When will COVID be over? In England, a step toward bringing the pandemic to a close came on July 19, dubbed “Freedom Day” by the tabloids, when restrictions limiting social contact were lifted. It meant no cap on the number of people who could meet, no national mask restrictions and no social distancing requirements. But after scrutiny of public health statistics, the Freedom Day moniker seems more a wish than a decision taken after careful deliberation of risks and benefits.
Shortly before it declared an end to COVID restrictions, England faced the highest number of weekly coronavirus infections since it was under a strict national lockdown in January. In the latest upsurge, businesses were forced to close, and the U.K.’s prime minister, health secretary and chief finance minister tuckedthemselves away in self-isolation. Any cause for celebration was lost against a backdrop of events that conveyed the sense that England—which has now seen three national lockdowns and about 132,000 COVID-19 deaths—was hurtling toward another pandemic disaster.
By removing rules on mask use, social distancing and the number of people who can meet, Prime Minister Boris Johnson marked England as the first country to attempt to transition out of the pandemic by relying on vaccinations alone for protection against the coronavirus. The rest of the U.K.—Northern Ireland, Scotland and Wales—have eased some restrictions but not as many.
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Leading scientists, writing in a letter in the Lancet, have branded the reopening a “dangerous and unethical experiment” that could cause unnecessary deaths, propagate so-called long COVID in hundreds of thousands and encourage the emergence of yet another hypercontagious variant.
It is unclear what comes next. After a sharp spike in daily cases in England that reached 56,282 on July 15, infections dropped to 20,007 by July 27. But rather than coming all the way down, they stabilized there and crept up above 28,000 in early August. Epidemiologists are grappling with public health data to determine whether the recent surge is the beginning of an exit wave—an uptick in cases caused by the easing of restrictions and surge in activity—or whether it might have been caused by a “superspreader” event such as a soccer tournament.
At best, what England is now going through may give the rest of the world strategies that point the way out of the pandemic. It may also serve as a warning against reopening too quickly. The eyes of health ministers across the globe are on England as it becomes a national guinea pig that reveals pitfalls—and some successes—in its attempt to negotiate its way out of the pandemic. “The stakes are high, and everyone is watching as this is new territory for all of us,” says Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh in Scotland.
Freedom Day
Whether the U.K. government will stay the course is still a shaky proposition. It has made U-turns on several key decisions before. Facing a spike in cases fueled by the homegrown Alpha variant, the government infamously “canceled Christmas” last December 19 by banning get-togethers of people from different households in London and southeastern England. Three days earlier it had promised not to do exactly that. Freedom Day, which was postponed by a month from its originally scheduled date of June 21, marks the fourth and final step in England’s road map to normality. That process began when schools reopened in March. Nonessential businesses were allowed to do so on April 12. And up to six people or two householdscould once again meet indoors starting on May 17.
But the government has refused calls from leading scientists to furtherdelay a full reopening as the impact of the highly infectious Delta variant has been felt. As nightclubs returned and all restrictions were lifted on July 19, several regions in England reported their highest infection rates to date. Johnson received a message a day earlier from the National Health Service app to self-isolate because he had come into contact with the U.K.’s health secretary Sajid Javid,who had received a positive test. Johnson was not alone: between July 8 and 15, the app had alerted more than 600,000 others to self-isolate. So many received that message that pub and supermarket chains were forced to close because of labor shortages.
The British decision raised eyebrows in another country fighting a hard and politically fraught battle against COVID. “It’s scary. Given the high circulation of the virus, I don’t think this is a good strategy,” says Maurício Nogueira, a virologist at the Faculty of Medicine of São José do Rio Preto (FAMERP) in Brazil. “But it's not just science at play; it’s politics and economics.”
One factor in the renewed surge has been soccer fanaticism—which perhaps presages what other nations can anticipate when crowds are drawn to major public events. Buoyed by England reaching its first major tournament final in decades, fans crowded homes, pubs and stadiums for a month to watch their national team compete in the UEFA European Championship, also called the Euros, beforeit crashed out in the final on July 11. A health official in England’s North East region said soccer “supercharged” virus transmission. Scotland also saw infections rise and fall in line with its earlier departure from the tournament. “The question is: Were the Euros the entire driver of what we are seeing or just a wave in a wave?” Woolhouse asks.
The removal of restrictions will have a gradual effect as public behavior adjusts. The reopening of nightclubs was a more muted affair than the scenes in pubs during the Euros. “A lot of mixing now will provide more opportunities for superspreading, although some mobility data suggest folks are being cautious,” says William Hanage, an epidemiologist at the Harvard T. H. Chan School of Public Health. “So it might be a long burn over the summer rather than a massive spike.”
Vaccine Gamble
For the moment, the U.K. government is undeterred by the surge in infections. Johnson has emphasized that the country’s strategy focuses on having vaccines break the link between COVID-19 and hospitalizations and deaths. At this point, most of England is protected by vaccines. More than 74 percent of its adult population has received two doses, and 89 percent of adults have been jabbed at least once.
But the government’s reliance on vaccines alone is an unprecedented stress test. Israel and some U.S. states reimposed mask mandates once the danger of the Delta variant became apparent. “This is the bottom line: What level of partial protection will the vaccines deployed in the U.K. have against this variant?” Nogueira says. “I’m inclined to say there won’t be a lot of deaths—the vaccines will do their job. But it’s a tricky experiment to do in real life.”
The U.K.’s vaccination campaign relies largely on AstraZeneca’s and Pfizer’s jabs. Both vaccines have exceeded expectations—even against Delta, for which they are respectively 92 and 96 percent effective against hospitalization following two doses, according to Public Health England.
But Delta’s rampant spread in the U.K. and abroad has dented confidence in the vaccines as the only measure to control COVID. “Vaccines are brilliant, but with what we’re seeing with the Delta variant, it’s a little ridiculous to put all your eggs in the vaccine basket,” says Susan Butler-Wu, a clinical microbiologist at the University of Southern California.
Delta, which is as infectious as chicken pox, according to an internal Centers for Disease Control and Prevention report, has driven a surge in cases across the U.S., spurred China’s worst outbreak since the initial one in Wuhan and forced Australia to reimplement lockdowns. As the first country with a high Delta prevalence to strip back all restrictions, England has unwisely become an “experimental arm” for the world to study how well inoculation alone can hold up, Butler-Wu says.
So far the results of that reopening have fallen short of the disaster some public health experts predicted. There were 70 COVID-19 deaths recorded in England on August 12, up from four daily deaths on July 12. That is around the same number of people on average who die from flu and pneumonia each day in England, and short of the worst-case scenario of up to 200 deaths a day modeled by the Scientific Advisory Group for Emergencies (SAGE), which advises the U.K. government.
But as winter approaches, people will retreat indoors, where transmission is higher. And the damage caused by COVID is not revealed by mortality figures alone, says Deepti Gurdasani, an epidemiologist at Queen Mary University of London. Some 750 people a day are being hospitalized for COVID in England, and the number of those suffering from long COVID continue to increase.
Herd Immunity
Mask mandates and other restrictions should remain in place until vaccine coverage grows, Gurdasani and more than 100 other leading scientists argued in the recent letter in the Lancet. But the point at which restrictions can be relaxed safely is increasingly elusive. More than 90 percent of England’s population has coronavirus antibodies from either vaccines or natural infection, according to the U.K.’s Office for National Statistics, yet infections continue to surge.
The persistent outbreaks in the U.K. suggest that the world has a long way to go until it can leave the pandemic behind, Woolhouse says. “This problem is not going to be solved solely by the vaccination program,” he adds. “We’ve still got months, possibly years, to navigate while this virus is circulating, and we should be prepared for that.”
The upsurge in cases also highlights the growing difficulty of reaching herd immunity and why the future of the pandemic in rich nations will increasingly center on the unvaccinated. “If we’re worried about an exit wave now or in the future, then we need to reach as far as possible into these pockets of unvaccinated people,” Woolhouse says. For low- and middle-income countries with a dearth of vaccines, it is a sobering reminder of how far they still need to go to catch up. “If I were a minister of public health in some other countries, I’d be worried that this means that it’s going to be a long time before we have the vaccination coverage that will stop this thing being transmitted,” he says.