On 19 July 2021, England dropped the last of its legal restrictions on public behaviours in regards to the control of COVID-19.In the week following, 267,875 people in the UK tested positive for the disease.
However, the number of cases recorded daily has been falling. The most recent peak was Saturday 17 July, when 54,674 were reported. The most recent daily figure, for Sunday 25 July, reports 29,173 new cases.
Yet the number of COVID patients being admitted to hospital is on the rise, and there have been 450 deaths due to the disease in the last seven days.
Now, scientists who wrote to the UK Government prior to the so-called 'Freedom Day' have expressed concern for children and young adults returning to schools in the autumn.
On 7 July – nearly two weeks ahead of Freedom Day – 122 scientists and experts wrote a letter to the UK Government condemning the decision to reopen the country.The letter was then signed and supported by another 1,200 individuals and organisations including the British Medical Association, the Royal College of Nursing, and international scientific bodies.
According to the experts behind the letter, published in the journal The Lancet, the so-called Freedom Day would lead to unmitigated transmission, which would "disproportionately affect unvaccinated children and young people who have already suffered greatly". They write that allowing transmission to continue, or even increase, over the summer holidays could "create a reservoir of infection" which could then spread rapidly around schools and universities when they start the new term in autumn.
The reopening could further subject deprived communities to COVID-19, write the scientists, as we know some are disproportionately at risk.
And according to a pre-print study – which has yet to be peer-reviewed – the move to step 4 of the Roadmap could provide "fertile ground for the emergence of vaccine-resistant variants", said the experts.
"There is a huge amount of concern within the scientific community," Dr Deepti Gurdasani, one of the key authors of the letter, told BBC Science Focus. Gurdasani is a clinical epidemiologist focussing on the spread of genetic disease and the statistical modelling of populations.
"The UK's strategy is reckless and dangerous, and has been justified based on false narratives. The narrative is that the consequences of opening up now are better than if we waited until autumn.
"We have 21 million people unvaccinated... by easing restrictions we're essentially letting an unmitigated pandemic spread."
The majority of the 21 million are children and young adults, which Gurdasani feels is very concerning. "At least protect [children] from infection by putting mitigations in place... but mitigations in schools have been slowly reduced and removed."
Why did the Government move to step 4 on 19 July?
In Prime Minister Boris Johnson's Freedom Day speech, he said he believed in reopening England.
"The logic remains ... that if we don’t open up now, then we face a risk of even tougher conditions in the colder months when the virus has a natural advantage and we lose that firebreak of the school holiday.
"And there comes a point when restrictions no longer prevent hospitalisations and deaths, but simply delay the inevitable. And so we have to ask ourselves the question: if not now, when?"
The impact of the decision to move to step 4 of the Roadmap – in which outstanding legal restrictions on social contact and life events are removed, and any closed businesses are reopened – was modelled by several teams of scientists.
One such study was by Imperial College London, which compared the impact of reopening of the country on the 19 July, or at the later date of 16 August. The results of the research showed that reopening with a gradual increase of transmission on the 19 July would delay the third wave and reduce its number of casualties, compared with a complete reopening where transmission spreads rapidly (and no-one wears masks, social distances, and adheres to other measures) on both the 19 July or the 16 August.
Figures from the Office for National Statistics collected before Freedom Day suggested that 64 per cent of adults would continue wearing face masks in shops and on public transport. As of 26 July, there is no new data to confirm this.
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Gurdasani says there is a number of problems with applying the results of the Imperial College London study to real life. "For example, the model used in the study only looks at the number of deaths, not at the potential for an increase in cases of long COVID. The model doesn't consider the impact of vaccinating children. And it also doesn't look at the effect of giving booster doses over winter."
"So, we're being given two false options: either accept mass infections now, or mass deaths later – the truth is neither has to happen."
However, one of the authors of the Imperial College London study, Dr Raphael Sonabend, explained toBBC Science Focus that their paper does not suggest one reopening date is better than the other.
"Our models demonstrate potential scenarios in the future based on a set of specific assumptions," said Sonabend. "We do not claim that one decision is ‘better’ than another based on our models.
"We did not model ‘unlocking’ in autumn or winter, we only considered unlocking on 19 July or 16 Aug. Whilst the short delay [of unlocking in August] did reduce the peak of the next wave slightly, it had less of an impact than unlocking on 19 July with a gradual increase in social mixing as individuals continued to use face masks, social distancing, handwashing, and Test, Trace and Isolate.
"As stated in our report, we do not model the possible effects of booster doses or vaccinating under-18s and nor do we consider outcomes related to long COVID.
"We do consider: a range of vaccine efficacy scenarios, a range of immune escape scenarios, and the impact of continued caution and gradual increase in social mixing. The outcomes we primarily consider are deaths, infections, hospital admissions, and the effective R number."
What should the UK do now?
"I don't believe controlling a pandemic is a personal responsibility, it is a collective responsibility. There are things that people just cannot do to protect themselves and families," said Gurdasani. But, that being said, there are things she recommends individuals do to try to reduce transmission.
"You should aim to meet people outdoors, and if you can't, please consider using high-grade masks inside and keep windows and doors open.
"Please continue to wear masks – you might think you're protected from double vaccination, at least against severe disease, but you can still catch COVID-19, get ill and spread it. No-one is 100 per cent protected."
Gurdasani points to comments by Prof Neil Ferguson, who has been involved in modelling of scenarios for the UK since the start of the pandemic. Ferguson told the BBC's Andrew Marr Show on 18 July thatmillions will likely get infected over the coming weeks, with half a million people (predominantly young) expected to get long COVID.
"It’s very clear that this situation is avoidable. Countries like Israel, with higher rates of vaccination than us, are stating very clearly that they will not take ‘the dangerous path of the UK’.
"Instead, they continue with mitigations in classrooms, while they vaccinate their adolescents and take measures to contain their current outbreak."
"[In the UK] we are seeing high levels of hospitalisation among children that would have been avoidable – hospitalisations among children are at the January peak," said Gurdasani.
"None of this is inevitable. It’s clear we could take steps to contain transmission now, while vaccinating adolescents to protect them ahead of school openings in autumn.
"To my knowledge these scenarios have not been commissioned for modelling by our Government, which should provide an indication perhaps of what the Government is willing, or not willing, to do."
BBC Science Focus has contacted PHE for comment, but have yet to receive a response.
About our experts, Dr Deepti Gurdasani and Dr Raphael Sonabend
Dr Gurdasani is a lecturer in machine learning at Queen Mary University of London. Her work focuses on applying machine learning principles to the modeling of disease, and has worked with Genomics England. Her work has been published in journals includingCell, Nature CommunicationsandScience Advances.
Dr Sonabend is a data scientist working at Imperial College London in the COVID-19 real time modelling team. His research into SARS-CoV-2 has been published in Science and the Wellcome Open Research journals, while hismathematical modelling has been published inthe Journal of Open Source Software.
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