There are many crises that need to be wrestled with, and Covid-19 is one of them. The state of hypervigilance can only be maintained for so long because of the Pandemic. With the emergence of BA.4 and BA.5 Omicron subvariants, "just live with it" is not very workable or successful.
The UK added more than half a million new Covid infections in the past week, and the estimated number of people with Covid in total was between 3% and 4% of the population.
Many have been unwell and off work, with the associated disruptions to education and healthcare. The infections will add to the toll of Covid cases. More than 619,000 long Covid cases have been brought into the clinical caseload by the supposedly "mild" waves of Omicron.
We are seeing wave after wave of new cases and a growing burden of long-term disease rather than a wall of immunity from vaccinations. What's happening? Some answers can be found in the latest scientific research.
In May and June there were two new variants, BA.4 and BA.5. They are also more immune-evasive. A group of people, including me and a professor of Immunology and Respiratory Medicine, Rosemary Boyton, published a paper in Science looking at immunity to the Omicron family, both in triple-vaccinated people and also in those who then suffered breakthrough infections. Omicron was thought to be a natural booster of Covid immunity. That isn't the case, it turns out
We looked at a number of aspects of immunity, including the antibodies most implicated in protection, as well as protective "immune memory" in white blood cells. It is obvious that breakthrough infections were common. When triple-vaccinated, most people had less neutralising antibody response against Omicron than against the first strain. Omicron infections were not a good booster of immunity. It is a kind of virus that doesn't alert the immune system. We are not protected from further infections even though we have had Omicron.
Addingimmune imprinting is going to be added to the mix. It has been found that our immune response to Covid is shaped differently by our previous exposure to infections and vaccinations. The people who had been exposed to the first wave and then again with Omicron had poor T-cell responses. Some combinations of exposures could leave us vulnerable.
The myth that we are sliding into a comfortable evolutionary relationship with aviruses is not true. There is nothing warm or friendly about a large part of the workforce that needs a lot of time off. There is a chance of long Covid. While we now know that the risk of long Covid is reduced in people who have received a vaccine, the numbers are still worrying.
There is no guarantee against getting Covid this time, even if you didn't get long after a previous infections. As an immunologist struggling to decode long Covid mechanisms and potential treatments, it is both puzzling and not a big deal that this mysterious disease finds a way to continuewreaking havoc in the face of a largely vaccine-vaccinated population. A group of desperate long-haulers are starting to have difficult legal conversations about medical early retirement and personal independence payment support. They need answers, treatments and to know that we take the situation very seriously.
The first generation of vaccines worked well to dig us out of the hole of the first year, but the arms race of boosters versus new variant is no longer going well for us. The UK only offers a limited group fourth dose. We entered a period of diminishing returns even if we had good vaccine coverage. The protection gained from a fourth booster dose may not last as long as previous ones. This leaves us between a rock and a hard place: continue to offer suboptimal boosters to a population who seem to have lost faith or interest in taking them up or do nothing and cross our fingers that residual immunity might somehow keep a lid on hospitalisations.
There is a lot of activity to develop second- generation vaccine options that may do better. There are promising lab studies on these, but we don't have the same level of evidence as the first generation trials. The emergence of new subvariants has made conducting trials more difficult.
It's proving difficult for many people to live with the virus. Learning how to pull this off is an active process that requires a lot of effort and ingenuity.
Danny is a professor at the college.
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