Only Boris Johnson could come up with a cheap slogan like “Freedom Day” in the middle of a deadly pandemic. (This is reminiscent of his joke in the early stages of the pandemic about “operation last gasp”).
Idiotic remarks aside is it indeed crazy and irresponsible to remove all remaining Covid restrictions (laws and that ambiguous middle-ground of “government guidance”) now as this widely backed letter in the Lancet argues?
The authors of this letter – who could be said to be from the pro-lockdown side of academia – make 5 arguments. Let’s consider them. Before we do that let’s just remind ourselves of the context. Currently 50% of the UK population has been offered both doses of a vaccine (spaced apart by more than the manufacturer’s recommendations in the case of Pfizer of course). This includes all the especially vulnerable groups. By some point in September all over 18 year olds will have been offered 2 doses. Vaccinations in children has not yet been decided. Lifting all restrictions now will lead to more infections than if they were maintained until, say, September when all adults will have been offered a vaccination. This delay is what the authors of this letter in the Lancet want.
(1). They argue that children will suffer from long Covid. The evidence on “long Covid” in children is fairly weak. Unfortunately, there may be an element of a syndrome where parents and children exaggerate their problems because they see some kind of advantage in doing this. This article originally published in the New Scientist confirms that “Often, blood tests and scans also fail to supply any answers”.  Of course there is a pressure group which argues that doctors are not treating the condition seriously. The same article reports on an Italian study which found that approximately 25% of children who had had Covid reported the continuance of at least one debilitating symptom after 120 days. I don’t know if these were self-reports or symptoms which were confirmed by doctors. (The New Scientist article is behind a paywall). I am not convinced that the argument to maintain restrictions to reduce overall infections and thus infections in children and thus, in turn, cases of long Covid in children – which effect a minority and about which some doubt exists amongst doctors as to their validity – is a very strong one. Possibly; but it depends on how much of an actual medical problem long Covid in children actually is. But, more to the point, if this is a valid argument then it follows that these authors are demanding vaccination of all children. (Only relatively marginal protection would be obtained by delaying the end of all restrictions in the UK; much more would be obtained by direct vaccination of children). That certainly sharpens the debate. AstraZeneca causes serious blood clot events in 1 in 100,000 recipients. Pfizer has a small risk of heart inflammation which effects young men in particular. I think a responsible scientist would want to be very sure that long Covid in children is a real, widespread, and serious condition, before ordering a vaccination programme which could (especially if AstraZeneca is used) cause a large number of serious adverse events in children.
(2) The second argument is that lifting all restrictions now will lead to an increase in transmission in schools. This argument suffers from the same fault-line as the preceding argument. There will be an indirect effect. More adults will be infected and thus more children. The authors acknowledge that the requirement for contacts of infected children to isolate is being removed but assert that the real disruption in schools is via transmission not isolation. (I am not sure how this argument works; surely the disruption is when children cannot attend school?) But again; the logic of this argument is that they are calling for all children to be vaccinated. This is so because transmission between school students will only be reduced significantly if and when there is herd immunity in this actual population and here they assert that they don’t accept herd immunity by infection. Vaccination of all children is the logic of these arguments but the authors don’t admit it; probably because they understand that vaccinating children is an ethically very controversial area. But sooner or later we can expect the signatories of this letter to call for the vaccination of all children because this is the internal logic of their position.
(3) The third argument is that removing restrictions now with its attendant greater increase in infections than if restrictions were maintained until say September when all adults will have been offered a vaccine will create a greater pool for variants to emerge in. As far as I understand the science of how viruses mutate this appears to be a valid argument. Statistically anything which reduces the overall infection rates will reduce the overall chance of variants emerging and thus the overall chance of a variant emerging which is not covered by the existing vaccines. Of course; there will always be some risk of such a variant emerging. This is an argument about probability. The government and those scientists who are in favour of removing the remaining restrictions may feel that the benefits of opening up are greater than the possible risk from this direction. And, in general we can note, that so far variants have been covered quite well by existing vaccines.
(4) The fourth argument they make is that the increased volume of hospitalisations which will result from not delaying lifting restrictions will place an additional burden on health service staff. It is good to see this argument being made candidly. (I think it is a main driver for the call to continue with restrictions but has not always been made openly). But let us at this point note that the majority of people currently dying in hospital are those in vulnerable groups who have declined vaccination. It is true that if overall numbers of cases are reduced then less of the vulnerable unvaccinated will end up in hospital. But – the logic here is that the authors are making a case that restrictions should be continued as if there were no vaccinations and in order to protect those who choose not to be vaccinated. I would guess that the government has simply decided that as far as this cohort goes they have made their decisions. It is indeed very tough on health service staff that they are having to deal with these people. It is a real problem. But I think the problem should be addressed at source; what to do about people in at-risk groups who are not accepting vaccination. If the solution to this problem is to maintain restrictions as if there were no vaccination programme then there is in fact no end to this.
(5) The fifth argument is that Covid affects disproportionally the most “deprived” communities. Any avoidable increase in infections will disproportionally affect these communities thus “deepening inequalities”. Of course one reason why certain communities are disproportionally affected is because they are more reluctant to get vaccinated.  Basically – people further down the socio-economic scale show greater vaccine hesitancy. This argument is valid but as with the fourth point it does not follow that the solution is a blanket lockdown which affects everyone. In both cases the authors are trying to solve problems in specific groups by applying restrictions to the whole population. Of course this approach will work because the sub-groups will be affected by inclusion in the whole group. But in both cases one can argue that it would be better to focus on the specific problem and allow those who are not in these groups to benefit from their own choice (to get vaccinated).
The arguments of this letter in the Lancet are not all that strong. They would be stronger if they were open about the logic of their position which is that all children should be vaccinated. Apart from this the main weakness of the position is that they are thinking in terms of a whole population approach. Against this one can argue that problems such as vaccine hesitancy in vulnerable groups and amongst certain “deprived” communities should be tackled directly rather than taking a whole population approach. My guess is that (silly rhetoric aside) this is the view of the government at this stage.
The main valid argument seems to me the one about doing anything which increases the statistical likelihood of a variant emerging which is not covered by an existing vaccine. That is a matter of probability and while the argument is valid I can see that on the other side of the argument people might think that delaying the full end of restrictions in order to gain a few percentage points on a probability scale is not the right choice. It depends a bit on whether your instinct is to take risks or always to try to minimize any risk at all. My guess is the present government errs on the side of risk-taking.
Having said that I don’t see the arguments presented here are all that strong I can also see the point of view which says: full vaccination of all adults (who accept it) will have been achieved by September. Why not wait just a little longer and be safe. As one lecturer and GP quoted by the Independent says “why go for herd immunity by infection when you could reach it by vaccination”.