It’s been a month since England dropped most of its coronavirus restrictions, a move that was welcomed by much of the country’s hard-pressed business sector but criticized by thousands of scientists as a “dangerous and unethical experiment.”
In an open letter published in the Lancet medical journal, they argued that a rising number of Covid-19 cases, the new Delta variant and the fact that a large part of the UK population was not yet fully vaccinated made the move too risky.
But the government was determined to push ahead.
It removed all limits on mixing and allowed venues like nightclubs and sports stadiums to open at full capacity starting on July 19. Face masks are no longer required apart from in a few specific locations, such as airports and hospitals. And as of Monday, fully vaccinated people are no longer required to quarantine after coming into contact with someone who has tested positive for coronavirus.
A month on, it’s becoming clear that while vaccination works, the reopening has come at a cost.
“The UK is averaging around 90 deaths a day from Covid. Our reopening has been far from an unqualified success,” said Kit Yates, co-director of the Centre for Mathematical Biology at the University of Bath.
While the death toll is much lower than it was at the peak of the pandemic, when as many as 1,300 people were dying every day, experts like Yates say it’s still unnecessarily high.
And with roughly 800 Covid-19 patients ending up in hospital each day, the UK’s public health system is once again under pressure and unable to provide non-emergency care at the level that is needed, Yates said.
“There isn’t capacity to carry out all the routine treatment that’s necessary. As a result people are missing out on lifesaving treatment,” he said.
The number of people waiting for routine hospital treatment has risen to 5.5 million in July from 4.4 million in February 2020, according to NHS Providers.
“If there was one lesson I wish other countries would take from watching the UK’s attempt to reopen is that vaccines are not the whole solution to the problem,” Yates told CNN.
“Yes, they make a huge difference, but if you want to keep on top of this disease then you need to back vaccines up with other tried and tested public health measures: Mask mandates in indoor public spaces, ventilation in schools and work places, a functioning, locally-driven test, trace and isolate system in combination with support for isolation,” he added.
Cases dropped, then rose again
Epidemiologists expected the reopening would lead to an increase in the number of people becoming infected with the coronavirus – but this didn’t happen, at least not immediately.
While the number of new cases increased just before the restrictions were lifted, it went down in the first few weeks after the reopening. This unexpected drop was likely down to the fact that contacts between people didn’t increase as rapidly as some predicted, and because the Euro 2020 football tournament, which led to a spike in cases, ended on July 11.
“Thankfully, although technically we’ve lifted restrictions, the UK looks a very different place than it did before the pandemic. My workplace is still practically deserted. It’s quite clear that people are not behaving as they were before the pandemic,” said Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh.
“There’s an awful lot of scope for people to change their behavior more to allow more transmission of the virus in the future. Whether they will, we don’t know – predicting people’s behavior in the face of an unprecedented pandemic is a fool’s game, really,” he said.
The spike in cases before the reopening meant a large number of people were in quarantine after coming into contact with someone who tested positive. More than 2 million people were “pinged” by the track and trace app in July alone, according to the NHS.
On top of that, the school summer vacation got underway in England on July 16.
Christina Pagel, director of the Clinical Operational Research Unit at University College London, said it has now become clear that schools played an important part in the overall picture, adding that cases in children have been halving every week since the beginning of the holidays.
But while the overall infection levels dropped in the first few weeks after the reopening, they have started creeping up again.
“In the last two weeks, cases in adults have started going up again, and more than you would know just from looking at the numbers, because they’re kind of masked by the big drops in cases in children,” Pagel said.
She said the increase in cases is worrying, because July and August are precisely the months when it should be easier to keep infection levels down.
“We’re still in a situation where we have a lot of cases and a lot of poor health from Covid, so I think there is kind of a bit of trepidation about what happens when we go back to school in September,” she said.
While hospitalizations in the UK are on the rise, the proportion of people who end up in hospital now is much lower than it used to be, thanks to vaccination.
“In January, before the vaccination program really got into full swing we were maybe seeing upwards of 10% of cases going on to be hospitalized. Now that figure is down to between 2% and 3%, so vaccines are making a huge difference,” Yates said.
The data also shows that while overall vaccination rates matter, the key is in the detail.
The UK has fully vaccinated 60% of its total population, according to Our World in Data, while in the US, that figure stands at 51%, according to the US Centers for Disease Control and Prevention. While the overall rate is similar, the US has more unvaccinated elderly people who are more vulnerable to the disease.
“In the over-50s, in our vulnerable populations, we have 90% to 95% fully vaccinated. And that’s making a really big difference. So we do have a lot of hospitalizations, but it’s nowhere near as high as it could be,” Pagel said, referring to the UK population.
“And if you look at places like Florida, which is seeing unsustainable hospitalizations, this is because they have a higher number of people who are still vulnerable, so even though they have high vaccination rates overall, it’s not helping them as much because of how its distributed in their population,” she added.
According to the Florida Department of Health, 79% of people aged between 60 and 64 and 86% of people above the age of 65 have been vaccinated.
Kids on the front line
In England, next month’s return to school is a major risk, because most kids won’t be vaccinated against the disease.
The UK medicines watchdog, the MHRA, has approved the Pfizer and Moderna shots for children and teenagers aged 12 and above, but only clinically vulnerable teenagers have been able to get the shots so far.
The government said Sunday that 16- and 17-year-olds will be offered the vaccine by next week, but there has been no announcement on inoculation for younger children.
“We will see lots of students meeting up indoors in schools at which few or no mitigations have been put in place … we should expect to see further rises in transmission when this happens, which will inevitably lead to more cases, more hospitalizations and tragically more deaths,” Yates said.
Deepti Gurdasani, a clinical epidemiologist and senior lecturer in machine learning at Queen Mary University of London, has long been critical of the government’s approach to the reopening, arguing that the plan put children at unnecessary risk.
“They may not individually get hospitalized or die at the same rate, but if enough of them get infected, then a large number will still get hospitalized and sadly, some will die. And they do get long Covid,” she said, pointing to data released by the Office for National Statistics earlier this month, which showed that 34,000 kids aged 17 and under are suffering from long Covid, with 22,000 of them saying their illness is having an impact on their day-to-day activities.
“These are not mild cases … 7,000 have had persistent symptoms for more than one year. That’s not mild,” she said.
Pagel said that while schools don’t appear to be major drivers of new infections when overall community transmission levels remain low, they become a problem when Covid levels are higher – as they are right now in the UK.
“Every other high income country is doing at least one of three things … they are either vaccinating adolescents, or they’re keeping in mitigation (measures) in schools such as masks and social distancing, isolation and (investing in) ventilation, or they’re keeping community transmission low … most of them are doing two of those things. We’re not doing any of them,” she said.