The views of experts and health professionals on whether the COVID pandemic is over, and on the lifting of COVID self-isolation after a positive test.
First published in February 2022.
Question: IS THE PANDEMIC OVER?
Having removed Plan B restrictions and the legal requirement to wear face masks, the UK Government has declared that the UK has passed the Omicron peak and suggested that it is time for the British people to live with Covid-19 “like it does flu”.
What the experts say...
Dr David Nabarro, WHO Director-General’s Special Envoy on COVID-19 Preparedness and Response, Co-Director and Chair of Global Health at the Institute of Global Health Innovation, Imperial College London:
“The end is in sight, but how long is it going to take to get there? What sort of difficulties will we face on the way?
“Those are the questions that none of us can answer because this virus continues to give us challenges and surprises.
“It’s as though we’re just passing the halfway mark in a marathon and we can see that yes, there is an end and fast runners are getting through ahead of us. But we’ve still got a long, long way to trudge and it’s going to be tough.
“I keep wondering what the people who make these amazing predictions know that I and my colleagues in the World Health Organisation don’t know.
“You see, what people are seeing from around the world and reporting to the WHO is this is still a very, very dangerous virus, especially for people who’ve not been vaccinated and who’ve not been exposed to it before. It can also mutate and form variants and we’ve seen several but we know there are more not far away.
“So quite honestly, we are not saying that this should be considered to be like flu or indeed like anything else.
“It’s a new virus, and we must go on treating it as though it is full of surprises, very nasty and rather cunning.”
Professor Peter Openshaw, Mucosal Immunologist and Respiratory Physician, Professor of Experimental Medicine, Faculty of Medicine, National Heart & Lung Institute, Imperial College London, and a Member of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag):
“We have no way of concluding that viruses have to become less severe over time.
“It could be the next variant – and there will be another – could be more severe for all we know. There’s no rule about this.
“Omicron and sub-lineages of them are able to escape previous immunity so they are going to increase in number over time.”
Professor Aris Katzourakis, Professor who studies Viral Evolution and Genomics at the University of Oxford:
“The word ‘endemic’ has become one of the most misused of the pandemic. And many of the errant assumptions made encourage a misplaced complacency. It doesn’t mean that COVID-19 will come to a natural end.
“A disease can be endemic and both widespread and deadly. Malaria killed more than 600,000 people in 2020. Ten million fell ill with tuberculosis that same year and 1.5 million died. Endemic certainly does not mean that evolution has somehow tamed a pathogen so that life simply returns to ‘normal’.
“As an evolutionary virologist, it frustrates me when policymakers invoke the word endemic as an excuse to do little or nothing. There’s more to global health policy than learning to live with endemic rotavirus, hepatitis C or measles.
“There is a widespread, rosy misconception that viruses evolve over time to become more benign. This is not the case: there is no predestined evolutionary outcome for a virus to become more benign, especially ones, such as SARS-CoV-2, in which most transmission happens before the virus causes severe disease.
“Thinking that endemicity is both mild and inevitable is more than wrong, it is dangerous: it sets humanity up for many more years of disease, including unpredictable waves of outbreaks.”
Dr David Putrino, Director of Rehabilitation Innovation for the Mount Sinai Health System, Assistant Professor of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, New York:
“There is a lot of temptation to say ‘Look, it’s going to be endemic. Just go out and get it over with.’
“But we’re seeing firsthand how much it just devastates an individual to live with long COVID. It doesn’t seem like a proportionate risk. For me, it seems like a really huge gamble [to assume] that you’re not going to be the one in 10, or even the one in 100, who goes on to have your entire life turned upside down.”
Sir Jeremy Farrar, Director of the Wellcome Trust and former SAGE member:
“I just don’t think you wake up on Tuesday and it’s finished. It’s not going to happen like that.
“The transition from [the] acute phase of the pandemic to something new, not yet defined, it’s really difficult – bumpy, different around the world, different within a single country, with the degree of inequity that’s happened globally, but also nationally.
“My concern is that there will be too fast a shift to saying it’s all over and we will lose the humility of accepting that we’re only two years into a novel human pathogen, that is still a huge amount of uncertainty.
“My worry in the push to try and move on from this [is that] we ignore those other scenarios, which are less rosy but we should be absolutely prepared for.
“I would be in favour of continuing for instance, mask wearing on public transport, in enclosed spaces, etc. And I would be pushing ever harder on trying to encourage people to be vaccinated, get their boosting doses, and make sure that everybody has access to the vaccines from a UK perspective.”
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization:
“Since Omicron was first identified 10 weeks ago, almost 90 million COVID-19 cases have been reported to the WHO. We are now starting to see a very worrying increase in deaths, in most regions of the world. It’s premature for any country either to surrender or to declare victory.”
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Question: IS THE INCLUSION OF COVID REINFECTIONS INTO THE DAILY DASHBOARD A GOOD IDEA?
What the experts say...
Professor Sir David Spiegelhalter, Winton Professor of the Public Understanding of Risk at Faculty of Mathematics, University of Cambridge:
“We have always known that the daily number of reported cases was a substantial undercount of the actual number of infections – the ONS Covid Infection Survey shows that we have to at least double the daily count.”
“Including reinfections will be an improvement, and will reduce the apparent case-fatality rate, but nobody should have taken this very seriously anyway. The case-fatality ratio is inevitably an overestimate of what is the better measure – the infection fatality ratio, ie the proportion of those who are infected who die, whether or not they become confirmed cases.”
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Question: IS LIFTING COVID SELF-ISOLATION RULES NOW A GOOD IDEA?
Prime Minister Boris Johnson told the House of Commons that he is soon to announce the lift of all remaining restrictions, including the self-isolation rules on positive cases.
What the experts say...
Professor Aris Katzourakis, Professor who studies Viral Evolution and Genomics at the University of Oxford:
“There is no way dropping self-isolation can be described as sensible public health policy.”
Professor Stephen Reicher, Professor of Social Psychology, School of Psychology & Neuroscience, University of St Andrews, Member of the Scientific Advisory Group for Emergencies (SAGE) subcommittee on behavioural science:
“Taking away the obligation to self-isolate is the final and most powerful way of saying ‘it’s all over’ and that infections don’t matter.
“We know that perceptions of risk are critical to adherence and that people won’t do things if they believe there is no need to do them, however much they are urged.”
“This is a pandemic of inequalities.
Amongst the most deprived, roughly 1 in 16 people has Omicron.
Amongst the least deprived it is 1 in 30.
So when you end all measures and let infection rip, remember, you don’t just cause harm, you specifically harm the most vulnerable.”
Professor Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, a member of Independent Sage:
“Given how there are still many people in England unvaccinated, this seems a surprising decision but it will be important to see the advice on which it is based.
“Otherwise there is a risk that it will be seen as a distraction from the prime minister’s many other problems. And of course, as the prime minister says it all depends on what happens next, something none of us can know.”
Professor Devi Sridhar, Professor & Chair of Global Public Health, Edinburgh University Medical School:
“Are we all thinking the same thing? It feels like some of UK decision-making around COVID-19 is being driven by parties. Even Denmark, which has largely released restrictions bc of high vaccine uptake, still requires people to isolate if positive so they don't infect others.”
Professor Colin Davis, Professor of Psychology, Chair in Cognitive Psychology, School of Psychological Science, University of Bristol:
“I have questions:
Has the Chief Medical Officer commented on the plan to end self-isolation rules?
He is not going to be a passive bystander, surely?
How much sickness and death will result from this change of policy?
What are the immunocompromised supposed to do?”
Dr Mike, Doctor in Emergency Medicine in the NHS:
“If you are immunocompromised or vulnerable this is terrible news.
We are not following the science.
We haven’t immunised the world.
We are not following WHO guidance.
Designed to placate Tory backbench rebels and a vocal part of the population.”
Professor Christina Pagel, Director of University College London’s clinical operational research unit, member of Independent Sage:
“Dropping isolation makes work and socialising riskier and boosters are waning, COVID keeps evolving and it is harder to know about local case levels.
“Basically the government plans that we will all get COVID several times – like a cold but with a much more dangerous disease.
“Not science based.”
“We’re concerned the Government have announced plans to bring forward the scrapping of isolation rules in England and know how much anxiety and anger it will cause for people in our community.
“We’re yet to see the Government set out their plan describing how the country will learn to live with COVID, specifically how people with blood cancer and others who are immunocompromised will be able to return to a normal life.
“That plan must include additional support for our community including employment support and making it as easy as possible to access vital COVID treatments. Ministers also need to ensure the public know that there are 500,000 in the UK for whom the vaccine is less effective... and therefore are not as ‘free’ as everyone else.
“It is reckless for the Secretary of State to say that this change will makes us the ‘freest country in Europe’ as it will mean the opposite for anyone less protected by vaccination.
“Throughout the pandemic, we’ve called for someone in Government to take responsibility for the immunocompromised and our calls have been ignored. Now more than ever, it’s vital this happens for our community to get the support they need.”
Dr Nisreen Alwan, Associate Professor in Public Health, University of Southampton. Public Health. Epidemiology:
“Here’s a bit of perspective. If you have diarrhoea or vomiting you’re required to stay off school or work for at least 2 days after your last episode (48 hours symptom-free) but if you have COVID you won’t be required to isolate at all even while symptomatic? 😱
“ONE in NINE kids aged 2-11 in England had COVID the week ending 5 February. Highest of all age groups. This is before scrapping isolation requirement when infected, removing the final layer of protection for kids in school if this happens in a couple of weeks.”
Dr Rachel Clarke, NHS Palliative Care Doctor:
“I understand the political benefits of declaring the pandemic over – but I want to hear from Whitty, Vallance or Van Tam urgently, in person, on television, explaining how on earth this is following the medicine/science. Isn’t the public owed that?”
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Dr James Gill, Honorary Clinical Lecturer, Warwick Medical School:
“Frankly I see no justifiable reason for the scrapping of this law, certainly not from the perspective of patients, nor from a business case either as the omicron variant is highly contagious, and thus more likely to spread through a staff group if people feel compelled to come to work with a “mild COVID-19 infection”.
“One clear fact about recovery from COVID-19 as with any significant viral infection is that if a patient pushes too hard in the aftermath of the infection, this will slow their recovery. By removing the legal imperative to isolate following a COVID-19 infection, I have significant concerns:
i) Patients will become complacent in the face of infection, especially milder cases, resulting in further spread – keeping in mind that currently 1.3 million patients are estimated to be effected by long COVID, and our understanding of the clear causes of this is currently still lacking;
ii) That complacency may result in further morbidity to patients, encouraging people to push themselves to return to full activities sooner, potentially risking prolonging their recovery;
iii) Business will feel able to push workers to return sooner as they are no longer protected by law;
iv) We lose one of the few social benefits of the pandemic: that the concept of being in work whilst unwell, particularly if symptomatic, is something to be discouraged and frowned upon;
v) Whilst it does feel the end of the pandemic may be in sight, the pandemic is not over yet. There is still the risk of further mutations, which keeping current isolation protocols go a small way towards reducing.
“I’m not sure that dropping laws designed to protect people and slow the spread of a pandemic is wise whilst a pandemic is still in progress – even if it means that bosses have to accept the challenge of not expecting ill or infectious staff coming into work.”
Professor Lawrence Young, Virologist & Professor of Molecular Oncology, University of Warwick:
“Removing the requirement for isolation in the face of high infection levels will inevitably result in increased spread of the virus. The real level of current infection is uncertain given increasing use of lateral flow tests and inadequate reporting. This will be further compromised as people will not see the value of testing when they have symptoms or come into contact with infected individuals.
“We need to remain vigilant for the arrival of new variants and not let our guard down – testing, tracing and virus genome surveillance are vital. It is important that we stress the need to continue to protect the clinically vulnerable. Waning vaccine-induced immunity will mean that we are likely to see people being reinfected. The pandemic isn’t over and, if we’ve learnt anything over the last 2 years, it’s that the impact and future of COVID-19 remains unpredictable.”
Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds:
“For the past two years, we have mis-used the opportunity of the spring and summer, where behaviour limits transmission, not to make good on the hard-earned control from harsh lockdowns, but to hurriedly attempt to pretend that COVID has disappeared. We ate out, we enjoyed “freedom day”, and for many this has indeed happened without harsh consequences or impacts upon new-found freedoms. However, the promises around there not being a need for further restrictions in the future have proven hollow, and the reticence and delay with which they were implemented led to them being all the more damaging.
“Yes, we have vaccines, yes, the booster programme staved off the worst of the Omicron wave, yes we have reached a point where the entire nation is exhausted as a result of the above (in)actions. However, someone once said that “the true measure of any society can be found in how it treats its most vulnerable members.” Thus, whilst the reluctance to control the spread of SARS-CoV2 has been evident since the beginning of the pandemic, highlighted by recent revelations, I would insist that if we are being told it’s time to move on, then we must not forget that this is not something that a considerable minority of the UK population will be able to do to anywhere near the same degree. We must, as a nation, remember this and as for other health conditions, make all necessary and reasonable provisions to ensure that memories do not fade and that altruism endures. In my view, the way in which this is being implemented is a profound mistake. Again.
“Literally blinding ourselves by removing testing and isolation robs us of the most fundamental means of controlling the spread of this virus.”
Dr Eric Topol, Professor of Molecular Medicine, Founder and Director of the Scripps Research Translational Institute, Editor-in-Chief of Medscape:
“The data that supports abandonment of self-isolation after a positive test, announced by Boris Johnson today for the UK:”
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- Text: This piece was first published in PMP Magazine on 9 February 2022.
- Cover: Flickr/Number 10 – Simon Dawson. - Boris Johnson hosting Prime Ministers Business Council. | 8 February 2022. (Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)