Intended for healthcare professionals

Opinion

Covid-19: One year on from “Freedom Day,” what have we learnt?

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1803 (Published 19 July 2022) Cite this as: BMJ 2022;378:o1803
  1. Simon Williams, lecturer in psychology1,
  2. Susan Michie, professor of health psychology and director2
  1. 1School of Psychology, Swansea University, Wales, UK
  2. 2Centre for Behaviour Change, University College London, London, UK

If we are to successfully live with covid, we need to draw on past lessons, say Simon Williams and Susan Michie

Although many people in the UK may think that the covid-19 pandemic is over1—an understandable conclusion given its relative lack of media coverage and the government’s “Living with Covid” strategy2—it is still very much ongoing. In June and July we witnessed the third wave of cases and hospitalisations in 2022 alone,3 with another potentially more severe wave predicted for the coming autumn or winter.4 In between these waves, the level of transmission has remained high. This is unsustainable for many reasons, including the pressure it puts on the NHS, the large scale illness and absenteeism it leads to, the burden of long covid, and the potential for further, more deadly variants to evolve.

Recent data suggest that protective behaviours, like mask wearing or self-isolating when ill, have been falling in recent months.5 Moreover, the government has removed protections like free testing and financial support for self-isolation, and has not taken steps to make the environment safer—either by ensuring adequate ventilation and/or air filtration in public spaces or maintaining momentum in the covid vaccination and communication campaigns.

A year ago, ahead of the so called “Freedom Day” in the UK on 19 July 2021, the government published a SAGE paper that looked at how we maintain behaviours that reduce the transmission of infection.6 The report argued that, with the removal of legal measures, protective behaviours against covid-19 would not be sustained without a variety of coordinated interventions across the private and public sector.

Unfortunately, their advice on how to move from a rules based approach to one that manages risk in a more holistic way through our everyday behaviour has not been followed by the government. To start with, it would help to emphasise how key behaviours can still minimise risk, such as socialising outdoors, working from home when possible, and, crucially, staying at home when ill. We also need to remember that tackling a pandemic is not just down to an individual’s motivation, but also the capabilities and opportunities they are provided (or not provided) with.7 And individuals are of many types—employers, managers, planners, politicians—everyone has a part to play.6

The Swiss Cheese model of pandemic risk management proposes that multiple layers of protection are necessary in order to build a more resilient system that minimises risk of failure while maximising the ability to operate effectively.89 So, what behaviours and what supports do we still need to consider for the next phase of the pandemic?

Firstly, we need look for ways to maintain reasonable behaviours that help to reduce transmission:

Face masks

High grade (FFP2/FFP3) face masks remain an important mitigation tool to help reduce the spread of infection.10

Covid testing

People should be encouraged to test for covid during predicted or emerging case rises when they are symptomatic or when they are visiting someone who is vulnerable. This will help people to identify whether they have the virus and to inform their decision as to whether and for how long they should isolate (see below).

Open windows

Opening windows has been shown to lower transmission risk indoors and air filtration is also effective.11

Vaccinate

People should be enabled to get all vaccines for which they are eligible by appropriate targeted communication and accessible opportunities.

Isolation

People should be encouraged by managers and colleagues to stay off work if they feel unwell or have symptoms associated with covid, flu, or other infectious diseases.

Distancing

Social distancing can take many forms and it doesn’t mean cutting off social contact altogether. Socialising should occur outdoors as much as possible and indoor settings can be arranged to avoid crowding. People can consider when they take public transport and which venues they visit according to both how much distancing is possible and the ventilation in place.

Secondly, we need supportive policies that could be tailored to objective assessments of the situation threat. For example, free testing could be reintroduced during specific periods when rates are starting to or forecasted to increase (especially for certain groups, for example those who are symptomatic, clinically extremely vulnerable, or in “high contact” and essential professions). At these times, FFP2 masks could be provided free of charge to those eligible for free prescriptions. Offering financial support to self-isolate and encouraging more home working should be reintroduced when rates are high.

Organisations should look to build more sustainable hybrid work models that might, for example, include greater home working during the winter. As well as clear communication of the benefits of natural fresh air, investment in ventilation in schools, workplaces, public transport, and other public indoor settings should be pursued.

Communication campaigns for vaccines need to emphasise the ongoing need to “top up” immunity. Vaccine drives, including the first booster drive during the omicron wave last winter and future campaigns, need to have strong, clear recommendations. We should still be trying to reach those who are unvaccinated or partially vaccinated, making sure that vaccines are accessible to all and that information and support is available to allay people's concerns.

The current UK strategy omits the “learning” from “learning to live” with covid.12 If we are to successfully live with covid, we need to draw on past lessons and follow an evidence based approach.13

Footnotes

  • Competing interests: SM is a member of the Scientific Pandemic Influenza Group on Behaviours (SPI-B): 2019 Novel Coronavirus (Covid-19) and of Independent SAGE. SW has received funding from Public Health Wales and Senedd Cymru for research on covid-19, but the views expressed in this article are that of the authors only.

  • Provenance and peer review: not commissioned, not peer reviewed.

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