-19 infection and resulting hospitalisations. The impact of returning to workplaces on transmission will depend in part on how much it increases the number of contacts people have, both in the workplace and as they travel to work.
“I hope that some respiratory hygiene measures and behaviours will persist in the long run; just as we improved hygiene in hospitals to help reduce the spread of MRSA, we need to think how to build better resilience against respiratory infections in settings like hospitals and care homes, as well as in the community.
“We may be moving into a phase of the pandemic where the population has a high level of immunity to severe disease, arising from natural infection and vaccination. But we must recognise that there is still great uncertainty. Hospitals are still under immense pressure, even with a reduction of COVID-19 admissions, and infection rates remain very high. We may yet see a new variant which causes more serious disease, and the effect of waning immunity is unclear, so we will need to continue keeping a close eye on the data in order to manage future risk.”
Prof Allyson Pollock, Clinical Professor of Public Health, University of Newcastle, said:
“The plans laid out today in the commons are all very sensible.
“Mass testing should stop as there is no evidence it reduces transmission, nor is there any evidence that asking children to wear masks in schools reduces transmission or protects against infection.
“Isolation of contacts should be subject to local public health outbreak team to decide the risks – not a blanket self-isolation of contacts. Testing should be reintegrated into clinical care as part of clinical diagnosis. Testing of symptomless people, if done, should be carefully targeted and evaluated and subject to principles of screening. We also should move away from defining cases of infection as a positive test- to clinical symptoms and clinical significance. Combining asymptomatic infections with symptomatic cases is misleading and distorts the statistics on infections in unvaccinated, people with previous infection, vaccination etc.
“It is very important to allow relatives access to care homes and this is long overdue.”
Prof Robert Dingwall, Professor of Sociology, Nottingham Trent University, said:
“This is a major step forward in assimilating Covid-19 to the set of ordinary respiratory infections that have co-evolved with humanity since before history began to be documented. There is still some small print, which looks as though it will be maintained until March, but there is now an explicit political will to dispense with this as soon as possible. The advocates of NPIs have had two years to demonstrate that their benefits are proportionate to their harms and largely failed to produce the necessary evidence according to the long-established standards for evaluating interventions.
“Clearly, it will take some time to bring down the levels of fear generated, both by accident and design, over the last two years. We need a period of mutual respect between those who wish to move forward at pace to re-establish the basic order of social relations and interactions that has been disrupted and those who are more nervous and wish to continue to act in ways that they believe to be protective. Anyone who wishes to continue wearing a mask and distancing themselves from others should be allowed to do so. It is the course to a soft landing, as we saw after Freedom Day in July 2021.
“It would be helpful if the community of behavioural scientists could turn their attention to the challenge of explaining the universality and tolerability of risks in everyday life rather than perpetuating anxiety? What can we do to address the evident problems of community mental health that will be one of the legacies of this episode. There are also many outstanding scientific challenges to improve the portfolio of vaccines and therapies for all respiratory viruses. We need to reflect on the implications for health care systems. Has austerity gone too far in relation to the NHS and damaged its capacity for resilience under pressure or is it a matter of poor management that has failed to plan for the different demands of summer and winter? There are important cultural issues to explore in our understandings of health, illness and mortality? Is it either practical or desirable to imagine that we can control nature to the extent of eliminating all infections? Do we recognise that care homes are in the end of life care business in the same way as hospices? We need to plan for remedying the social, psychological and educational damage to children – and to resolve that school closures will never again be a knee-jerk response to an epidemic infection. All of these matters require the active engagement with the full range of social sciences that has been conspicuously absent since March 2020.
“These announcements are not the end of the pandemic agenda but they do signal the end of the state of exception and elite panic. The experience of the last two years has exposed many fault lines in class inequalities, in the rule of law, in the balance between expertise and democracy. Let these now be the subject of politics as usual.”
Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said:
“While it’s true to say the UK is the first nation in Europe to emerge from the tightened restrictions because of the Omicron wave, that probably has as much to do with the fact that we were first to experience the variant, as it does with anything the government has done to try to limit its spread. If Plan B restrictions ever suppressed infections and I believe they will have done, removing them will mean that the numbers will not fall as quickly as they would have done with them still in place.
“Infection numbers are still very high in the UK, but the population-wide immunity is substantial and that is helping to suppress spread and to keep people out of intensive care. However, it’s like trying to fill a bath that leaks, mass vaccination and widespread recent infections have topped up the nation’s immunity, but that will soon start to deplete and if there is still a lot of virus circulating, an Omicron bounce is possible. Similarly, nobody knows what variants could be generated anywhere in the world. The idea that it’s inevitable that future variants can only be less potent in terms of lethality is pseudoscientific nonsense.
“To say that Covid-19 restrictions have been eased is something of an understatement, instead they’ve almost been completely thrown off and it’s impossible not to suspect that the nation’s health is not the only factor ministers are taking into consideration.”
Prof Lawrence Young, Virologist and Professor of Molecular Oncology, Warwick Medical School, University of Warwick, said:
“Removing Plan B measures in the face of extremely high levels of infection is a risk. With over 94,000 cases reported yesterday, talk of an end to the pandemic is premature. Infections are raging across Europe and other parts of the world, reinforcing the need to take a cautious approach to easing restrictions. Perhaps it would have been wiser to wait for another couple of weeks before removing the advice to work from home and the face coverings mandate. There’s no guarantee that infection levels will continue to fall and the NHS remains under extreme pressure. It’s important that we learn from previous experience. We’ve been here before when we thought that the delta variant would be the end and that no variant could possibly be more transmissible. Remaining cautious while gradually easing restrictions is right for now but we need to stay alert for a possible resurgence of omicron infection and for the arrival of new variants. There is no room for complacency.”
Prof Francois Balloux, Professor of Computational Systems Biology and Director, UCL Genetics Institute, UCL, said:
“The Covid-19 Omicron wave is currently receding in the UK, with number of cases having fallen sharply over recent days, and hospitalisations now following suite. The situation provides a case for lifting restrictions.”
“Though, healthcare remains under severe stress and the transition into a , long-term, lower number of daily cases needs to be managed carefully. An overly fast return to pre-pandemic behaviour could lead to viral flares, which could cause considerable problems for the NHS, and may risk further delaying the return to ‘post-pandemic normal’.”
“As such, it may be helpful if contact rates in the population didn’t shoot up immediately, but rather slowly increased towards their pre-pandemic level over the spring. This may be achievable through entirely non-coercive measures, as the population will likely remain largely careful over the coming months, in particular if cases momentarily went up again.”
“Work from home, for those whose job permit it, is often considered to be an acceptable restriction, and it is highly effective at reducing viral transmission. It would thus be ideal if the return of people to their workplace were only happening gradually.”
“It is fair to state that the UK has never been in such an auspicious epidemiological situation since the beginning of the pandemic. Protection by vaccines, in particular for those who had three doses has held out remarkably well at protecting against Omicron morbidity and mortality, and has kept hospitalisations and deaths largely in check.”
“Omicron is not the last variant, as viruses continually evolve. Though, given the levels of immunisation achieved in the UK through vaccination and prior infection have, no future viral variant can realistically set us back to a dire situation like those experienced in March 2020, or during the Alpha and Delta waves.”
Prof Trish Greenhalgh FMedSci, Professor of Primary Care Health Services, University of Oxford, said:
“The SARS-CoV-2 virus is transmitted primarily through the air. Sharing indoor air with others while unmasked, especially if speaking or singing, will greatly increase the risk of catching Covid-19. It makes no difference whether these are “people you don’t normally meet” or not. The key factor is sharing indoor air. Examples of high-risk settings are church (where you sing with people you “normally meet”), concerts, open-plan offices, pubs, restaurants and night-clubs. To reduce your chance of catching Covid-19, avoid these and similar situations, work from home if you can, and ensure that you and others are fully vaccinated.”
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:
“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.
“Whilst Omicron does show an increased tendency to infect the upper airway first, this is by no means exclusive, and the less severe impact on a per infection basis we’re seeing is largely a result of our privileged position of being a wealthy, and thereby highly vaccinated country. Comparisons to January are flawed because of this very simple fact, and we should instead assess the impact of Omicron, and indeed the seemingly now forgotten Delta wave, based upon what might otherwise have been achieved but for relative inaction over the summer months of 2021. Severe COVID is now essentially a vaccine-preventable disease.
“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. Yes, it is clear that on a case-by-case basis our population is experiencing less severe outcomes to infection, particularly for vaccinees, but the sheer scale of Omicron infections means clinical impact remains considerable – it’s simple maths, really. Some suggest that this is comparable to influenza and so should be acceptable, but whilst the clinical impact may be similar in years when vaccines aren’t well matched, the majority of influenza related deaths are in fact due to secondary bacterial pneumonia; this is not the case for SARS-CoV2, but I do not condone fruitless arguments around “with, not of” and we are talking about a doubling of deaths due to respiratory viruses at present rates.
“The constant comparisons to January are disguising the very real impact that Omicron – and Delta – have had upon the NHS. But, more importantly, this has disproportionate impact on clinically vulnerable people, those not able to receive or respond to vaccines, and the vast numbers of people that have developed long COVID symptoms and continue to live with them, including tens of thousands of children, and some remain affected even since spring 2020. Yes, the ICU capacity (which, remember, was doubled since the first wave) has not buckled, but 2000 admissions per day has put undue pressure on healthcare leading to hospitals declaring emergencies and, again, essential healthcare provision suffering. Our understaffed, exhausted NHS workforce are being asked to catch up on 2020/21, address standard winter pressures, in addition to dealing with Omicron. There have been platitudes saying that patients aren’t “that unwell” and only need some oxygen, fluids and other support, but if you’re admitted to hospital it does actually mean that you would likely be in considerable trouble if that wasn’t possible; you are seriously unwell.
“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. Expanding omicron infections within this group might well lead to extension of the Omicron wave, as seen for Delta last year.
“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.”
Comments sent out before the measures were officially announced by the PM in the Commons:
Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, Respiratory Sciences, University of Leicester, said:
“Early on in the COVID-19 pandemic in 2020, many virologists already thought that SARS-COV-2 would eventually become endemic and seasonal – like the other seasonal respiratory coronaviruses.
“Even with the sporadic appearance of more locally-restricted variants, like beta (from South Africa) and gamma (from Brazil), which eventually did not spread much beyond their original populations – overall, the more globally spreading alpha (from UK), delta (from India) and omicron (from South Africa) variants are becoming more transmissible and less severe.
“Note that any such variant will eventually out-compete any more serious variant that keeps people in bed – as opposed to being mild enough to allow them to continue mixing in society.
“The pattern with omicron that we are seeing in the (admittedly, now well-vaccinated) UK population is a move towards less severe, more transmissible variant that is not requiring hospitalisation for most people. So the level of restrictions will reflect the balance between preserving economic growth, social and psychological welfare and educational requirements.
“Those who are more vulnerable with chronic medical conditions may still choose to wear a mask in crowded indoor areas and on public transport – and this is their choice – just like choosing to wear a scarf. This should not be a problem.
“Whatever the decision on which restrictions to lift or retain, this is again just part of living with the virus as it becomes more endemic and seasonal.
“As a virologist, I’m waiting to see if it becomes truly more seasonally-restricted – as with flu – with eventually most cases occurring in autumn/winter and fewer in spring/summer, as we see to some extent with the other seasonal common cold coronaviruses.”
Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:
“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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www.sciencemediacentre.org/tag/covid-19
Declared interests
Dr Stephen Griffin: “Member of Independent SAGE.”
None others received.