The new variants of Covid-19 have changed the nature of the pandemic. We are no longer facing the same situation as in March or even November. Our response must change accordingly.
It is now clear that variant B117 of Covid-19 is already established in all parts of the UK. Being an estimated 56% more transmissible than pre-existing variants, it is likely to constitute 90% of all cases by mid-January. According to UK government briefings, even current tier 4 restrictions are insufficient to deal with its spread. Indeed, no single measure is likely to be sufficient to bring the pandemic back under control. Rather we need an integrated response that brings together all the instruments we have to deal with the infection.
How do we do this? My colleagues and I on Independent Sage are proposing a five-point emergency plan, which would allow the UK to start 2021 with a comprehensive strategy in place to deal with the crisis. All five parts of the plan must happen in concert and they need to be accompanied by a comprehensive communications campaign.
First, there’s the question of vaccination. The rollout of vaccines is a key part of the strategy to combat Covid-19 and must be accelerated as a matter of urgency. This should be organised through the over 8,000 GP practices in the UK, supported through additional staff and resources, and coordinated via local public health structures.
However, vaccination cannot be the entire strategy. This is because of the time taken to complete it (that’s even if we reach the target of 2 million vaccinations a week called for by members of the government’s influenza modelling group), uncertainties over its duration of immunity and impact on transmission, and restrictions on its use in some populations (eg children, pregnant women and breastfeeding mothers).
All this is exacerbated by the fact that, due to the increased infectiousness of the new variant, a higher proportion of people need to be vaccinated in order to achieve population immunity. In the medium term there will be pockets of the population in which the infection continues to circulate, with periodic outbreaks inevitable. Vaccination can complement but not supplant other interventions.
This takes us to the second point: national control measures are essential. Further restrictions are necessary in two main areas. The first of these ispersonal travel, especially international travel. This must be monitored and regulated effectively, with advance application for travel to and from the UK, a negative PCR test prior to travel and managed isolation on arrival. The second area is education. Schools should remain closed until buildings are made as safe as possible for pupils and staff. This includes smaller class sizes (achieved through hiring extra teachers and teaching rooms), adequate ventilation and free masks for all pupils.
Universities should move to online teaching as the default until Easter at least. This will allow students to study from home, avoiding issues arising from travel and crowded campus accommodation. For school, college and university students, there should be universal provision of computers and wifi connections to ensure everyone can study remotely. Schoolchildren without space for home study should be taught along with vulnerable children and children of key workers.
Our third point in the plan is about the UK’s test, trace and isolate regime. Throughout the pandemic, the government has reduced the issue of a testing system to the numbers of people who are tested. However, testing is only the first step in the process. It must be part of a strategy designed to trace contacts as quickly as possible so as to isolate them before they can infect others. This requires not only forwards tracing (identifying who you might have given the infection to) but also backwards tracing (where you got it from).
The government’s contracting out of the test and trace system has shown the private sector is not up to the job – and nor can it be. Effective tracing and supported isolation depend upon local public health staff who know their patch and are trusted by the community. The need for a “public health reset” of the testing system remains urgent.
Finally, practical support is necessary in order to enable people to self-isolate. The continued failure to address this issue in the UK has led to continued low adherence (less than 20% for those with symptoms) and contrasts markedly with the 90-95% rates achieved in places like New York, which supports isolation with everything from financial assistance and hotel accommodation to pet care.
Next, workplaces. When the government relaxed restrictions in July, they handed over responsibility to employers and owners of facilities to make their premises safe but with limited guidance, minimal support, and virtually no formal regulation. While many enterprises have worked assiduously to ensure that adequate Covid mitigations are implemented, this is not true of all. It is now critical to ensure that we have robust systems to prevent the spread of infection. This should include funds for necessary changes, inspection of all premises and certification of those meeting the required standards. This would have the added advantage of increasing public confidence in using certified premises (shops, hospitality etc).
Finally, financial support for the public is crucial. Inequalities are playing a central role in this pandemic. The disease impacts more on vulnerable populations as do the measures used to control it. People on low incomes are more likely to lose jobs and suffer financially than the more affluent, many of whom have profited from this pandemic. The firm measures we propose here are both morally and practically untenable without enhanced support for individuals and local businesses that will be affected most.
At a time when the UK (population 67 million, Covid deaths 70,752) has been experiencing more than 30,000 new cases a day and prevaricating about what measures are needed, Australia (population 25 million, Covid deaths 909) instituted immediate and far-reaching restrictions in Sydney after an “outbreak” of 38 cases. One local person responded by saying: “Let’s go early, let’s go hard and let’s get this baby.” This makes a good mantra for the pandemic as a whole. Our plan is a minimum for what needs to be implemented – without delay.