LONDON (NYTIMES) - There are downsides to most Covid-19 precautions. Keeping children home from school can cause them to fall behind. Working from home can impede creativity. Staying away from friends and relatives can damage mental health. Wearing masks can muffle speech, hide smiles and fog eyeglasses.
For all of these reasons, the ideal Covid-19 policy for any society balances the benefits and costs of precautions. It acknowledges that excessive caution can do more harm than good.
Over the past year, Britain's Covid-19 response has included some major victories. The country rushed to vaccinate people and was also willing to reimpose behaviour restrictions last winter. These measures helped cause a sharp drop in caseloads.
In response, Britain reopened over the summer, allowing people to live largely without restrictions. Schools and workplaces have returned to normal, without masks. Restaurants are booked. Finding a taxi on a Saturday night in Central London is again a challenge.
"There's a feeling that finally we can breathe," Dr Devi Sridhar, head of the global public health programme at the University of Edinburgh in Scotland, wrote in August. "We can start trying to get back what we've lost."
Britain now seems to have lost a sense of balance, as Dr Sridhar has also suggested. Cases have surged this fall, hitting a three-month high of around 52,000 infections on Oct 21, more so than in the rest of Europe, the United States or many other countries.
Yet Prime Minister Boris Johnson's government continues to oppose measures that could reduce cases.
Britain can offer lessons for the US and other countries. The Delta variant arrived in Britain earlier than in many other places, making it something of a leading indicator. Cases in Britain rose for about two months starting in May and then started falling. But the decline did not last.
Over the past week in the US, cases have also stopped falling. The reasons are not clear, as is often the case with Covid-19, and the recent increase is minuscule. But it is a reminder that the pandemic will probably keep having ups and downs.
Experts say Britain seems to be making three main mistakes that are aggravating the pandemic.
1. Not enough vaccinations
Despite being ahead of most of Europe on vaccinating adults, Britain waited to approve vaccines for adolescents. It did not recommend vaccinating 12- to 15-year-olds until September, weeks after many students had returned to school. Today, only 21 per cent of that age group in England are vaccinated, compared with 80 per cent of adults.
The US faces a related challenge. About 57 per cent of Americans aged 12 to 15 have been vaccinated, and children five to 11 are on the verge of becoming eligible. A significant number of parents remain wary, partly because Covid-19 is rarely severe in children. But vaccinating children - in addition to the individual benefits - is likely to hold down cases for everyone else.
The biggest problem in the US is a vaccination rate lower than in most other high-income countries.
2. Waning immunity
The pace at which vaccines lose their effectiveness remains a subject of intense debate. Most experts believe that the vaccines remain excellent at preventing severe illness even months after shots are given. But the bulk of the evidence suggests that the vaccines do lose some of their ability to prevent at least mild infections. That is especially true of the AstraZeneca vaccine, which has been widely used in England.
Britain's initial speed at vaccinating people brought down caseloads early this year. Yet it also meant that waning immunity became a problem sooner than in countries that were slower to give shots. Britain is now offering boosters to people aged 50 and older as well as healthcare workers and the medically vulnerable.
Over the next few months, waning immunity could become a growing problem in the US, especially for more vulnerable people. All Americans age 65 and older are eligible for boosters, along with anyone who received the Johnson & Johnson vaccine and some other people.
3. Live and let live
Behaviour restrictions - like mask wearing - may not appear as effective as their proponents sometimes suggest. Britain offers a case study: Scotland, where masks are often mandated, has a similar level of Covid-19 spread as England, where masks are less common, as Mr John Burn-Murdoch of The Financial Times has written. If masks determined Covid-19 spread, Scotland's rate should be lower than England's.
But there is a difference between a precaution having a modest effect and no effect. Masks do help, according to a wide variety of evidence, even if their impact is sometimes overwhelmed by other factors. Britain seems to be suffering from a lack of almost any restrictions, including mask mandates. Among the biggest problem, Mr Burn-Murdoch noted, is the number of crowded indoor gatherings across Britain, including Scotland.
When cases are falling, it often makes sense to let people live more freely. When cases are surging, the reverse is true. Britain is ignoring that lesson - and pleas from many experts.
The bottom line
Britain's recent Covid-19 policy has led to deaths and overwhelmed hospitals.
"When a healthcare system fails, increasing numbers of people suffer and die needlessly," Dr Kenneth Baillie, an intensive care physician and a researcher at the University of Edinburgh, wrote on Twitter. "This is happening, now, all over the UK."
Still, it is worth putting Britain's troubles in perspective. The country's high vaccination rate means that only a tiny share of recent cases have led to severe illness, and the death rate this fall has been a fraction of what it was last winter.
"This virus is going to be with us for years, if not the rest of our lives," said Dr Willem van Schaik, a microbiologist at the University of Birmingham in England. "We've definitely left the worst behind us."
Despite the Covid-19 surge in Britain, the US - where the overall vaccination rate is lower - arguably remains in worse shape, with a considerably higher death rate per capita.
Why? Vaccination rates still matter more than anything else.
