Health Warnings for new COVID restrictions?
On Tuesday, Prime Minister Boris Johnson further tightened restrictions in England to suppress transmission of COVID-19, introducing a 10pm curfew on all bars and restaurants and mandating they become table service only, whilst also expanding previous restrictions, for example including organised team sports within the ‘rule of six’, and reintroducing guidance to ‘work from home’. Moreover, Johnson has warned that these measures will likely continue over the next six months and that failure to bring cases down will result in tougher restrictions.
Increasing cases, reaching levels unseen since early May, and a higher ‘R’ (reproduction) rate between 1.1 and 1.4, prompting the COVID Threat Level to be raised to 4, indicating that cases are increasing or rising exponentially, have been used to justify these new restrictions. YouGov polling has indicated 78% public support, with 45% arguing these measures don’t go far enough, with household mixing not banned (excluding in Scotland and Northern Ireland), schools, colleges and universities remaining open and the much touted ‘circuit breaker’ being rejected.
Nonetheless, 13% believe these measures go too far, arguing that the ‘cure’ will be worse than the ‘disease’ given low hospitalisations and deaths and exacerbated economic and public health impacts. Having spent August urging people to ‘Eat Out to Help Out’ and return to work, the government’s reversal in tone has been staggering, but increasingly contentious and exaggerated ‘science’ and the unfeasibility of eradicating COVID-19 suggests this change in tone with new restrictions is unnecessary.
Monday’s presentation by Chief Medical Officer Professor Chris Whitty and Chief Scientific Officer Sir Patrick Vallance presented a bleak outlook, estimating that COVID transmission could double every 7-8 days with inaction and lead to 50,000 daily cases by mid-October and 200 daily deaths by mid-November. Nonetheless, these estimations have been accused of exaggeration, with measured rates of rising transmission in France and Spain 5x lower, with Vallance himself admitting this scenario was not a ‘prediction.’ Such exaggeration and empirical evidence otherwise therefore provides little justification for new restrictions.
Moreover, Whitty and Vallance’s predominant focus on cases has been fervently challenged. Professors Sunetra Gupta, Carl Heneghan and Karol Sikora highlighted in an open letter the greater effectiveness of using evidence-based hospitalisations and deaths to inform restrictions. Whilst the lag between testing positive and hospitalisation and deaths could mean this approach risks restrictions coming too late, especially given continued uncertainty over the rate of asymptomatic transmission, evidence from France and Spain suggests that rising cases have not necessarily translated into mass hospitalisations, especially with higher COVID transmission amongst lower-risk younger people and greater testing picking up more cases. Such an approach highlights the faults in directly comparing the first peak with the current situation, especially with far greater knowledge of the disease and testing capacity despite current issues with demand, thus making the impact of rising cases relatively less significant than hospitalisations, and thus failing to justify new restrictions.
Moreover, the open letter shows focusing on hospitalisations and deaths has highlighted the ineffectiveness of ‘blanket interventions’, with 89% of deaths amongst over 65s and 95% amongst those with underlying health conditions. Additionally, as COVID-19 will likely become a seasonal virus similar to other respiratory diseases, ‘blanket interventions’ will only serve to delay COVID transmission and be heavily reliant upon an unlikely immediate and effective vaccine to avert major socioeconomic damage, especially as high seasonal hospitalisations and deaths will continue irregardless. Consequently, whilst those at lesser risk are not immune from COVID-19, more targeted interventions amongst those at higher risk would be more effective at suppressing the virus without causing wider socio economic damage before a vaccine is found, whilst imposing less restrictive measures on those at lower risk will enable easier adaption to COVID-19 whilst reducing transmission to the most vulnerable.
These new restrictions also exacerbate COVID’s detrimental impact on non-COVID NHS services given their understandable focus on the pandemic. As stated in the aforementioned open letter, Cancer Research UK have estimated that the pandemic has resulted in 2 million missed or delayed cancer screenings and 1200 additional deaths every 2 years. New restrictions, especially given the stable level of COVID hospitalisations, risks unnecessarily diverting more attention away from non-COVID NHS services, exacerbated by greater public fear of seeking necessary treatment, as evidenced by lower A&E admissions during lockdown. Additionally, further restrictions risk further exacerbating worsening mental health, with depression having already doubled, and tripled amongst 16-39 year olds, during lockdown according to Office for National Statistics (ONS) data.
Further economic consequences will come from these unnecessary restrictions. ONS data has showed that 695,000 people have been made unemployed during the pandemic, and with many more job cuts expected, further restrictions risk unnecessarily exacerbating this, especially amongst young people and those on lower incomes, and within the hospitality and leisure sectors, which have already been hit hard by lockdown. Whilst a second lockdown has been viewed as potentially more economically damaging, unnecessary restrictions like those currently imposed would cause businesses to struggle to rebuild, for example, economic interactions will likely decline given that schemes like ‘Eat Out to Help Out’ have been linked with rising cases.
Moreover, given the lack of scientific consensus, encroaching civil liberties through these restrictions sets a potentially dangerous future precedent risks reducing the threshold for the executive imposing future restrictions without damaging political capital. Despite Parliament being side-lined after granting the executive such powers earlier this year, executive dominance of Parliament makes Parliamentary approval of future powers highly likely, and thus such contention sets a worrying future precedent.
Ultimately, newly imposed restrictions resemble a disproportionate response to rising cases, particularly with low hospitalisations and deaths. Whilst rising cases and issues with testing are concerning, that cases are predominantly amongst lower-risk populations and that more testing capacity is being sought does not mean the NHS will be overwhelmed by hospitalisation, and thus these new restrictions risk unnecessarily detrimental economic, mental and physical health impacts. Furthermore, like other respiratory viruses, humanity will have to adapt to living with COVID-19 and mitigate risk through vaccination. Until this exists, political effort needs to be focused on effectively protecting those most at risk, especially the elderly in care homes and ensuring that testing and contact tracing meets demand.
Image: Andrew Parsons / No 10 Downing Street