Probably the most famous quote in the history of English football was that made by Kenneth Wolstenholme at the end of the 1966 World Cup final where he stated as Geoff Hurst broke clear of the West German defence to score the 4^th goal that “Some people are on the pitch…. they think it’s all over…….it is now”. I have been reminded of this quote as we reach April 1^st, 2022 when all Coronavirus restrictions in England essentially come to an end. We are moving from a period of pandemic restrictions to one of “living with Covid”. Whilst the prevailing narrative has focussed on “it’s over” the national data sets would suggest it is most definitely not. We are currently experiencing another wave of infections driven by the Omicron BA-2 variant. Cases of Covid infection have been rising steadily over the past couple of weeks and we are now seeing hospital admissions and deaths rise too. This has led to an interesting tension between current politically driven and public health driven advice.

The overriding question then is why remove all restrictions now if infection rates are so high. The answer sits with science and the success of the vaccination programme, and the protection it affords, which to date has seen 86% of the eligible population have two jabs and 68% boosted with a third. Furthermore, we are now at the start of the Spring booster programme for the over 75s and the most vulnerable. The introduction of the vaccine has seen a dramatic fall in serious illness associated with infection and the UK government now believe that this is a virus we can live with and we should get on with our lives in a sensible and cautious way without the need for mandated restrictions. The advances gained in both the vaccination programme, anti-viral therapies and treatments have been enormous and underpin completely the current and future situation. So, the narrative shifts to one that emphasises learning to live with the virus and to that end the Government has provided us with guidance. The UK Government’s “Living with Covid Plan” COVID-19 Response – Living with COVID-19.docx (publishing.service.gov.uk) has four key principles at its heart:

• Removing domestic restrictions while encouraging safer behaviours through public health advice, in common with longstanding ways of managing most other respiratory illnesses;
• Protecting people most vulnerable to COVID-19: vaccination guided by Joint Committee on Vaccination and Immunisation (JCVI) advice, and deploying targeted testing;
• Maintaining resilience: ongoing surveillance, contingency planning and the ability to reintroduce key capabilities such as mass vaccination and testing in an emergency; and
• Securing innovations and opportunities from the COVID-19 response, including investment in life sciences.

So, in addition to the restrictions already removed from 1 April, the Government will:

• Remove the current guidance on voluntary COVID-status certification in domestic settings and no longer recommend that certain venues use the NHS COVID Pass.
• Update guidance setting out the ongoing steps that people with COVID-19 should take to minimise contact with other people. This will align with the changes to testing.
• No longer provide free universal symptomatic and asymptomatic testing for the general public in England.
• Consolidate guidance to the public and businesses, in line with public health advice.
• Remove the health and safety requirement for every employer to explicitly consider COVID-19 in their risk assessments.
• Replace the existing set of ‘Working Safely’ guidance with new public health guidance

My major concern with these changes is the massive scaling back of infection testing. In doing so we run the risk of creating a data vacuum. Being able to test and undertake scientific surveillance of the virus’s future development would help us identify any future threats from new variants; particularly those classified as being “of concern”. What we should have learned from the past two years is that the ability to understand the virus and rapidly scale up our response is critical.

What is also now abundantly clear from the current data is that this is far from over and it is going to take some time for us to adapt as a society. The ongoing consequences for the most vulnerable sections of our society are still incredibly challenging. It will not be a surprise to any health professional that the pandemic was keenest felt in communities already negatively impacted by health inequalities. This has been the case ever since the publication of the “Black Report” (DHSS 1980), which showed in detail the extent to which ill-health and death are unequally distributed among the population of the UK.  Indeed, there is evidence that these inequalities have been widening rather than diminishing since the establishment of the National Health Service in 1948. It is generally accepted that those with underlying health issues and therefore most at risk will be disproportionately located in socially deprived communities. Consequently, there is a genuine concern that the most vulnerable to the virus could be left behind in isolation as the rest of society moves on. However, we are now at a new critical moment which most will celebrate. Regardless of whether you believe the rolling back of restrictions is right or not, this moment in time allows us an opportunity to reflect on the past two years and indeed look forward to what has changed and what could happen in terms of both Coronavirus and any other future pandemic.

Looking back, I have no doubt that the last two years have changed life considerably in several  positive and negative ways. Of course, we tend to migrate to the negative first and the overall cost of life, levels of infection and the long-term consequences have been immense. The longer-term implications of Covid (Long Covid) is still something we need to take seriously and fully understand. What is not in doubt is the toll this has had on individuals, families, communities and the future burden it places on our NHS. The psychological impact of social isolation and restrictions has been enormous and especially so for our children, young people, the vulnerable and the elderly. The social and educational development of school children is of particular concern. The wider economic implications of the pandemic will take some time to recover. Yet, whilst the negative implications cause us grave concern many features of our lives have improved. Many have identified that this pandemic has helped them re-asses what is important in life, how important key workers are in ensuring society continues to operate smoothly and the critical role health and social services must play in times of health crisis. Changing perspectives on work, work life balance and alternative ways of conducting business have been embraced and many argue that the world of work will never be the same again.

On that final note it’s important that as a society we have learned from what I have previously described as the greatest public health crisis in my lifetime. Pandemic planning was shown to be woefully inadequate and we must get this better because there is no doubt there will be another pandemic of this magnitude at some point in the future. Proper support for health and social services are critical and the state of the NHS at the start of all this was telling. Yes, it rose to the challenge as it always does but health and social care systems were badly let down in the early stages of this pandemic with disastrous consequences. Proper investment in science and research is paramount, for let’s be honest it was science that came to our rescue and did so in record time. There will inevitably be a large public enquiry into all aspects of the pandemic, its management and outcomes. We can only hope that lessons have been learned and we are better prepared for both the ongoing management of this pandemic and inevitably the next one.

Dr Stephen O’Brien

FHES

Originally posted here