The COVID alert level for the UK was recently downgraded by the government from “3” to “2”. This move was based on advice ministers received from the four UK chief medical officers, the NHS England national medical director and the UK Health Security Agency.
Level 2 indicates that while COVID is still spreading, the number of infections is either stable or declining. In addition, the impact of COVID on healthcare services is low.
This is the lowest alert level the UK has been at since the government introduced this classification system in May 2020. While the move indeed reflects an improvement in the UK’s COVID situation over recent weeks, we need to remain vigilant. The alert level could certainly go up again, particularly come winter.
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By way of background, the COVID alert system categorises the UK-wide risk at a given time according to five levels. These range from level 1, where COVID is present but the number of cases and spread is low, to level 5, where COVID infections are widespread and rising, and there is a real risk of healthcare services being overwhelmed.
The decision to move to a higher or lower alert level is informed by a range of factors, and mathematical modelling based on these factors. They include the number of infections, hospital admissions and deaths, as well as the reproduction number (R), which gives a sense of whether the epidemic is growing or shrinking.
When the alert levels were first introduced in May 2020, the UK was initially placed at level 3. It went up as high as level 5 in early 2021 due to the large epidemic wave caused by the alpha variant that led to a large number of infections and put many parts of the health system under immense pressure.
Similarly, in December 2021, it went up to level 4 due to the emerging threat of omicron. In the periods in between the epidemic waves it has gone down to level 3; the government last de-escalated from level 4 to level 3 back in May 2022 after the wave caused by the omicron subvariant BA.2 subsided.
Level 2 fits with the UK’s current trajectory
Over the past ten months there have been three large epidemic waves in the UK driven first by the original omicron variant at the end of 2021, followed by omicron subvariants BA.2 in March 2022, and then BA.4 and BA.5 in June to July 2022. All three waves led to many people becoming infected.
These waves also resulted in hospitalisations and deaths but at much lower levels than previous waves. Much of this is down to the high levels of protection in the population due to vaccination. At the peak of these waves, they added to the burden for busy hospitals and health services.
However, the situation has improved in recent weeks with COVID infections and deaths, along with a falling burden of COVID on health services.
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What are the implications of this shift?
For most of the public very little has changed since the lifting of the majority of public health measures against COVID earlier in the year. This move shouldn’t change anything for most people.
That said, the timing of this change in alert levels has coincided with the pause in regular asymptomatic testing in the last few remaining settings such as hospitals, care homes and prisons where until recently it was still being carried out.
Looking ahead
Based on infection trends, this move to downgrade the alert level makes sense and is proportionate to the current risks. Public health measures against COVID come at a cost and this cost has to be factored in and balanced against any expected benefit.
While the situation has greatly improved, the threat hasn’t gone away. COVID is still present and continues to spread in the community, albeit at lower levels. There are other variants circulating too, such as BA.2.75, although they have not caused significant hospital pressures.
Elsewhere large epidemics continue to occur, such as in Germany and Japan in recent weeks. We will need to stay vigilant and watch out for new threats. We also need to make sure our vaccines and new treatments continue to be effective against COVID.
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We’re not at the stage of the pandemic yet where the evolution and spread of the virus can be predicted with certainty. The alert level could certainly go up again. Much depends on whether another variant emerges that spreads easily and causes more severe disease.
There is also a possible worst case scenario where we could have a perfect storm of rising COVID infections, occurring in the winter months at the same time seasonal flu and infections with other winter viruses are at their peak. Such a situation could place the healthcare system under immense strain at a time of year when they are usually at their busiest.
Regardless of the alert level, if we want life to return to normal and at the same time avoid the harms of COVID infections, we will need to maximise vaccine protection. COVID vaccinations, including boosters, are especially important for people at higher risk of severe COVID such as the elderly and people with pre-existing health conditions.
If the most vulnerable people are protected, the threat posed by future epidemic waves of COVID, and likewise the need for more restrictive public health measures, can be minimised.
Andrew Lee has previously received research funding from the National Institute for Health Research. He is a member of the UK Faculty of Public Health and the Royal Society for Public Health.
