UK scales back routine Covid-19 surveillance

On 24 February 2022, the UK government removed the legal requirement for people in England to self-isolate after a positive covid-19 test result, with the other UK nations also easing restrictions.1 In doing so, the UK is acting ahead of many of its international peers to embark on a “vaccines only” strategy, hoping that existing immunity in the population will allow a “return to normal.” This view is in sharp contrast to public opinion. In a recent poll by market research company YouGov, only 17% of respondents thought that ending mandatory self-isolation was appropriate.2

The removal of legal restrictions makes the people of England part of an experiment in which much remains uncertain.3 This is acknowledged by chief government advisers Chris Whitty and Patrick Vallance, who accompanied Boris Johnson’s announcement with a warning that rates of covid-19 infection and hospital admission remain high.4 Of equal concern, the government’s announcement also introduced plans to scale back two crucial pillars of the UK’s covid-19 surveillance: the Office for National Statistics’ (ONS) covid-19 infection survey and daily reporting of data on the UK Health Security Agency (UKHSA) covid-19 dashboard.15 When, and to what extent, these important resources will be scaled back remains unclear.

The ONS survey is a world leading example of random population sampling to estimate covid-19 prevalence over time.67 The UKHSA dashboard has been a vital resource for the public, clinicians, journalists, and researchers, allowing them to identify local trends as well as providing national data. The dashboard received up to 19 million hits a week in September 2021.8 Data to understand and promptly respond to covid-19 outbreaks are essential for public health and the NHS, as well as for the wider public.

We remain in the middle of a global pandemic caused by a novel pathogen and complicated by the repeated emergence of new variants. Policy decisions to manage new outbreaks rely on robust and timely data—the alpha, delta, and omicron variants all became dominant in the UK within weeks of the first reported cases.9 Although omicron is associated with a significantly lower risk of hospital admission and death than previous variants, the government’s Scientific Advisory Group for Emergencies (SAGE) acknowledges that this may be the exception rather than the rule, emphasising the need for ongoing vigilance to detect future variants.10

From 1 April 2022, when universal free covid tests are withdrawn leaving only limited testing in place, most SARS-Co-V infections in England will remain undetected and unreported. Our ability to track the emergence of new variants or trends in the incidence of infection and disease will become more reliant on robust, cross sectional surveys such as the ONS survey. Scaling back the survey, as proposed, risks missing emerging variants or concerning rises in prevalence that could herald the need for further restrictions; moreover, the survey cannot provide accurate and timely local data, as currently provided by the UKHSA dashboard. The detrimental effects of delayed action are now abundantly clear, and we must not fall behind at this critical moment when the UK’s pandemic is gradually coming under control.11

In announcing the latest relaxation of restrictions, the prime minister asked the public to take individual responsibility for their actions, yet informed decisions are reliant on the availability and accessibility of information. Throughout the pandemic people have relied on regional reporting of covid-19 cases on government dashboards and in news media, and they will continue to need such accessible information for the foreseeable future.

While most people have received two or more doses of a covid-19 vaccine, almost 10% of adults in England have not received a single dose and around 30% have not had a booster.12 Many others remain at high risk of disease despite vaccination because of underlying health conditions. The public health implications of immunity waning over time remain uncertain.1314 As we move into a period of largely optional (and paid for) testing and voluntary self-isolation, it is crucial that people have easy access information to guide their actions and help minimise covid-19 risks to themselves and their families.

The UK has been a world leader in the routine surveillance of covid-19 and the transparent reporting of covid-19 data. Scaling back vital data systems prematurely is a false economy and may need to be reversed to manage future waves of infection. The UK has the resources and infrastructure to continue existing surveillance, which has clearly identifiable benefits. We need to sustain our existing surveillance capabilities until we are certain that the pandemic is over in the UK, which won’t be until covid-19 is controlled globally.

Jonathan Clarke, Thomas Beaney, Azeem Majeed

A version of this article was first published in the British Medical Journal.