Prime Minister Boris Johnson has set out his ‘strategy for living with COVID’, which includes ending all domestic restrictions in England, including the legal requirement to self-isolate after a positive COVID test. Johnson says the guidance is “moving from government restrictions to personal responsibility”.
The restrictions were due to expire on 24 March 2022, but will now end one month earlier.
“From 24 February, we will end the legal requirement to self-isolate following a positive test, and so we will also end self-isolation support payments, although COVID provisions for Statutory Sick Pay can still be claimed for a further month,” Johnson told the House of Commons on 21 February.
“Until 1 April, we will still advise people who test positive to stay at home. But after that, we will encourage people with COVID-19 symptoms to exercise personal responsibility, just as we encourage people who may have flu to be considerate to others.”
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However, some scientists and doctors have expressed concern that the move is too soon and that it relies too heavily on vaccinations.
“Removing the requirement for isolation in the face of high infection levels will inevitably result in increased spread of the virus,” Professor Lawrence Young, a virologist and professor of molecular oncology at University of Warwick, told the Science Media Centre.
“The real level of current infection is uncertain given increasing use of lateral flow tests and inadequate reporting. This will be further compromised as people will not see the value of testing when they have symptoms or come into contact with infected individuals.
“We need to remain vigilant for the arrival of new variants and not let our guard down – testing, tracing and virus genome surveillance are vital. It is important that we stress the need to continue to protect the clinically vulnerable.”
Shouldn’t we be learning to live with COVID?
Prior to the announcement, Dr David Strain, the clinical lead for COVID services at the Royal Devon & Exeter NHS Foundation Trust, spoke to BBC Science Focus. He said ending the requirement for self-isolation with COVID-19 is premature. While learning to live with COVID is something we all want, Strain said we should be focusing on the current situation.
“We are really keen that we do, at some point, get rid of these restrictions and find ways to live with it. But for as long as hospital waiting lists are still growing, and we still have more people in hospital than we did when we went into Plan B, I think we’re probably premature to be dropping these restrictions.”
“We are once again pushing those who are clinically extremely vulnerable back into isolation, whether that be based on their age, whether it be on their co-morbidities… anybody who’s got cancer or who’s got a kidney disease. It’s putting all of that population back into isolation again. Except this time it’s doing so without a legal mandate and therefore without financial protection for those who need to work from home.”
63% of Britons oppose the decision for people in England to no longer have to self-isolate if they test positive for Covid-19
— YouGov (@YouGov) February 22, 2022
All Britons
Support: 30% / Oppose: 63%
Con voters
Support: 42% / Oppose: 53%
Lab voters
Support: 14% / Oppose: 82%https://t.co/p3nh9gdn3J pic.twitter.com/AL9jZCMbeT
Are we putting vulnerable people at risk?
Dr Raghib Ali, a clinical epidemiologist at the University of Cambridge and frontline clinician, says the risk for vulnerable people isn’t likely to change with the removal of restrictions, because many people who can will continue to self-isolate.
“I understand why people who are vulnerable are concerned, but I don’t think it’s going to make a difference to their risk… It’s not like we’re going from 100 per cent of people [testing positive] self-isolating to zero per cent.
“From what I’ve learned, voluntary behavioural change is very, very important to what actually happens. Back in 2020 between the second and third lockdowns, household visiting decreased, even though it was generally allowed, and it increased during the third lockdown, even when it was illegal. This is because, although it didn’t align with the law, it did align with the relative risk at that time – the risk was very low, so people increased their contacts. I’m not saying it was right to break the law. Of course, it wasn’t. But that’s what in practise will happen.”
Based on this previous experience, Ali believes the trajectory of infection rates will be unchanged by removing or keeping restrictions. “I’m confident, based on how people have behaved until now, that the majority of people will continue to isolate if they have symptoms,” said Ali.
However, relying on people to self-isolate without the legal requirement may exacerbate already existing inequalities, said Dr Stephen Griffin, a professor in the school of medicine at the University of Leeds.
“Vulnerable people require others to test, wear masks and isolate in order to prevent their exposure to infection. These trivial, and now familiar exercises are a small price to pay in order to allow everyone to move forward together,” Griffin told the Science Media Centre.
“Another [suggestion] was the opportunity to pay for testing, and advice to isolate when symptomatic but without financial or legal support. This exacerbates inequalities already present in society, and I would suggest that the vast majority of families can ill afford sufficient [lateral flow tests] to act responsibly.”
In his House of Commons announcement, Johnson said that from 24 February, self-isolation support payments would be ending “although COVID provisions for Statutory Sick Pay can still be claimed for a further month”. Many scientists and clinicians, including Ali, have said it would be better to continue with current provisions of sick pay for the foreseeable future.
Why are we stopping testing?
Mass testing is expensive, and it becomes less accurate the lower case numbers go, said Ali.
“For all health care interventions, we use a standard measure called the number needed to treat. So, if you need to test 1,000 people to prevent 1 infection, you might say, ‘Well, that’s not bad use of money’. If you need to test 10,000 people to prevent 1 case, then you might say that that’s not the best use of money. Maybe we should spend that on something else instead.”
These kinds of trade-offs require evidence, said Ali, and currently the understanding of the effectiveness of mass testing relies on observational evidence.
“You could ask, did countries which had no free lateral flow testing do worse than us? In Ireland or in any other comparable European country, it doesn’t seem that they’ve had significantly worse outcomes.
“That’s not the best level of evidence, though. It would be much better if we did a trial in the UK and compared two areas, one with free testing and one without, and see what the outcome is at the end of two months or something. I hope that will happen and that’s what I would advise the government to do.”
What if a new variant emerges?
Yet removing the restrictions “could undermine any hope of a preemptive rapid response to a new wave of infection.” according to Griffin.
“Naturally as a virologist I am also concerned that allowing high prevalence [of the virus] in a partially vaccinated population is a recipe for virus evolution to accelerate… we cannot predict the origin or nature of the next, inevitable variant of concern.”
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The Scientific Advisory Group for Emergencies (SAGE) have advised the government that “there is considerable uncertainty about the future path of the pandemic, and there may of course be significant resurgences”.
Johnson told ministers that SAGE are certain that new variants will emerge, and it’s possible they will be worse than Omicron.
However, Ali said the presence or removal restrictions will not affect the likelihood of a new variant. “There’s no there’s no guarantee that the virus will spread more [following 24 February]. In addition, a new variant can come from anywhere in the world and it will come to the UK, because we can’t stop that.”
Will we see more long COVID cases due to the restrictions ending?
Strain is the medical advisor for Action for ME, a charity supporting people with myalgic encephalomyelitis, a post-viral illness similar to long COVID. He said we have yet to figure out how to live with the virus long-term, especially considering there are millions of people in the UK with long COVID.
Some have even expressed concern for an increase in the prevalence of long COVID, if people are made to continue working while suffering with COVID-19.
“One clear fact about recovery from COVID-19, as with any significant viral infection, is that if a patient pushes too hard in the aftermath of the infection, this will slow their recovery,” said Dr James Gill, honorary clinical lecturer for Warwick Medical School.
“By removing the legal imperative to isolate following a COVID-19 infection, I have significant concerns… including that patients will become complacent in the face of infection, especially milder cases, resulting in further spread.
“Keeping in mind that currently 1.3 million patients are estimated to be affected by long COVID, and our understanding of the clear causes of this is currently still lacking.”