The red list needs to go

1 Oct

No logical justification for the red list

A month ago, I wrote an article where I asked the question “what is the red list for?”. I argued that with the government now focusing the red list on variants of concern, there was little if any justification for having any countries on the list at all, based on the data.

Since then, the UK has amalgamated the green and amber lists into a new “Rest of World” category. For fully vaccinated travellers from those countries, pre-travel testing has been dropped. Whilst the post arrival test remains, it will move to cheaper lateral flow tests from the end of October. However, no changes were made to the red list rules. Eight countries were removed at the last review, but there are still 53 countries on the red list today.

Just this week, Ireland abandoned its own version of the red list. Hotel quarantine will no longer be required to enter Ireland from any country. Could the UK follow suit at the next review next week?

Whether they will or not, I certainly believe that they should, based on the science. The actual decision will be based mainly on politics, and I’ll come back to that question. But first I’ll remind you of the reasons I set out a month ago for why the red list was no longer serving a useful purpose, based on the data.

My main argument was that none of the variants that the government is worried about are worse than Delta, and that these variants were dying out worldwide in the face of Delta in any event. I thought that the figures were quite compelling when I wrote the article, but we now have another month’s worth of data.

What does it show? Let’s go through the main variants one by one.

Lambda

The heartland of Lambda is Chile and Peru. A month ago, I argued that whilst Lambda appeared to be able to hold its own against Gamma, the early indications following the introduction of Delta into these countries showed that it was dying out in the face of Delta. I’ve updated the figures for the latest data and you can see that this trend is now even more compelling. Two other variants that the government is worried about, Gamma and Mu, appear more resilient in the face of Delta in these countries. I’ll come back to those in a moment. But this data seems pretty compelling to me that Lambda is not a worrying variant compared to the others.

*Source: GISAID, GridPoint analysis. Last weekly data point amalgamates the four most recent weekly figures to compensate for small sample sizes.*

Mu

Before the WHO started coming up with Greek letter names for the variants, this one would have been called the Colombia variant. It became dominant there during the year and appeared to be able to outcompete Gamma. A month ago, it looked like it would recede in the face of Delta, but to be honest the data were a little inconclusive. With the benefit of another month of figures, I think it is now very clear that Delta wins again.

Gamma

Brazil was the origin and has remained the heartland of the Gamma variant. The latest data confirm the, now familiar, trend. Delta domination once it arrives.

Beta

The final “big variant” that the government has been worried about is Beta, previously known as the South Africa variant. This was the one that caused the panic that led to the creation of the short-lived and much derided “amber plus” category. It only ever had one occupant, France. It was killed off only a couple of weeks after it was created when the few Beta cases in France disappeared.

Keeping South Africa on the red list at the last review because of the Beta variant was doubly dumb. Firstly, Beta had already disappeared in South Africa, as outraged politicians from the country were quick to point out. But secondly, the fact that Beta did not survive in the face of Delta in the country of its birth also shows that Beta is not a threat to the UK.

The chart below shows the latest data. The “No WHO Name” category in the chart appears to be sequences that could only be partially identified. They are known to be some kind of B.1 sub-variant, but it is unclear which kind. That’s a grouping that includes both Beta and Delta. So, Beta has almost completely died out and Delta is victorious again.

We need to stop worrying about existing variants

I hope you will agree that the data are pretty compelling that none of the existing variants is worse than Delta and will not spread in a country that already has Delta. Which is why no other country is currently worrying about any of the existing variants.

Perhaps countries should be kept on the red list on a precautionary basis, if their sequencing capabilities are low. But plenty of countries that aren’t on the red list today don’t submit good sequencing data.

Of course, another more worrying variant could emerge, but that could happen anywhere in the world. Unless and until such a variant is discovered, continuing to force hotel quarantine on travellers from specific countries doesn’t have any logical basis.

Would continuing with the red list protect the UK from a future Delta-beating variant anyway?

The image I used at the top of this blog post shows the worldwide split of variants over time. I’ve reproduced it below for convenience. It shows how quickly Delta has gone from first discovery to total global domination. The UK’s failure to put India onto the red list early enough was widely blamed for the arrival of Delta into the UK. I think it is a statement of the obvious to say that the only thing that could perhaps have been achieved with swifter action would have been a short delay in its arrival. The only chance of keeping it out permanently would have been to quickly put the entire world on the red list - to do a “full Australia” and close the border to the world. Any other policy would have meant adding country after country to the red list as Delta spread across the world. I can’t imagine anyone could believe that that would have kept Delta out, and the UK would have ended up in the same place anyway, hiding behind a fully closed border.

What makes anyone think that the story with a future Delta-beating variant would be any different? If a highly vaccine resistant variant were to emerge, there could be value to buying time to develop and deploy a new vaccine. But as we have seen with the spread of Delta, there are only two real strategies that can work: shut your country off from the rest of the world, or shut the country which has the virus off before it has had a chance to spread. To do the latter would require swift and effective global co-ordination. Wait, I think I just saw a pig fly past the window.

The politics

Whatever the science and the data say, what the government actually does next week will be driven mainly by politics.

When hotel quarantine was first introduced back in February, public support for travel restrictions was at an all-time high (see chart below). About 80% of the UK population supported quarantine for all arrivals and about 60% went as far as supporting stopping all flights. Since then, public support for the restrictions has been waning and the latest opinion polls show that support has fallen to the lowest level recorded since YouGov started tracking opinions in April 2020.

Ireland’s move to abandon hotel quarantine is perhaps more politically significant in the UK than it might appear. The UK operates a “common travel area” with Ireland, with travellers from Ireland treated as domestic arrivals into the UK. It would be political suicide to introduce border restrictions, given the sensitivities in Northern Ireland. Whilst it is legally possible to continue to insist that travellers from red list countries who enter the UK via Ireland need to go into hotel quarantine, enforcement will be a real issue.

Last week, the United States announced the removal of restrictions on travel from Europe and other places. It shifted from a system where different countries were treated differently to one where the rules vary only based on vaccination status. In justifying the move, the White House explained that the new approach was “…based on individuals rather than a country-based approach, so it's a stronger system.” Abolishing the red list would be entirely in keeping with this philosophy.

The final nail in the coffin of hotel quarantine could be the news that even Australia has decided to phase it out.

It is possible that the government will not want to eliminate the red list completely. Perhaps all we will get next week will be some loosening of the rules, for example replacing hotel quarantine with home quarantine for red list countries. Maybe more countries will be removed from the list, with others staying on it. But as I hope I have explained in the first part of this post, coming up with a logic for why any countries should be treated differently at this point is increasingly tricky. Maybe it is wishful thinking on my part, but I am beginning to think that it is politically easier to abolish the red list than to amend it at this point.

Recent announcements by other countries have provided plenty of political cover for the government to move boldly and abolish the red list next week. As Prime Minister Boris Johnson said when he removed domestic restrictions, “if not now, then when?”.

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Robert Boyle