By Rosie Pitcher
With a relaxation of COVID-19 restrictions, which came into effect on the 24th February 2022, the UK Government no longer requires people to self-isolate if they have tested positive for COVID-19 or have come into contact with someone infected. Yet the Prime Minister’s announcement of these changes has prompted a myriad of criticisms from other political parties, the British public, and most notably, the scientific community. The alteration comes as part of the new ‘living with COVID-19’ plan, through which the Government is attempting to return life in the UK to normal. This relies on the immunity that has been built up in the population through extensive vaccination coverage.
Experts have mostly been discouraging the lifting of restrictions, warning that the removal of self-isolation will leave vulnerable populations at extreme risk. People in high-risk groups include elderly and pregnant people, those with conditions such as diabetes, cardiovascular disease, cancer and Down’s syndrome, and anyone with an illness that requires immunosuppressant medication. These groups remain at high risk of becoming seriously ill or dying from COVID-19, even after vaccination. While the rest of the public no longer has any legal obligation to carry out cautionary behaviours, vulnerable communities have been advised by the NHS to continue to work from home, avoid crowded spaces, and practice social distancing. At the very least this is likely to result in these people feeling increasingly ostracised and overlooked. Moreover, their lives are at risk if they do encounter people with COVID-19.
In the week ending February 11th, 1,185 people died from COVID-19 in the UK. It is unlikely that this weekly figure will significantly decline in the immediate future. Some scientists have accordingly pointed out that the Government seems to find this level of death acceptable. Respected health professionals including those representing The British Medical Association have stated that the decision is neglecting the most vulnerable people in society, and that the UK Government should be doing more to protect them.
While the rest of the public no longer has any legal obligation to carry out cautionary behaviours, vulnerable communities have been advised by the NHS to continue to work from home, avoid crowded spaces, and practice social distancing.
Not only are vulnerable people being placed at extreme risk by the removal of restrictions, but many in the scientific community have also warned the change could result in the emergence of new variants of COVID-19. Following the pattern of previous coronavirus outbreaks, SARS-CoV-2 has evolved variants that are more likely to evade our natural defences. These alternate strains emerge as the virus undergoes mutations, primarily those optimising its exploitation of the human receptor protein ACE2, a protein found on the surface of epithelial cells, allowing it to efficiently infect our cells.
One of the first variants of concern was the Alpha variant (B22.214.171.124), which arose in late 2020 and had multiple mutations in the genes coding for its spike protein. These allowed it to spread approximately 50% faster than the first iteration of SARS-CoV-2. Replacing Alpha were Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2). all of which emerged at a similar time and shared mutations which allowed them to spread quickly around the globe. Particularly, Delta was recognised as an extreme threat, as it was found to have mutations that allowed the virus to multiply faster in people’s airways. This meant it could outpace initial immune responses. Delta was approximately 60% more transmissible than Alpha, and therefore able to outcompete it in fitness. The most recent variant of concern is Omicron (B1.1.529), which emerged in November 2021 and is worrisome due to its genomic differences to Delta. Its 30 mutations linked to spike proteins allow it to infect people who have had COVID-19 before and also people who have been fully vaccinated. Each new variant that emerges appears to be more transmissible and more likely to evade our immune system. There is great concern that another even more infectious variant will emerge. Without precautionary restrictions in place, a new variant would be able to spread rapidly through populations.
Unfortunately, it is virtually impossible to predict patterns of variance, particularly in response to vaccination. The evolutionary forces that drive antigenic change, the mutations allowing new variants to evolve, are likely to grow stronger in response to increasing rates of inoculation because a large proportion of the population will gain immunity. It is possible that the virus could transform into something more threatening. However, COVID-19 could also become endemic as a relatively trivial seasonal cold. This seems to be what the UK Government is hoping will happen.
There is great concern that another even more infectious variant will emerge. Without precautionary restrictions in place, a new variant would be able to spread rapidly through populations.
All viruses must balance their ability to infect and multiply in the body while also keeping the host healthy enough to allow transmission. The ultimate fitness goal of any virus is to infect as many hosts as possible, which is why more transmissible variants outcompete the others. But if a virus kills its host or makes the host too ill to move around and infect others, it cannot spread further. This is why some people suggest we may have now seen the worst of COVID-19, and that it will become less deadly as it situates itself in the population. The newer variants like Omicron, despite being much more transmissible, have shown a lower virulence and mortality rate, suggesting COVID-19 is unlikely to cause large numbers of deaths again, and is more likely to remain a relatively non-lethal, but highly contagious disease. Some epidemiologists remain hopeful that the worst outcomes of the virus, in terms of deaths and hospitalisations, are over. Removing restrictions will allow the economy to recover further from the blow of the pandemic. After all, influenza viruses causing seasonal flu can cause thousands of deaths in the UK in a bad year, and there are few restrictions in place to prevent transmission of those.
However, scientists have pointed out that the long-term debilitating effects of COVID-19 make it incomparable to a common flu. The Government is keen to begin treating SARS-CoV-2 as if it is a common influenza virus, but it is from an entirely different family of viruses. We remain unsure of its full and long-term impacts on health. According to Dr Deepti Gurdasani, an epidemiologist at Queen Mary University of London: ‘People are still comparing COVID with flu, but since when did flu cause symptoms for more than six months in hundreds of thousands of people?’.
A decrease in deaths from COVID-19 does not mean the pandemic is over. The reality of the situation is highly complex and unpredictable. The best scientists can do to forecast any new variants is to track the way the existing variants have mutated in the hopes that future strains will follow a similar pattern.
It is possible that the virus could transform into something more threatening. However, COVID-19 could also become endemic as a relatively trivial seasonal cold. This seems to be what the UK Government is hoping will happen.
We will not eradicate SARS-CoV-2 in the near future, and vulnerable groups remain at high risk as long as it exists in the population. With increased immunity and boosters, it is unlikely that healthcare systems will be entirely overwhelmed again. Nonetheless, it still seems as though the Government is making a significant gamble in removing restrictions while cases remain high. Even if the average person will only experience a seasonal cold, those in vulnerable populations must continue to take maximum precautions, or else they face the threat of hospitalisation or death.
It is also worth considering that the virus would have to be under control in every continent for the pandemic to be anywhere near over. Vaccine coverage, whilst improving, is not optimal in this country nor worldwide, and many nations remain in devastation from the effects of the disease with little capacity to control it.
To prepare for a future pandemic, we can only hope that both the public and the Government have learned from COVID-19. It is expected that even though self-isolation will no longer be compulsory, many people in the UK will still isolate if they test positive, continue to wear masks and generally act with caution. This will hopefully soften the impact of the removal of restrictions. If another outbreak of this scale is to be prevented, trends will have to monitored closely and the Government prepared to act very quickly if another variant of COVID-19, or a new pathogen altogether, emerges.