July 6, 2021

further comments on announcement of plans to remove more restrictions from 19th July

A few more comments from scientists on the planned easing of restrictions on July 19th.

Dr Julia Faulconbridge, Chartered Psychologist and member of the British Psychological Society’s Division of Clinical Psychology, said:

“One of the most worrying aspects about the announcement from the prime minister and the health secretary is how all the emphasis is now placed on the individual, with the public told to use their individual judgement and responsibility when it comes to wearing masks and social distancing. It is all now on the I, rather that the ‘we’. Throughout this pandemic, most people have understood that the best way to get through it is by pulling together and supporting each other. Most people are in favour of doing the things that not just protect ourselves, but protect each other and that is the most powerful tool we have at our disposal to get through this.

“What we needed from the prime minister were really clear messages about what people need to  do to protect other people as well as themselves – that wearing masks and social distancing, when possible,  are still very important. What was also missing was any sense of what employers, schools etc  need to do to make areas as safe as possible through ventilation and other methods and how the Government will support them and us to do this. Instead we got the message that you can make your own judgements,  and life is back to ‘normal’,

“The idea of the 19 July being a ‘freedom day’ is a misnomer because it isn’t about freedom, it is about how we can best manage to keep schools going, to keep businesses open and enable people to have social lives whilst preventing another major wave. For many – the elderly, the clinically vulnerable, younger people who are not vaccinated this is not a “freedom day” but actually the opposite. They will no longer feel safe to go to places that may be crowded and where others are unmasked. They are also very concerned about the removal of what support was available for them.

“The announcement focused on the lower numbers of hospitalisations and deaths as a result of the vaccination programme, but with numbers being forecast to reach 100,000 /day these numbers will soon become significant. Long Covid is a serious problem, with 10-20% of people, including children, who catch the virus suffering illness. disability and psychological problems for months and that appears to have been completely neglected in yesterday’s announcement. Whilst the health minister spoke of wanting to avoid the mental health consequences of restrictions, he ignores the psychological consequences of allowing the infection rate to simply grow through the lack of society-wide mitigation measures.”

Nick Pahl, CEO of the Society of Occupational Medicine (SOM), said:

“Following the end of restrictions on 19^th July, employers should continue to ensure that they have the necessary measures in place to give confidence to workers that their workplace is safe. Workplaces need to carry out effective risk assessments using advice from the HSE. Vaccination should be encouraged but we are in agreement with the Faculty of Occupational Medicine that this should remain voluntary (see https://www.fom.ac.uk/covid-19/covid-19-guidance-on-vaccination-and-testing). Ending the legal requirement to wear a face covering will present a risk in some working environments, in particular for front line workers. The impact of this higher risk must be mitigated – for example through the appropriate level of PPE, adequate ventilation and social distancing. The impact of further reopening and mixing should be reviewed. As CIPD has stated, the end of restrictions is a signal for the start of greater freedom and flexibility in how, when and where people work.”

Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds, said:

“It’s very difficult to gauge the contribution of any single measure on infections as they act in concert to reduce the spread of the virus, and some perform better under different circumstances than others. For example, wearing masks indoors in poorly ventilated spaces that are busy is the best thing you could possibly do, other than increase the ventilation in that setting. Ventilation is key for combatting indoor transmission, yet sadly many industrial and school buildings are lacking in this department – simple CO2 monitors can go a long way to help spot when rooms become unsafe as a proxy for poor ventilation. This could have been an easily implemented measure that may have helped protect class bubbles.

“There is understandably some confusion around when or where to implement different measures to contain the virus. For example, face shields are only helpful against direct sprays of infectious materials and will not help in most circumstances. It is also frustrating to see the implementation of distancing alone in poorly ventilated spaces in place of e.g. masks, as aerosols will not be counteracted. However, distancing IS effective against direct exposure and spread by respiratory droplets, which retain ballistic properties, with 2 metres of course being far superior to 1. There is also an element of people feeling overly secure when outdoors, yet time spent in close proximity to others outside can still present considerable risk. People also need to remember that LFD tests are a red, rather than a green light test and the best individual risk mitigation strategy remains being vaccinated with both jabs.

“Whilst many of the measures are often considered very much on an individual basis, we need to understand that the relaxation of these will have a profound effect at the population level as a whole, both for SARS-CoV2 and its host (us!). A good example of this is the face coverings warn by many considerate folks and I very much hope this continues – whilst the reduction in virus emissions per individual may be moderate, the collective effect upon the exposed population is likely more than just additive. We are also at risk of driving further evolution of the virus by allowing widespread circulation amidst a partially vaccinated population – only around 50% of the population has had both doses. In my view, this number needs to be dramatically higher.

“Taken together, the collective loss of restrictions we are due to see in July will no doubt lead to a sharp increase in transmission. All the factors holding the Rt of the delta variant somewhat in check currently will be released, and we will get our first taste of just how infectious this virus really is. Sadly, already increasing hospitalisations will also accelerate, deaths will follow and many will develop long COVID. This seems to be a price the government are prepared to allow the public to pay, which I find incredible.

“Population immunity is classically defined as the proportion of the population that needs to be immune in order to prevent sustained community transmission, i.e. the Rt value is always well below one, so any potential outbreak is automatically self-limiting. The proportion of the population AS A WHOLE required for this to occur is theoretically 1-(1/Rt). So, when the original Wuhan virus (Rt=3) emerged, the vaccination target would have been around 65-70%. We are yet to reach even this target at present, which is why we continue to see exponential growth in infections.

“However, with B117 (alpha) and now delta, their ability to transmit is far, far higher, even with restrictions holding some in check, than the original strain. Thus, complacency is the enemy here as it is widely accepted that delta has a value two or three times that, possibly much higher, placing the proportion at up to 90% or more. Nevertheless, despite a tremendous vaccine effort, UK double vaccine coverage still remains at around 50%. However, population immunity isn’t a barrier that you suddenly pass and it just happens – it builds once you get past a certain tipping point in the vaccine programme. We also know that this protection MUST be achieved using vaccines, as immunity by natural infection is not only weaker but also short-lived by comparison. Hence, the notion suggested by some of allowing the virus to spread through the under 18s without a vaccine, is both amoral and dangerous in my opinion.

“Perhaps the most frustrating aspect of the relaxations announced this month is that the level of vaccination required to achieve a broad population immunity is achievable within a matter of months. Rushing the unlock will therefore lead to dramatically more cases, mortality and morbidity.”

Dr Simon Kolstoe, Senior Lecturer in Evidence Based Healthcare, University of Portsmouth, said:

“The successful vaccination programme has clearly provided reason for optimism and justification for relaxing many restrictions, but the increasing number of cases due to the current Delta variant is worrying. It is therefore important that we carefully assess the most appropriate actions moving forward. Face masks, for instance, are a proven health intervention that reduces the spread of coronavirus. Unlike other interventions such as social distancing or restrictions on certain types of events or activities, they have very little impact on business or people’s social lives. Maintaining widespread use of face masks would be a reasonable and proportionate precaution to keep in place – ideally mandatory when in confined, crowded and poorly ventilated places such as public transport.”

Dr Raghib Ali, Senior Clinical Research Associate, MRC Epidemiology Unit, University of Cambridge; Honorary Consultant Physician in Acute Medicine, Oxford University Hospitals NHS Trust, said:

“On balance, I think there is now a reasonable case to move from restrictions to guidance. As I have stressed throughout the pandemic, the harms of Covid need to be balanced against the harms from restrictions. When hospital admissions were in their thousands and the NHS was unable to provide all services, it was clear that restrictions would reduce overall harm. However we are now in the situation where admissions are less than a tenth of the peak and highly unlikely to reach levels seen previously given the very high vaccine uptake and effectiveness.  Restrictions were also justified until we had at least offered vaccination to all adults, which is why I backed the four week delay but by July 19 all adults would have had one dose and vast majority of those at high risk of death and hospital admission would have had both doses.

“With vaccination, the threat from COVID to health has been very significantly reduced and so restrictions should be reduced accordingly.

“Finally although we await this week’s data it seems that there is little to be gained from delaying step 4 beyond July 19^th as an exit wave is inevitable in those who will not be vaccinated and there are some advantages of having this wave in the summer when schools are closed. A delay will likely just postpone these infections, hospital admissions and deaths to the autumn/ winter when the NHS will be less able to cope.”     

Comment on whether delaying reopening further would only delay a future wave: Prof Azra Ghani, Chair in Infectious Disease Epidemiology, Imperial College London, said:

“We are currently experiencing a growing outbreak with cases doubling approximately every 9-10 days. Even if there was no change to the current restrictions, we could expect cases and hospitalisations to increase in the coming week, although the peak would be limited. The size of any subsequent fourth wave over winter would depend on how fast restrictions were eased, the extent of vaccine uptake in the young, the impact that the booster vaccine programme has in further increasing levels of vaccine immunity, and the decision on whether or not to vaccine teenagers. We have time between now and winter to manage this.

“Easing restrictions now is highly likely to speed up the growth, resulting in a higher peak with the cases occurring over a shorter time period. The only way that this would “protect” against a fourth winter wave is if the level of transmission is allowed to rise to such an extent that herd immunity is achieved through natural exposure in combination with vaccination. In doing so, we risk exposing young people who have not yet had the opportunity to receive both vaccine doses, and our children, to the as yet unknown longer-term consequences of this virus.

“The scientific community has always argued that the best approach is to be cautious, and to ease restrictions gradually, relaxing first those that are most damaging to society (from either a health and/or economic perspective) but keeping in place less onerous restrictions such as facemasks, handwashing and where possible social distancing. Doing so would minimise the health consequences whilst also buying time for any necessary mitigation (such as booster doses or vaccination of teenagers). In contrast, suddenly lifting all restrictions carries some big risks. Even if vaccines do keep deaths at low levels, current trends in hospital admissions, if extrapolated to the levels of transmission that we know from other countries that this virus can reach, could put a severe strain on the NHS.

“Even more worrying is that with just over 50% of the population fully vaccinated, by letting the virus run through the population we are creating the perfect condition for the selection of mutations that allow the virus to evade the vaccine. This strategy may therefore not only be risky for England, but could also set back the global fight against the pandemic.”

Professor Lawrence Young, Virologist and Professor of Molecular Oncology, Warwick Medical School, University of Warwick, said:

“This is a big gamble. The wall of protection offered by vaccination is not solid – it’s affected by rising cases numbers, hospitalisations and the ever present threat of new variants popping up that are vaccine resistant. Far better to have maintained some mandatory restrictions (e.g. face masks in crowded spaces such as shops and public transport) and waited until a greater proportion of the population is fully vaccinated. And this includes getting on and vaccinating youngsters particularly the 12-15 year olds. While this group doesn’t suffer the same degree of illness after infection, they do spread infection and can suffer from long Covid. Vaccinating younger age groups would also protect from further disruption to their education. Other countries are forging ahead with vaccinating younger age groups recognising that this is the way to generate the level of population immunity required to protect the community from the spread of the delta variant.”

PM’s speech, Monday 5 July: https://www.gov.uk/government/speeches/pm-statement-at-coronavirus-press-conference-5-july-2021

Previously issued comments on this topic:

05/07/2021 Comments on media coverage reporting that various restrictions will be lifted at the next stage of England’s roadmap out of lockdown: https://www.sciencemediacentre.org/expert-reaction-to-media-coverage-reporting-that-various-restrictions-will-be-lifted-at-the-next-stage-of-englands-roadmap-out-of-lockdown/

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.