Winning the war on Covid-19: what comes next?

Next month marks two years since Prime Minister Boris Johnson announced tough restrictions on people’s lives, aimed at stopping the spread of Covid-19. The toll on the country since then has been immense and latest figures show that more than 160,000 people have died after testing positive for Covid-19.

This burden has fell hardest on the older population and also disproportionately impacted those on lower incomes, in insecure employment and from ethnic minorities.

According to the National Office of Statistics (ONS), in January 2022, Covid-19 was still the third leading cause of death in both England and Wales after Alzheimer’s disease and ischaemic heart diseases.

It was, therefore, met with mixed emotions when the government this week launched a 62-page ‘Living with Covid’ strategy that ends all remaining Covid legal restrictions in England.

• Further reading: The Covid Inquiry: Johnson addresses the ‘let it rip’ strategy

Key measures are that people who test positive, and their close contacts will no longer be required by law to self-isolate, including those who are unvaccinated.

Other changes are that from 1st April, the Covid provisions on statutory sick pay will be removed. This allows employees to claim sick pay and Employment and Support Allowance from the first day they are not at work. Also, the general public will no longer be able to access free tests although they are expected to still be available for people over 80 years and those classed as ‘clinically vulnerable’.

Johnson said: “Restrictions place a heavy toll on our economy, our society, our mental wellbeing and on the life chances of our children. And we do not need to pay that cost any longer.”

He added that vaccines and other pharmaceutical interventions will continue to form our first line of defence against Covid-19.

The plan covers four main pillars:

• Removing domestic restrictions while encouraging safer behaviours through public health advice, in common with longstanding ways of managing other infectious illnesses
• Protecting the vulnerable through pharmaceutical interventions and testing, in line with other viruses
• Maintaining resilience against future variants, including through ongoing surveillance, contingency planning and the ability to reintroduce key capabilities such as mass vaccination and testing in an emergency
• Securing innovations and opportunities from the Covid-19 response, including investment in life sciences

Do NHS staff still need to test for Covid-19?

NHS England wrote to healthcare bosses today (Wednesday)  to provide an initial update of the new plan and to outline the areas that are being reviewed and may change, and to highlight those areas that will remain the same.

It said that healthcare staff who have tested positive for Covid-19 should not attend work until they have had two negative LFD test results taken 24 hours apart. The first test should not be taken before day five after their initial positive test. These tests need to be 24 hours apart, and providing they are medically fit, they can return to work on the morning of day six providing they tested negative 24 hours earlier.

Further guidance for staff and patients exposed to Covid-19 is expected from the UK Health Security Agency (UKHSA) later this week.

It added that in line with previous NHS England and NHS Improvement guidance published in March 2020, NHS organisations and their subcontractors are expected to ensure that any member of staff, including bank and sub-contractor staff, who have to be physically present at an NHS facility to carry out their duties, receives full pay for any period in which they cannot attend work as a result of public health advice.

Covid-19 testing for patients

NHS England said it will write to healthcare staff in the coming weeks with the specific detail of the various testing protocols for patients and staff.

It added that the current testing protocols should continue until further guidance is received. For now, NHS staff should continue to access their tests via the universal offer online until advised otherwise and community pharmacies will continue to provide a supply of tests until 31 March.

In extremis, regional testing leads will have a supply of tests to be accessed on an emergency basis provided to them by UKHSA.

The visiting guidance is being reviewed in light of the new plans and the outcome of a review will be shortly published so that visitors can attend hospitals and healthcare settings in a manner that continues to protect patients and staff.

Will this exacerbate existing health inequalities?

The Prime Minister said that symptomatic testing for vulnerable patients will remain available which will support access to Covid-19 treatments. Yet many organisations believe that some of the measures threatens to exacerbate already existing health inequalities for certain groups.

Crucially, it will create a two-tier system, where those who can afford to pay for testing – and indeed to self-isolate – will do so, while others will be forced to gamble on the health of themselves and others.

The Health Foundation said that the government’s overriding principle in launching this new strategy appears to be the need to reduce public spending on the management of Covid-19. This is understandable given the huge resources that have gone into the pandemic and the pressing need for major investment across public services as the country recovers. But the right balance of support is needed.

David Finch, Assistant Director of Healthy Lives, added: “The strategy fails to recognise and make provisions for the unequal impact that Covid-19 has had across society so far and the unequal risks from ‘living with Covid’. Expecting people to take personal responsibility to reduce the spread ignores the fact that there is insufficient sick pay coverage which means the incentive for many will be to continue to go out to work and not stay at home if they are infected. The removal of statutory sick pay from day one of isolating will only further increase this risk.

“Furthermore, limits to free testing could lead to infection rates increasing more rapidly in poorer communities where the impact of infection may be more severe given the lower uptake of vaccines in more deprived areas of the country. This could have a knock-on effect on the backlog of NHS care, with some of the most deprived areas having already faced the most significant service disruption through the pandemic. The government must do more to protect those who are most vulnerable and exposed as we learn to live with Covid-19.”

Are we living with Covid or ignoring it?

The British Medical Association had the most damning response to the plan and said that living with Covid-19 must not mean ignoring the virus all together, which in many respects, the government’s plan in England seems to do.

Dr Chaand Nagpaul, BMA council chair, said that the announcement failed to protect those at highest risk of harm from Covid-19, and neglects some of the most vulnerable people in society.

“We recognise the need, after two years of the pandemic, to begin thinking about how we adjust our lives to manage living alongside Covid-19, but as the BMA has persistently said the decision to bring forward the removal of all protective measures while cases, deaths and the number of people seriously ill remain so high is premature,” he added.

“On the one hand the government says it will keep monitoring the spread of the virus, and asks individuals to take greater responsibility for their own decisions, but by removing free testing for the vast majority of the population on the other, ministers are taking away the central tool to allow both of these to happen.”

The BMA also highlighted that people will want to do the right thing, and not knowingly put others at risk if they are infected, but how can they make such a judgement if they have no way of knowing if they’re carrying the virus or not? This is especially important for those who come into contact with people who are at much greater risk of becoming ill with Covid-19, such as elderly relatives or those who are clinically vulnerable.

It said it was completely illogical to provide free tests to clinically vulnerable people – and only once they develop symptoms and are potentially very unwell – but not providing any free tests to friends or family who come into contact with them. The priority should be protecting them from infection in the first place. The same goes for care home staff, who will only be tested if they have symptoms, by which time they could have passed on the virus to vulnerable residents.

It added: “There must also be urgent clarity around testing provision for NHS workers. People visit hospitals and surgeries to get better, and not to be exposed to deadly viruses, and the continuation of testing for healthcare workers is invaluable in protecting both staff and patients.”

The NHS Confederation also highlighted the risks of watering down the ability to monitor the spread and evolution of coronavirus and urged the government to reconsider its plan with dedicated funding for continued access to Covid tests for all NHS workers in patient-facing roles.