Closing our eyes to covid won’t make it go awayBMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o743 (Published 21 March 2022) Cite this as: BMJ 2022;376:o743
- Kit Yates, senior lecturer
- Twitter: @Kit_yates_maths
It’s been over three weeks now that cases of covid-19 and hospital admissions have been rising in England. Still, many of the people I speak to are unaware that we are potentially entering yet another wave of this coronavirus pandemic.
Quite understandably, given the appalling events in Ukraine, the news cycle has largely moved away from covid. The BBC’s coverage of the removal of all remaining UK travel restrictions made no mention of the fact that these measures were being removed in the face of rising cases and worsening pressures on the NHS.1 The seven day average of reported cases is now as high as it was in mid-December 2021, at over 70 000 cases a day. This is against a background of significantly reduced testing, meaning the true number is likely to be substantially higher.
The rises are being driven by a combination of factors in England. Firstly, it seems likely that immunity from the booster vaccine may be waning in older populations. This age group were among the first to receive their boosters and they typically have the worst outcomes upon being infected with covid.2 But with the age-staggered delivery of the booster programme, if these rises were driven solely by waning immunity, we would expect to see cases and admissions rise in different age groups at different times. Instead, the uptick happened across all age-groups at roughly the same time.
Secondly, the impact of the government’s decision to remove all remaining covid mitigations will undoubtedly have served to increase the number of people being infected and admitted to hospital as a result of covid, especially while some employers have been encouraging their staff to come in to work while testing positive.3
Thirdly, we have a new subvariant of Omicron, BA.2, which is now dominant across the whole of the UK. Even more transmissible than its predecessor BA.1, which caused the wave we have just exited, BA.2 is likely fuelling much of the rise in cases we are seeing across Europe at the moment.4 It is worth remembering that the UK is not the only country to have relaxed covid mitigations in recent weeks, with much of Europe also taking the view that is it time to “move on from covid.”
Fourthly, a perhaps underplayed factor driving the recent rises is behavioural change. As covid falls off many people’s radars and the government sends the message, both explicitly and implicitly through the relaxation of mitigations, that the UK is “past the pandemic,” people’s behaviour becomes less cautious. Opinion polls suggest that people in the UK are taking fewer precautions now against covid than at any point during the pandemic.5 Inevitably this will make a big difference to the spread of the disease.
At the same time as we are experiencing rapid rises in cases and increased pressure on hospitals, the government is focused on dismantling many of our covid surveillance systems.6 This is despite the fact that we know, in the face of an ongoing and uncertain pandemic, that it’s always better to be more informed—to have more independent data streams to draw on—than less. Thankfully we will still have the ONS infection survey, albeit in a reduced form. However, funding cuts to the REACT study—which survey’s 150 000 people across England every month to give us a picture of covid infection across the country—means we will be hindered in our ability to see what is happening with covid. It’s ironic that after so much boasting about being “world-beating” on vaccination and test and trace, that the government is axing one area of the UK’s covid response that genuinely is world-leading—our surveillance capabilities. The withdrawal of funding for the ZOE coronavirus study and REACT is consistent with the government’s ongoing quest to convince us that things are “back to normal” by removing the ability to properly track what’s happening with covid.
Despite what we are being led to believe, coronavirus is still a threat, and it will be while we fail to take precautionary measures. You don’t mitigate against an infectious disease by not keeping track of it anymore. You mitigate against it by taking measures like improving ventilation, like implementing good public health messaging, like encouraging masks in crowded indoor environments, like providing easily accessible testing which allows people to know when they are infectious and take appropriate action.
The removal of free mass testing is part of the same strategy. Boris Johnson’s insistence that he will ensure that the general public will “always be able to buy a test” completely misses the point. Many people in the UK will not be in the position to spend a significant portion of their budget on testing each week. Others will simply be put off by the cost. The consequence will be that testing drops even further than it already has, people become less aware when they are infectious and consequently less able to take the “personal responsibility” that the government have been advocating for so vociferously in the aftermath of their removal of other covid mitigations.
The prime minister has been advancing the idea that it is time we “get our confidence back.”7 But closing our eyes and hoping for the best isn’t confidence, it’s foolhardy recklessness. While we continue to view covid as a national-level issue that we can unilaterally declare ourselves “past” by removing mitigations and testing, we will continue to feel the impacts of new covid variants, which will inevitably lead increased sickness and a higher healthcare burden, whether we choose to recognise that or not.
Competing interests: KY is a member of Independent SAGE.
Provenance and peer review: commissioned, not peer reviewed