As the UK heads to a lifting of virtually all COVID-19 restrictions on 19 July 2021 the reality is that the pandemic will not suddenly be over. In the Downing Street briefing of 5 July 2021, Prime Minister Boris Johnson referred to “learning to live with COVID,” and the need to “balance the risks.”
It is only because of the success of the vaccine campaign in weakening the link between COVID-19 cases and hospital admissions and deaths that this final lifting of restrictions is possible. Cases, primarily amongst the unvaccinated, will continue to rise for some time but with those most likely to become seriously ill with COVID-19 protected by vaccination, the hope is that the vast majority of new cases will cause only a mild illness in otherwise younger, healthy people.
The lifting of most restrictions is not without risks, the UK will be the first country in the world to try and return to a pre-pandemic normality, but as PM Johnson said, “If we don’t try and open up now we run the risk of either opening up at a very difficult time when the virus has an edge, has an advantage, in the cold months, or again putting everything off to next year." (1)
The virus will not disappear and we will have to live side by side with it for many months, and possibly years, to come.
What does living with COVID-19 mean?
The consensus of the UK Science and Technology Committee is that the long-term goal has to be to live with the virus - not fight to eliminate it.
Their chairman, MP Greg Clark told the BBC, “We can't aim for ‘zero’ Covid deaths, the UK is going to have to live with some level of Covid infections and deaths in the future.”
When pushed for what might constitute an acceptable level of infections and deaths he admitted, “I don’t think you’re ever going to have a precise figure [for acceptable levels], just as we don’t target a figure for road deaths.”
It is a valid point. We know, as fact, that every year a certain number of people will be killed or injured as a direct result of a car accident. We know there will never be a time when there are no road traffic accidents. We continue to go out and drive our cars not because we are foolish but because it is deemed an acceptable risk. Whilst we could have an accident, statistically we are far more likely to not have an accident.
For most of the past 18 months COVID-19 presented a far greater risk to health than driving a car. Nearly 129,000 people have died from COVID-19 in the UK in comparison to the 1,870 people who were killed in road traffic accidents over the whole of 2019. (2)
If there were as many fatal road accidents per year as there have been COVID-19 deaths we may feel less inclined to drive our cars. Recognising a risk does not mean we should always take that risk. To live with COVID-19 we first needed to reduce that risk, and that meant protecting those most likely to become seriously ill and/or die from COVID-19. The UK’s vaccination programme has now offered a COVID-19 vaccine to every adult over the age of 18 years. 45 million adults have received a first dose and 33 million adults have received a second. The hope is that all adults will have received two doses by mid-September and a third, booster dose will then be rolled out for those in the original groups 1 to 9 (those aged 50 and over or medically vulnerable) who were vaccinated at the beginning of the campaign.
Now we have vaccines why can’t we eradicate COVID-19?
It certainly sounds plausible that if we now have vaccines against COVID-19, could we not drive it away completely? Sadly even with vaccines it is virtually impossible to eradicate a virus.
Mankind has only achieved it once, with smallpox. The total eradication of smallpox was declared in 1980 but it took many years to reach that point. It was achieved through vaccination but the smallpox virus also behaved very differently to the coronavirus and this aided the work to eradicate it. (3)
Firstly, it was easier to track and trace people with smallpox. Unlike COVID-19 there is no such entity as an asymptomatic illness with smallpox or a silent spreader.
Secondly the smallpox virus did not mutate as fast as the coronavirus does which meant the vaccine did not have to be regularly adapted to include booster shots against new variants. And once the vaccine was given it was easy to know if it had worked because a small pustule developed at the injection site. (4)
Despite these distinct advantages over COVID-19 it still took decades of work to reach complete eradication of smallpox.
Trying to achieve total elimination of COVID-19 is not just about waiting until everybody is vaccinated either. As Professor Francois Balloux of London’s UCL University said, “Eliminating Covid-19 completely would require a huge economic and social cost, and would not be compatible with the individual rights and freedoms that characterise post-war democracies." (5)
Ongoing lockdowns and restrictions could become harmful in their own right. The physical, mental and financial hardships they cause cannot continue as and when the gains from them become less and less. The “Zero Covid” approach may seek to eliminate the virus but at enormous cost to society.
So if we have to live alongside the virus anyway why didn’t we ease lockdown earlier?
If living alongside the virus is the only option is there an argument that lockdown restrictions should have been lifted far sooner? Or never even imposed?
The short answer is “No.”
Although scientists predict that COVID-19 will eventually occupy a similar role to flu in the human disease repertoire, this was not the case over the last 18 months. The COVID-19 pandemic was not like a bad flu season, it was far worse.
In England in winter 2019-20 the number of flu deaths was 7,990; in winter 2018-19 there were 3,996 flu deaths and in the severe outbreak of winter 2017-18 there were 22,087 flu deaths. (6)
COVID-19 deaths to date in the UK are close to 129,000. In one year, COVID-19 has already killed nearly four times as many people in England as flu did over the past three years combined. (7)
If we had lifted all of the lockdown restrictions earlier, and before the vaccination campaign began, we would have seen many, many more COVID-19 deaths with some predicting up to 500,000 deaths if no lockdown measures were implemented. (8)
The NHS was brought near to breaking point during the second wave of the pandemic and it had to be protected, not just so it could still admit and treat COVID-19 patients but so it could try and continue its non-COVID-19 work that continues to back up. Easing restrictions too quickly, and before more of the population were vaccinated, could have sent the NHS into a final tailspin. With patients sometimes having to be sent to ITUs hundreds of miles away from where they lived as hospitals up and down the country ran out of beds it was not just political talk or posturing when we were told there was a threat to the NHS - it was very real and at the peak of the second wave of infections it came perilously close to not being able to treat some people. (9)
Professor Chris Whitty, the Chief Medical Officer for England, has explained that the biggest challenge now is to "keep ahead of the virus."
He suggests we can get to the point where we "de-risk" COVID-19 though sadly that does not mean no-one will die. Society will have to reach a point where it decides what he describes as a "tolerable" level of death. That sounds harsh but we are doing it all the time, though usually without realising it whether it’s going out in our cars or living alongside flu. (10)
The New “Normal”
Details about what level of restrictions may remain after 19 July are yet to be finalised by the government but this is the current information.
The wearing of face masks will no longer be mandatory but an individual’s choice. Professor Whitty has outlined the three scenarios where he would continue to wear a face mask which are, "The first is any situation which is indoors, crowded, or indoors with close proximity with other people... the second situation I'd do it is if I was required to by any competent authority... and the third reason is if someone else was uncomfortable if I did not wear a mask," he said. (11)
Some will be keen to ditch their face masks at the first opportunity but many will want to keep wearing them. Mask wearing will, I suspect, remain commonplace in the UK and no longer something associated only with overseas visitors. Personally, I will continue to wear one on public transport and indoor, public places until the COVID-19 case rate drops substantially.
Those who test positive for COVID-19 will continue to self-isolate for 10 days even if asymptomatic. However, the self-isolation rules for their contacts will change. Instead of also having to isolate they may instead be asked to take a daily lateral flow test and isolate only if they test positive for COVID-19. Those contacts who have been fully vaccinated may not be required to isolate at all.
Although there will be no legal requirement to carry a proof of vaccination status, some businesses may choose to require them and will be entitled to refuse entry to those without proof.
School bubbles are not expected to continue after the summer and pupils will no longer be sent home en-masse whenever there is a case of COVID-19 in their class or year. Instead, just like the general population, contacts of a positive case will be asked to take a COVID-19 test and only those testing positive will have to self-isolate. Fully vaccinated teachers will not have to self-isolate if a pupil in their class tests positive. There will be no more face masks, staggered starts and finishes to the school day or social distancing measures within schools. (12)
Although masks will not be mandatory on public transport, the London mayor Sadiq Khan is calling for masks to remain compulsory on London Transport and many mayors throughout the UK are following suit. Some airlines have said masks will still be required on their flights. (13)
Will the new normal include compulsory COVID-19 vaccination?
Unlike many countries around the world, childhood vaccination is not legally enforced in the UK. Generally, neither is adult vaccination with some exceptions in certain professions. All health care workers who carry out EPPs (Exposure Prone Procedures) must be vaccinated against Hepatitis B and have documentation to prove they have ongoing immunity as a prerequisite for work. There is ongoing discussion at the time of writing as to whether vaccination against COVID-19 will be made mandatory for certain healthcare professionals in the UK.
Individual organisations and companies will not be asked to take on the vaccination of their staff as all UK citizens will be vaccinated by the NHS. However there may be ramifications for people refusing to have the vaccine with regard to their employment. For example, a plumbing firm in London has already stated that its employees must be vaccinated against COVID-19. (14)
It is too soon to know how exactly employment law and COVID-19 vaccination are going to mesh together given the legal ramifications of compulsory vaccination. (15)
Overseas Travel
Proof of COVID-19 vaccination may become a prerequisite for travel to many places. This is already the case with Yellow Fever whereby some countries require proof of vaccination before allowing entry.
Organisations that regularly send employees overseas, especially to low income countries that are particularly vulnerable disease-wise, may find they can only send those who have been vaccinated.
It is too soon to know how holiday travel will be affected long term. Rules over vaccine and/or quarantine requirements differ country to country around the world and are continually changing. The UK is currently operating a red/amber/green labelling system for overseas travel based on the level of infection in a country. However, a country declared “green” (and therefore safe to travel to) may not be accepting overseas visitors. This is the case with for example, Australia and New Zealand, who whilst on the UK's green list are not allowing anyone other than their own citizens to enter.
The UK, along with the USA and Israel, are speeding ahead with their vaccination campaigns. This is not the case with most other countries making it increasingly likely that foreign travel will remain chaotic and disrupted for months to come as rules keep changing depending on an individual country’s COVID-19 status.
In Conclusion
In the UK, COVID-19 is no longer as deadly as it was this time last year. A year ago 1 in 10 people with COVID-19 ended up in hospital, now it is 1 in 50. Those in hospital are tending to be less sick and recovering quicker. A year ago, 1 in 60 people with COVID-19 died, that figure is now less than 1 in 1,000. However, cases are rising daily and another wave of infections is being seen. The difference is that the vaccination programme has broken the link between the number of cases and the number of hospital admissions and deaths.
As the risks from the virus diminish, it is still important to realise they will not disappear. Indeed, as Professor Paul Hunter from the University of East Anglia says: "Covid will never go away. It's inevitable that we're going to catch it repeatedly for the rest of our lives, whether we have had the vaccine or not. The issues becomes not whether it is safe to lift all restrictions, but when would it be safest to do so. Waiting until the Autumn when schools are back and the flu season is getting under way could make the situation worse.” (16)
COVID-19 is here to stay and we are unable to change that. The hope is that through the combination of the restrictions of the last 18 months and the roll out of vaccinations, the UK has finally reached the stage of being able to manage it. The whole world will be watching to see if our vaccination "wall of immunity" is going to be strong enough to keep us unlocked.
(12) https://news.sky.com/story/covid-19-school-bubbles-to-end-in-england-gavin-williamson-says-12349910
(15) https://www.pinsentmasons.com/out-law/guides/coronavirus-can-uk-employers-require-staff-vaccinated
