Finding resilience in a new COVID-19 world

...the rush to remove COVID-19 restrictions and restore ‘normal’ life seems to be contributing to more problems than are being communicated by the government and the media

COVID-19 is circulating at such high levels in the UK right now that it is causing significant disruption to the country. Many people are off sick, across all sectors of the economy. The NHS is being disrupted to such an extent that recent investments are not sufficient to solve current capacity problems, leading to several critical incidents across the country. The NHS Confederation has raised the alarm: the rush to remove COVID-19 restrictions and restore ‘normal’ life seems to be contributing to more problems than are being communicated by the government and the media.

So what to do?

A country in a quandary

As a country, we find ourselves in a quandary. There is clearly little appetite for resuming the level of restrictions we tolerated and sacrifices we made in the first two years of the pandemic. And, for the avoidance of doubt, we at the NHS Confederation is not calling for the return of these restrictions as some commentators seek to portray our position.

These restrictions were incredibly important, but as well as reducing deaths, maintaining NHS capacity and buying us time to develop vaccines and successfully roll out our fantastic vaccination programme, it is indisputable that they also had negative side effects for our health and wellbeing and the economy. With deaths currently at a lower rate for COVID-19, and the vaccination programme being so successful, it is understandable that we feel we have ‘earned’ liberation, even as the number of people infected is higher than ever.

But in our zeal to return to normal, I wonder if we are in denial about what normal now means. Or more specifically, what we need to do to maintain the experience of normal that everyone wants.

An unpredictable and evolving risk

Removing all restrictions is certainly a crowd-pleaser for some, but perhaps we should be asking more questions about what problems this may cause behind the scenes now, and in future. We know that COVID-19 has not gone away, nor has it turned into an innocuous, run-of-the-mill, cold-like virus. It’s still very much an evolving risk that continues to be unpredictable in the magnitude of its impact. What we do know is that many experts warn that we can anticipate more severe forms of the virus in the coming months or years. And that we do not want this to interrupt our experience of normal any more than it has to.

So, what are our options to maintain our way of life in way that minimises personal or public hindrance, but maximises our ability to experience ‘business as usual’ even as the COVID-19 virus maintains a fluctuating presence in our lives? This is the question that I believe the scientists and the government must now focus upon and invest in.

Whether the question is about masks, or lockdowns, or vaccination, or ventilation, or all manner of other mitigations, the question remains the same.

Where and when is mask wearing helpful?

It is informative to reflect on the mask-wearing experience in Japan. This practice largely arose to help prevent transmission of the Spanish flu pandemic in 1918-20. But since then, there has been an evolution from ubiquitous, mandatory mask-wearing to prevent a specific disease, to people choosing to wear masks in crowded places or where ventilation is poor, or as a precaution when they personally feel under the weather. The practice, which has been supported by public health campaigns, is now used to prevent potential spread of infection in times and places where that risk is increased. The motivation is about wanting to avoid making family, friends and community members sick, reducing sick days to help support the economy, and generally being a good citizen.

In 2022 we know that mask wearing plays an important part in preventing the spread of a wide range of infections, especially if the mask is high quality, such as FFP2/N95. But rather than engaging in politically weighted debates about yes or no to mask wearing in public, it may be more productive to understand where and when mask wearing would be particularly helpful (like in health and care settings, when around clinically vulnerable people, or in crowded, poorly ventilated places), so people can make informed choices. The same is true for all potential mitigations.

We also know that masks (or other mitigations) by themselves are not the answer to ensuring our normal way of life is not derailed by new variants, but we need to fully understand their role. To give the country a chance of maintaining business as usual in this ongoing COVID-19 reality, whether in the NHS, care sector, or wider economy, we now need to reap rewards from the huge amounts of investment in scientific research during the pandemic: what works best at the system level to reduce transmission of viruses? For example, how do we select and deliver the right vaccination strategy? How do we effectively, sustainably, affordably improve ventilation indoors?

The government should reinvigorate its public information campaign on COVID-19 based on the most recent facts, to be clearer about the rates of infection and impact of the virus

The government should reinvigorate its public information campaign on COVID-19 based on the most recent facts, to be clearer about the rates of infection and impact of the virus. This should inform, encourage and empower adoption of the most effective and proportionate approaches to reduce transmission, whether that is individual practices like mask wearing in certain settings, meeting outdoors where possible and getting booster jabs when eligible, or system approaches like better ventilation in buildings.

In this reality where we need to balance pandemic resilience and being able to live our best life, the big questions are: what works, and how will we implement it?

Dr Layla McCay is director of policy at the NHS Confederation. You can follow Layla on Twitter @LaylaMcCay