Four questions for the government on its Covid strategy

Boris Johnson signalled a dramatic change of approach at Monday’s Covid-19 press conference, if also sounding a note of caution. In just a fortnight’s time, the government plans to lift almost all restrictions in England (the devolved governments are working to their own lockdown easing plans). This will herald the end of the “one metre plus” rule and of restrictions on indoor and outdoor mixing, meaning people will be able to elbow their way to a bar and go to nightclubs, gigs and other large events. Masks will no longer be compulsory in shops or on public transport.

The government says this “big bang” is possible because the vaccines are working and have “weakened” the link between cases and hospitalisations and deaths. Rather than government rules, people will be expected to use their own judgement – though Johnson and his scientific advisers offered reminders that Covid-19 is spreading rapidly and people should “behave accordingly”.

The prime minister has the support of his party, his cabinet and a majority of the public in lifting restrictions.^[1] But others – including scientists and trade union leaders – are more divided, with some arguing for some measures to stay in place until everyone has been fully vaccinated. Even if most people want to see an end to restrictions, many will harbour their own anxieties after such a difficult 18 months. Here are four questions the government needs to answer to build confidence in its plan.

1. Does the government have the evidence to justify the ‘big bang’ approach?

The recently installed health secretary, Sajid Javid, has said that releasing restrictions is not only important for people’s freedoms and the economic recovery but also “the best way to protect people’s health”.

Those with concerns doubt this. They believe an uncontrolled outbreak will lead to further deaths – the vaccines are working brilliantly but are not perfect and there are still pockets of susceptibility – and harm from “long Covid”. Almost a million people in the UK have the latter, with over 175,000 reporting a severe impact on day-to-day life.^[2]

The government should be clear about the calculation it is making. It is not enough to say restrictions can be lifted without overwhelming the NHS. Ministers should set out their expectations about the current wave – how long it will last, how many people will be hospitalised, and so on – and how they have balanced these against the cost of ongoing restrictions.

Chris Whitty, the chief medical officer, noted there was disagreement among scientists but said some (including him) thought delaying the lifting of restrictions into the autumn or winter could lead to a worse outbreak due to seasonal effects, even if more people would be double vaccinated. Will the government publish modelling supporting this view? What about the impact of a shorter delay, with restrictions still being lifted in warmer months?

The core question the government faces is whether to aim to reach herd immunity (estimated at 85% of the population) more quickly through a larger outbreak or more slowly through an extension of the vaccine programme. It needs to persuade people it has got that judgement right.

2. What does the evidence say on mask-wearing?

Perhaps the most controversial part of the government’s announcement is the plan to end the mandatory wearing of face masks in shops and on public transport. This would be the most obvious visual cue of a new approach – and would appeal to more libertarian parts of the Conservative party.

But many experts have concerns: Dr Peter English, former chair of the BMA Public Health Medicine Committee, called it “grossly irresponsible”. There are questions about whether individual transport providers will implement their own policies. Transport for London (TfL) has yet to make its position clear. Andy Burnham, who as mayor of Greater Manchester controls Manchester’s tram system (but not the wider regional transport network) has questioned the policy, arguing that differing rules could lead to confusion and calling for a “re-think”.

It is unclear just how much of a shift in behaviour the change would lead to, given current policies are weakly enforced and most people support continued mask wearing in crowded places.

But the change could make many people feel more uncomfortable, even unsafe, in shops or on public transport. A significant number of people cannot be vaccinated for medical reasons; many young people will not be vaccinated by 19 July. Does the government expect them to rely on others’ sense of “courtesy”? What impact does the government think some feeling less safe will have on the return of pre-pandemic economic activity?

3. How will a focus on “personal responsibility” affect remaining measures, like self-isolation?

The most important measure that will stay in place is contact tracing and isolation, but this will be adapted. People who have been double-vaccinated will not be required to quarantine if they have been contacted, and the policy of “bubbles” and contact isolation in schools will be changed.

This is sensible, but it may make it harder to persuade those still required to isolate to do so. Many younger people are not expected to get their second vaccine until mid-September. With levels of social contact and consequential transmission likely to rise (especially in younger age groups, with many working in hospitality and similar sectors) so too will the number asked to self-isolate. The small number of double-vaccinated people who do contract the virus will still need to isolate, too.

What messaging is the government planning to ensure that those who need to isolate do so? Will it offer greater financial support, as has been trailed (but has been lacking throughout the crisis, undermining compliance)? Will it increase the use of ‘test and release’ (where regular, even daily, testing replaces isolation) to minimise disruption?

4. How will the government adapt its approach if things go badly?

With the current outbreak concentrated in schools and among young adults, the big uncertainty is how much it will jump over into older and more vulnerable groups. There is already some evidence of this happening in parts of the country, such as in the North East.^[3] This may be caused by levels of immunity and full vaccination being lower.

The other major threat, as the UK gets close to reaching herd immunity, is of another variant emerging. Most scientists think future variants are unlikely to fully evade vaccines entirely, but could chip away at their effectiveness and make the likely winter outbreak more severe. Variants are both more likely to emerge, and more difficult to control, when there is a large outbreak.

The prime minister was notably less emphatic than he has been previously on the “irreversibility” of measures, saying only that he “hoped” to avoid further legal restrictions. This is sensible, given the uncertainties ahead. The government should, however, offer clarity about how it will monitor its approach in the coming months – and what it will do to ensure it has the tools to continue to manage the threat of Covid over the longer term.  

1. https://www.thetimes.co.uk/article/voters-back-the-july-19-bonfire-of-covid-rules-9zkqd92j9
2. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronavir…
3. https://coronavirus.data.gov.uk/details/cases?areaType=region&areaName=North%20East