Living on Plague Island

‘The pandemic is over – we are all back to normal – aren’t we? Why do we need to keep collecting data that just makes everyone’ depressed‘ ‘ ‘we need to stop talking about it’.

In 2023 the UK government in it’s various guises has been systematically dismantling key sources of official data which enable governments, agencies and individuals to assess levels of infection across the population, spot problems on the horizon, including identifying new variants with the potential to cause illness and track levels of Long Covid. This is despite the fact that infection rates remain very high – the final ONS infection survey published in the third week of March revealed that about 1 in every 40 people in England were infected, and as many as 1 in 20 of the over 70’s. The position in early April is also well set out by Professor Christina Pagel in her recent presentation to Independent Sage on the numbers

Other sources of data which have disappeared, include the ONS dashboard which has become of limited value for estimating the prevalence of Covid since required testing for COVID via a PCR test was scrapped, and more recently, hospitals are no longer required to test and record whether patients are positive for Covid. The dashboard does continue to record one measure of the number of deaths due to Covid, but tracking deaths is hardly the kind of early warning monitoring system that is required.

This dismantling of information systems is part of the so called ‘living with Covid’ policy of the UK government; it means the media will be less inclined to run reports about it and people will become even less aware of the risks posed than they are at present. They might also become even more antagonistic to those still taking precautions such as mocking of mask wearing – I will return to the issue of masks in a later piece.

This policy poses particular problems for clinically vulnerable people because we need to be able to assess the risks at any given point in time; if the rate of infection is less than 1 in a 100, for example, we might be more inclined to take risks and attend medical appointments, than if it is, say, 1 in 30.

Even though the impetus for terminating the ONS Infection Survey will no doubt that come directly from the government and the UKHSA, it is very unfortunate that ONS appear to have given up on something that they acknowledge to be ‘a shining example of random sampling’ ‘Known globally as the ‘gold standard’ for infection analysis, the survey has been recognised by the Centres for Disease Control and Prevention (CDC) and the World Health Organisation (WHO)’ at a time when the pandemic is very much on-going, the virus is acknowledged to be unstable, new strains of the virus with the potential to cause major harm could emerge. This comes at a time when so many vulnerable families who need information are unprotected because the vaccines and treatments are far from perfect.

In a letter to participants ONS have said that ‘we must now consider how we can make COVID-19 and Long COVID surveillance proportionate and balanced alongside emerging healthcare priorities’. And ‘UKHSA will confirm details of any new surveillance surveys that continue beyond 31 March 2023 in due course. As valued survey participants you would be uniquely placed to help support any future survey’. It is now 16 April and we are still waiting for even an initial roadmap of the way forward.

It could well be that the data needed could be collected in a more cost effective way but it seems extraordinary to this writer with my long experience of government research, that the infection survey should be dropped before any new data collection mechanism is put in place.

We urgently need a document that sets out data needs on Covid prevalence across different areas and population sub groups, strength of anti body responses to infection and vaccines, a method of identifying new variants and indeed new infectious diseases quickly, information on population behaviours, and a measure of the extent of long Covid.

In my view this information continues to be crucial and it is difficult to see how it could be collected without a large scale random sample not dissimilar to the ONS infection survey. Many commentators argue that the survey should have been extended rather than terminated in order to provide an early warning system on new infections and illnesses which would become a key long term resource on health issues.

It is difficult to see what the alternatives are. Some commentators argue that the ZOE app could replace the survey but it is clear that this is not credible given that ZOE is a self selecting sample, relies on people doing Lateral Flow Tests in the correct way, and is at best a very quick indication of whether infection levels are rising or falling amongst the ZOE contributors at any one point in time. There is also speculation that waste water analysis could replace the survey. This is interesting, but there are a number of obvious drawbacks, not least the lack of lab capacity to undertake analysis on the scale needed.

In sum we urgently need to see the fully worked up plan on the way forward.