Open season

The announcement that the UK government intends to scrap almost all Covid-related restrictions in England on 19 July has led to significant concerns that it is yet again taking a risk with the pandemic that is not justified by the evidence. Covid cases are rising rapidly with latest figures showing a rise of 49% on a week ago (+383% over the last four weeks). Boris Johnson admitted in his speech to the nation that numbers could double to 50,000 per day by the time “Freedom Day” arrives. New health secretary Sajid Javid suggested in a radio interview that they could even rise to 100,000 per day. For the record, the previous record high was 68,053 on 8 January. For those who recall Boris Johnson’s promise that “data not dates” would determine the government’s policy actions, the latest announcement has raised more than a few eyebrows.

Is this a just policy?

There is no support for this strategy from the medical profession with the BMA calling for the continued use of face masks, arguing that even if the vaccination strategy has lowered mortality risks, the risk of infection has not disappeared which could have significant health impacts due to complications resulting from long Covid. However, the move appears to be a political response to the vocal and ill-informed anti-mask movement which somehow sees masks as an infringement on personal liberty. Indeed, this TV interview with a backbench Conservative MP spoke volumes when she called the wearing of masks on public transport “an infringement of civil liberties.” Ironically this concern for civil liberties was invoked on the day that parliament debated a policing bill which even many Conservative MPs find draconian. More seriously, as members of the medical profession pointed out, the wearing of masks gives people freedom to do things more safely that they may not otherwise be able to – such as travelling on public transport or visiting a restaurant.

One of the issues thrown up by this debate is the trade-off between personal and social responsibility. Anti-maskers argue that they should be allowed to exercise their own judgement as to when to wear them. Pro-maskers argue that since masks generate a positive externality by protecting others as much (if not more so) than the wearer, their use generates a wider social benefit. Welfare economics has attempted to build on the idea of Rawlsian justice as a way of assessing social choices, in which we have to balance the greatest possible amount of liberty being given to each member of society subject to the constraint that liberty of any one member does not adversely affect any other member.

To the extent that a person not wearing a mask impinges on the rights of those who wish to take precautions against Covid, the economist (not to mention the Rawlsian philosopher) would argue that simply doing away with masks flies in the face of social justice. After all, a public space belongs to everyone – not simply the group that makes the most noise. For the record, after Israel last month eliminated the requirement to wear a mask, 10 days later it was forced to backtrack.

Is there a herd immunity argument in favour of opening up now?

The proportion required to be vaccinated in order to achieve herd immunity differs according to the disease – for measles it is 95%, for polio 80%. Previous estimates suggest that such immunity for Covid would require between 60% and 70% of the population to be vaccinated (some estimates put the proportion even higher). For the UK alone, we are in the window, with around two-thirds of the adult population now having received two doses of the vaccine (though that figure drops to around 50% once we allow for children, who are not scheduled to receive the vaccine). But on a global basis we are nowhere near this. According to the respected website Our World in Data, only 24.4% of the world’s population has received one dose of the vaccine. So long as country borders remain open – even if only partially – the risk of cross-border transmission remains high.

A recent article in Nature suggested that herd immunity to Covid is now unlikely to be achieved and the epidemiology community is “moving away from the idea that we’ll hit the herd-immunity threshold and then the pandemic will go away for good.” As new variants emerge – much like the delta variant – and immunity begins to wane, the likelihood is that Covid will become an endemic disease in much the same way as flu. In this sense, at least, the UK government’s argument that we will have to live with Covid is consistent with scientific thinking. However, this is not an argument for ending all restrictions.

On the plus side, although cases are rising sharply, hospital admission and mortality rates have not. This provides strong support for the government’s argument that the vaccine programme has helped break the mortality link. Whether or not this remains the case cannot easily be predicted. The UK population is only partially vaccinated and virologists fear that ending restrictions in such an environment will create a breeding ground for new Covid variants. Even if the worst case does not arise, the medical evidence is clear: Avoid unnecessary exposure to Covid.

A recipe for economic chaos

It is perfectly understandable that parts of the hospitality industry want to get back to business as usual. But the wider economic costs of opening up are potentially significant. The government plans to scrap the working from home guidance and it will be up to employers to find an agreement with staff as to how the transition back to the workplace will be managed. However, the self-isolation rules requiring people to quarantine for 10 days in the event they come into contact with Covid will only be lifted on 16 August. On the basis that two people are forced to isolate for every recorded case, 100,000 cases per day as per Sajid Javid’s suggestion, would result in 1.4 million people having to self-isolate in the second half of July and first half of August.

Even if the number of cases is “only” 50,000 per day, it still implies that 2% of those in employment will be affected which will have significant implications for businesses. It is likely that many employers will continue to allow their employees to work from home but there are many jobs where this is simply impossible (e.g. retail). There will thus be some very heated conversations between employers and employees about the appropriate time to return to work.

Last word

In some respects the government’s insistence on setting a date to end restrictions is reminiscent of the approach to the Brexit deadline: Announce the date; implement the policy and deal with the fallout later. But given the government’s past approach to Covid which has seen it criticised for being too slow in applying lockdowns and closing borders, not to mention the policy towards old-age care homes, it is reasonable that people are concerned about the consequences of opening up at a time of rising Covid cases. The government knows that it cannot afford to get this policy wrong. Many people’s lives literally depend on it.