Covid restrictions back to 'Plan A'

This week the UK government announced the end of the enhanced “Plan B” covid restrictions that were introduced last year in response to the arrival of the omicron variant. Some have been sceptical about the timing, particularly given that we’re still detecting around 100,000 cases per day. Chris Smith asked Edinburgh University public health specialist Linda Bauld to take him through why, in her view, the government have made the decision they have…

Linda - The UK government was very clear. They didn't want to keep "Plan B" in place for any longer than necessary, and that's an important principle that they are sticking to. What they've been looking at is a basket of indicators. The first one is what's happening with infection in the community, and they look at population surveys and private households, and also cases. You can see cases have gone down about a third over the last seven days. They're then looking at capacity in the NHS, but admissions to hospital have not gone anywhere near what was feared in some of the modelling. In fact, over the last seven days, they've gone down around 5%. Importantly they're also looking at intensive care and that has not been stretched primarily because of vaccines. What they are concluding is that the Omicron wave has been a big wave, but it's mostly been of infection and not severe outcomes. Therefore, they can't keep restrictions on the population longer than they think is necessary.

Chris - One point that some people have indeed made at one of the Downing Street press briefings is when one of the journalists said, 'But look, we've still got very high levels of mortality.' What's the reason that they're comfortable having that number of mortalities, but still making these changes?

Linda - I think there's a recognition that the vaccines are not 100% protective. People might be older and more vulnerable and, like with other viruses, we may always have people who lose their lives as a result. They've never been willing to state a threshold for tolerating that but I think, at this stage in the pandemic, they're recognising that there will be some ongoing harms and also that they have to balance those up against the other accumulated harms to the economy, education, social harms, etc.

Chris - Because, Susan Hopkins, from the UK Health Security Agency, she was also presenting this week and she alluded to, as I think did Sajid Javid, a survey that the office for national statistics are carrying out which is looking more closely at death statistics and death certificates to try to understand what really constitutes a death from COVID as opposed to a death with COVID. Someone might have died of something else, for example, but they happen to have also tested positive for COVID in the last month?

Linda - That's right. When you look at the death certificates, the analysis does suggest that, at the moment, the majority of those people who are losing their lives are losing them because of the COVID infection. But, there is also a substantial group for whom it's just one factor. The other thing we've done some analysis on in England is looking at the proportion of people in hospital because of COVID or with COVID. You can see there's now a greater proportion than earlier in the pandemic who are there with COVID. In other words, they test positive when they come into the hospital rather than they're there because of COVID.

Chris - I think the number that was cited was somewhere between 40% and 50%. So, it's quite big, isn't it? People who were in hospital, but happened to be detected to have coronavirus infection, but they're not there because of it.

Linda - That's correct. I'm most familiar with the data from Scotland and, in Scotland, 60% of people who are in hospital with COVID are there because they are being admitted for COVID, but 40% or 4 out of 10 people, which is a big number, just happen to have COVID but are perhaps being admitted because they've had a fall or they're in for a treatment, etc.

Chris - One of the things you raised just now was you said, 'intensive care beds'. That is probably the most reassuring graph that's being presented, isn't it? In the sense that the number of people who are in ventilation facilities is now lower than it was before Omicron arrived on our shores. I suppose that's giving policy makers quite a lot of confidence that actually we are not seeing a translation to severe disease like we did. Therefore they probably do feel more comfortable easing restrictions despite the fact we still do have high numbers of cases: 100,000 a day.

Linda - That's right. There's two really interesting features about intensive care: one of them is that the admissions are as low as they were last summer when so-called 'Freedom Day' was introduced in England. You can see from a policy perspective, if you're focusing on that indicator, there's not a rationale to retain restrictions from the government's point of view.

Chris - I'm very much a glass half full person, and I'm quite optimistic about the direction of travel, but let's assume that these measures; stepping back from them is the right thing to do, and we do end up back in a position where we were last summer. What should the focus shift onto? What do you think we should really dwell on next to make sure that we are as prepared as possible for next winter, but also the twists in the road that may still be yet to come?

Linda - I share your optimism for the next few weeks and months, but I think there's a number of factors. The first one is, let's keep a close eye on waning protection from vaccines. The 'Joint Committee on Vaccination and Immunisation' said no booster at the moment. That seems definitely proportionate. There are indications from Israel that their rapid rollout of a 4th dose may not have had an impact and may not have been necessary. The second thing is looking ahead, we have to give people good and accurate advice about their own behaviours so that they can protect themselves. An assessment of risk for an individual will vary depending on how much of a risk COVID is to you. That might be face coverings, even if they're not mandated, distancing, thinking about avoiding crowd places, etc. The third thing is, think about environments; how do we COVID proof/improve different environments? How do we use ventilation? How we think about working environments like offices? What can we do in schools where there is still arguably more we could do? Etc. The final thing is surveillance. The big threat for the future is a new variant, and we need to just make sure we're participating with all our global collaborators.