The Netherlands, Germany, South Africa and the United Kingdom are among several countries which have announced plans to lift the majority of COVID restrictions, despite the continuing spread of the highly contagious Omicron coronavirus variant.
The raft of announcements, including plans to scrap COVID self-isolation for those who test positive in England and an end to social distancing rules in the Netherlands, come as leaders and health officials in some regions have argued that the pandemic is entering a new phase and urged populations to begin “learning to live with COVID”.
Last week, Anthony Fauci, the top infectious diseases expert in the United States and adviser to President Joe Biden, said the US was exiting the “full-blown pandemic phase”. In January, Spanish Prime Minister Pedro Sanchez called on European countries to begin treating the coronavirus as an endemic disease akin to the flu.
The suggestions that the pandemic is entering a new phase come after early studies appeared to show that the dominant Omicron variant causes less severe disease than other strains of the coronavirus. Health officials have noted that in countries with relatively high vaccination rates, the spread of Omicron has not led to a substantial increase in hospitalisation and death rates.
However, some scientists and public health officials have warned that moves to end COVID regulations could be premature at this stage in the pandemic.
According to the Omicron-related guidance provided by the World Health Organization (WHO) on January 7, a “multi layered and targeted” approach is needed to counter the Omicron-led COVID-19 wave. The United Nations health agency “strongly advises” rapid testing, contact tracing, isolation of cases and “supported quarantine of contacts” to help reduce transmission.
In late January, as the Omicron wave in South Africa began to recede, the government said those who test positive for COVID-19 but present no symptoms would no longer need to self-isolate. Contacts of those who test positive would also no longer need to self-isolate if they remain asymptomatic.
Mosa Moshabela, a professor of public health at the University of KwaZulu-Natal (UKZN), said the directives were “adequate and strong” in light of declining cases, high immunity levels and workforce disruptions.
However, he felt the government “fell short” on communicating the new isolation policies to the public – and to strongly highlight the need for “personal responsibility”.
“They needed to say, ‘we no longer legally compel you to isolate if you are asymptomatic, but that doesn’t mean you have to give up your responsibility to protect people around you,’” Moshabela told the press.
Several European countries, including Denmark and Norway, have already dropped most of their coronavirus restrictions. In the Netherlands, face masks, social distancing and health passes will no longer be required in most places this month, as Austria, Switzerland and Germany have also announced plans to lift most COVID curbs.
Meanwhile, British Prime Minister Boris Johnson last week said almost all COVID rules in England could be lifted by the end of the month – including the “legal requirement to self-isolate if you test positive” – a month before the planned date.
During February 7-13, the UK reported 388,877 cases, almost a 30 percent decline from the previous week.
While the proposals to coexist with the virus have been welcomed by many in Johnson’s Conservative Party, some public health experts urged caution.
Paul Hunter, a professor in medicine at East Anglia University, said it would have made more sense to lift the restrictions towards the end of winter in the UK in late March.
“Infection rates are still high but have started to fall fairly rapidly during the last week. However the BA.2 variant of Omicron is still increasing,” he said, referring to an Omicron subvariant that appears to be more transmissible than the original Omicron strain, according to early studies.
“If we wait till the end of March respiratory viruses spread much less rapidly and so easing then would be more sensible in my view.”
Protecting the vulnerable
Some of the most pressing concerns around the scrapping of isolation periods and other restrictions have been expressed by groups tending to vulnerable communities, including the elderly and those with pre-existing conditions.
“Scrapping self-isolation will mean that some disabled people will be feeling very anxious and could potentially be placed in situations that could prove deadly,” James Taylor, director of strategy at disability equality charity Scope, said in a statement.
“Nobody should be forced to gamble with their lives, and we need the government to explain to disabled people how they’ll be safe when this decision is introduced,” he added.
Taylor said since the spread of the Omicron variant, some disabled and immunocompromised people have felt increasingly like they have been “left to fend for themselves”.
“We must not forget about disabled people in the rush to live with COVID,” he added.
The charity Blood Cancer UK said authorities needed to inform the public that there “are 500,000 in the UK for whom the vaccine is less effective” and remained susceptible.
Raywat Deonandan, an epidemiologist at Ottawa University, warned that ending self-isolation requirements in countries where population immunity had not reached a high level would likely result in increased community transmission of the coronavirus.
“If there is not a high level of population immunity, either through vaccination or recovery from infection, this [ending isolation rules] means a higher probability of serious disease … likely leading to an increase in hospitalisation and death,” he said.
UKZN’s Moshabela noted that if the lifting of restrictions leads to a greater spread of the virus, there could be a potential increase in long COVID cases – a post-coronavirus condition that can cause prolonged breathlessness, fatigue and cognitive dysfunction.
“Long COVID raises the question of – can we afford to expose people to the virus … It is still going to lead to a pressure on the health system, except it won’t be in short space of time like during a surge of cases,” he said. “We still have to accommodate for that.”
Concern over economy
Almost two years into the pandemic, one of the key arguments behind dropping restrictions is the negative effect they can have on economies.
Doenandan said while it was “undoubtedly true to a certain extent” that isolation periods did hurt the economy and led to worker shortages, outbreaks in low vaccinated workplaces could make people “sufficiently sick and make them less productive, and this will hurt the economy as well”.
“We’ve seen a lot of evidence, not just from this pandemic but from other diseases, like malaria, where uncontrolled infection results in serious economic blows. Public and economic health are not separate constructs; they are intertwined,” he said.
A better alternative to scrapping all isolation rules was to “flood nations with tests” Deonandan suggested – and at the very least “keep people with symptoms of respiratory illness out of workplaces and schools should be a permanent change to how we live our lives”.
Timothy Sly of Ryerson University in Toronto said while it was “inevitable” that restrictions will be loosened as cases go down it was necessary not to allow the virus to spread in an uncontrolled manner, which could “overwhelm hospitals and medical staff”.
“The relaxing of precautions must be taken carefully, and slowly – watching the indicators for hospitals, ICU, and wastewater virus load,” he told press.