Is it too early to lift Covid restrictions while the NHS is in crisis?

Today, Boris Johnson announced that England will revert to ‘Plan A’ measures, due to the declining numbers of Covid cases and hospital admissions.

This means that all Plan B restrictions, including mandatory mask wearing on public transport and in most indoor venues, Covid passports for large gatherings of 500 people or more, and working from home where possible, will no longer be required from next week.

With the number of people infected with Covid-19 in the UK showing the most significant fall since the start of the Omicron wave (according to the Office for National Statistics), epidemiologists like Professor Mike Tildesley are growing increasingly, yet cautiously, confident that the peak in cases has passed.

However, while the data seems to paint a positive picture, scientists are warning that this overall levelling off could be short-lived and some say that lifting restrictions now could lead to extra pressure on the NHS, which is currently in the midst of a staffing crisis.

An exhausted workforce and Covid

All sectors, but particularly the health service, are struggling to cope with widespread absences caused by the rapid spread of the Omicron variant.

By the first week of January, 24 hospital trusts in the UK had declared critical incidents as an exhausted workforce struggled to keep up with demand. In some hospitals, the situation became so desperate that armed forces personnel were sent to fill vacancies.

The level of exhaustion felt by staff has been highlighted in a survey by the Royal College of Physicians, which found that roughly two thirds of doctors (69%) felt overwhelmed at least once while at work in the past three weeks, with around a fifth (20.5%) saying they felt overwhelmed almost every day.

It also found that 7.5% of respondents were off work, with roughly half of these absences due to Covid-19. With so many people off work, the majority of doctors (55%) have been asked to fill a rota gap at short notice at least once during the past three weeks, adding further stress to their working days. Of those, almost a quarter (24%) had been asked to fill a rota gap at least once while on annual leave.

Danny Mortimer, chief executive of NHS Employers and deputy chief executive of the NHS Confederation said the results of the survey confirm that staff shortages and an exhausted workforce “present the greatest challenge to the recovery of our NHS and the return of safe, high-quality health services for all.”

He added that the government must now clearly describe “how their investments will help and what further priorities they will set to boost workforce numbers” as “weary healthcare staff need to be given hope that help is coming.”

Worryingly, the levels of demand facing the workforce are leaving doctors at risk of sleep deprivation which is affecting their ability to safely care for patients, according to a recent survey by the Medical Defence Union.

Of the 532 doctors who took part, a quarter said they feel sleep deprived on a weekly basis which has affected their ability to concentrate and make important decisions. This translated into 40 near misses and seven cases in which a patient actually sustained harm.

Dr Matthew Lee, chief executive of the MDU, said that pressures on frontline healthcare workers are likely to get worse for doctors in the coming weeks and for this reason, it is more important than ever that staff who are fit to work are properly supported so they can care for patients safely.

Will reducing the isolation period to five days help ease pressures?

To ease some of the pressure facing the workforce, the government announced various measures designed to get more healthcare professionals back to work, including reducing the mandatory isolation period to five days.

The new rules mean that people in England who test positive for Covid can get out of isolation if they receive a negative lateral flow test (LFT) result five full days after symptom onset or their first positive LFT (depending which comes first).

However, the UK Health Security Agency (UKHSA) has warned that cutting the isolation period could actually be “counterproductive” and exacerbate staffing shortages.

This is because modelling by the Agency suggests that 10-30% of people will still be infectious on day six, meaning that in some settings, such as hospitals, shortening the isolation period could lead to more people being infected and worsen shortages.

However, the UKHSA say they will keep their position under review and their assessment “may change as we continue to learn more about the features of the Omicron variant compared to, for example, the Delta variant.”

The British Medical Association said that because healthcare professionals are frequently in contact with the clinically vulnerable, the government must provide them with high-grade face masks to reduce the risk of infecting their patients and colleagues.

Dr Penelope Toff, BMA public health medicine committee chair, explains this is also true for the general public and there must therefore be a clear understanding that there is still a risk they can infect others, “so they should be cautioned to take particular care to wear masks, keep their distance and ensure there is adequate ventilation indoors.”

“Furthermore,” she added “easing self-isolation requirements alone will not resolve the sky-high level of infections in the community – which is the main driver of health service staff shortages – and with many people still not fully vaccinated, unvaccinated or with weakened immune systems, there is a significant risk of severe disease among these groups and of further variants of concern arising.”

Dr Toff suggests that people should ensure they continue isolating if they feel unwell and greater steps must be taken to encourage uptake of vaccination.

Mandatory vaccination law for health workers risks exacerbating staffing crisis

There are also concerns that when the mandatory vaccine law comes into effect, thousands of nurses and doctors could leave the health service and exacerbate the staffing crisis.

The new law states that NHS staff in England who have direct contact with patients must have had their first dose of a Covid vaccine by 3 February or they could be out of a job by the end of March.

UNISON the union is urging the government to rethink its plan to bring in a vaccine mandate, saying that although it is “very clear” that vaccination is “the best way” to tackle Covid-19, a mandate is not the right approach.

The TUC is also calling for the policy to be delayed with immediate effect, as the plan will “exacerbate this crisis, creating a bureaucratic and staffing nightmare for NHS trusts and making it impossible to maintain safe staffing levels in the coming weeks.”

The government’s own impact assessment of the policy concluded that as many as 73,000 staff could leave the profession if they chose not to get jabbed. With the 93,000 vacancies already facing the NHS, the law could therefore have a devastating impact.

Frances O’Grady, the TUC’s general secretary, said: “We are in the middle of an NHS staffing crisis, born not only from Covid absences but also long-term problems that need long-term solutions. Now is not the right time to introduce more bureaucracy.

“As hospitals declare critical incidents amid a surge in Covid cases, the NHS cannot afford to lose experienced and skilled staff”.

Public behaviour could have a huge impact on how well the NHS copes

With so many healthcare professionals at risk of leaving the profession as a result of burnout and the introduction of the mandatory vaccine law, some experts are saying now is not the right time for the government to relax nearly all Covid restrictions.

Prof Graham Medley, an expert in infectious disease at the London School of Hygiene and Tropical Medicine, and one of the government’s lead modellers, warns that while the number of cases and hospitalisations does appear to be going down, there is still the risk of a long, flat peak which will see infections and serious illness drop very slowly.

It is also important to remember that the number of people testing has also reduced significantly over the past couple of weeks, after the government put new guidance in place that people in England who test positive on a lateral flow test will no longer need a confirmatory PCR test.

Prof Medley told the BBC that if we remain at the same sort of levels of infection we have at the moment for some time, “the NHS will remain under huge pressure.”

Dr Chaand Nagpaul, Chair of the British Medical Association (BMA), said removing effective infection control measures, like mask wearing, will “inevitably increase transmission and place the public at greater risk, especially for those who are vulnerable”.

“This decision is clearly not guided by the data,” he added, as the latest figures show there are nearly 19,000 patients in hospital in the UK, up from roughly 7,000 in December, when Plan B measures were first introduced.

The NHS Confederation has similarly warned that “even with restrictions and many people going further to protect themselves and others, the number in hospital with Covid is high and the numbers are only going down very slowly.”

“Covid-19 has not magically disappeared, and we are likely to have to learn to live alongside it for years to come. Lifting restrictions doesn’t mean a return to normality is inevitable.

“We need to be honest with the public that a decision to lift restrictions is a trade-off. We will have greater freedoms but the cost – at least in the short term – will be that more people are likely to get sick with Covid, and that the health service will continue to have to deal with the extra burdens that this creates,” said Matthew Taylor chief executive of the Confederation.

While the government “recommends” wearing masks in enclosed or crowded spaces, without a mandate, there is a risk that cases could start to rise again, putting added pressure on the NHS as it tries to tackle the backlog of six million patients awaiting treatment.