Currently, there is much discussion of the UK governments vision to end all covid-19 restrictions in England on 19 July, so-called Freedom Day. This is the endpoint of the UK governments covid-19 roadmap. A postponement was previously put in place because the final condition for ending lockdownthat no new variant had appeared to raise new concernshad been missed due to steeply rising cases caused by the delta variant. As Freedom Day approaches, new cases of covid-19 are rising steeply, with projections that this may rise to 100,000 cases/day. That would be a worse trajectory than the UKs European neighbours or the USA.
The case that the end of covid restrictions will proceed as planned on 19 July is predicated on the point that, despite the enormous caseload, this no longer carries the same ramifications as in the first two waves. The link between infection, hospitalisation, and death has been weakened by the highly successful vaccines and vaccination programme. Transmission is high, but hospitalisations and fatal cases are low. To clarify, the vaccines in use, in most people, generate good levels of neutralising antibodies and substantially reduce the chance of serious infection and death by delta after two doses. The problem is the most people caveatthose at the lower end of the distribution of neutralising antibodies are susceptible to breakthrough infection. [1,2] Secondary school children are currently ineligible for vaccination, and yet are susceptible to infection and have proved an excellent viral incubator during this wave. At the time of writing, concerns about the race to unlock are being raised by experts, including Mike Ryan, the WHOs executive director for health emergencies, who has warned of the epidemiological stupidity of ending covid restrictions, and other leading public health experts who have published an open letter in The Lancet.
The polarisation of the debate bears witness to the fact that the cost benefit analysis is now more nuanced than in early 2021, when 1800 deaths were reported in a single day and the risks were immediate and self evident. With the UK among those countries with the privilege of relatively high vaccination levels and daily fatalities in double figures, it seems only right to ask what level of intervention is appropriate to our relationship with the virus as it is today and is likely to be in the future.
Among the arguments raised in support of Freedom Day are that we have to move on (the now or never), re-establish normality, and rejuvenate the economy. Israel is cited as a country achieving this, even in the face of a growing wave of delta breakthrough cases.
The difficulty is that the national situation and the interlinked global situation are far from under control. Allowing the virus freedom to circulate at high transmission levels in a partially vaccinated population is a concern. It is a real-life, population-level embodiment of viral immunologists laboratory experiments to model the emergence of immune-escape mutants. Such real-world vaccine escape variants are indeed starting to be sequenced [3]. The delta variant has replaced alpha as the dominant variant at present, but the possibility of other global variants coming around the curve remains. If the past 18 months have taught us anything, it is that virus outbreaks traverse the world fast, even in the face of border controls.
Lastly, there is the concern about the long term cost, in the form of new cases of long covid. We still cannot fully assess the time course of this disease process, but certainly there are hundreds of thousands of people whose lives have not yet returned to normal after more than a year. It is known that long covid ensues after SARS-CoV-2 infection, across the severity spectrum, and irrespective of asymptomatic or severe/hospitalised outcome. There is thus no reason to assume that an infection wave in a partially vaccinated population will incur less than the predicted 10-20% of all infections leading to long covid. This suggests a period in which we tolerate up to 10-20,000 people per day, many of them children and young adults, entering the pool of individuals with long covid.
Its important to move forward, but the list of cons reminds us that this virus is an ongoing, formidable, and unforgiving foe, demonstrating time after time the high cost of the smallest miscalculation. This supports a case for continued caution and to go slowly and steadily with a stepwise, evidence-based easings of restrictions.
Daniel Altmann, professor, Department of Immunology and Inflammation, Imperial College London.
Rosemary Boyton, professor, Department of Infectious Disease, Imperial College London, UK & Lung Division, Royal Brompton and Harefield Hospitals, London, UK.
Competing interests: none declared.
References:
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The pros and cons of Freedom Daya view from immunology - The BMJ - The BMJ
- Scipher Medicine and Atropos Health Partner to Accelerate Precision Medicine and Expand the Immunology Multimodal Network - Business Wire - December 23rd, 2024 [December 23rd, 2024]
- AbbVie to expand immunology pipeline with $200m Nimble Therapeutics acquisition - PMLiVE - December 23rd, 2024 [December 23rd, 2024]
- Sir Gustav Nossal Professor of Immunology to honour giant of Australian science - Walter and Eliza Hall Institute of Medical Research - December 9th, 2024 [December 9th, 2024]
- Research Assistant in Immunology - Surrey, United Kingdom job with UNIVERSITY OF SURREY | 384335 - Times Higher Education - November 28th, 2024 [November 28th, 2024]
- Reflecting on Pioneering organoids and 3D cell cultures for animal and human health - British Society for Immunology | - November 28th, 2024 [November 28th, 2024]
- Innate Pharma Announces Publication in Science Immunology Highlighting Innovative Next-generation ANKET - Business Wire - November 20th, 2024 [November 20th, 2024]
- TRexBio Announces $84 Million Series B Financing to Advance Pipeline of First-in-Class Immunology Programs into Clinical Development - Business Wire - November 20th, 2024 [November 20th, 2024]
- Discovering Solutions for Long COVID: A T-Cell Immunology Breakthrough - Infection Control Today - November 20th, 2024 [November 20th, 2024]
- Innate Pharma Announces Publication in Science Immunology Highlighting Innovative Next-generation ANKET IPH6501 - The Bakersfield Californian - November 20th, 2024 [November 20th, 2024]
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- What it's like in allergy and immunology: Shadowing Dr. Fraser - American Medical Association - November 12th, 2024 [November 12th, 2024]
- Dr. Naba Sharif Elected President of the New Jersey Allergy Asthma and Immunology Society - Newswire - November 12th, 2024 [November 12th, 2024]
- Department of Microbiology and Immunology Named a National Milestones Program - Stony Brook News - October 26th, 2024 [October 26th, 2024]
- Astria Therapeutics to Present at Upcoming American College of Allergy, Asthma, and Immunology Annual Scientific Meeting - businesswire.com - October 26th, 2024 [October 26th, 2024]
- Remembering immunology educator, researcher Tom McDonald, PhD - University of Nebraska Medical Center - October 13th, 2024 [October 13th, 2024]
- Systems immunology approaches to study T cells in health and disease - Nature.com - October 13th, 2024 [October 13th, 2024]
- Leading the charge to discover answers in immunology - The University of Arizona - October 2nd, 2024 [October 2nd, 2024]
- New mouse models offer valuable window into COVID-19 infection - La Jolla Institute for Immunology - October 2nd, 2024 [October 2nd, 2024]
- Wide-Moat AbbVie Poised for Growth, Driven by Innovation in Immunology Beyond Humira - Morningstar - October 2nd, 2024 [October 2nd, 2024]
- Lilly's immunology unit scores another FDA nod with eczema treatment Ebglyss - FiercePharma - September 23rd, 2024 [September 23rd, 2024]
- Huang Named Head Of Pathology And Immunology - Mirage News - September 15th, 2024 [September 15th, 2024]
- Huang named head of pathology & immunology - Washington University School of Medicine in St. Louis - September 15th, 2024 [September 15th, 2024]
- Apogee Therapeutics to Participate at the Stifel 2024 Immunology and Inflammation Summit - Yahoo Finance - September 15th, 2024 [September 15th, 2024]
- Eliem Therapeutics to Participate at the Stifel 2024 Virtual Immunology and Inflammation Summit - StockTitan - September 15th, 2024 [September 15th, 2024]
- UCLA receives $120 million from Alya and Gary Michelson for new California Institute for Immunology and Immunotherapy - UCLA Newsroom - September 2nd, 2024 [September 2nd, 2024]
- Boosting vaccines for the elderly with 'hyperactivators' - Boston Children's Answers - Boston Children's Discoveries - June 27th, 2024 [June 27th, 2024]
- Immunologists Want You to Know These Dust Mite Allergy Facts - Yahoo Lifestyle UK - June 27th, 2024 [June 27th, 2024]
- How Ragon Institute's new building aids its mission Harvard Gazette - Harvard Gazette - June 27th, 2024 [June 27th, 2024]
- Insights into CRS and NPs: Visual and Bibliometric Analysis - Physician's Weekly - June 27th, 2024 [June 27th, 2024]
- Biogen joins immunology wave with $1.15 billion acquisition of HI-Bio - STAT - May 24th, 2024 [May 24th, 2024]
- Biogen Buys Desired Growth In Immunology With $1.15bn Hi-Bio Deal - Scrip - May 24th, 2024 [May 24th, 2024]
- Biogen Boosts Immunology Portfolio with $1.8 Billion Acquisition of HI-Bio - BioPharm International - May 24th, 2024 [May 24th, 2024]
- Owkin Unveils AI-Driven Oncology and Immunology Pipeline, In-Licenses Best-in-Class Asset OKN4395 - Yahoo Finance - May 24th, 2024 [May 24th, 2024]
- Biogen to expand immunology and rare disease portfolio with $1.8bn HI-Bio acquisition - PMLiVE - May 24th, 2024 [May 24th, 2024]
- Astria Therapeutics to Present at Upcoming European Academy of Allergy and Clinical Immunology Congress - Business Wire - May 24th, 2024 [May 24th, 2024]
- Biogen to buy Human Immunology Biosciences in deal worth up to $1.8B - MM+M Online - May 24th, 2024 [May 24th, 2024]
- COVID-19 Re-Vaccinations Elicit Neutralizing Antibodies Against Future Variants - Technology Networks - May 24th, 2024 [May 24th, 2024]
- HIV Vaccine Candidate Induces Broadly Neutralizing Antibodies in Humans - Technology Networks - May 24th, 2024 [May 24th, 2024]
- Pasteur Fiocruz Center on Immunology and Immunotherapy is inaugurated in Cear - Fiocruz - May 24th, 2024 [May 24th, 2024]
- Biogen to buy Human Immunology Biosciences in up to $1.8 billion deal - Marketscreener.com - May 24th, 2024 [May 24th, 2024]
- Fellow Focus in Four: Marat Kribis, MD, Rheumatology, Allergy and Immunology - Yale School of Medicine - April 15th, 2024 [April 15th, 2024]
- Long COVID Can Now Be Detected in the Blood - Technology Networks - April 15th, 2024 [April 15th, 2024]
- Rimjhim Agarwal selected as Major Symposium speaker at the American Association of Immunologists ... - La Jolla Institute for Immunology - March 29th, 2024 [March 29th, 2024]
- Seeking new horizons: Where innovators find opportunities in a fast-changing immunology landscape - IQVIA - March 29th, 2024 [March 29th, 2024]
- Researchers identify new way to inhibit immune cells that drive allergic asthma - EurekAlert - March 29th, 2024 [March 29th, 2024]
- Innovation in Oncology and Cancer Immunology Research - Boehringer Ingelheim - March 29th, 2024 [March 29th, 2024]
- Measles outbreaks show the risk of under-vaccination | News | Harvard T.H. Chan School of Public Health - HSPH News - March 29th, 2024 [March 29th, 2024]
- Immunology-oncology ELISA Kits Market to Witness a Healthy Growth by 2030 - WhaTech - March 29th, 2024 [March 29th, 2024]
- Spring Allergy Season Is Getting Worse. Here's What to Know. - The New York Times - March 29th, 2024 [March 29th, 2024]
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- Researchers identify viable vaccine targets for hepatitis C infections - News-Medical.Net - March 29th, 2024 [March 29th, 2024]
- Three research projects awarded funding from the Immunology Institute Pilot Project program - University of Alabama at Birmingham - February 29th, 2024 [February 29th, 2024]
- Deal Watch: AbbVie Adds To Immunology Pipeline Through Deal With OSE - Scrip - February 29th, 2024 [February 29th, 2024]
- AbbVie and Tentarix Announce Collaboration to Develop Conditionally-Active, Multi-Specific Biologics for Oncology ... - PR Newswire - February 29th, 2024 [February 29th, 2024]
- Integrating single-cell multi-omics and prior biological knowledge for a functional characterization of the immune system - Nature.com - February 29th, 2024 [February 29th, 2024]
- Renowned immunologist and four-decade UAB researcher Max Cooper, M.D., will deliver this year's Marx Lecture - University of Alabama at Birmingham - February 29th, 2024 [February 29th, 2024]
- Inactivation of TGF- signaling in CAR-T cells | Cellular & Molecular Immunology - Nature.com - February 29th, 2024 [February 29th, 2024]
- Babies use their immune system differently but efficiently | Cornell Chronicle - Cornell Chronicle - February 29th, 2024 [February 29th, 2024]
- Antibody reduces allergic reactions to multiple foods in NIH clinical trial - National Institutes of Health (NIH) (.gov) - February 29th, 2024 [February 29th, 2024]
- Mestag Therapeutics Enlists Leading Cancer Biology and Immunology Advisors to Support Clinical Development of its ... - GlobeNewswire - February 21st, 2024 [February 21st, 2024]
- Theratechnologies announces publication in Frontiers in Immunology on TH1902 - TipRanks.com - TipRanks - February 21st, 2024 [February 21st, 2024]
- Smoking has long-term effects on the immune system - Institut Pasteur - February 21st, 2024 [February 21st, 2024]
- Spring Allergies Attack More Than Just Your Nose - ACAAI Public Website - American College of Allergy Asthma and Immunology - February 21st, 2024 [February 21st, 2024]
- Theratechnologies Announces Publication in Frontiers in Immunology that Deepens Understanding of Sudocetaxel ... - GlobeNewswire - February 21st, 2024 [February 21st, 2024]
- Shikhar Mehrotra named co-leader of Cancer Biology and Immunology research program at MUSC Hollings - The Cancer Letter - January 27th, 2024 [January 27th, 2024]
- Gut Microbiome Benefits of Breast Milk Revealed in Mouse Study - Technology Networks - January 27th, 2024 [January 27th, 2024]
- Research on Immunological Diseases Launches with Hungarian Participation - Hungary Today - January 27th, 2024 [January 27th, 2024]
- UCLA to turn former shopping mall into centers for research on immunology and quantum science - The Associated Press - January 8th, 2024 [January 8th, 2024]
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- HI-Bio Announces $95 Million Series B Financing to Advance Targeted Therapies for Immune-Mediated Diseases - PR Newswire - January 8th, 2024 [January 8th, 2024]
- Beyond Cytotoxicity: The Importance of T Cell Memory - The Scientist - January 8th, 2024 [January 8th, 2024]
- IKAROS: Unlocking the secrets of the immune system's key player - News-Medical.Net - January 8th, 2024 [January 8th, 2024]
- UCLA to turn former shopping mall into centers for research on immunology and quantum science - The Caledonian-Record - January 8th, 2024 [January 8th, 2024]
- Revolutionizing Vaccine Research: The Power of a New Algorithm - SciTechDaily - December 31st, 2023 [December 31st, 2023]
- Impact of the gut microbiome on immunological responses to COVID-19 vaccination in healthy controls and people ... - Nature.com - December 22nd, 2023 [December 22nd, 2023]
- Two new practice parameters offer recommendations for treating anaphylaxis and atopic dermatitis - News-Medical.Net - December 22nd, 2023 [December 22nd, 2023]
- Physician and Patient (Un)Wellness in Allergy and Immunology During COVID-19 and Beyond: Lessons for the Future - Physician's Weekly - December 22nd, 2023 [December 22nd, 2023]
- Researchers Identify Why Some Cancers Do Not Respond to Immunotherapy - NYU Langone Health - December 22nd, 2023 [December 22nd, 2023]
- MU's Haval Shirwan recognized for achievements in immunology - Columbia Daily Tribune - December 22nd, 2023 [December 22nd, 2023]