It is now a fact of life that most of us know several people that currently have, or have had, covid. This is no surprise given the abandonment of ‘non-pharmaceutical interventions’, such as mask wearing, contact tracing, and isolation. To make matters worse, we are now facing the most infective variant so far.
Decreasing isolation time
We have already dropped isolation period for adults to five days but on top of this comes the news that children (who are currently a major driver of infection) are deemed to be superhuman as they only need to isolate for three days before returning to school. In fact, the advice for children with “mild symptoms” is that they should still go to school regardless. Being cynical, this might be seen as part of the plan to increase infections across the population.
The latest ONS Survey for week ending 1 April showed that almost five million people or one in 13 of us in England had the infection. So, given high numbers of both infection and vaccination rates, are we reaching the infamous ‘herd immunity’ stage, promoted in the Great Barrington Declaration? Will this be the end of covid? Have we won the battle?
At the moment, it would be a brave or foolish person to suggest we have won, when we are seeing such high rates of infection. Staff absences are now severely affecting hospitals and many other sectors – the travel industry is facing chaos just as we approach the Easter holidays, with airlines having cancelled hundreds of flights already. And it’s not just infections that are soaring, but deaths too, with the latest figures showing an 11.7 percent increase over the last week – now over 160 a day.
Herd immunity has failed
The ‘herd immunity’ project has clearly failed, as evidenced by the fact that increasing numbers of people are being infected for the second or even third time. The UK Health Security Agency estimates that 10 percent of cases are now reinfections – that would be 490,000 people for the week ending 1 April. Why is this happening?
This coronavirus continues to create new variants and the highly infectious Omicron B.A2 is a major step change in the make-up of the viral coat. There is also now a new variant – Omicron XE – which is a combination of both the previous Omicrons mutations and is yet more infectious. When this virus mutates it is the more successful changes for infectivity that win, so any variant that can bypass the immunity provided from previous infection (or vaccination) will have a bigger population to infect.
A recent study demonstrated that while protection from previous covid infection was robust providing around 90 percent protection against reinfection with alpha, beta, and delta variants, this was dramatically reduced for Omicron to around 60 percent.
How severe are the reinfections?
Evidence suggests that for most people the reinfections will be less severe; immunity from prior infection and vaccinations offer greater protection against the need for hospitalisation or ICU treatment.
However, each time we are infected there is the risk of developing complications such as long covid. We currently have no information on the number of incidences of long covid in those reinfected with Omicron – so we wait to see how large an issue this is.
But what is certain is that many who are reinfected are not asymptomatic – the Zoe app has shown most people have symptoms like a runny nose, headache, fatigue, sneezing and sore throat, while other studies suggest we should also look out for nausea and diarrhoea. Two years into this pandemic, the NHS has finally updated the official list of symptoms to include this wider range, adding nine ‘new’ ones to watch out for – with the infamous ‘loss of smell’ now being much less prominent.
The timescale for the illness can vary, with some feeling poorly for only a few days where others take 10–14 days to feel able to return to work. This begs the question – if we are now expecting to catch covid at least once a year, potentially losing weeks of work – how long will society consider this to be an acceptable form of ‘living with covid’? This is very different to the expectations around flu, which we are likely to catch only once every five years.
What could be done?
The simple answer is that lots can be done, as indicated by Independent SAGE. Some people will continue to alter their behaviour to avoid exposure, for example by avoiding large indoor gatherings or using high-quality masks at events (for some venues this is unobtrusive and easy, like in a dark cinema).
While masks have been contentious for some people, others still choose to mitigate their risk of catching covid this way. Evidence shows that masks are effective in reducing covid transmission. Upgrading to better quality FFP2 masks, particularly in areas where there is a high infection rate, make a difference. So, when numbers are high it’s worth using a mask on public transport, large indoor events and schools where no HEPA filters in use.
Attending outdoor events rather than indoor ones is another option for people who want to reduce their risk of catching covid – and this is certainly easier and more attractive during the summer. However, there is much more that could be done without the need for masks or major behaviour change.
Improving ventilation
There is now a huge body of evidence that this virus (along with the winter vomiting bug Norovirus) is spread by aerosol, so improving air quality in buildings can make a significant difference to the infection rate. Improving ventilation systems and using air purification/sterilisation, for example HEPA filtration, can make a big impact. One study from the US demonstrated that the use of HEPA filters in schools reduced the infection rate by 41 percent while another provided evidence of their effectiveness in hospitals.
Other actions are really based on the good practice we have developed over the past two years. Access to free testing (as is still available in Scotland and Northern Ireland) encourages the right behaviours and then linking this to support for those who need to isolate for a period. Even isolation for five days will make a difference.
Covid is not over. We will continue to get further waves like the current one, with some leading to more hospitalisations and deaths. Society does need to adapt to living with the virus, and although it appears our politicians and a percentage of the public are not yet ready for this, my prediction is that it will happen. We will change, so we can survive.
