Medical Centre

If you only have mild symptoms how safe is it to go into an office or other workplace?

The question you should ask yourself is would you be comfortable being in the same office as someone who had a positive Covid-19 test the day before? Now that the legal requirement to isolate after a positive test in England is ending, employers will need to carry out risk assessments and implement their own infection control policies. My advice would be for employers to remain cautious for now and advise employees with symptoms or a positive Covid-19 test to stay off work for a period until we have more experience about the effect of the change in rules.

I’ve had plans to go for dinner and drinks with friends for a birthday party but have tested positive. If we’re all triple vaccinated how big a risk is it if I still go?

People who are fully vaccinated can still become infected. If you test positive for Covid-19, I would advise not attending the event, particularly if it is going to be in a crowded indoor venue where there is a significant risk of infecting others who are present. Although Covid-19 vaccination does substantially reduce the risk of serious illness and death, there is still a risk to older people and those who are clinically vulnerable even if they are fully vaccinated.

Will GPs and hospitals still only see you if you have no Covid symptoms?

If you have Covid-19 symptoms, you should inform your GP or hospital before they see you so they can take suitable precautions. We are still awaiting guidance for the NHS on how the new rules will operate for them, such as whether face masks will still be required in healthcare settings. However, because they deal with people who are clinically vulnerable, the NHS will need to take appropriate precautions to prevent someone with Covid-19 infecting other patients.

I was told to shield during the lockdowns, and now triple jabbed. Is it safe for me to go to places where people might have Covid?

If you are in a group that was advised to shield during lockdowns, Covid-19 still poses a risk to you even if you are fully vaccinated. You should continue to wear a well-fitting FFP2 mask in places like shops and on public transport. Whether you go to places with a higher risk of Covid-19 such as nightclubs is a personal decision that you need to take but I would advise being cautious until infection rates in the community fall further.

I work in a care home. What if I test positive, do I go into work as normal?

People living in care homes are at very high risk of a serious illness and death if they become infected for Covid-19. Care homes should therefore keep appropriate infection control measures in place, such as asking staff who test positive for Covid-19 to self-isolate for a period.

If everyone is going about normal life even if they have Covid, what’s likely to happen to infections and could it lead to herd immunity?

In recent weeks, the number of Covid-19 cases, hospital admissions and deaths have been falling. The high level of immunity in the population from vaccination and previous infection should keep the number of serious cases of Covid-19 at a manageable level. However, people’s immunity does decline over time, which is why the government has just announced that those at highest risk from Covid-19, people aged over 75 years and those with weak immune systems, will be offered another booster vaccination. The long-term future remains uncertain and we don’t yet know if an additional booster will be offered to a wider group of people later in the year. We also don’t know what will happen next winter when there may be a lower level of immunity in the population. Finally, there is always the risk that a more infectious variant of the coronavirus may emerge like the Omicron variant that we faced late in 2021. Unfortunately Covid-19 will remain with us for the foreseeable future and become part of our lives, like other respiratory infections such as flu.

These comments were first published in the Daily Mirror.

Read Questions and Answers on the New Covid-19 Rules in England in full

The UK government has announced that people in England self-isolating because of a Covid-19 infection will be able to end their isolation period after 5 full days instead of the previous 7 days if they test negative on both day 5 and day 6 with a lateral flow test and do not have a temperature. The change comes into force on Monday 17 January 2022. What are the implications of the government’s decision to reduce the isolation period to 5 days for people in England with Covid-19? In summary, it’s a pragmatic step with some benefits but there are also some caveats and concerns that the government needs to address.

A shorter isolation period will allow people to return to work, education and social activities more quickly than the previous 7-day or 10-day isolation periods that we had in England. This will help address workforce shortages in the economy and will also allow children and students to resume their education. A shorter isolation period may also lead to greater compliance, as many people do not comply with longer isolation periods.

But some people will remain infectious after 5 days, so there are risks from this policy. A lateral flow test will identify many of the people who are infectious but some will be missed by the tests. It’s essential therefore that people also focus on their symptoms and not just rely on the results of their lateral flow tests. We need to remember the expression that doctors have: “Treat the patient and not the test result.”

If you remain unwell after 5 days – for example., if you have a high temperature or a bad cough – you should continue to isolate. Although many people of working age will have a mild infection – particularly if fully vaccinated – some people will have a more prolonged illness. The government does not mention cough as one of the symptoms that should lead to a longer isolation period – probably because a cough can persist for some time after a respiratory infection. If you feel well and have a mild cough, that is acceptable. But if you have a severe cough, you should consider extending your isolation period to longer than five days.

People should also not rush back to work and other activities too quickly. Take the time you need to fully recover from your illness before you return to work or education. Everyone is different and we recover at different speeds from an illness. This is irrespective of the results of your lateral flow tests. Base your recovery on how you feel and not just on your test results.

The government’s new policy is largely based on one modelling study which estimated that people with negative lateral flow tests on day 5 & day 6 are as likely to be infectious as people after a 10-day isolation period (7% v. 5% is the government’s estimate). Ideally, we would have stronger evidence from real-world studies about people’s infectivity after different isolation periods (5, 7 & 10 days) and what extra information is obtained about infectivity from lateral flow tests. But this research would take some time to complete and review. The government has therefore taken the decision to act now – but it must assess the impact of its new policy and collect the data needed to do this.

We need careful evaluation of the new shorter isolation period to ensure that people are following the guidance on self-testing and symptoms, and not ending their isolation period too early, and thereby putting others at risk of infection. We also need to consider how the guidance would be applied for people dealing with clinically vulnerable people. This would include guidance for NHS staff, those working in care homes, and people providing social care.

Finally, would you want to share a room with someone who was 5 days past the start of their Covid-19 infection and who was coughing all over you? Follow the guidance, particularly on symptoms, and don’t just rely on the results of the lateral flow tests to predict how infectious you are to avoid placing others at risk of infection.

Read Isolation for people with Covid-19 in England: Follow the guidance carefully in full

Over the last few weeks, the United Kingdom has experienced a record number of covid-19 infections, driven by the rapid spread of the Omicron coronavirus variant, with the daily reported case numbers approaching 200,000 on some days. This has placed considerable pressure on the NHS through a combination of people seriously ill from covid-19 and staff absences. Other parts of the economy such as public transport have also been badly affected by staff absences.

A sustained period of high infection rates would be very damaging for the UK. But there are now signs that the number of covid-19 cases in London – the first area of the UK to face the wave of infection from Omicron – may have peaked. In which case, a similar pattern of declining case numbers may be seen in other parts of the UK later this month.

There were several factors that drove the early increase in Omicron cases in London. London is the UK’s main international travel hub with the UK’s busiest airports located nearby. Overseas travellers who are infected with a new coronavirus variant are more likely to arrive in the London region than in other parts of the UK. London also has a very large number of international visitors – for activities such as work, study, tourism, leisure, and sports events. London is the also UK’s largest city and is very densely populated, with many overcrowded households, often with people from three or more generations living together, which makes infections more likely to spread, including to clinically vulnerable groups who will be at much greater risk of adverse outcomes such as hospitalisation.

London also has a lower covid-19 vaccination uptake than other parts of the UK. Around 20% of people aged 12 and over in London remain unvaccinated, compared to a national average of about 10%. Although vaccines provide less protection from symptomatic infection with Omicron than from the previously dominant Delta variant, they do still provide good protection from serious illness, particularly in people who have had  their booster vaccination. The lower vaccination rate will lead to infections from Omicron spreading more quickly in areas such as London; as well as increasing the likelihood of severe disease. This would in turn increase hospital admissions from covid-19 and pressures across the NHS in London.

After increasing vary rapidly in London, the Omicron wave now shows signs of abating with the number of covid-19 cases and hospital admission dropping in recent days. We can’t confirm yet that the drop will continue; and nor what the impact will be of schools, universities and workplaces reopening. But if the decline is sustained, other parts of the UK can also expect to see similar falls later this month with case numbers dropping first, followed by a drop in hospital admissions after a lag period. This means that the outcome of the Omicron wave well may be less severe than predicted in the more pessimistic government models, particularly in the areas of the UK with the highest vaccination rates.

However, we can’t yet relax our covid-19 control measures. The number of covid-19 cases in the UK will remain high – compared to previous waves – for some time. The NHS will continue to be under pressure, perhaps for many months, trying to cope with the impact of covid-19 on top of the usual winter pressures that it faces each year whilst also trying to deal with the backlog of work that has built up during the pandemic. The NHS will also continue to be affected by staff shortages due to illness. Although the government may wish to declare “victory” against Omicron and end its Plan B measures later in January, it should refrain from doing so. The public also need to continue to practise good infection control measures, building on the “Three C Approach” to personal safety limit the impact of covid-19.

Measures such as wearing face masks in indoor settings should remain in place, with the government and public health agencies encouraging people to use well-fitting FFP2 masks that provide better protection for the wearer, rather than loosely fitting surgical or cloth masks. More targeted use also needs to be made of publicly-funded lateral-flow tests. Finally, the covid-19 vaccination drive must continue – for those who are currently unvaccinated as well as for those who are now eligible for a booster vaccine. A high uptake of booster vaccines will protect against serious illness and buy time until modified vaccines that target Omicron become available later this year.

In conclusion, the experience of London offers some positive news for the rest of the UK and for the government. But we must remain cautious and continue with our covid-19 control measures until infection rates are substantially lower than they are now. We also need to be fully prepared to deliver another booster vaccination programme later this year, whilst also continuing to target the 10% of people aged 12 in the UK and over who remain unvaccinated.

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

Read London is an important barometer for the omicron wave in the United Kingdom in full

Why are some scientists concerned about the new Covid variant that has been found in France?

Whenever a new variant of the coronavirus that causes Covid-19 is identified, there are always concerns that it may prove to be more infectious than previous variants and spread quickly in the population. We saw this previously with the Alpha, Delta and Omicron variants, each of which spread rapidly in the UK, leading to waves of infection that put a lot of pressure on the NHS.

Should we be worried, and why?

The B.1.640.2 variant was first identified over a month ago and so far, it has not caused the massive global spike in Covid-19 cases we have seen with the Omicron variant. There is now very good identification of variants in many countries, so that the spread of a new variant can be monitored. If a variant is spreading rapidly, the World Health Organization will label it as a Variant of interest (VOI) or a Variant of Concern (VOC) depending on its severity. This has not happened yet with B.1.640.2. We should remain cautious, monitor the spread of any new variant, including B.1.640.2, but not get over-anxious.

Both Omicron and the new variant appear to have emerged in Africa, which has the lowest vaccination rate. Is that the reason?

Variants can emerge anywhere. The Alpha variant was first identified in the South-East of England and the Delta variant was first identified in India.

Will it become normal for variants to emerge and spread around the world like Omicron?

The coronavirus that causes Covid-19 will mutate constantly. Most mutations are of no great consequence but occasionally a mutation will appear that can cause a wave of infections – such as the Alpha, Delta and Omicron variants. We may well see other variants emerge and spread around the world in the future.

Are variants getting milder, or is it possible that another variant will be deadlier?

There is no guarantee that a variant will be milder. The Alpha and Delta variants were shown to be more likely to cause a serious illness that the original version of the Coronavirus. In the case of Omicron, the evidence thus far shows that it generally causes a milder illness than other variants. However, because of the very large number of Omicron cases, some people will still have a serious illness.

Could Omicron bring about the end of the coronavirus pandemic?

It’s unlikely that Omicron will bring an end to the Coronavirus pandemic. However, with updated vaccines that can target a new variant such as Omicron and antiviral drugs that can be used early in an illness, we can suppress the severity of disease caused by Covid-19 and allow people to live more normally.

If the world has to live with Covid, what might that look like?

This will vary from country to country. In the UK, high levels of vaccination – including with a modified booster vaccine later this year to target Omicron if the government approves this – combined with antiviral drugs will allow our society to function more normally. Countries with low vaccination rates and weak health services are still likely to face large waves of infection. It’s possible that we will need regular vaccinations – as for flu – to allow us to live with Covid-19. It is also always possible that a variant will emerge against which vaccines are less effective. But the good news is that vaccine manufacturers can modify their vaccines quickly if this happens.

Why is the booster important for Omicron?

The immunity provided by Covid-19 vaccines weakens after a few months. A booster vaccine substantially increase people’s protection from serious illness, including from Omicron. Ensuring that people are fully vaccinated with three doses of vaccine will reduce the number of people who are seriously from Covid-19, and keep down pressures on the NHS.

A version of this article was first published in the Daily Mirror.

Read Questions and Answers About New Variants of SARS-CoV-2 in full