'Freedom' day: Is the UK ready to lift all COVID-19 restrictions?
The UK’s July COVID-19 reopening has scientists divided. Medical News Today spoke with various researchers and doctors, and they all agreed on one point: fully reopen or not, keep some restrictions such as mask-wearing in place.
As the U.K. reemerges from many months of caution, COVID-19 lockdowns, and restrictions, everyone has one question on their minds: Is it right to lift all measures at once?
Dubbed England’s “freedom day” or the government’s “Step 4” in plans to return to normal, July 19 is the date the British government seeks to end all legal, social, and economic restrictions imposed to mitigate the effects of the COVID-19 pandemic.
Previously, the U.K. had given June 21 as its grand reopening day; however, the number of newly confirmed daily COVID cases and below target vaccination rates forced the government to postpone the date by at least 3 weeks.
The U.K. government said that delaying the date would enable more people to receive first and second vaccinations against COVID-19. Its plans included offering a first dose of the vaccine to all over-18s and providing two-thirds of adults with a second dose by July 19.
Prime Minister Boris Johnson and his government have been reluctant to keep restrictions in place any longer, provided the data support it. This includes evaluating the success of the nation’s vaccination program and the impact COVID-19 cases have on the National Health Service (NHS).
Both scientists and Johnson have acknowledged that although vaccines have
So, could a reopening of this scale effectively erase (almost) all progress recorded so far, or has the U.K. got everything under control? Will the U.K. have, according to Keir Starmer, the leader of the opposition Labour Party, a “summer of chaos and confusion.” The scientists have weighed in.
What will change with the lifting of restrictions?
Lifting restrictions includes removing limits on the number of people that can meet socially in any setting, including at home.
Nightclubs and other shuttered businesses can open, and hospitality venues, such as pubs, cafes, and hotels, can operate at full capacity.
The plans include scrapping physical distancing guidelines, and mask-wearing is likely to become optional in England; however, it may remain mandatory in public settings, such as hospitals. Companies will no longer instruct their employees to work from home.
Meanwhile, Scotland, Wales, and Northern Ireland will be implementing their own rules and will likely not follow suit with England’s ‘no masks’ plan.
In general, the government will expect people in England to make their own informed decisions after July 19.
Overview of current COVID-19 situation in the UK
The U.K. currently has the world’s 7th highest death toll from COVID-19 at just over 128,500.
Overall, newly confirmed cases now average around 32,000 a day in the U.K. Latest figures indicate that about 2,700 people are currently in hospital, a 50% increase from the previous weeks’ figures.
According to the latest weekly update from Public Health England (PHE), the number of people presenting with the delta variant has reached 54,268 within the last week and increased by 32%, bringing the total to 216,249. The delta variant currently makes up 99% of newly confirmed cases across the U.K.
A study conducted by the Imperial College London has also found that this surge of infections is most prominent in the younger population, specifically, those 5-12 years who are unvaccinated, and those aged 18-24 years who have only recently been eligible for the vaccine. The researchers said the youth were testing positive for SARS-CoV-2 five times higher than older people.
PHE has reiterated that two doses of the Pfizer or AstraZeneca vaccines remain effective against hospitalization for the delta variant at 96% and 92%, respectively.
According to Our World in Data, the U.K. has administered over 80 million doses of COVID-19 vaccines so far, and 34.2 million people have received both doses. That translates to around 51.3% of the entire population being fully immunized. This figure remains below the 60–70% threshold scientists estimate is needed to achieve herd immunity.
Is England ready?
Scientists are divided.
Yes, some scientists argue
Some scientists believe this is the right time to go ahead with the reopening. They argue that delaying the reopening date will only lead to a bigger surge later on.
“Opening up now is definitely better than in September or October when kids go back to school,” Prof. Tim Spector, an epidemiologist from King’s College London, told Medical News Today.
Right now, at the height of summer, people spend more time outside, in theory, and the schools will soon be out in the U.K., which means the virus won’t have as many crowds or enclosed spaces in which to circulate.
Even though the U.K. has seen its infection rates rise over the last few weeks due to the delta variant, it has not seen a spike in hospitalizations or deaths, unlike the first wave of the pandemic. This indicates that the current COVID-19 vaccines are working to prevent severe cases.
Prof. Spector said he is broadly in agreement with the July 19 date for reopening.
“We need to move into a new phase of the COVID-19 pandemic. We have realized that we will not get rid of COVID-19, and we are moving into a clear endemic phase where there will be thousands of cases all the time, and it is never going to go away. We are going to be fighting new variants with vaccines.”
Branding it a “new era,” Spector told MNT the reopening was a way for the government to get rid of methods and mitigating measures that are no longer working, such as contact tracing, “which is no longer useful or relevant.”
He said the vaccines were working and driving the pandemic toward being a case of mild flu.
In parallel, the Office for National Statistics (ONS) suggests that around 9 in 10 adults in most parts of the U.K. are now likely to have COVID-19 antibodies.
Other countries, such as Germany, lifting travel bans on the U.K. has also strengthened the sentiment.
But scientists point out some caveats
However, Spector pointed out that he does not agree with everything about the government’s plan.
“I think I would’ve kept a few rules on in high-risk areas. […] It wouldn’t be wise to encourage people to go on a crowded tube train without a mask, for example.”
In places where recurrent infections take hold of the community and turn into “hubs of infection,” Spector believes, deeper investigation is needed to get the number of cases down and reduce the long-term morbidity of the country.
He says in the U.K., one of these places has been the West Midlands.
He adds, “You could ask scientists in Manchester why every time there is an outbreak, it is always the same place and look into that.”
He stressed that local public health authorities need to be given more decision-making power to get to the bottom of such cases.
“They should be able to do what it takes to stop the harm. I would like to see more local power that doesn’t hurt the people doing fine and is fair.”
He was referring to nationwide or region-wide lockdowns where restrictions on a more local scale would suffice.
Spector acknowledges that there will be some adverse outcomes from this reopening. One, he says, is the inevitable rise in infections, which will occur naturally due to relaxing measures.
The U.K. Health Secretary Sajid Javid has estimated that the number of daily cases could reach 100,000 per day over summer 2021.
“It will be a trade-off,” Spector told MNT.
As for older people and the clinically vulnerable, such as people with immunosuppressed conditions, Spector says they will have to face this problem as they do “every winter with the flu.”
No, it is too early; some scientists say
Other scientists say it is too premature for a reopening of this scale.
In a letter to the medical journal
As one of the more than 120 scientists who signed the letter, Trish Greenhalgh, professor of primary health care and a practicing general practitioner, believes now is not the time.
“I think the rationale [behind the government decision to reopen] is to help reboot the economy, but it’s likely to backfire. Sick workers are unproductive, as are quarantining ones. Sick consumers don’t go shopping,” she told MNT.
For her and many other scientists, reopening should wait until the country has achieved adequate vaccination.
“[T]he government should delay complete re-opening until everyone, including adolescents, have been offered vaccination and uptake is high, and until mitigation measures, especially adequate ventilation and spacing, are in place in schools.”
“Until then, public health measures must include those called for by the World Health Organization (WHO) — universal mask-wearing in indoor spaces, even for those vaccinated, the Scientific Advisory Group for Emergencies (SAGE), the US Centers for Disease Control and Prevention (CDC) — ventilation and air filtration, and Independent SAGE — effective border quarantine; test, trace, isolate, and support,” the scientists wrote in their letter.
The British Medical Association (BMA) has also objected to the lifting of all restrictions.
“As case numbers continue to rise at an alarming rate due to the rapid transmission of the delta variant and an increase in people mixing with one another, it makes no sense to remove restrictions in their entirety in just over 2 weeks’ time. [W]hile we were pleased to see the government react to data in delaying the easing on June 21 last month, ministers must not now simply disregard the most recent, damning numbers by rushing into meeting their new July 19 deadline.”
– Dr. Chaand Nagpaul, BMA council chair
The U.K.’s rush to lift all restrictions has not sat well with international organizations either.
“The idea that everyone is protected and it’s ‘kumbaya’ and everything goes back to normal — is a very dangerous assumption anywhere in the world. We’d ask governments to be really careful at this moment, not to lose the gains that we’ve made,” said Dr. Mike Ryan of the WHO.
The reopening has also ignited fears about no restrictions creating a perfect breeding ground for new, potentially more dangerous variants that could evade vaccines.
“My epidemiology colleagues are concerned that this virus has a high propensity to mutate, and the ‘survival of the fittest’ principle will ensure that new variants are adapted to their environment better than the ones they replace,” said Prof. Greenhalgh.
Preliminary modeling data has also supported this.
“This would place all at risk, including those already vaccinated, within the U.K. and globally. While vaccines can be updated, this requires time and resources, leaving many exposed in the interim,” said scientists in The Lancet.
Dr. Jonathan Stoye, a virologist at the Francis Crick Institute in London, reminded us that although COVID-19 vaccines give good protection, this is “not absolute.”
Dr. Stoye told MNT that it is not yet clear whether there is an increased risk of such variants emerging in places where those vaccinated and non-vaccinated live side by side as in the U.K., compared to countries where the majority is still unvaccinated.
“In either case, the priority must be to reduce levels of virus replication. However, I am reassured by the probability that any such changes are likely to be gradual, as we see with the influenza virus, without rapid increases in susceptibility.”
“Monitoring virus evolution and adjusting vaccine composition should be sufficient to meet this threat,” he added.
Talking ethics
The reopening decision has received criticism for completely disregarding the lives and safety of vulnerable people.
The British Liver Trust has called for the government to reconsider its decision to end all COVID-19 restrictions in England to protect the clinically vulnerable, including those with advanced liver disease, those who have severe immunosuppressed conditions, or those who have had a transplant.
“[P]atients had finally started to enjoy some normality. Now, with rising infection rates, many people with liver disease say that they’ve already started reducing that precious social contact they’d been waiting so long to regain. Some are even starting to shield again. There is a real concern regarding the announcement that face masks will become discretionary and they will have less protection,” the charity said in a statement.
Pamela Healy, OBE, chief executive of the British Liver Trust, said such vulnerable persons “will feel let down, forgotten and that their freedom has been taken away” if the government goes ahead with the reopening and lifts all restrictions on July 19.
“They will feel unsafe doing simple activities, such as using public transport, going shopping, or attending functions.
Dorry L. Segev, MD, professor of surgery and epidemiology at Johns Hopkins University, said unvaccinated people were not just a threat to the vulnerable.
“[The unvaccinated] will spread this virus to each other, to vaccinated people with suppressed immune systems who are less protected, and even to vaccinated people with perfectly fine immune systems.”
Hence, from an ethical perspective, the reopening falls short. Those at least risk from COVID-19 would be expected to make decisions to protect those at most risk, not endanger them further.
Whether you base it on Immanuel Kant’s Golden Rule – “do unto others as you would have done unto you” or John Rawls’ “A Theory of Justice,” from an ethics perspective in philosophy, “the imperative to protect others is quite established. So no, given the inequalities of how COVID-19 affects different individuals, this is not an ethical move,” Dr. Sherrill Stroschein, senior lecturer in politics at the University College London (UCL), told MNT.
When the economy and people’s livelihoods enter the conversation, things also get tricky.
Dr. Stroschein said people in the U.K. have been presented “a false dichotomy” and made to choose between being healthy or having an economy.
And despite the government introducing an impressive furlough program but not indicating that it will continue until the remainder of the population is vaccinated also poses a problem. Dr. Stroschein adds:
“The economy is made up of people and will be stronger if we manage the pandemic in sensible ways. Especially when one considers the social costs of high infection rates and the pressures on the NHS, as well as the long-term costs of long COVID.”
Finding common ground
Despite advocating for opposite sides, both Prof. Greenhalgh and Prof. Spector believe it is not smart to forgo all restrictions at once — especially masking.
“Like everyone, I yearn to get back to normal. I think masks would help us do that. Masks have been a symbol of the loss of freedom, but actually, if we’re all masked, we’re all better protected, hence can be more confident to do things like going to the cinema or travel by bus or train,” Prof. Greenhalgh told MNT.
Pointing out inconsistencies in the U.K. government’s current approach — such as being told to be mindful of “Hands, Face, Space” but abolishing requirements for mask-wearing after July 19 — Dr. Stoye said he agrees.
“I would strongly favor the continued use of masks in confined spaces for at least the next few weeks,” he said.
Dr. Segev also said mask mandates should be the last thing to be lifted.
“Abandoning mask mandates in indoor spaces where strangers encounter strangers and vaccines are not required makes absolutely no sense. Wearing a mask isn’t that difficult. […] We’ve proven in the last 18 months that we can wear masks and be just fine,” he told MNT.
The government also needs to work on ensuring proper ventilation.
“We should also be focusing on ventilation — a well-ventilated indoor space is much safer than a stuffy one. We need to use these minor changes to help achieve our ‘freedom’ instead of dismissing them as oppressive,” said Prof. Greenhalgh.
Spector says public transport, grounded, and unventilated areas are places that should warrant a mask-wearing requirement.
Stroschein also advocates for the practice of mask-wearing in venues, such as shops, to remain in place. She says this has two aspects: proportionality and common sense.
“Wearing a mask is a minor inconvenience … [contrasted] with the serious harm done if an immunocompromised person picks up the virus from someone not wearing a mask and becomes very sick. […] There is no economic benefit of removing masks. In fact, if people who worry about contracting the virus stay out of shops as much as possible, they are not spending as much money, and the economy is harmed.
Professor Stroschein believes this shows that lifting the mask mandate is more of an ideological decision or an identity issue.
“There are other problematic aspects, particularly regarding schools and isolation/ testing and children, but the mask aspect is the clearest example that something other than science or economics is driving this policy.”
Long COVID
“I think long COVID is the main issue that hasn’t been addressed so far. […] There are more people waiting for cancer and heart treatments; these are chronically more important [than COVID-19],” Spector told MNT.
Using U.K. Coronavirus (COVID-19) Infection Survey data, the ONS estimated that 1.5% of the population — or 962,000 people — reported experiencing symptoms of long COVID, with 812,000 saying that the symptoms had either adversely affected their day-to-day activities or limited them to a great extent.
However, official figures from the Department of Health and Social Care show the number of people who have had one or more COVID-19 symptoms that have lasted at least 12 weeks is closer to 2 million.
Researchers say this will put immense pressure on the economy if most of its working population and healthcare system have to deal with long-term illness and disability.
Long Covid does not only affects adults.
According to a study by researchers at UCL, the percentage of children developing long covid after having COVID-19 is over 4.5%.
Another
This could mean that children end up becoming the key to the pandemic.
“Many believe they will be the reservoir that will keep this thing going because they are not vaccinating children,” Prof. Spector said.
Prof. Chris Whitty, the U.K. government’s chief medical adviser, has said he expects “a significant amount more Long Covid” after July 19, particularly in the younger population who are not fully vaccinated.
However, he has also warned that there is no proof whether vaccines provide adequate protection against the most common symptoms of long Covid, which are extreme fatigue, brain fog, joint pain, and muscle weakness.
Hence, now is the time to warn people of the dangers of COVID-19, not of death, said Prof. Spector.
It is important to change that emphasis and tell people what symptoms to be aware of to prevent people from passing on the infection to others, he added.
Bottom line: too early to lift all restrictions
Despite differences in opinion about the date when the U.K. can ease into normalcy once again, researchers and scientists have converged on one aspect: it is too early to lift all restrictions.
Most agree that keeping certain restrictions in place, such as mask-wearing on public transport and in shops, should remain until current outbreaks are under control, and most of the population, including adolescents, have received vaccinations to achieve population immunity.
According to adult and pediatric specialist and anesthetist Pieter Peach, allowing the virus to transmit through the population uncontrolled could lead to poorer economic outcomes, shuttered businesses, chronic disability, delayed non-COVID-19 healthcare, and more deaths.
A high rate of transmission in schools and children will also lead to significant educational disruption,
People who have immunocompromised conditions, those who have not had a vaccination, and the clinically vulnerable are likely to suffer the most from a complete reopening due to reduced protection against COVID-19 even if they are fully vaccinated.
If the U.K. government does go ahead with its current plan, scientists recommend that people in the U.K continue to take personal precautions for themselves and loved ones, get vaccinated, and show empathy.
“Immunocompromised people need to get vaccinated, but act unvaccinated. The government should prioritize all efforts to study and improve immunity in immunocompromised people,” said Dr. Segev.
While it is an indisputable fact that as a society, we will have to learn to live with the new coronavirus and manage outbreaks as best as possible, it would be best to do so in a manner that avoids hundreds of thousands of new infections.
Failing to do so could lead to a generation that will have to live with disability and chronic health problems, not to mention the loss of workforce.
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