ARE we “admitting defeat”, or learning to “live with” Covid?
For those most vulnerable to serious illness as a result infection, the easing of rules on testing and self-isolation might trigger anxiety that efforts to contain the virus are unravelling.
For businesses and public services struggling with rocketing staff absences, there is probably a sigh of relief.
Close contacts - including household contacts - of a positive case are no longer be required to quarantine for 10 days.
As long as they are fully vaccinated (including a booster or third dose) and return daily negative results using a lateral flow device (LFD), they can go to work.
This exemption has already been in place for health and social care workers, although those based in certain settings - such as oncology departments - may be temporarily redeployed.
READ MORE: Six in 10 Covid patients admitted 'because of' infections since Omicron became dominant
Yet, by Boxing Day, a record 462 care home staff in Scotland were missing after testing positive for Covid, and Covid absences in the NHS have more than doubled in just three weeks to 5,500.
To put that into context, NHS Covid absences are at levels last seen in May 2020 - but, back then, the total number of patients being admitted to hospital was also 30 per cent lower than normal.
Now it is more like 10% below pre-pandemic levels.
At the same time, the number of beds being lost to delayed discharge currently exceeds 1,500, compared to around 700 back in May 2020, as Omicron-driven absences in social care increasingly leave elderly hospital patients in limbo.
The pressure on beds is simply unprecedented: NHS staff shortages mean fewer beds can be safely provided for patients despite enormous treatment backlogs; physical distancing requirements continue to reduce total capacity; and spiralling Covid admissions mean space is increasingly lost as patients - with or without symptoms - have to be isolated.
Covid patients do not have to be sick with the virus to pile pressure on hospitals. A critically ill car crash patient who happens to test positive on admission can result in a whole area of intensive care being sealed off.
An elderly person who contracts the infection while in hospital for other treatment might take much longer to recover; a bed that might have been freed up in two or three days ends up occupied for two weeks.
These are the real reasons why Omicron is pushing the NHS to breaking point.
Cutting self-isolation from 10 to seven days - the other major change announced this week - should mean that a majority of Covid positive people can return to work three days earlier. But it won’t apply to everyone.
To be clear, self-isolation can only end on day seven if the person has no fever and tests negative on days six and seven.
Evidence suggests that roughly 15% of people will remain infectious by day seven, and the vast majority of these individuals will test positive on an LFD. If so, they must remain in isolation for the full 10 days.
As Professor James Chalmers, an expert in respiratory medicine at Dundee University, put it: "If you don’t take a lateral flow test, if you just exit self-isolation at day seven, the modelling suggests a 15% risk that you are still infectious, so anybody who cheats these rules is putting others at risk.”
It is easy to understand why vulnerable people feel worried.
But with Omicron spreading faster than our testing capacity can cope and critical public services, from railways to care homes, struggling to stay afloat, Nicola Sturgeon has signalled the Scottish Government’s intention to “adapt our thinking about how to manage the virus”.
This is not about “giving up on trying to control Covid completely”, she insisted, but facing up to the fact that “the kind of measures that have helped us control transmission in past phases are becoming less tolerable and causing more harm”.
Before Omicron emerged, leaked documents relating to an exit strategy dubbed ‘Operation Rampdown’ revealed how the UK Government might wind down its pandemic response.
The 160-page dossier envisioned an end to the legal requirement for those infected with Covid to self-isolate; dismantling Test and Trace; and scrapping free PCR and lateral flow tests.
“We will no longer be prioritising the previous objectives of breaking chains of transmission at all costs,” it stated.
READ MORE: Sturgeon announces key changes to testing and isolation rules
Omicron has scuppered this for now, but mass testing and mandatory self-isolation will end.
PCR testing is already being rationed to key workers and the symptomatic. Eventually it will be limited, as was at the beginning, to hospital patients.
Lateral flows will stop being an everyday tool to gauge whether you are safe to socialise or work, but might remain important for entry into certain high-risk settings such as care homes or hospitals.
Work is already advancing on the next generation of rapid DIY Covid tests, with a new saliva swab trialled in Singapore reportedly achieving PCR levels of accuracy in minutes.
Self-isolation will probably be scrapped next for those who are positive but asymptomatic and fully-vaccinated, before gradually being abandoned altogether.
How exactly we get there depends on a tricky trade-off of risks, but increasing use of oral antivirals which can stop Covid progressing from infection to serious disease will be one part of the equation.
If we’re lucky, the virus itself will evolve over time into something much milder, but Omicron-specific vaccines could get us there faster.
The real Holy Grail would be a vaccine which not only cut hospitalisation risk, but stopped infections, as this would truly end the pandemic.
Many consider this highly unlikely - maybe even unnecessary.
However, scientists in San Francisco are currently working on intranasal vaccines - where a shot is inhaled through the nose instead of injected into arms - on the basis that triggering the mucosal immune system might prevent the virus invading the respiratory tract in the first place.
There is no doubt we are at a crossroads in the pandemic, however.
If managing the eruption of Covid vexed governments, navigating a safe path out poses the biggest challenge yet.
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