Illustration by Zeyd Anwar; New Politic; Pippa Fowles / No 10 Downing Street; Andrew Parsons / No 10 Downing Street; Pippa Fowles / No 10 Downing Street.
The government wants us to believe they have beaten the pandemic. They claim their strategy — which allows the virus to spread unimpeded through the population — will move us from pandemic to endemic, where Covid-19 remains present in the population but at manageable levels, much like flu.
Health Secretary Sajid Javid argues that the country’s high vaccination rate — we have fully vaccinated seventy percent of adults, though this is only fifty-five percent of the whole population — has created a “wall of defence” which will prevent a return to mass hospitalisations and deaths.
Many scientists are more cautious. “You would expect [herd immunity] to peak at different times in different parts of the country as there are differing levels of immunity,” says John Edmunds of the London School of Hygiene & Tropical Medicine. “But we saw a synchronous drop in cases right across England. This suggests an external factor.”
He believes the two most likely causes of falling cases are the hundreds of thousands of isolations that followed the end of Euro 2020 and school closures. “This bout of self-isolation occurred across the country at the same time, it looks like it reduced cases,” Edmunds said. They “would go up again if not for the effect of school closures.”
Others believe we remain far from herd immunity and that behaving as if we are at the finishing line is dangerous for public health not just here but across the globe.
Herd immunity, argues James Hamblin, public health policy lecturer at Yale University in the US, is the point where the “additive effects of imperfect individual immune protection can become, overall, perfect.”
We have herd immunity for diseases such as measles because the population wide level of immunity is so high that even if the virus is present it finds no one to infect and quickly dies away.
With daily Covid-19 cases still at tens of thousands per day we are clearly far from achieving true herd immunity. The result is thousands if not millions of Covid-19 infections that could have been avoided if the Government had kept more restrictions in place until a greater proportion of the population had been fully vaccinated.
These infections have consequences. Somewhere between twenty to thirty five percent of people who do not need hospital go on to develop Long Covid symptoms that last for months or longer.
Symptoms cluster into groups: respiratory, tiredness (fatigue, muscle aches) and neurological (brain fog, problems concentrating, dizziness). Over two hundred different symptoms have been reported. Even mild infection can cause cognitive deficits.
People who are sick enough to be hospitalised but survive can suffer even worse outcomes. “Survival with complications is the most common outcome from severe COVID,” says intensive care doctor Rupert Pearce. “Hundreds of thousands of patients will experience lasting harms.”
Complications such as organ damage are high even in previously healthy people who were admitted to hospital. One study found twenty seven percent of nineteen to twenty-nine-year-olds and thirty-seven percent of thirty to thirty-nine-year-olds experienced complications. Around fifteen percent were unable to look after themselves after discharge.
Vaccines dramatically reduce spread and protect most people from severe disease and hospitalisation but they do not protect everyone. High case numbers are a risk for both vaccinated and unvaccinated, all the more given the higher transmissibility of the Delta variant, now proven to be transmissible by vaccinated people.
High infections put vulnerable groups at risk. Almost four million people are undergoing treatment or have conditions which weaken their immune systems, rendering vaccines less effective. Some are permanently unable to take vaccines.
“Many clinically extremely vulnerable people feel they are on their own, having to rely on others taking responsibility, and without support to keep safe,” said Louise Rubin, head of policy and campaigns at disability charity Scope.
Children are being systematically failed. Delta causes more severe disease in children than earlier variants. Over one thousand children in England were hospitalised in July alone. At one in two hundred child cases this is a significant increase on previous waves.
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The Delta variant is estimated to kill one in fifty-thousand children. With twelve point seven million under sixteens in the UK that means two hundred and fifty four more deaths if children are left unprotected, yet the Government refuse to act.
Instead they are deliberately making the situation worse. On 17 May they removed the requirement for masks to be worn in schools as part of a strategy of deliberately infecting children to aid progress towards herd immunity.
Most nations see this strategy as inherently dangerous. As well as known risks of death and childhood Long Covid there are as-yet-unknown long term health complications which could take years to discover and fully understand.
Many nations are doing all they can to protect children. The US Center for Disease Control (CDC) recommends mask use in schools, investment in ventilation and distancing. Many European nations including Spain have similar policies.
The US is vaccinating over twelves and will add younger children in the early autumn. Israel, France and others are doing the same.
“Immunologists, vaccine experts, child global health experts, and infectious disease experts argue that we will need to [vaccinate] kids to reach high population coverage worldwide,” says Professor Gavin Yamey of Duke University. “The benefits for the adolescents, their families and their communities far outweigh the very tiny risks.”
In the UK we are only just beginning to vaccinate sixteen and seventeen year olds. The Government still refuses to vaccinate younger teenagers or children.
The final — and potentially worst — risk inherent in the Government’s strategy is the heightened potential of new variants.
Mike Ryan, the World Health Organisation’s head of emergencies, believes Britain’s strategy of relying on vaccines alone while allowing the virus to spread is “epidemiological stupidity”.
He cautions against a “premature rush” back to normality. “For a lot of the world this thing is only getting started,” he says. “I’m pleased for countries that are getting this under control. But please spare a thought for those living without vaccines.”
The virus, says James Hamblin, is “evolving in the worst direction, adapting to infect human cells much more effectively than it once did.” Giving it free rein creates millions of avoidable opportunities for it to mutate, potentially becoming more transmissible and severe.
Britain’s partially vaccinated state makes the development of vaccine-resistant variants more likely, says Christina Pagel of UCL and Independent SAGE, making it all the more important that case numbers are kept low.
“Any mutation that can infect vaccinated people better has a big selection advantage and can spread,” she says. “Because of our position as a global travel hub any variant that becomes dominant will spread to the rest of the world. We saw it with Alpha and I’m sure we contributed to the rise of Delta through Europe and North America.”
SAGE, the Government advisory body, argues that “the number of variants will depend on control measures… If population mixing and transmission is low, new variants are less likely to spread.”
Stephen Griffin, virologist at the University of Leeds, argues this is further reason to end the virus’ “unmitigated spread amidst a population where just over half of us are fully [vaccinated].” If the virus does mutate further it will be because we gave it opportunity.
Many public health experts are horrified that none of these outcomes factor into public policy decisions. “The formal roadmap criteria only explicitly considers hospitalisations,” writes Christina Pagel, which creates “a massive problem.”
Many believe that the Government are under little pressure to change course. Media and opposition have largely accepted the Government line that ICU capacity is the measure of success. As a result Long Covid, risks to children’s health, organ damage post hospital and the risk of new variants are treated as risks worth taking or the unavoidable outcomes of unlocking restrictions.
Some scientists have made this worse, argues Deepti Gurdasani of Queen Mary University. By following the Government line despite knowing its flaws and the danger to public health they “have made a mockery of public health and science.”
She and others believe there has not been enough discussion of alternative strategies to the Government’s repeated swings from lockdown to periods of mass infection which have damaged the economy, physical and mental health.
The media and opposition could, they argue, have done more to point to the many examples of nations which have successfully followed a zero Covid strategy using a combination of functioning test and trace, controlled borders, masks, social distancing and — when necessary — limited lockdowns.
These countries not only have better public health outcomes, they have better economic outcomes, yet UK media still often make the false statement that the Government have been forced to choose between health and economy.
“Countries that focused on keeping virus spread near zero got their economies moving faster than those that balanced higher infection rates with fewer restrictions on economic activity,” says consulting giant McKinsey, “saving thousands of lives and trillions in livelihoods.”
While Labour have at times been severely critical of Government mishandling of the pandemic they have not consistently called for zero Covid or any other alternative strategy. Some campaigners accuse them of being unwilling to speak out on issues of public safety, including safety measures in schools. At times Labour has appeared inconsistent, for example seemingly calling for restrictions to be more and then less stringent within days.
Labour may come to view the pandemic as a missed opportunity. They have used the pandemic to argue that the Government is incompetent, which while true in itself has not been sufficient to inform the public that a better strategy is both possible and desirable.
Keir Starmer; Jonathan Ashworth; New Politic
Labour could and should have made the case for a zero Covid strategy, using the advantage of being an island nation to control borders to keep out variants, developing a functioning test and trace system and investing in adequate safety measures in schools. Doing so would have put more pressure on the Government to change course and could have been used to present Labour more clearly as a government in waiting.
This leaves the UK in a dangerous position. Case numbers are not as high as some feared when restrictions were removed but most scientists expect the return of schools to lead to a new surge in infections.
What frustrates many scientists is that there is a clear route to ending the pandemic but we are nowhere near to taking it.
“If this were an outbreak movie it would’ve ended when we discovered and mass produced several vaccines that stop the virus,” says Hamblin. “Instead we’re in a bad sequel that no one would ever see or make and is a hundred hours long.”
Vaccines have given us the chance to end the pandemic. A combination of patent waivers (to allow countries to manufacture their own vaccines), technological assistance (to help build needed infrastructure) and urgent manufacture (making use of all available production capacity) could allow us to achieve vaccination at global scale.
Instead we have developed nations hoarding vaccines but with large numbers still unvaccinated — due to vaccine hesitancy and the exclusion of children and young people from vaccination programmes — and developing nations with negligible access to vaccines. Only thirteen percent of the world’s population is fully vaccinated, almost entirely within the developed world.
To contribute to the global effort the Government should protect public health at home and minimise risk of a new variant by acting to prevent the huge number of infections current in our part-vaccinated population. As a priority it should “vaccinate all adolescents, invest in ventilation in schools, workplaces [and] businesses ahead of winter [and] consider booster doses among the most vulnerable,” says Deepti Gurdusani of Queens University. It should do more to pressure world leaders to waive patents and invest in vaccine production capacity on a global scale, as it failed to do at the G7.
It is not too late for the Government to take a different course. Instead it seems intent on reaching herd immunity as quickly as possible, almost uniquely through a combination of vaccines and deliberate mass infection.
As Labour seeks to take the initiative in the autumn it should make a clear critique of the dangers of this strategy central to its messaging. Britain has been badly failed by a Government driven by ideology and hampered by incompetence. It’s past time we demanded better.
