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The Prime Minister announced the move to Plan B in England at a Downing Street press conference on Wednesday.
Prof Penny Ward, Independent Pharmaceutical Physician, Visiting Professor in Pharmaceutical Medicine at King’s College London, said:
“Yesterday’s announcement comes as a timely reminder that prevention of illness caused by an airbourne virus is difficult without forcing people apart and separating the yet-to-be from the currently infected. It is disappointing not to have heard more from the scientists concerning the deployment of antiviral antibodies and/or small molecule antiviral medications and to note the NERVTAG comments1, focusing on the potential for antiviral resistance. Perhaps they missed the information provided by Merck at the recent FDA Advisory Board in which the steps taken to evaluate the resistance pattern of molnupiravir – including in vitro experimentation, in vivo animal studies and sequencing of virus detected during treatment – was described. This product does not act in the same way as other nucleoside agents and by virtue of its different mechanism of action provides a high bar to the risk of emergent resistance. That said, NERVTAG is correct to surmise resistance, if it occurs, is most likely to emerge among infected immunosuppressed patients. All the more reason to try to protect these individuals from infection in the first place one might think, not just by vaccination (to which they may well not respond) but also by proactive use of monoclonal antibodies, particularly those with documented activity vs multiple strains, including omicron, to prevent infection in this high risk group and thereby reduce the need for any use of small molecule antivirals in the first place. Just a thought.”
Prof Paul Hunter, Professor in Medicine, UEA, said:
“Whilst most of the statements in the minutes of SAGE of 7 December reflect what has been said a number of times already, one paragraph is worthy of further comment. That is paragraph 15: ‘15. It is highly likely that Omicron will account for the majority of new SARS-CoV-2 infections in the UK within a few weeks. Omicron may partially or largely replace Delta over this period, but the extent of this depends on the degree to which they are infecting different cohorts of people, which is not currently known. It is possible that both could continue to spread concurrently, which would mean that the Delta infections and hospitalisations would be in addition to Omicron ones. It is also possible that Omicron will completely displace Delta.’
“If the doubling time for omicron continues as currently then omicron will become the dominant variant, though it should be noted that the AY.4.2 variant of delta is also increasing quite rapidly at present. Whether omicron will replace delta or not is a really important question. We have seen that delta effectively replaced the alpha variant in the UK, replaced the beta variant in South Africa and replaced the gamma variant in Brazil. In the UK as far as I can tell we haven’t had a case of alpha variant infection for over a month. In ecology it is accepted that when two species compete for the same niche in a habitat then one of them often becomes extinct at least locally.
“For viruses however, whether one variant can totally replace another depends in large part on the degree of cross-immunity between them. For replacement of delta variant infection with omicron, omicron would need to provide sufficient immunity against delta that the proportion of people suspectable to delta falls. The problem is that from South Africa that omicron is causing substantial increases in the rate of repeat infections in people who have already had a previous infection. If a delta infection does not provide reliable immunity to omicron, then the reverse is also likely to be the case. So, omicron may not replace the delta variant as quickly or as completely as we saw with delta and alpha. What this means is that we may have two simultaneous epidemics, one from omicron and one from delta (most likely AY.4.2). This raises the concern about Delta and omicron coinfections, where both variants infect the same person at the same time. In general coinfections of any respiratory viruses are associated with more severe disease and we certainly saw that early in the pandemic with covid and influenza coinfections.
“All this makes it very difficult to predict the course of the next couple of months. The booster vaccine campaign will be more effective against delta and we may see cases of delta starting to fall because of immunisation rather than omicron. Nevertheless we need to be aware of the potential for coinfection with delta and omicron, If coinfections become a problem this could have significant implications for management and for control of infection in hospital.”
Prof Trish Greenhalgh FMedSci, Professor of Primary Care Health Services, University of Oxford, said:
“The re-introduction of mask mandates is welcome at this time when a new mutation of SARS-CoV-2 is spreading alarmingly quickly. There is strong and consistent evidence that this virus is airborne and that the main way it spreads is by people breathing in viral particles suspended in the air. Wearing a well-fitting, high-filtration mask (such as a FFP2) does three things: it reduces emission of viral particles from the wearer; it protects the wearer against viral particles suspended in the air; and it sends a message to others that we care about them and are taking the pandemic seriously. Since the beginning of the pandemic, evidence has accumulated that masks are safe for the vast majority of people, including children. The US Centers for Disease Control and Prevention has recently updated its guidance on masks with a summary of key evidence.”
Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:
“Vaccine passports which include self reported lateral flow tests are highly flawed. Self testing will not achieve the same level of sampling quality from the throat compared to an experienced swab taker.
“People can report a positive result as negative or just report that they have done the test using the number on the strip without even doing the test.
“Lateral flow tests will miss a percentage of infectious cases.
“Most of Europe only accept vaccination or recent infection and do NOT use the lateral flow tests.”
Dr Simon Williams, Senior Lecturer in People and Organisation, Swansea University, said:
Are these new measures evidence-based?
“The jury is still out on Covid passes. A recent evidence review by the Scottish government did not find evidence of the vaccine passport scheme’s effectiveness in terms of reducing transmission, although it did find ‘a relatively slight impact on uptake of vaccinations’. Similarly in Wales, COVID passes were extended in November, but there is to date no published evidence that they substantially contribute to reducing transmission. It is important to note that the scheme in England is unlikely to have widespread impact because it is currently only being used for large events, which are relatively infrequent and not attended by a substantial proportion of the population. It stands to reason that if COVID passes are to be impactful they would need to be used in settings where more people visit more often, for example cinemas and nightclubs, but also pubs, bars and restaurants, as has been used in other countries such as Denmark.
“Aside from vaccines, working from home – for those who can – is one of the most important interventions to reduce transmission. Data suggests that far fewer of us are working from home this winter compared to last, and so there is potential to significantly reduce the total amount of contact currently taking place. Research has shown how those who go into work have on average twice as many close contacts as those who don’t. Telling people to work from home has been shown to effectively reduce contacts. And if we reduce contacts we reduce transmission opportunities. Of course, working from home is much easier for some than others, and the government and employers also need to play their part to make working from home easier. The first step is clear and consistent guidance for employers and workers.”
Prof Neil Greenberg, Professor of Defence Mental Health, King’s College London, said:
“It is evident that the understandable focus on whether Omicron is more deadly or not appears to have missed the potential mental health impacts of moving to plan B. Whilst the new measures are not in themselves overly restrictive, many people are likely to fear the uncertainty of the future now more than ever. There have now been multiple new measures introduced in a quick succession and the message this gives is that it is more likely than not that even more restrictive measures will be introduced in the very near future. Members of the public who have put their psychological wellbeing eggs in the ‘I have to have a good Christmas with my family this year’ basket are likely to view the Prime Minister’s announcements today as another nail in the coffin of their mental health. Those working in frontline services, including health and social care, can only infer that they are about to go from the frying pan into the fire. In my view, there should have been much more active discussion of the mental health impacts of the arrival of and response to the new variant. Furthermore, the plan B announcement should have included active measures that the government will be putting in place to ensure that the public’s mental health, as well as physical health, needs are being considered in the planning process.”
Prof Lawrence Young, Virologist and Professor of Molecular Oncology, Warwick Medical School, University of Warwick, said:
“The driving force behind cases of infection are a combination of two things – the amount of immunity in the population and human behaviour. It is clear that while vaccines do a lot of the heavy lifting when it comes to keeping COVID-19 under control, other interventions are also required to prevent case numbers rising. Faced with rapidly increasing levels of infection with the Omicron variant on the back of persistently high levels of delta infection, the only way to break the chains of transmission is to continue to expedite the booster campaign while also using other behavioural approaches such as more widespread use of face coverings, covid passes in crowded venues and, where possible, working from home. Even if Omicron infection turns out to be milder, as data from South Africa suggests, high transmission rates will still result in a large number of hospitalisations. The hope is that these Plan B restrictions will give us some breathing space to continue at pace with the roll out of booster shots while attempting to quench the spread of the Omicron variant in the run up to Christmas.”
Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, Respiratory Sciences, University of Leicester, said:
“In the absence of data about the true clinical severity of omicron in the UK population, measures to limit its spread are a wise precaution – and these restrictions will also reduce the spread of delta and other respiratory viruses.
“The rate of doubling is getting more like flu which has a much shorter serial interval (the time between successive cases) than previous globally dominating SARS-COV-2 variants (alpha, delta).
“This is what I would expect to see in a virus that is further adapting to a new host. Possible reasons for this might be two-fold: the virus eclipse (replication) phase is shorter – but also, infected individuals might be less sick or even asymptomatic – and are able to still move about in society to spread the virus to many others.
“So daily case numbers might then be increasing because more virus can replicate per unit time in a single host – but also because one infected yet only mildly ill person can still spread the virus to many others – in whom the virus can again replicate at a faster rate, causing only mild illness, to spread the virus even further.
“Imposing restrictions now will reduce delta and omicron variants and seasonal flu cases more significantly than if such restrictions are delayed and implemented next week, for example.
“Booster COVID-19 and seasonal flu vaccines will still reduce the severity and possibly the spread of these viruses leading into Christmas/New Year and beyond – and the sooner people get these, the sooner we can start to reduce the daily case numbers, hospitalisations and deaths from all of these viruses.
“Complying with these measures helps to protect you, your family, friends and colleagues – regardless of what others do or don’t do.
“If more of us follow these restrictions now – we can hopefully reduce the need for any local or national lockdowns later – which will be bad for everyone.”
Dr Shaun Fitzgerald, Royal Academy of Engineering Visiting Professor, University of Cambridge, said:
“This new variant is real problem and the scientific evidence laid out by the CMO is clear. We have to act sooner than perhaps we think, and this has been the message from the GCSA throughout this pandemic. So, additional measures now do indeed seem sensible.
“As someone who has looked at ventilation for a long time, one may well ask whether we can just increase ventilation rates for example to compensate for the additional transmissibility of the Omicron variant. Alas, the modelling studies confirm that pulling one lever a bit harder on its own to tackle this kind of change is unlikely to have the necessary impact. We can’t simply ventilate our way out of this problem. Increasing the ventilation rate would help a bit, but other measures are needed and these were clearly explained in the press briefing this evening.
“The term ‘hierarchy of controls’ is rather helpful in situations like this. The first and most significant one is limiting our contact with others, and hence the ‘work from home if you can’ policy seems extremely sensible. Clearly it is not as enjoyable working at home physically isolated from work colleagues, but if we can, then the modelling shows that this is a significant measure. Secondly, when the Prime Minister said that Christmas parties and nativities could still go ahead, he was absolutely clear about what was necessary in these scenarios; the first thing mentioned, after of course the jabbing, was ventilate and then additional easy-to-do things such as hands. And then the use of face coverings in a wider range of indoor settings is very helpful.”
https://www.gov.uk/government/news/prime-minister-confirms-move-to-plan-b-in-england
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Prof Penny Ward: “I am semi-retired, but I am owner/Director of PWG Consulting (Biopharma) Ltd a consulting firm advising companies on drug and device development. Between December 2016 and July 2019 I served as Chief Medical Officer of Virion Biotherapeutics Ltd, a company developing antiviral treatments for respiratory viral diseases. Previous employee of Roche, makers of tocilizumab (anti IL6 antibody) and CMO of Novimmune, makers of empalumab (anti IFN gamma antibody).”
None others received.