Is it wise to lift England’s Covid restrictions fully?

At the start of this pandemic, one key ethical justification for restrictions was to protect the NHS from being overwhelmed. Yet, despite rapidly rising cases, the number of patients in hospital with Covid has remained relatively low (similar to the start of October). It is clear that the vaccination programme is reducing deaths and hospital admissions from Covid-19. The benefit of continuing restrictions is now far smaller than it was.

There are certainly dangers. We could prevent cases of Covid and some deaths by continuing lockdown measures for some while longer. Indeed, we could prevent the greatest number of Covid deaths by reversing previous decisions and returning to stricter lockdown, for example, stopping people from meeting outside household bubbles and closing restaurants, pubs and schools.

Yet the key issue is one of proportionality. The lockdowns have been effective, but they have had huge impacts on the community’s physical and mental health, on education, and the economy. There have been reported increases in rates of loneliness, anxiety and depression, suicidal thoughts and self harm, particularly affecting young people. Although it remains a concern, there does not appear to have been an overall increase in rates of suicide, though there have been dramatic increases in the numbers needing urgent treatment for eating disorders.

Critics of the planned easing have pointed out that the burden of the predicted wave of Delta variant cases over the summer will fall on the young, and those from deprived communities. Yet the burdens of lockdown measures have also fallen and would continue to fall disproportionately on these same groups.

The key ethical question is how to balance personal freedoms with safeguarding the health of the community. The government’s plan for 19 July places a great deal of weight on the former ethical value (freedom). But there are costs to be borne, and little explicit acknowledgement of who will bear these costs nor how we can mitigate them.

Even if it doesn’t overwhelm [hospitals], the anticipated surge in cases over the summer (with both acute and long-term health consequences) will place an increased load on an already overburdened health system. Some measures (for example, mask-wearing on public transport) represent a minimal incursion on personal liberty, and should continue.

There is a difficult ethical balancing act to be struck, as in many decisions during this pandemic. Freedom will come at a price.

Those of us in the “not yet” camp call attention to a different set of facts from those in the “open up” camp. Covid-19 infections are growing exponentially, with a doubling time of nine days and 100,000 cases daily predicted before the end of July. Hospitalisation rates are rising rapidly and putting pressure on an overstretched NHS. Mild (ie, non-hospitalised) Covid in children may still lead to long Covid, whose long-term outlook is unknown. Masks and physical distancing are evidence-based measures to reduce spread of an airborne virus; they are relatively minor disruptions and people have got used to them. The economy stands to suffer heavily if large numbers of people are off sick or isolating.

“Not yet” advocates propose delaying re-opening until everyone, including adolescents, have been offered vaccination and all possible measures have been put in place – notably ventilation, or filtration of air, and physical spacing – to make our schools, workplaces and public transport as safe as possible. The World Health Organization recommends universal mask wearing in indoor spaces, even for the vaccinated; quarantine at our borders and the test-trace-isolate programme should continue. This, they say, will ensure that everyone is protected and make further restrictions or lockdowns in the future less likely.

While I am firmly in the “not yet” camp, I also feel it is time we recognised that this pandemic is a complex phenomenon unfolding in a complex system and act accordingly. Complex systems have non-linear dynamics. Small things can have large effects (eg, the Delta variant entered the UK, perhaps in just one infected person, and became dominant within weeks) and large things small effects (a huge, centralised track-and-trace system proved staggeringly inefficient and contributed little). Such dynamics make accurate prediction of the impact of interventions impossible. None of us know for sure what will unfold, any more than we can predict a White Christmas.

Complex systems must be handled in ways that embrace uncertainty. We need to observe the system, divine its patterns and key interdependencies, and empower people to respond to change in an agile and creative way. Above all, we need dialogue and deliberation to examine this highly complex problem from multiple different angles. The media can help by facilitating scientists and others with different perspectives to work through the possibilities and trade-offs.

The “open up” camp, for example, has found itself backing the abolition of mask mandates – not least because the mask, like lockdown, has come to symbolise loss of freedom. But since masks are highly effective at preventing airborne transmission, continuing to wear them will increase people’s freedom to safely travel on public transport, work in shared spaces and take part in leisure activities. The “open ups” could usefully draw on the science of masks (whose experts are mostly to be found among the “not yets”) to support the process of opening up.




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