England is to end all of its remaining legal coronavirus rules – including the requirement for people with covid-19 to self-isolate – under a ‘living with covid’ plan announced today in parliament by UK prime minister Boris Johnson.
The significant shift means the country will begin to rely on guidance rather than rules backed with enforcement, almost two years after Johnson first ordered the nation into lockdown as the pandemic surged. Today’s step is about “moving from government restrictions to personal responsibility”, he said.
Self-isolation of people who test positive for the coronavirus will become guidance rather than a legal requirement from 24 February, and routine contact tracing will cease. Testing will be scaled back, with PCR and lateral flow tests no longer free for everyone from April. Ministers said tests cost £2 billion in January, though that figure is unusually high: it has more typically been £1.2 billion per month on average.
Whether the government is “following the science”, as it claimed in the early stages of the pandemic, is an open question. The office of Patrick Vallance, chief scientific adviser to the UK government, didn’t comment when asked this morning if he supported the move, pointing only to minutes from the Scientific Advisory Group for Emergencies (SAGE).
“It’s not a science decision: none of the recent SAGE minutes suggest this is a good time to be doing this,” says Christina Pagel at University College London. “We still have some of the highest infection rates we’ve had. I think it is the wrong time and sends the wrong message.”
Scaling back surveys and monitoring
An end to free testing will have a big impact on the UK’s covid-19 monitoring and surveillance infrastructure. The UK has been a world-leader on genome sequencing, which helped detect the alpha variant in Kent in 2020.
The Sanger Institute, for example, only sequences PCR tests from the UK Health Security Agency, not paid-for tests, so an end to widespread free tests in April will drastically limit the samples it can draw on.
The UK’s flagship monitoring scheme, the Office for National Statistics’ covid-19 infection survey, will continue with a breakdown by age and region to help track the disease, Johnson told parliament.
However, another random swabbing survey, REACT, run by Imperial College London, is expected to be axed at the end of March, New Scientist understands. Officially, no decision has been taken. A team from the US Centers for Disease Control and Prevention is visiting the UK this week to see how it can learn from the scheme.
Meanwhile, a survey measuring levels of social mixing, known as CoMix, will stop collecting data from the UK on 3 March. Christopher Jarvis at the London School of Hygiene & Tropical Medicine, who leads the survey, says he is relaxed about the end: “It’s definitely been useful but I don’t think there will be any major decisions that can’t be made without it.”
Following in Denmark’s footsteps
Whether the lifting of legal rules will drive a surge in England’s covid-19 figures remains to be seen. The rolling seven-day average for daily cases stands at around 37,000 as of 13 February, the most recent figure, with around 1000 people admitted to hospital daily, while deaths have been relatively stable at more than 100 a day for most of February.
One glimpse into the future may come from Denmark, which lifted its remaining legal covid-19 mitigations on 1 February. “I think it has proved to be the right decision,” says Troels Lillebaek at Statens Serum Institut, Denmark. Cases have subsequently plateaued and are now falling.
Denmark has been accused by some people of seeing surging death rates after the relaxation, but Lillebaek says the concerns have stemmed from misunderstanding how Denmark counts deaths. Currently, about 60 per cent of people dying with covid-19 are dying due to the disease, and 40 per cent due to other causes. With the delta variant, covid-19 was causing around 80 per cent of deaths in people who had the disease.
Despite pressure on the healthcare system it hasn’t been overwhelmed, says Lillebaek. Most people are either discharged immediately or the next day after being assessed, he says. For example, of 1587 current hospital admissions who have tested positive in the past 30 days, just 40 are in intensive care and of those only 18 are on respirators.
“It’s going as good as you could have hoped. We have been through the wave: in Copenhagen and Zealand it has already peaked,” says Lone Simonsen of Roskilde University, Denmark. Extremely high booster vaccination rates in older age groups in Denmark has been key for making the relaxation possible, she says.
Nonetheless, she says that even with the protection offered by vaccinations, people are still getting mildly sick. “It’s not fun. [But] once you’ve had it you can enjoy the silver lining of an excellent immunity,” says Simonsen.
Article amended on 22 February 2022
We corrected the rolling seven-day average figure for England
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