Why do we still tell people to isolate – even after two jabs?

Last Wednesday was supposed to be the day of 70-year-old Moira Bygrove’s long-awaited family reunion. Having shielded for the best part of a year, she’d seen her new grandchild – born in March 2020 – just a handful of times.

She’d had both vaccine doses, and with families finally able to meet indoors, she would be guest of honour at her son-in-law’s birthday party.

But just a few days before the get-together, a text sent to Moira’s phone dashed all her hopes. It was from Test and Trace: she was told she’d been in contact with someone with Covid symptoms in the past 48 hours and must isolate for eight days.

‘My first thought was, I’ve had two jabs – and the last one was way back in early April,’ says Moira, who recently moved to Llandudno in Wales from Manchester. ‘It made me wonder why I bothered even getting the jab in the first place.

‘I also became anxious, worrying that this is going to keep happening and I’m never going to properly get my life back. What if I get pinged again and again?

‘I was elated to get my second jab. I thought: at last – freedom is around the corner. Now I’m not so sure that’s true.’

Moira is not the only one to feel baffled by this situation.

John Rosenthal, a 67-year-old transport company owner from the Isle of Wight, is currently self-isolating – despite receiving his second jab several weeks ago. A dog-walking friend tested positive and he was contacted by Test and Trace. 

John, who lives alone, says: ‘Obviously I can speak to people on the phone, but it’s not the same as being in my office with people. But I’ve been vaccinated, so it all seems quite unnecessary.’

Scientists from the UK and US have begun to think the same.

Currently, the 20 million fully vaccinated Britons are subject to the same inconveniences as everyone else: ten days of self-isolation if a contact tests positive, ten days of quarantine if returning from an amber or red-list country, as well as social distancing and mask-wearing, of course. 

In England they could even face a fine of £200 for not complying. It’s vital that, while the current rules are in place, people continue to follow them. But some experts say these rules are trailing behind the science.

Speaking to The Mail on Sunday’s Medical Minefield podcast, Professor Monica Gandhi, an infectious disease expert at the University of California, San Francisco, says: ‘I don’t think this is a good idea and actually here in the US, the government has recommended otherwise.’

Meanwhile, Professor Jackie Cassell, public health expert at Brighton and Sussex Medical School, says it is almost ‘inevitable’ that the UK will exempt fully vaccinated people from testing and quarantine. She says: ‘The effect the vaccines have on transmission is massive, way more than we ever could have expected.’

Professor Lawrence Young, a virologist from the University of Warwick, told this newspaper that while quarantine for fully vaccinated people was ‘questionable,’ and ‘a bit extreme’, it was safer to err on the side of caution for now.

Last week, the Centers for Disease Control in the US released interim guidance for fully vaccinated people, confirming that they can ‘refrain from quarantine following a known exposure’, ‘refrain from testing following a known exposure’ and ‘refrain from self-quarantine’ after travelling into the US from abroad.

The guidance added that they need not wear masks unless it was a requirement of individual institutions. Closer to home, the Republic of Ireland is also lifting restrictions for fully vaccinated individuals. 

Health officials have launched a ‘vaccine bonus’ scheme – fully vaccinated people do not have to wear masks indoors or socially distance, and the Irish government is reportedly considering scrapping self-isolation and quarantine for them too.

Last week, England’s Deputy Chief Medical Officer, Professor Jonathan Van-Tam, was resoundingly positive about the ever-decreasing Covid threat level, thanks to the success of the vaccination programme. 

Deaths, he said, are at an ‘extremely low place’, and added there was nothing to suggest the jabs aren’t protecting against becoming ill with the highly transmissible Indian variant.

So why isn’t the UK following the US and Ireland’s lead and freeing those who have been jabbed twice from restrictions? Some say there are still ‘unknowns’ about the extent to which Covid vaccination protects individuals from getting asymptomatic infections and therefore spreading it without knowing.

While there is concrete data to show the vaccines protect against serious illness, from all variants, there is less proof it stops low-level infection. And with cases of the Indian variant quadrupling in several areas as restrictions ease, officials have said now is not the time to take any risks.

But emerging data suggests asymptomatic transmission may, in fact, be near-impossible for those who have had two jabs.

In March, a study of US health workers found a 90 per cent reduction in asymptomatic infections among those fully vaccinated with the Pfizer jab, while studies in Israel found at least an 86 per cent reduction in these transmissions.

Other data from Israel shows that, for the small number of vaccinated people who do become infected, the amount of viral cells in their nose and throat is a quarter of those in people who are unvaccinated. The lower the viral load, the less likely they are to pass the virus on.

‘The data we are seeing suggests that no one who is fully vaccinated is passing on the virus,’ says Prof Gandhi. ‘So it’s becoming the consensus here in the US that you don’t need to quarantine after you have had your vaccine.’ She points to care homes, where positive cases occasionally crop up in fully vaccinated residents, but the infection fails to spread.

She said: ‘If you are fully vaccinated, it’s possible you can still test positive with the virus, but along with the fact you are incredibly unlikely to get sick as a result, you are also incredibly unlikely to pass it on because the viral load in your nose and throat is so low.

‘The common denominator in these care home infections is always an unvaccinated, or partially vaccinated, care home worker. It is far more likely they are the source of infection as opposed to the fully vaccinated residents.’

Meanwhile, some British experts say ditching self-isolation rules could encourage more people to come forward to get jabbed. ‘This could work as an incentive in areas such as Bolton and Blackburn, where take-up of the vaccines has been low,’ says Prof Cassell.

‘These areas have high levels of socio-economic poverty, which means people feel unable to isolate if asked because they can’t afford to. So they don’t get tested for fear of being quarantined and, as a result, infection rates have remained high in these areas throughout the pandemic.

‘If we said to these people that they wouldn’t have to isolate if they got vaccinated, and they could go about their work even after exposure, I think we’d see an increase in take-up among those who have been hesitant so far.’

One of the reasons not to follow the US’s lead is the lower efficacy of the Oxford-AstraZeneca jab compared to the Pfizer and Moderna – which are the two most commonly used in the US.

There is now evidence that the Pfizer jab prevents transmission in close to 100 per cent of cases, while for AstraZeneca the figure has been reported at being roughly 50 per cent, following two doses. But Prof Gandhi says this is likely to be ‘a gross under-estimation’. 

The studies look for the virus in swabs taken from the nose and count this as an infection – but the ultra-sensitive methods used in the AstraZeneca trials were probably picking up tiny amounts that would never have been infectious, she added.

Despite this, other experts say we must wait until the infection rate comes down even further before we take any chances.

The percentage of those for whom the jab won’t work at all is estimated to be between ten and 20 per cent. And with about 2,000 new infections every day, they say this is enough to pose a significant risk of increases in hospitalisations.

‘It is likely to be a very small percentage, but when you are talking about millions of people, even a small percentage can still be a large number,’ says Prof Young.

‘I think levels of infection need to get much lower before we can be confident that we can get back to a more normal situation where fully vaccinated individuals are exempted from all restrictions.’

Another concern is how effective the vaccine is at stopping the Indian variant spreading.

Prof Young says there is some evidence coming from India that shows ‘if you’re fully vaccinated, you can still get infected and possibly spread the virus further’.

Cambridge University scientists recently found that 33 staff members of a care home in New Delhi tested positive for the Indian variant, despite having had two doses of the AstraZeneca jab. It’s important to point out that none had anything more than mild symptoms.

And real-world evidence from the UK seems reassuring. Covid infections in England rose after dropping for five straight weeks, the Office for National Statistics said on Friday. 

They estimated around one in 1,110 people had the virus at any time in the week to May 15. This had been primarily driven by infections in the North-West of England – although these were primarily in younger, unvaccinated groups.

In Bolton, infections have surged by more than 70 per cent over the last seven days. The rate there is 15 times higher than the national average – higher than it was during the January peak, when the country was ordered to lockdown – and continuing to rise.

There were, as of yesterday, 30 people being treated for the virus is hospital – with seven in intensive care, according to reports.

Of these, a handful were partially vaccinated having had one dose, but the majority hadn’t had a jab despite being eligible.

Meanwhile, the national picture is also promising, in terms of vaccine effectiveness: infections in the over-60s, most of whom are inoculated, have remained relatively stable.

Boris Johnson has confirmed the country is still on track for lifting of all social distancing restrictions on June 21 – and on Friday, jabs were being offered to those in their early 30s. Despite this, the most coherent argument for continuing to ask vaccinated people to isolate, should they be exposed, is a logistical one.

There is data to show that the immunity the vaccine provides lasts for six months – but beyond that, scientists say there’s a chance it could wane, as is true for the flu vaccine.

‘Duration of protection is a very important consideration. People who were vaccinated very early on, in January, could well see their protection wane by the summer,’ says Professor David Salisbury, vaccine expert and former director of immunisation at the Department of Health.

‘This is why there are already plans for a booster in the autumn, but it will take a while to get round to everyone.’

Experts have voiced concerns about the difficulty in keeping track of when people were vaccinated and policing their behaviour, creating even more red tape for the already stretched Test and Trace system.

Last week it was revealed that a glitch in the Test and Trace system that occurred this month meant that more than 700 Covid cases were not reported to local health teams, potentially allowing the disease to spread further.

Shockingly, more than 300 of those cases were in Blackburn with Darwen, where the Indian variant has become rife.

Prof Gandhi also suggests the US’s decision to make life easier for fully jabbed individuals was an incentive, designed to tackle the growing problem of vaccine hesitancy.

Jab refusal is far more widespread in the US, compared with the UK.

In recent weeks, the uptake of vaccinations in the US has slowed and in some states, such as Iowa, the majority of counties have stopped asking for new doses.

In Georgia, only roughly a third of the population has taken at least one dose of the vaccine, yet the state has already decided to shut down its mass vaccination sites, suggesting the demand is lacking.

Some studies have suggested as many as a quarter of Americans don’t want the jab.

When announcing new guidance, Dr Rochelle Walensky, the director of the Centre for Disease Control, said: ‘Over the past year we have spent a lot of time telling Americans what they cannot do, what they should not do. Today I’m going to tell you some of the things you can do – if you are fully vaccinated.’

Prof Gandhi agrees, saying: ‘Focus groups in the US show not having to wear a mask and being around others are positive motivators for getting people to have [the jab].’

As for the situation in the UK, Prof Gandhi sees no reason why such restrictions should remain in place. ‘There is no question that you have done an amazing job getting people to accept the vaccine, while we have variability across our country. You’ve successfully stopped the virus. In the UK, it’s [no longer] an epidemic.

‘Your Prime Minister was highly criticised [for being too lax] at the start of the pandemic, so now it’s caution overkill.

‘At some point, you have to give people their lives back.’