Not again?

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Reaction to news of the new Omicron COVID variant seems to be united by one phrase “Not again.”  However, exactly how that phrase is being used seems strongly polarised. Whilst there is auniting theme of “Oh no, not again -just when we thought we were through the worst!” For some people “Not again?” carries the view that we are once again in an at risk position with the fear that previous mistakes are being repeated and that we are vulnerable because of current decisions. On the other hand “Not Again!” is a defiant statement from some. The attitude is that there is nothing to be worried about and that they will not be complying with COVID restrictions – not again, not this time.

The first response seems particularly associated with those who have been calling for the so called plan B approach to COVID.  Over the past few months, the UK approach has been that the virus is something we need to learn to live with as it transitions from epidemic to endemic.  This means the Government have been happy to live with relatively high case numbers providing this doesn’t leas to pressure on hospital admissions and significant increases in mortality. Plan A in England has been:

  • To allow society to re-open at close to pre-COVID normality
  • To maintain a form of contact tracing especially within school contexts
  • To leave it to people’s discretion as to whether or not they wear face masks but to encourage them in crowded/poorly ventilated venues.
  • To introduce booster jabs currently available to over 40s 5 months after the second jab.
  • To vaccinate under 15s with a single jab initially.

In Scotland and Wales, as is the case across much of Europe, face masks remain compulsory and immunity passports have been introduced for a range of venues.

The expectation for England was that should we see hospital admissions beginning to spike and pressure on the NHS then “plan B” would come into play. Exactly what would be involved is uncertain, but it is believed that the Government’s preference is to avoid lockdown type measures if possible but compulsory face masking on public transport and in shops would resume whilst vaccine/immunity passports would be introduce in England and extended in Scotland and Wales.

Some people argued that in the light of increasing cases prior to the October half-term we should move to plan B quickly.  We then saw a few weeks of reducing cases followed by a further cycle of increases which may have come to an end at the weekend. During that time admissions and deaths have been falling.  Additionally, countries and provinces that have retained compulsory masking and deployed immunisation passports have experienced significant case increases too.

This suggests to me that Plan B was not necessary and may well not have been effective in responding to the situation we had prior to the emergence of Omicron.  As I’ve suggested before, it looks like facemasks have a particular role to play in conjunction with other measures at a specific stage in the virus. In other words, if you have social distancing, the facemask gives you a further additional protection. Similarly, I suspect that requiring facemasks will, in the early stages signal and encourage modified behaviour. It’s the change to normal behaviour that is crucial.  People will be less likely to engage in social interaction as they get used to masking.  I would also expect that factor to diminish as people become more and more used to masking. 

Meanwhile vaccination passports are dependent upon vaccine efficacy. This is important because if vaccine efficacy is substantially affected by Omicron then preventing the unvaccinated from attending events is unlikely to do much to prevent its spread.

What this means is that rather than Omicron being used to push through plan B, we actually need to focus on plan A for the new variant.  I would expect that plan to include the following

  1. Taking all measures necessary to delay potential spread whilst we get more data.
  2. Modify vaccination policy depending on the evidence available.

As I’ve mentioned before, it is possible that the variant won’t require any change to vaccine policy at all. However, should there be significant loss of vaccine efficacy the question will be “Should we deploy a modified vaccine targeted towards the mutations in Omicron?” This may not be necessary and instead the preferred route may be to bring forward booster jabs for the wider population and second jabs for under 15s.

In terms of step 1, the government have decided that the best way of achieving this is to require face masks in shops and on public transport whilst reintroducing 10 day isolation and international travel restrictions. The aim of this is to buy time. 

This leads me back to the second response we are seeing.  The response from some has been a strongly worded “Not again -not this time.” Those responding this way believe that we are overacting to the new variant which may turn out to be ‘a storm in a teacup.’” This response sees COVID measures as an infringement of rights.

This has led to some holding to the first position accusing those not willing to comply with the measures of being selfish. This of course assumes that the measures will be effective.  To be honest, I’m not convinced they will be. If we are still seeking to restrict Omicron from entering the country then we need rapid checks and quarantining at airports, simply selecting some countries to put on a travel ban list is like playing a game of Russian roulette. Meanwhile if the virus is already spreading in the community then I don’t think face masks will be of much use. And if the vaccine remains effective against the new variant then we are in no different a position to the one we have been particularly if it prevents serious illness.

Furthermore, the assumption that it’s better to just do something presumes that there isn’t a cost to people’s health and well-being from introducing measures.

My personal take is therefore that it is unhelpful to simply seek to squash an understandable response. It’s frustrating too that few people seem to actually be asking “what will work and what is needed?”  We seem to forgo the request curiosity around those two questions.

At the same time, whilst I may have some personal opinions on what will be most effective, I remain unconvinced that there are major moral or theological arguments against a country enacting emergency measures during a national or even international emergency. The Government is morally entitled to and responsible for making difficult decisions. We may not like or agree with them but I believe it is wisest, and most compassionate to comply whilst being ready to challenge and question the efficacy of such measures.

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