For the clinically vulnerable, Freedom Day has yet to arrive – The Economist

Dec 9th 2021

MARK NICHOLLS would not allow a parcel into his home, let alone a friend. Deliveries sat outside for 48 hours: he could not risk any exposure to covid-19, even from a box. Twenty-one months on he is confident enough to visit the supermarketbut only at 11pm, once crowds have thinned. My life is permanently altered, he says. Every journey has to be meticulously planned to limit the risk. I need to avoid crowded places. I will be working from home indefinitely.

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Mr Nicholls is not alone in fearing contact with others. In England alone 3.7m people have been identified as clinically extremely vulnerable during the pandemic because of conditions or treatments that can suppress their immune system. For the first 12 months those at risk of severe illness from covid-19 were advised to shield: to stay at home, avoid face-to-face contact and arrange deliveries of essentials such as food and medicines.

In the summer, however, the United Kingdoms four constituent nations began to relax restrictions at different speeds. Masks remained mandatory in some public settings in Scotland, Wales and Northern Ireland, but in England on July 19thdubbed Freedom Daythey became merely recommended, and limits on socialising were scrapped. The 6.6% of Englands population who had been shielding were advised they could meet people outside but should avoid anyone who had not been fully vaccinatedwhich, in effect, meant staying away from anyone they did not know well.

An uptick in cases was followed by a convoluted roll-out of top-up vaccines. The most vulnerable could receive a third primary dose eight weeks after their second jab, whereas the wider population were allocated a single booster after six monthsrecently revised to three in the hope of avoiding a burst of new infections by the Omicron variant. However, even NHS staff were confused about eligibility criteria and many immunocompromised patients were wrongly told to wait until the six-month mark, says Richard Evans of Blood Cancer UK, a charity that was deluged with inquiries. A poor job was done of explaining the rules, he says, leaving some clinically vulnerable people feeling in despair, like theyve been forgotten.

Even as life returned to normal for many, in mid-October the Office for National Statistics suggested that 22% of the clinically extremely vulnerable in Englandmore than 800,000 peoplewere still shielding. Life-satisfaction scores were markedly lower in those who were continuing to shield. Almost all the rest were still taking extra precautions, such as social distancing, avoiding crowded spaces or asking family and friends to take lateral-flow tests before meeting. Prolonged spells out of the workplace meant some employees had to disclose invisible medical conditions they would have preferred to keep private, says Sarah Berry from Crohns and Colitis UK, another charity.

Many such people are frustrated by lax messaging and enforcement, about mask-wearing in particular. Usage fell noticeably over the summer and autumn. Coverings are now compulsory again in England in most indoor spaces and on public transport as Omicron spreads.

Shambolic messaging about airborne transmission has not helped, says Deepti Gurdasani, a clinical epidemiologist at Queen Mary University of London. We have a prime minister who has repeatedly been observed in places where hes recommended masks should be worn, and where policy suggests masks should be worn, like in hospitals or on trains, but he hasnt been wearing them. Minimising transmission is central to ending lockdowns, she adds. Unless you make society safe for everyone, including the vulnerable, there is no exit strategy. As long as community transmission is high, no matter what you do you cant keep it safe.

Molnupiravir, an antiviral medicine reportedly due to be offered to vulnerable covid-19 patients under a pilot scheme, offers some hope of reducing mortality from the virus among those most at risk of severe illness. But the only way to allow them to return to anything like normality is a vaccine-plus approach, says Trish Greenhalgh, a professor of primary care at Oxford University. Everyone has to be vaccinated and have their boosters, plus we have to look at ventilating buildings, mask-wearing, tracing contacts, testingthe whole lot.

This feels some way off, however. Your triple-jabbed, severely immunocompromised correspondent did not feel safe even at a recent early-morning blood test in south-east London. The windows stayed shut as people piled in. Two nearby patients had ignored instructions to wear masks. I dont have one on me, said a man, who accepted a mask from a nurse. The other patient sighed as she tweaked the covering tucked beneath her chin.

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This article appeared in the Britain section of the print edition under the headline "Underlying issues"

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For the clinically vulnerable, Freedom Day has yet to arrive - The Economist