England’s so-called “freedom day” is fast approaching – with stage four of lockdown easing on July 19. At the same time, cases of Covid-19 are rising.

The latest data from the Office for National Statistics (ONS), collected via swabs from randomly selected households, suggests one in 260 people currently has Covid. This time last year, that number was estimated at one in 2,200 people. 

So, what’s going on? Why would politicians even consider easing restrictions with cases rising in this way? As always, there’s a balance between the economy, plus people’s physical and mental health to consider. 

The numbers are complicated

Covid cases are just one metric of many, as the overall picture of public risk is very different to summer 2020, explains Dr Peter English, a retired consultant in communicable disease control and past chair of the BMA Public Health Medicine Committee.

“On the one hand, we are now experiencing yet another wave of Covid-19 infection, despite manifold restrictions. Case numbers around the country are well above 100 new cases per day per 100,000 population (the UK summary currently shows the overall rate to be 214.4 per 100,000). Case numbers in children and young people have risen particularly dramatically,” he says. 

“Yet, on the other hand, a large proportion of the people most at risk have already been vaccinated with at least one, if not two doses of a Covid-19 vaccine; and the available vaccines are all more than 90% effective at preventing disease severe enough to require hospital admission, so the rate of hospital admission and death has not increased in the way that it did in previous waves of infection.”

The third wave of cases is causing a rise in the number of people in hospital with Covid-19, but not yet at the same speed or on the same scale as the peak witnessed during the second wave.

A total of 1,611 patients were in hospital in England with Covid-19 as of July 2, according to NHS England – up 25% on the previous week and the highest number since April 20. Meanwhile, the rate of Covid-19 deaths across the UK remains very low, with 0.2 deaths per 100,000 people in England for the week to June 29, compared with 14.5 at the peak of the second wave.

Long Covid is also a factor

Dr English has concerns about the risks to young, unvaccinated people, though – particularly when it comes to long Covid.

“It seems that about 1% of children who are infected are ill enough to require hospital admission and many children and young people suffer long Covid,” he says. “We know that the infection can damage the lungs, brain, and other organs; and such damage may cause long-term or permanent impairment. Young people may carry such impairment for the rest of their lives.”

This has the potential to harm young people directly, he says, but there could also be a substantial cost to society if a whole generation requires more care, and is less able to contribute through work and taxes. 

“It is far too soon to be sure of the extent of the long-term harms,” he says, “And this should require a degree of caution.”

Vaccination isn’t the full story

Boris Johnson and Matt Hancock have both cited the UK’s swift vaccination programme as a success, helping us move towards the grand unlocking.

But Dr Julian Tang, an honorary associate professor and clinical virologist at the University of Leicester, believes vaccination efficacy is being “over-hyped”. 

“Comparisons with last summer in the absence of any vaccination, less widespread testing and lower levels of natural immunity are not really relevant and somewhat misleading now,” he says. 

Despite headlines to the contrary, Dr Tang tells HuffPost that “the link between infections and hospitalisations and deaths has never been broken”. 

“The vaccines have done what they were supposed to do, which is to convert infections to mild or asymptomatic disease,” he explains. “They also reduce the level and duration of viral shedding to some extent, as they stimulate antibody and cellular responses ahead of any exposure, so that the immune system is already primed to deal more efficiently with the virus when it appears. But hospitalisations are gradually rising, as will deaths, as infections increase also.”

Dr Tang acknowledges the balancing act facing the country. “Of course we have to open the economy to some extent and return to more normal models of education”, he says, adding that now might be the time to do it.

If we wait until winter, when we’re spending more time indoors and flu cases tend to rise, it could be even trickier. 

It’s now about ‘personal responsibility’

Boris Johnson says he intends to end social distancing and mask-wearing laws in England on July 19, effectively handing over more personal responsibility to the public regarding Covid restrictions. Although, the PM has warned now is not the time to get “demob happy”

But Dr Stephen Griffin, associate professor in the School of Medicine at the  University of Leeds, is concerned about the timing, with cases of the highly infectious Delta variant continuing to rise. 

“The impatience with which restrictions are due to be relaxed is likely, in my view, to greatly amplify the number of infections we see caused by the Delta variant, and so cause unnecessary harm along this road,” he says. 

“I am also concerned that the notion of allowing personal discretion to guide the implementation of what restrictions remain will be ineffectual, and represents an abdication of responsibility from the government.” It’s reminiscent of the “somewhat pointless ‘stay alert’ message” of last year’s easing, he adds

“Whilst the majority of people will, I hope, continue to act responsibly, the principle of altruism will be undone by a minority that do not.”

It comes down to ethics

Dominic Wilkinson, professor of medical ethics at the University of Oxford, points out that “public health restrictions that reduce transmission have costs, and not just for freedom”.

“The lockdowns have been effective, but they have also had huge impacts on healthcare, education, and the economy,” he says. “Restrictions will only continue to be proportionate if their public health benefits are still sufficient to outweigh these costs.”

The nation must look at the overall ethics of lockdown, he argues, not just the number of cases and hospitalisations. 

“Some have claimed that the government is not ‘following the science’ in planning to relax the rules. However, science cannot tell us when to unlock. That depends on what we choose to prioritise,” he says. “Like all major policy decisions during this pandemic, decisions about relaxing restrictions are not purely scientific. These are ethical questions.”