ENGLAND'S FOOLISH QUARANTINE SYSTEM OFFERS LITTLE PROTECTION AGAINST COVID VARIANTS

 The Guardian 4 March 2021 - by Gabriel Scally

© Provided by The Guardian Photograph: Hollie Adams/Getty Images

The absence of a long-term strategy for managing Covid-19 has been a persistent flaw in the government’s response to the pandemic. Although the NHS deserves huge credit for its successful vaccination programme, the trajectory of the UK’s epidemic is still a rollercoaster, with positive news about vaccination rates followed by the emergence of worrying new variants. The latest example of this tumultuous ride is the hunt for a single case of a new variant first identified in Brazil that may partially evade the protection offered by vaccines.

Part of the problem is the porous nature of England’s public health controls and the government’s reluctance to implement stricter public health measures at ports and airports. Although travellers to England who are arriving from countries on the government’s red list must now quarantine in a hotel for 10 days, a policy that was only implemented almost a year after Covid-19 first entered the UK, the Brazil variant has already been found in at least 15 countries that aren’t included in this list. Six cases of the variant have been identified in the UK so far: three in England and three in Scotland.

Quarantining people at ports and arrival points is an old and highly effective measure to stop the entry of infectious diseases. In the past, quarantine was taken extremely seriously in England, and evading quarantine or falsifying documentation was a capital offence under the Quarantine Acts of 1800. But the government has been reluctant to interfere with travel during the coronavirus pandemic.

England’s economy partly relies on the global movement of goods and transport, so mandatory quarantine is a politically contentious move. But given the effectiveness of quarantine as a disease control measure, and the fact that variants can emerge from anywhere, it is both foolish and puzzling that ministers have opted for what effectively amounts to voluntary isolation for people arriving from countries that are not on the government red list.

Politicians may be hoping that vaccines will eventually solve the UK’s epidemic for good. And the vaccination programme has undoubtedly been a huge leap forward, which speaks volumes of the NHS’s capacity to respond during a crisis. But the danger of putting all our eggs into this basket is that new variants may emerge that elude the protection of vaccines. The Brazil variant can potentially reinfect those who have already caught Covid-19. Although it’s not yet known whether this variant bypasses the vaccines that we’re currently using in the UK, if a variant can’t be tamed through vaccinations, the effects may be like pressing a restart button on the pandemic.

© Photograph: Hollie Adams/Getty Images ‘Quarantining people at ports and arrival points is an old and highly effective measure to stop the entry of infectious diseases.’

This is why the government must set out its game plan for suppressing Covid-19 in the long term. The vaccination programme will go some of the way to stamping out the virus, but vaccines won’t achieve this on their own. Although they prevent people getting seriously ill, it’s not clear whether they prevent transmission. And we don’t yet have a vaccine approved for people under the age of 18. Even if younger people don’t get seriously ill from Covid-19, we know there’s a significant risk of them developing long Covid. If we take our foot off the brake, the virus could spread rapidly among young people in schools and universities. Although this wouldn’t necessarily lead to people being hospitalised, it would create opportunities for new variants to emerge.

In addition to vaccinating people, what’s needed is an effective, community-led public health strategy to identify and control new cases. As the number of people testing positive falls, we have a window of opportunity to regain this control. It will be particularly important to provide help in areas where the virus has been at its most prevalent, such as those with high levels of deprivation, overcrowded housing and black and minority ethnic communities.

Working through local communities, public health teams should adopt the internationally recommended approach of testing all close contacts of those who test Covid positive. As with quarantine, this seems a logical policy; those who have come into contact with someone who has tested positive are at high risk of becoming infectious themselves, even if they don’t have any symptoms. But instead of doing this, the government advises close contacts of those who have tested positive to come forward only if they develop symptoms.

The only way to prevent new variants from spreading in the UK is to eliminate the virus entirely – not just at home, but overseas too. One of the most important ways of doing this will be through vaccine sharing programmes. The UK and US have already been generous funders of the Covax scheme to deliver Covid-19 vaccines in low-income countries. As of 3 March, a total of 10m doses have been shared among 15 countries. But this is still a tiny amount compared to what will be needed to bring the virus under control. Only once we get a global grip on infections will the UK be truly safe from the risks of future Covid variants.

• Gabriel Scally is visiting professor of public health at the University of Bristol and a member of the Independent Sage committee