Intended for healthcare professionals


We can live with covid, but that doesn’t have to mean living with avoidable deaths and disability

BMJ 2022; 376 doi: (Published 10 March 2022) Cite this as: BMJ 2022;376:o638
  1. John Middleton, president
  1. Association of Schools of Public Health in the European Region

Messaging is everything in the covid-19 pandemic. Over the past few years, public health professionals have been painted with the dark tints of “killjoys” and “prohibitionists.” Some have even been called the “pro-lockdown experts,”1 as if a lockdown were something anyone would wish on our communities. We rightly listen when the great voices of public health who have charted us through the pandemic speak: Devi Sridhar tells us that covid-19 has been largely “defanged”;2 Chris Murray of the Institute for Health Metrics and Evaluation talks about “the end of the pandemic”;3 and Tom Frieden4 and David Heymann5 also prepare us for the end.

Among all of these commentators, there’s been a note of caution about when to apply the judgment of taking off the brakes and an emphasis on maintaining strong surveillance systems, continuing the effort to get everyone fully vaccinated, and keeping in the public consciousness the likelihood that social protections will need to be switched off and on,3 as the impact of omicron and the arrival of new variants dictate. We should also keep in mind the risk of the next variant being more severe with vaccine escape.6 Somewhere in the optimism and hope of a lot of this messaging from experts, the nuance and the caution has been swept aside in England by many politicians’ drive for political expediency. When the new “Living with covid” strategy was announced by prime minister Boris Johnson, our political leaders took the opportunity not just to relax our approaches to virus transmission but to throw them out altogether.7

The peak of omicron may be just passing, but deaths in the UK have remained at a plateau since the start of the year and are still averaging around 100 a day.8 The number of people testing positive for covid-19 is climbing and on 9 March 2022, more than 60 000 people had a positive test result.8 It is still adding to hospital activity, which is exhausting for healthcare staff, and which prevents other treatments being done, adding to the ever growing backlog of elective care. The vaccination programme has all but ground to a halt,9 even though around a third of UK adults haven’t had a booster dose. Even with a fully vaccinated population, we are not sure of how waning vaccine efficacy may play out.

The announcement of all restrictions ending creates the message that covid-19 has all but disappeared when it has clearly not. Suggestions in many countries that isolation periods be reduced—and now, indeed, the abolition of the legal requirement to self-isolate altogether in England—threaten to allow a second spike of omicron infections, putting vulnerable adults at further risk.

“Living with covid” means recognising that what we previously called “restrictions” should be called “protections.” The language of “freedom” and “removing restrictions” leaves the country unprepared for the next potential wave. Certain behaviours that people adopted and governments mandated during the first waves of the pandemic can still be helpful, and should be kept, to protect our health in winter in the future—whether from covid-19 or other respiratory viruses. These include working from home when possible, washing hands more frequently, wearing a well fitting N95/FFP2 mask in crowded and indoor public spaces, improving indoor air quality, and still enabling remote healthcare consultations.

It’s also vital that we leave behind a culture of presenteeism. Whether it is flu or any other respiratory virus, no one should go to work or feel pressured to if they are ill. The end of the legal requirement to self-isolate with covid-19 in England, along with the scaling back of sick pay and other financial support, is just plain reckless, particularly in a country where almost a quarter of workers receive only basic statutory sick pay and an estimated 9% receive nothing.10 The onus shouldn’t be on individuals to choose between coming to work and risking spreading the virus or losing out on income. Societal protections like sick pay should still reflect and acknowledge the benefit to society from people staying off work because they are ill and infectious, while protecting the incomes of those who are most vulnerable to financial hardship.

We need to learn from the new phase of the pandemic and strengthen primary and community services, school health, and occupational health.11 “Living with covid” also means acknowledging that no single measure can protect us from covid-19 so we need to have all our armoury of measures available at the same time to reduce transmission, disease, and deaths.1213

The pandemic has been characterised in the UK by the diversion of large sums of taxpayers’ money into private hands. Within 24 hours of the prime minister’s announcement of the end of all restrictions, new opportunities for the privatisation of the pandemic came out of the woodwork. Boots, for example, will now sell lateral flow tests at £5.99.14 Abandoning support for people who are self-isolating also effectively privatises the decision on isolation—putting the onus on employers to give employees proper sick pay (when they have failed to do so previously) and, potentially, on individuals to see if they can afford being off ill.

Our government’s messaging has long been characterised by political expediency ahead of public safety. We can live with covid, but that doesn’t have to mean living with avoidable deaths and disability.


  • Competing interests: JM is honorary professor of public health, Wolverhampton University. None further declared.

  • Provenance and peer review: Not commissioned; not peer reviewed.


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