Do I wish I had known in early 2020? I wish I'd known that a vaccine against severe disease and death from Covid-19 would arrive within a year, and that it would be a major issue in managing the disease. The UK government's response would have been changed by these two facts.
Several governments, including in Sweden, Netherlands and the UK, believed the best path through this crisis was to allow a controlled spread of infections through the population, especially the young and healthy. The idea was that if the herd got infections, they would protect a more vulnerable minority.
The concept came from our approach to other vaccines, in which we inoculate the majority of children against diseases that can be prevented by vaccination. herd immunity can be achieved if people only catch Covid once or if they get a vaccine. We would have eliminated Covid completely in the richer world where the estimates of antibody levels are more than 98%.
This is not the position we are in. The high number of infections with the Omicron variant means that herd immunity is likely impossible even if the vaccine is 100% effective. It was a gamble that Britain took early in March and unfortunately lost, as they relied on herd immunity to manage Covid-19 rather than on the strategies of east Asian countries to suppress it until a vaccine was available. The presence of variants will keep the disease going.
It is not all bad news. Vaccines have largely mitigated the impact of the virus on health services. The problem we face has shifted from mass mortality to a question of how to keep essential services running. Covid-19 is not a cold that can be treated like a common cold because it makes people so sick that they can't work. This has caused widespread disruption for airlines, border control, supermarkets, schools, hospitals, police forces and even Apple stores. It is worth pointing out that Omicron is still hospitalising and killing people, especially those who are unvaccinated, the clinically vulnerable, and elderly people. Making sure boosters are provided at the right time is an ongoing concern.
Governments are in a difficult situation. It's clear that it's better that no one is affected by this virus. There is increasing evidence that shows the negative impact Covid-19 has on the lungs, heart and brain. Long Covid prevalence estimates are very high.
How does one avoid infections while also being part of society and interacting with others? Humans enjoy being around other people and participating in group activities, whether dancing in nightclubs or singing in church. Asking people to restrict this for a certain period of time made sense in order to allow vaccines to be rolled out, and for clinicians to develop better protocols for treatment and understand the disease. South Korea has abandoned test and trace and China is struggling to bring cases down because of a variant in Omicron that is incredibly transmissible. Where does this leave us?
Several steps can help manage this seemingly intractable situation according to a group of fellow scientists.
First, governments must use testing, vaccines, and drugs to manage Covid-19 and replace the cruder non-pharmaceutical interventions of 2020 with scientific progress. Testing is important because it can help detect infectious individuals and prevent outbreak in the workplace. The end of free testing is a concern for managing this disease and avoiding future lockdowns. It's better for one person to be off work isolating then be forced into work where they can spread diseases and cause staff shortages. To reach the 70% target across all countries, vaccines must be rolled out to all parts of the world. This will have a significant effect on reducing the number of deaths caused by Covid-19 waves.
Alpha, Delta and Omicron were the first to react to a new variant which could alter the trajectory of the epidemic. The main fear of scientists is that governments may only have days to pull together data and respond.
Rapid testing to detect infectiousness and one-way masking should be used to protect healthcare workers and social care workers who are most at risk of infections.
Covid hasn't received the attention it deserves. An increasing number of people who are unable to return to work, or suffer from chronic illness, will be a major burden on healthcare services as well as the economy; and of course there is the core issue of the loss of a healthy and active life in terms of daily happiness and living free It's important to develop treatments for this condition because it's difficult to avoid Covid-19 infections. We need to support those who are suffering and find ways to reduce their pain.
The response to the Pandemic should not overshadow other major health issues on the horizon. The cost of living crisis, the number of children going hungry and living in cold, damp conditions and in poverty, the rise in child Obesity and physical activity, the mental health toll the Pandemic has taken on adolescents, and the rise in child Obesity and physical activity are some of Entering the age of reinfection means Covid has embedded itself in our world, and it must be viewed as part of the wider picture of human wellbeing and public health.
The University of Edinburgh has a chair in global public health.
There is an online event on Monday 25 April. She will talk about the lessons we can learn from the situation. You can book here.
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