We are living in two realities, one in which people have returned to living life as if Covid is over, and the other in which we are approaching record levels of infections, with an estimated 4.26m cases last week. Most of us know that people with Covid, work and education are being disrupted because of new patients and sick staff. Two months after the Omicron peak, admissions with Covid are still rising. More and more people are being admitted for other reasons, and admissions in over 65s are 15% higher than their January peak.
The idea that the epidemic is over is not true. Omicron is a major variant that took over in the UK in a similar way to Delta and Alpha. Most people now believe at least one of the three big myths of the Omicron age, which is why the ubiquitous narrative that the pandemic is over exists. We need to move past the myths and prepare for the future.
The first myth is that coronaviruses are not endemic and that we have to live with them. We have to live with Covid. Endemic is a disease that does not spread out of control in the absence of public health measures.
This does not describe Covid. We have just experienced the highest surge of cases with Omicron's BA.1 variant. The UK is experiencing a second Omicron wave just months after the first. They are changing our assessment of the evolution of coronaviruses and the implications for protection from previous infections. Chris Whitty, the chief medical officer, warned that new variant waves will come, but we don't know when or what they will be. There is nothing special about this latest wave and people have declared Covid endemic after every previous wave.
Even though covid will probably become endemic, it does not mean mild. There is a significant global burden of ill health and death from endemic diseases. Trying to ignore a disease that is so unpredictable feels like turning your back on a hungry tiger in the undergrowth.
We have to debunk the myth that coronaviruses will be milder than the last variant until it becomes a common cold. Over the past two years, new Covid variations have arisen. The current BA.2 wave is one of several that have arisen from different variant of concern. Delta and Omicron did not evolve from each other. They came from earlier strains. There has been no progression through the previous variations.
It's not true that viruses evolve to become milder. Evolution is driven by transmission, which means that more people will be affected. Because most Covid transmission happens while people have no or few symptoms, severity is not a driver of evolution, but a byproduct of whichever mutations improve transmission and how they interact with existing levels of immunity. For Alpha and Delta, this resulted in greater severity and for Omicron, it was less severity. The next variant could be more severe.
We don't know if the four other coronaviruses that cause common colds will eventually become the mild colds of today or if it will take years, decades or centuries. We don't know much about the evolution of coronaviruses in humans.
There is a myth that there is no point in waiting for the vaccine to return to normal. The UK has a high level of vaccination, particularly in older, more vulnerable populations, and the initial two dose roll out in adults is largely complete. The immunity from vaccines fades over time against severe disease and death.
Boosters help, but also mean it's a question of whether you're up to date with vaccinations. The majority of children remain unvaccinated. Around a third of over-12s are yet to receive their booster in the UK, and we only just started another booster round for people who are over 75 or clinically extremely vulnerable. The majority of children remain unvaccinated.
The way the virus will evolve to improve transmission is by evading our immune system, like Omicron did. As tens of thousands of people are finding out with their second Covid infections, existing vaccines will become less able to protect us from new infections. Prof Danny Altmann argues that instead of relying on frequent boosters of the same vaccines, we should develop better and longer lasting ones.
We should support existing vaccines instead of pushing them to their limits because of high infections. Normal life does not return us to normal behavior. It brings us back to a life with more disruption, more sickness and more strain on the healthcare system. We can learn to live with Covid better.
In the 18th and 19th century, we wanted to improve public health. We can make serious changes to infrastructure, such as better ventilation, less crowding, increased air purification and sterilisation, more green spaces, and changed work practices. Improved sick pay, housing and population health can be tackled. Over and above Covid, all of this is beneficial. We can do it, but we need to stop believing in myths.
The Clinical Operational Research Unit at the University College London applies advanced analytical methods to problems in healthcare.
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