Health experts say that they are ‘dumbfounded’ that the Government is ending the legal duty to self-isolate after testing positive and free testing for the public

Production line for COVID-19 vaccine vials

The Prime Minister’s announcement that domestic restrictions for controlling COVID-19 in England are to be abolished met with mixed reaction from health experts.

Some said that trends in the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and declining rates of hospitalisation supported the timing of the move, whereas others criticised ending the legal duty to self-isolate after testing positive and the decision to end free testing for the public.

One expert said that he was ‘dumbfounded’ by the majority of announcements from Number 10, and criticised the decision to base virus control solely on a vaccination programme that was not yet complete.

Earlier this week, the Scottish Government said that Scotland’s legal COVID-19 restrictions would be phased out on 21 March 2022, with First Minister Nicola Sturgeon saying that a ‘return to normality must go hand in hand with a continuing determination to look out for and after each other.’

Lifting of infection control measures

At a Downing Street news conference on 21 February, Boris Johnson announced that:

  • the remaining legal domestic restrictions in England would end
  • the legal requirement to self-isolate would be abolished from 24 February, with people testing positive instead being ‘advised’ until 1 April to stay at home
  • provision of universal free symptomatic and asymptomatic testing would stop from the beginning of April, but free symptomatic tests will be available to those at high risk
  • routine contact tracing would end, including venue check-ins on the NHS COVID-19 App
  • self-isolation support payments would end
  • the requirement for every employer to explicitly consider COVID-19 in their risk assessments would end on 1 April.

Staff and students in most education and childcare settings are no longer being asked to undertake twice weekly asymptomatic testing.

Mr Johnson promised that the Government would ‘retain disease surveillance systems and contingency measures’, including buying enough vaccines to ‘ensure our resilience in the face of future waves or new variants.’

A COVID-19 booster would be offered to people aged 75 years and older, older care home residents, and those aged 12 years and older who are immunosuppressed, he said, and an autumn annual booster programme was under consideration.

Will we follow Denmark? 

It is unclear whether sweeping aside COVID-19 rules will lead to rising cases, hospitalisations, and deaths. Denmark, which lifted its restrictions in early February, has experienced more recorded cases per capita than most other countries, partly fuelled by the emergence in January of the BA.2 subvariant of Omicron.

Commenting on England’s transition to a liberal approach to virus control, the British Medical Association (BMA) called for ‘urgent clarity around testing provision for NHS workers’, while the Royal College of Nursing (RCN) said that the Government’s response was ‘unplanned and ill-informed’, and likely to alarm healthcare staff.

Testing for front-line healthcare staff 

The BMA that said lifting restrictions now was ‘premature’. Dr Chaand Nagpaul, BMA Council Chair, said: ‘On the one hand, the Government says it will keep monitoring the spread of the virus, and asks individuals to take greater responsibility for their own decisions, but by removing free testing for the vast majority of the population on the other, ministers are taking away the central tool to allow both of these to happen.’

He called for preventative measures to be maintained for the most vulnerable, ‘including the provision of enhanced face masks, and clear guidance for both patients and clinicians.’

The NHS Confederation has said that it is worried that there was no mention of maintaining free COVID-19 tests for front-line healthcare staff. It pointed to its recent survey, in which 94% of healthcare leaders said that access to free testing should continue for NHS staff and other key workers.

Pat Cullen, RCN General Secretary, urged the Government ‘to reassure healthcare staff in England they still have access to tests.’ She said that nurses ‘need to be assured there are robust plans in place should the number of cases increase again, or a new variant emerges.’

Dr Simon Williams PhD, Lecturer in Psychology at Swansea University, is worried that ending free tests to the general public will ‘disproportionately affect those on the lowest incomes who, because of the lower vaccination uptake within their communities and because their jobs are often higher-contact, have been most affected by COVID.’

Can vaccines see us through? 

Some scientists and healthcare bodies are concerned that the Government is over-reliant on the vaccination programme to guide the next phase of its plan.

Dr Stephen Griffin, Associate Professor at the University of Leeds School of Medicine, who said that he was ‘dumbfounded’ by Mr Johnson’s strategy for ‘living with COVID’, told the Science Media Centre that, as a virologist, he was ‘concerned that allowing high prevalence in a partially vaccinated population is a recipe for virus evolution to accelerate.’

Earlier this month, the Scientific Pandemic Influenza Group on Modelling reported that academics had predicted a potential for transmission of SARS-CoV-2 to increase by between around 25% and 80% if the population were to return to pre-pandemic behaviours and no restrictions were in place.

However, Dr Raghib Ali, Senior Clinical Research Associate at the University of Cambridge, said that it was ‘unlikely that moving from mandates to guidance on self-isolation will lead to a significant increase in infections, hospitalisations, and deaths.’ It was ‘clear that people can be trusted to take personal responsibility for their actions—based on the level of risk at the time—without Government mandates’, he added.

Threat of new variants remains 

Professor Mark Woolhouse, Professor of Infectious Disease Epidemiology at the University of Edinburgh, said that the most immediate medium-term threat was the almost inevitable appearance of a new variant of SARS-CoV-2. ‘It is important that the public health agencies across the UK have plans in place to respond to that rapidly—within days—when it happens’, he said.

That point was stressed by both England’s Chief Medical Officer and Chief Medical Adviser at a press conference on 21 February.

As the Prime Minister spoke of his pride at how far the country had come in managing COVID-19, Professor Sir Chris Whitty warned that scientists ‘expect that there will be new variants and … some of them will cause significant problems’. Professor Sir Patrick Vallance said: ‘You can celebrate when the sun is shining, but take an umbrella with you.’

This article originally appeared on Medscape, part of the Medscape Professional Network.

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Lead image: James Thew/stock.adobe.com

Image 1: James Thew/stock.adobe.com