From April 1, free universal Covid testing will end for general public in England. See England's timetable for ending restrictions here.
Clearly this only applies east of the border but this will have real ramifications in Wales as well. With UK government deciding that the huge cost of free PCR and LFT tests - which Boris Johnson said had a £2bn pricetag in January alone - is no longer warranged, Wales would have to find funding from its other budgets (or raise taxes) in order to pay for it. The changes could also affect Wales indirectly because if cases rise in England there almost always a knock on impact in Wales as well.
But the decision in England also brings home the fact that, at some point, universal free testing for Covid will have to end. So when should the end come and what effect will this have? To try and answer these questions WalesOnline has spoke to leading academics to try and shine some light on this issue.
Read more: Welsh Government gives date it will consider changing isolation rules in Wales
What impact has free and universal Covid testing had on the pandemic?
"Testing has three main purposes," said Richard Stanton, professor of virology in the division of infection and immunity at Cardiff University. "To identify infected people so that they self-isolate. To identify infected people, so that contact tracing can be carried out and to understand the number of people infected, and which variants are circulating.
"The high level of virus sequencing in South Africa was critical to alert us all when Omicron started spreading, buying us time to put restrictions in place so that it didn’t overwhelm us."
According to Dr Julian W Tang, clinical virologist and honorary associate professor of respiratory sciences at the University of Leicester it also enables you to stop the spread of outbreaks when they happen. Leicester where he is based was the first part of the UK to go into a local lockdown in the summer of 2020 - though the result was not entirely successful.
He said: "Mass testing shows you where hotspots of infection are - to target isolation/quarantine and enforcement measures - to limit further spread. However, the UK has not been very effective at this because the self-isolation/quarantine has not been enforced and this has led to further spread of the virus."
How will the removal of free PCRs affect the on going Covid response?
Not in a positive way according to Professor Stanton. He said: "I think it’s likely to lead to higher transmission rates, because if people have to pay to be tested, many won’t bother. If they aren’t tested, then they won’t self-isolate, which means they can spread the virus to other people.
"It also sends a message that ‘the pandemic is over’ which will lead to people thinking that they don’t need to act any differently if they have it.
"Higher transmission rates can lead to the development of newer variants, higher levels of sickness and death, and will increase pressure on the NHS. Clinically vulnerable people will be severely impacted because they will be at much higher risk of catching the virus when they interact with others."
Speaking of new variants, how will the the reduction in PCR tests affect health experts ability to pick up new variants? What happens if the next omicron starts in the UK?
According to professor of molecular medicine at the University of Kent Martin Michaelis, the lack of monitoring and sequencing could result in future variants taking us by surprise.
He said: "PCR on its own is not sufficient to identify new variants. This will have to be done by sequencing. If we reduce our sequencing capacities, we will not be able to detect new variants as early as in the past. Therefore, there is a much bigger risk that we will be hit by future Covid-19 waves by surprise."
Professor Stanton agrees but says there are systems that could be put in place. He said: "It may impact our ability to track variants, and levels of the virus – however we do have a lot of testing already set up to monitor things like Flu. This takes representative samples from around the country to see which variants are spreading, without needing everyone to be tested. I’d expect surveillance of SARS-CoV2 to start being incorporated into that existing system, which should help with monitoring."
But if we don't stop free testing now, when will we?
This is a really interesting question and it doesn't have a clear answer. Clearly public spending on this scale when the public finances are already stretched needs to be under constant review.
Dr Michaelis said: "At this moment, this question is impossible to answer. There is no scientific reason why there should not be another Covid-19 wave.
"There are people, who argue that future waves would automatically be milder. However, this is a misconception. In the past, the Alpha variant was more deadly than the original strain, and Delta was more deadly than Alpha. The next variant could be as deadly or more deadly than Delta and as transmissible and as good at infecting people with pre-existing immunity due to vaccines and previous infections as Omicron.
"Since coronaviruses can recombine their genomic information when two viruses infect the same individual, a dangerous Delta-Omicron hybrid may emerge. Alternatively, a completely different variant may be formed somewhere. We need to be realistic about how little we know about which variants are circulating and evolving in different parts of the world. The origin of Omicron is completely unknown. Hence, reduced surveillance means that we are even more vulnerable than we are at the moment.
"Notably, large parts of the world have lower vaccination levels than us. Since viruses travel fast, we are only safe when everyone is safe. Hence, we need a long-term plan to deal with Covid-19. Covid-19 is very unlikely to go away, independently of how much we wish that it does. So far, we have hoped after each wave that this would have been the last one only to be hit by the next wave. If we want to get reliably and sustainably out of these cycles of increased and reduced restrictions, we will need significant levels of surveillance and testing for the foreseeable future. Otherwise, we may be lucky or not."
Dr Tang suggested that once cases are at a certain level of community infection is reached, free testing could end, but stressed there were no certainties. He said: "I suggested that when national daily case numbers drop to 1,000-10,000/day, these relaxations might be considered.
"But very difficult threshold to set with the Omicron BA.1/BA.2 variants circulating - which are very vaccine-escape variable. We need to monitor hospitalisations but it’s difficult to set thresholds for this also."
Who will be the worst affected by stopping free testing?
Throughout the pandemic, poorer people have been hit harder by Covid than richer people. The reasons for this are varied and nuanced and you can read more about it here. Making people pay for tests will likely exacerbate this problem.
Professor Stanton said: "Like many impacts, the effects of this decision will fall disproportionally on the disadvantaged in society who will be less able to afford to pay for the tests, and who are more likely to have public facing jobs that expose them to infection. In addition, people who get long Covid may be unable to get support, because they won’t be able to prove they had Covid (because they were never tested)."
How can the effects of removing free testing be mitigated?
According to Simon Williams, who is a behavioural scientist and a senior lecturer in people and organisation at Swansea University, people need to still maintain self isolation when people are unwell and provide support so people can do so.
He said: "The UK Government - and the Welsh Government when it decides to remove the policy around self-isolation - will have to make sure that workers and employers are encouraged and supported to be able to self-isolate. Ensuring that statutory sick pay is sufficient and continuing to make it available from day one of isolation or sickness, would be a good start. We also need to continue the cultural change around presenteeism – employers and organisations need to encourage and enable workers to work from home or stay at home (depending on circumstance and job type) when unwell, and so supporting continuing hybrid working arrangements will help many to stay or work at home, if unwell."
"After two long years, we have a lot to be optimistic about. Rates in Wales continue to decline an we have no further need for things like covid passes or social distancing measures. Thinkgs are looking up. However, we don’t want to throw the baby out with the bath water, and do away with self-isolation just yet - we need to continue, cautiously , to put the past two years behind us and get on with our lives.”
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