Are the planned cuts to UKHSA and expenditures to control COVID-19 warranted?

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hands in blue gloves pipetting liquid onto a Covid-19 antigen test

By Professor Aditya Goenka, Chair in Economics, Department of Economics

The Covid-19 pandemic started more than 2 years ago. With over 86% of the UK population vaccinated twice, 68% boosted, and seven-day average deaths below 300 it would seem time that the country moved on from Covid restrictions. In February 2021 the UK Government published its “Living with Covid-19” plan, which removed all domestic restrictions while basing its response on “Protecting people most vulnerable to COVID-19” and “Maintaining resilience”.

However, the pandemic is far from over. With successive mutations of the Omicron variant emerging that cause reinfections and evidence that even boosted individuals have inadequate immunity against infections,  infection rates remain high and the NHS has the fewest free beds since the start of the pandemic.

In this situation, reports which suggest that the UK Health Security Agency (UKHSA), tasked with dealing with COVID-19, is facing job cuts of 40% and suspension of routine testing in hospitals and care homes are alarming. There is also pressure on the NHS to remove COVID protocols in hospitals. This is ostensibly to cut costs and cut waiting times in hospitals.

However, this is a false economy.

COVID-19 has effects of mortality and morbidity (illness). Mortality has received the most attention, but the effects of morbidity are often underestimated. With a COVID-19 infection, there is an immediate effect where symptomatic individuals are incapacitated for up to 10 days. Somewhere between 10-30% of infected people further develop Long Covid, where symptoms persist for up to 45 weeks after infection. Recent studies show that there is loss of cognition equivalent to ageing by 20 years for hospitalised patients. A study of elite footballers shows that those infected can lose productivity of 5% half a year after infection. Research from other infectious diseases show that the morbidity effects alone can reduce GDP growth. Thus, these cuts to the UKHSA will lead to larger economy wide losses as the reduction in productivity can become long-lasting.

The cuts also go against the principles of protecting the most vulnerable. In the first 2 waves of Covid, there was high mortality due to the disease in care homes. In the third wave, there was lower mortality due to better testing and vaccination. Removing routine testing may result in a similar situation as in the early stages of the pandemic. Similarly, nosocomial infections (acquired in hospitals) were 20-25% of all infections in hospitals in the first wave. Nosocomial infections continue to persist and removal of routine testing in hospitals will increase pressure on the NHS.

These anticipated cuts are inconsistent with the principle of maintaining resilience. There were two successful aspects to UK public health response in controlling COVID-19: the rapid roll-out of vaccination, and infection and genomic surveillance. The testing data from self-administered tests, administered PCR tests, and the random surveys of the React Study gave a good picture of extent and type of infections that informed policy making. However, all these are being ended. Genomic sequencing of data from UK was 24% of all data in the international GISAID initiative, and invaluable in understanding the evolution of the virus. The funding cuts will mean that the ability to understand and control the growth of infections in the population of a rapidly changing virus will be compromised.

What should be done to balance the twin objectives of maintaining health and wealth when COVID persists, and the virus is evading immunity from vaccinations and prior infections? My ongoing research indicates that, if we care sufficiently about both, then health expenditures should be maintained and some form of restrictions of mixing, such as being able to work from home, are desirable. Acting as if the pandemic is over and life is back to normal will have adverse health as well as economic consequences.

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