Why it’s time to end Covid self-isolation

When the spread of a new pathogen causes severe disease and death in any sector of the population, many decisions have to be made on the basis of very little information. Many speculated that Covid-19 would share a similar fate to Sars, which was virtually eradicated, but it has stubbornly resisted all attempts at elimination and instead more closely followed the expected behaviour of the other seasonal coronaviruses, moving from an epidemic phase into an endemic state with an appropriate reduction in mortality.

With the omicron variant, we know that the fatality rate will be dramatically lower whether or not it has diminished in virulence, because most of what we are seeing is re-infections or vaccine breakthroughs.

This strongly endorses the immediate lifting of restrictions given their devastating consequences, and focusing policy instead on the vulnerable. The low risk of infection among the vulnerable arises from the maintenance of herd immunity through constant reinfection; any measure that interferes with this actually increases their risk. 

Self-isolation is a case in point. It may slow the spread of the virus but to what end? Meanwhile, such a requirement causes immense disruption to the normal functioning of society and our ability to provide healthcare and education to those in need.  

In order to move fully into “living with the virus”, it is essential to recognise that trying to limit its spread is not only extremely difficult but also undesirable if we are aiming for the sort of relationship we have established with other endemic coronaviruses.

Acknowledging that any attempt to limit the spread of infection is actually retrograde to society is a difficult step to take, and easily lends itself to being characterised as a “let-it-rip” strategy.  Yet the implementation of non-pharmaceutical measures such as self-isolation can actually cause more damage to the vulnerable, both by preventing the build-up of herd immunity and because they may be incompletely protected while the virus nonetheless still spreads and herd immunity inevitably accumulates (the “let-it-drip” scenario).

The option of living with the virus, without submitting to the endless cycle of testing and self-isolation, has been tried and tested with the other seasonal coronaviruses and the good news is it seems to work. The alternative is not only pointless but ultimately unworkable within a society that seeks to look after its children, the elderly, the sick and the poor, and would prefer to prevent a widening of the gulf between those who can afford the luxury of self-isolation and those who simply cannot.

It is vital, in any national conversation going forward, to recognise that the omicron wave has been milder not because of its inherent properties but because it has arrived in a landscape where most people have already been naturally exposed to or vaccinated against Covid, so that the vulnerable among them already have immunity against severe disease and death. 

Some have suggested that omicron gave us a lucky break. This is mistaken. While some very elegant studies have shown that this variant has some clear functional differences from its antecedents, there is no reason to believe it is intrinsically less virulent or more transmissible. It is a myth that all viruses evolve in this direction.

This means that we did not need to wait for omicron to happen before lifting the restrictions that have caused so much damage to so many. The Prime Minister today announced that Plan B measures, including mask wearing, will end. But he should go further and address Plan A measures, such as self-isolation.

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