We are currently in the middle of yet another wave of covid infection led by the new more infectious Omicron BA.2 variant. The government approach has firmly changed to one of reducing testing and one where our health secretary suggests we need to “live with” the virus. Indeed some of the discussion on this describes covid as ‘no more deadly than flu’, with some people taking a more extreme position that it’s ‘just a cold’, or maintaining that ‘people have to die from something’.
These arguments are based on the fact that many of us are now fully vaccinated and the Omicron variant has tended to result in less severe disease. So why are we experiencing another large wave of infections and is it really ‘no more deadly than the flu’?
Transmissibility, vaccine wane and relaxed mitigations
In an interview with the British Medical Journal Eric Topol, professor of molecular medicine at the Scripps Research Institute in California, said:
“I would attribute this to the ‘BA.2 triad.’ The variant has 30% more transmissibility than BA.1, but spread has been further enhanced by relaxed mitigation measures and waning of vaccine immunity.”
So, the government approach of removing simple precautions such as masks, ventilation and working from home is helping drive this new wave of infections, while the immunity provided by the vaccine is waning. Waning immunity is the reason why we are gearing up to provide a spring booster for those most at risk.
It’s not just a bad cold
Likening Omicron to flu or a bad cold is, I would suggest, dangerous or at best extremely disingenuous. Why do I say this?
There are several reasons. Firstly, we are now seeing a large increase in hospital admissions, which was highlighted as concerning by our chief medical officer Prof Chris Whitty at a recent conference. This far exceeds levels seen with flu and is a significant issue for hospitals, as it takes capacity away from working on the elective backlog – in fact, cancelled lists will just increase the backlog we have.
Secondly, a bad flu season in the UK would result in up to 30,000 deaths from flu or pneumonia – it is important to note that pneumonia is a major factor in this. Even in a bad year, deaths from flu itself are far fewer. With covid, we continue to see over 800 deaths a week (within 28 days of a positive test). If this continues at the same level, this will equate to 41,600 deaths a year, but we all know the actual horrific death toll since the pandemic started. Remember when we were told that a covid death toll of 20,000 would be a good outcome?
Have we become hardened to death?
It would appear that as a society, we have become hardened to these deaths and politicians believe this level is acceptable. This might explain the rhetoric around ‘people have to die from something’ and the old chestnut that ‘it’s only people with underlying health conditions that die’.
As a doctor I find it shocking that some people think it’s acceptable for people to die from covid if they have comorbidities ‘as they were due to die anyway’. This view has been totally refuted. Firstly, The Health Foundation demonstrated that each life was cut short by an average of ten years, so these people were certainly not ‘due to die anyway’. Secondly, ‘comorbidities’ include conditions such as diabetes, ADHD, depression and obesity, none of which mean death was imminent.
Long covid and other post-covid complications
However, I believe there are other more important issues that make covid very different from flu. These include long covid and the risk of other diseases developing after covid infection.
The Office for National Statistics estimates that 1.5 million people are suffering long covid for longer than four weeks, with over 800,000 reporting that the symptoms limit their daily activity. Over 0.5 million in the UK have had symptoms for over a year.
These patients will need considerable support from the NHS as part of diagnosis and attempting to improve their health. Obviously, this is a new issue that will require considerable investment in clinics and research – so is yet another demand on the NHS. We must ensure these individuals are not left behind and forgotten.
Worryingly, there is evidence that those who have had covid have an increased risk of cardiovascular issues such as stroke or heart failure for up to a year following infection. There is also evidence that developing diabetes is more common in the year following even mild infections. This is on top of reports of increased incidence of neurological and psychiatric issues and the effects on the lungs.
On the positive side …
My aim here is not to scare us all – it is important to remember that although these studies report a significant increase, the numbers remain relatively low (for example, the risk of stroke is around four extra per 1,000 people involved in the study).
What I hope I have shown is why likening covid to flu is simply not acceptable. In reality, the government’s current approach to tackling covid is potentially maximising future issues for our population. Many of us still hope that ‘living with covid’ will actually lead to changes that will make our lives safer, such as improved ventilation and use of HEPA filtration in buildings especially schools and hospitals.
We’ve seen this demonstrated elsewhere, most notably in New Zealand where sensible mitigations are still in place despite having opened up. Is it too much to hope that we can do the same in the UK?