It is a mark of how badly this government has misjudged the pandemic response that Boris Johnson made a pledge in February to focus on “data, not dates” in relaxing social restrictions. We had a right to expect this approach to Covid-19 from the very beginning: it should have been driven by scientific evidence and a sober assessment of competing courses of action. But government decision-making over the past 16 months has been too driven by cabinet politics and internal party management, and too little by the public health of the nation. Johnson’s apparent determination to relax at once a huge swath of Covid control measures on 19 July in spite of steeply rising infection rates, reveals that February pledge as hollow.
The government’s argument is that even though data has changed significantly in recent weeks, with the rapid growth of the more infectious and more vaccine-resistant Delta variant, the link between infection and death has been sufficiently weakened by the vaccination programme to allow its self-styled “freedom day” to go ahead. Ministers are right that vaccines have dramatically cut the risk of death for those contracting the virus: in January, one in 50 infections led to a death; today that figure is just one in 1,000. But there are several important reasons to exercise more caution than the government is showing.
First, a decade of underfunding followed by Covid-19 has left the NHS under the worst strain of its 70-year history. Doctors and NHS chiefs are reporting that the health service is struggling to cope as it tries to deal with the waiting list backlog caused by the pandemic. The number of Covid hospitalisations is again starting to rise. As infection rates continue to increase, there is a risk that even with a lower proportion of cases resulting in hospitalisation, the sheer number of cases will again overwhelm the NHS, with knock-on impacts for people with life-threatening conditions such as cancer that will go undiagnosed and untreated. One in 160 people in the UK now have the virus; the government’s estimates suggest that Covid cases will reach more than 100,000 a day soon after restrictions are relaxed.
Second, the impacts of long Covid can be extremely serious, and thousands of people – particularly teenagers and those in their 20s who do not yet have the protection of the vaccine – may end up living with its debilitating symptoms for months as a result of letting Covid spread rapidly through the unvaccinated population. We do not yet know enough about the long-term health impacts of long Covid. Yet its risks do not appear to have featured in the government’s calculations about opening up.
Third, there remains little data on the effectiveness of vaccines in the 500,000 immunosuppressed people in the UK. The government has also not yet issued guidance for the clinically vulnerable, who may end up needing to shield after 19 July because of relaxed restrictions. This could likely be avoided if relaxation was delayed until more people were vaccinated and population-level immunity was higher.
If the Delta variant had not been seeded so quickly in the UK after Johnson delayed putting India on the red list for international travel for weeks in the spring, the risks of simultaneously relaxing so many restrictions on 19 July would have been lower. England’s chief medical officer, Chris Whitty, has indicated that there may be advantages to opening up in the summer rather than the autumn, when the NHS will be under more pressure. But there are questions as to why the government is not delaying by a few more weeks until more people have received both vaccine doses. At the moment, just over half the population have received both doses; later in the summer that proportion will be significantly higher. This would help dampen the spread of the Delta variant, and reduce the risk of more vaccine-resistant variants developing. The government, instead, appears to be allowing Covid to spread among children and younger groups to build their immunity, rather than rolling out vaccination to 12- to 15-year-olds as some other countries are doing. But the risks of long Covid in adolescents are unknown and potentially significant.
These decisions involve finely judged assessments of risks and benefits, and a huge degree of uncertainty. Yet Johnson has repeatedly failed to act promptly during the pandemic, with fatal consequences. Moreover, his government has committed to dropping low-harm, low-cost interventions, such as compulsory masks in indoor public spaces, despite evidence that suggests they are effective in reducing community transmission and the high levels of public support for them. This gives the impression of a government still swayed by Conservative MPs ideologically opposed to masks because they ludicrously regard them as a symbol of curtailed liberty. Johnson’s emphasis on personal responsibility suggests he himself is still driven by a distaste for the collective measures needed to control a pandemic, and not enough by scientific evidence and data.
Time and again in this pandemic, Johnson has lifted social restrictions too early or delayed acting. With a virus that spreads exponentially in a population that is not fully vaccinated, the costs of these missteps can be unbearably high. As more and more people get their second vaccine, these trade-offs continue to shift. If the government goes ahead with relaxing most of the remaining restrictions on 19 July, we can only hope that this time it is a gamble that pays off. The political cost that Boris Johnson will pay if he is wrong will be high. The human cost that we will all pay will be tragic.
