Rising concern that Covid cases are on the up in the UK as temperatures get colder has sparked conversations around Britain’s approach to tackling the virus.

The UK Health Security Agency (UKHSA) said last week that there are “early signs of Covid-19 rates increasing as temperatures start to drop”. But in the US, cases have been falling, according to the US Centres for Disease Control and Prevention (CDC).

Few people would think of the US as being a “nanny state”. Yet when it comes to the rules about what to do when you get Covid symptoms the land that is typically seen as taking a laissez-faire approach to policy and regulations is taking a more hardline approach than the UK.

We looked at how the rules between the two countries compare on isolation and testing along with the availability of booster jabs.

Isolation

Language: In the US you “should isolate from others when you have Covid-19. You should also isolate if you are sick and suspect you have Covid-19 but do not yet have test results,” according to the Centres for Disease Control and Prevention (CDC), the official US government public health authorities.

By contrast, in the UK, you should only “try to stay at home and avoid contact with other people if you or your child have symptoms”, according to the NHS website.

This tallies with the UK Health Security Agency’s (UKHSA) advice, which says “If you have a positive COVID-19 test result you should try to stay at home and avoid contact with other people”.

The UKHSA and CDC have the same role, being charged with protecting the public’s health against disease. The US doesn’t have an equivalent to the NHS, which is the other main guide of public behaviour.

So while the US advice sounds more like a command – “should” – the UK advice makes the isolation sound much more optional, points out Simon Williams, a sociologist at Swansea University, who has been studying public behaviour and government communication around Covid since the pandemic began.

Duration: The other difference is in how long any isolation should last. In the US, the rules are to “stay home for at least 5 days” and “wear a high-quality mask if you must be around others at home and in public”.

After five days, if your symptoms are improving, you may end isolation “if you are fever-free for 24 hours (without the use of fever-reducing medication).”

But if you had symptoms and had moderate illness (you experienced shortness of breath or had difficulty breathing) “you need to isolate through day 10”.

In the UK, people should try to stay at home for 5 days after the day you took your test – and three days for children.

Beyond five days, you should only avoid meeting people who are at high risk.

“Although most people will no longer be infectious to others after 5 days, some people may be infectious to other people for up to 10 days from the start of their infection. You should avoid meeting people at higher risk of becoming seriously unwell from COVID-19, especially those whose immune system means that they are at higher risk of serious illness from Covid-19, despite vaccination, for 10 days after you took your test,” according to UKHSA website.

Tests

The attitudes to testing are also quite different between the countries.

In the US, the implication is that a person will test when they have Covid symptoms, says Dr Williams – “You should also isolate if you are sick and suspect that you have Covid-19 but DO NOT YET HAVE TEST RESULTS”, says the CDC website.

In the UK, the NHS website makes no such assumption and points out that “You are no longer required to do a Covid-19 rapid lateral flow test if you have symptoms. But if you or your child have tested positive for Covid-19….” – putting the emphasis on ‘not taking’ a test, rather than ‘taking one’, according to Dr Williams.

Meanwhile, the UKHSA website also emphasizes the fact that “Most people can no longer access free testing for Covid-19.”

As a result, it splits its guidance into two parts:

1. Actions you can take to protect other people if you are unwell with symptoms of a respiratory infection, including Covid-19, and you have not taken a test for COVID-19.

2. Advice for people who have taken a Covid-19 test and have received a positive test result.

Boosters

In the US, the CDC last month recommended that all Americans aged six months and older receive the updated Covid booster.

The CDC said: “Most Americans can still get a Covid-19 vaccine for free. For people with health insurance, most plans will cover Covid-19 vaccine at no cost to you.

“People who don’t have health insurance or with health plans that do not cover the cost can get a free vaccine from their local health centres; state, local, tribal, or territorial health department; and pharmacies participating in the CDC’s Bridge Access Program. Children eligible for the Vaccines for Children programme also may receive the vaccine from a provider enrolled in that programme”.

In the UK, the booster is available for all adults aged 65 years and over and people aged six months to 64 years in a clinical risk group, such as people with diabetes and pregnant women.

(UKHSA)

Covid cases

THE UKHSA said last week there are “early signs of Covid-19 rates increasing as temperatures start to drop” adding that: “Overall, Covid-19 hospitalisations increased to 6.13 per 100,000 compared to 5.67 per 100,000 in the previous week.”

In the US, cases have been falling, with a 0.8 per cent fall in cases in the past week.

“There is a big difference between the US and the UK in their approach in terms of isolation and vaccination policy going into winter. The UK is less directive and less cautious. It will be interesting to see if this makes a big difference or not on cases and hospitalisations,” said Dr Williams.

So what do the Covid scientists think about the UK’s more relaxed attitude to testing?

“This is an interesting comparison,” says Professor Lawrence Young, a virologist at Warwick University.

“The US is taking Covid much more seriously in emphasising the need for isolation to prevent the virus spreading as well as other precautionary measures.

“We are being much more cavalier in the UK with very poor public health messaging and a dangerously relaxed attitude to testing, masking, isolation and vaccination. The Covid virus is unpredictable and continues to change. Ignoring the virus won’t make it go away – quite the opposite,” he said.

Professor Steve Griffin, of Leeds University, argues that the UK approach is “self-defeating”.

“Workplace absences continue at very high rates, especially among teachers and other educational roles, and in the NHS. The solution to this not to send people back into work when they’re sick, but to prevent them becoming ill in the first place.

“We’re effectively saying in the UK that we no longer need to worry about either being infected by, or spreading infection with, SARS-CoV2, or indeed it seems any other respiratory illness. This is beyond insane, and goes against fundamental public health.

“Combined with the whittled down vaccine programme where uptake has been hampered by both slow acquisition of up to date boosters as well as a year of Govt messaging saying that Covid is over, this means we continue to see unacceptably high prevalence and ensuing harm, with no population level mitigations whatsoever,” Professor Griffin says.

However, Professor Paul Hunter, of the University of East Anglia, thinks “the UK has got it more right”.

“The thing with self-testing and isolation is that for it to work you have to have very high compliance,” he says, pointing out that very often people don’t know they have Covid – especially since free Covid tests ended. “So what value is it?,” he asks.

Professor François Balloux, director of the University College London Genetics Institute, added: “I believe the UK Covid recommendations are OK. More targeted vaccination campaigns are probably more effective. The 2023 autumn booster uptake in the US has been dismal.”

“As concerns booster eligibility, slightly over a quarter of the population is eligible in the UK. This is largely in line with the policy of other countries in Europe”.

“In the US, essentially everyone is eligible for a booster, but given the population in the US is in worse health, application of the UK criteria would make a far larger proportion of Americans eligible for a booster.”

Dr Renu Bindra, Deputy Director in Clinical and Public Health Response at UKHSA, said: Guidance produced by UKHSA and the NHS is clear that you should try and stay at home and avoid contact with others, particularly those who are vulnerable, if you have symptoms of a respiratory infection or have tested positive for COVID-19.

“This helps you to avoid passing on infection and is the best way to keep others safe. This guidance also provides advice on what you should do if you need to leave your home with these symptoms or following a positive test.”

“Effective vaccinations and treatments greatly reduce the risk of severe disease from COVID-19 and these are available for people at highest risk of becoming seriously ill.

“Over 7 million people have taken up this year’s autumn COVID-19 booster to date and we continue to encourage those at greater risk from the virus to come forward.”

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