COVID-19: THE KEY QUESTION. WHEN CAN RESTRICTIONS BE LIFTED?

The question everyone is asking is "When can restrictions be lifted and we get back to normal"?  The sooner the better!

The UK Government has suggested restrictions will be eased gradually as the vaccination programme progresses, before restrictions can be lifted completely.

With the newer more infectious strains, it could be 70% or more of the population being immune before 'herd immunity' is achieved.  That's when the virus has trouble finding the next person to infect, and infection rates can stay low without restrictions.  That's immune either from vaccination or from having had the disease.  Some estimates as high as 90%.  That's some time to go.

To assess which restrictions can be lifted when, a number of factors need to be considered.  It's like we have a set of weighing scales with the harms of the virus on one side balanced by the harms of restrictions on the other:

• When there are higher rates of infection, the harms of COVID-19 outweigh the harms of restrictions:
  

 

• When infection rates reduce, the harms of the virus reduce, the balance shifts, and restrictions can be eased:
  
  

What are the factors that need to be considered in assessing this balance?   How can easing of restrictions be accelerated?

 

THE FACTORS TO CONSIDER - IN FAVOUR OF EASING RESTRICTIONS

At the press conference yesterday, Matt Hancock the Health Secretary gave four factors that would allow restrictions to be eased. "We need to see...":

• "Number of deaths coming down"
• "Pressure on NHS reducing"
• "Vaccination programme working", seeing efficacy of vaccines in actuality
  
• "No new variant" or other factor
  

it is not simply a matter of saying restrictions can be substantially lifted as soon as the groups most likely to die have been vaccinated.  Hospitals are increasingly seeing younger people under 55 being admitted for treatment with latest reports at around 25%.  People of all ages, including children, are also susceptible to LongCOVID, even when not hospitalised.  That's a set of problems that not only can significantly adversely affect their health, but will also put much greater ongoing strain on the health service to treat them.

For some reason Hancock did not explicitly mention LongCOVID, though must be aware of this set of health problems.  Whilst many people affected have not needed hospital treatment, there is a new study concluding "Nearly a third of people who were discharged from hospitals in England after being treated for Covid-19 were readmitted within five months – and almost one in eight died".  That study is awaiting peer review, but in the meantime we need to be very wary of how COVID-19 is affecting people long-term, whether they have been hospitalised or not. 

The Independent SAGE group of health specialists recently wrote to the Sunday Times mentioning how dangerous it would be to relax restrictions after vaccination ony of those most vulnerable to death.  The points raised have been put into a clear animation by Vicki Martin:

• Protecting the vulnerable by vaccination does not make the virus innocuous
• Vaccine-resistant mutations can arise
• Whilst mortality may fall, pressure will still exist on critical care, as 3 in 4 patients are under 71
• Vaccination of more vulnerable groups will do little to reduce the prevalence of LongCOVID
• The risk of death does not change dramatically on turning 70

We also need to consider that with high rates of infection in the working population:

• Vaccination is not perfect, so vulnerable individuals are still at risk. A vaccine 90%-95% effective means 1 in 20 to 1 in 10 are still susceptible to catching the disease
• We don't yet know whether vaccination reduces the possibility of someone carrying the virus and transmitting it to others
  
• High rates of hospitalisation result in other treatments being suspended
  
• High numbers of people off work ill is extremely disruptive to their places of work.  That includes key workers.  Plus those self-isolating.
  
• That produces an economic hit too.

So there's a whole host of factors.  With a common theme that the lower the infection rate the better.  As close to elimination as possible.

THE FACTORS TO CONSIDER - THE HARMS OF RESTRICTIONS

On the other side of the balance, we are all aware of the harms of restrictions, including:

• Financial pressure on individuals and firms
• A significant hit to the Exchequer through a drop in taxes, plus higher public expenditure for health measures and financial support
  
• Individuals' loneliness and lack of social interaction
• Restrictions on entertainments, holidays and other enjoyable activities
• Severe disruption to education, and the impact that has on parents
  

 

SO WHEN TO EASE RESTRICTIONS?

The factors above contain significant unknowns.  It is also unclear how quickly vaccine can be produced, checked safe, and distributed.  Dates given by the Government for easing restrictions are little more than conjecture at this stage.  It will take weeks to begin easing restrictions, and more likely months to remove restrictions completely.

How can easing be accelerated?  It's all about getting infection levels right down across the country.  Infection levels would reduce significantly with a very tough three-week FireBreak, with as many people as possible self-isolating.  In combination with vaccination, that would certainly help to bring forward when restrictions can be eased.  A sensible investment?