On 17 March 2020, the UK’s chief scientific adviser, Patrick Vallance, said that keeping the UK death toll below 20,000 would be a good outcome of the pandemic. This number equaled the number of lives claimed each year by seasonal flu, Britain’s deadliest infectious disease until then. Two years later, we’ve already passed 200,000 deaths: 10 times more than originally expected. What have we learned about Covid-19 in this time period and what old beliefs and myths from the early pandemic still exist?
First, Covid-19 is a disease that can also kill young people, especially those who are not vaccinated. The prevailing idea is that Covid is only a threat to the elderly. But consider that the US has surpassed a million deaths, and roughly a quarter of those deaths are in working-age people, that is, those under 64. Another quarter are in people between the ages of 65 and 74. It’s not a disease that just kills people over 80, as Prime Minister Boris Johnson reported: “Hardly anyone under 60 goes to hospital … and of those almost all survive. And I don’t buy all that cluttered stuff from the NHS anymore. Folks, I think we may need to recalibrate… There are a maximum of 3 million people over the age of 80 in this country.
However, the death rate from Covid-19 has also decreased significantly over time. At the start of the first wave in 2020, a third of patients admitted to hospital died, putting the disease on par with Ebola’s death rate. The death rate is now estimated to be lower than seasonal flu for all age groups. This progress is due to mass vaccination, better clinical management in the hospital and the discovery of new therapies and drugs.
One thing that has changed significantly since the early stages of the pandemic is that you are now likely to have Covid-19 multiple times. This virus continues to evolve and new variants have emerged with immune escape, meaning they can re-infect those who have had Covid-19 before. Avoiding infection becomes more difficult as the virus becomes more transmissible: We have seen that estimates of R0, the theoretical number of people each new case continues to infect in a population without immunity, rise as new variants emerge. The original wild type was estimated to have an R0 of 3.3. Delta was rated at 5.1, with the ability to reinfect humans. Omicron (BA.1) raised this to 9.5, with BA.2 up to 13.3. Estimates from South Africa put our current dominant BA.4/BA.5 strain at 18.6. While this type of score should be interpreted with caution, the BA.4/5 variant was compared to measles, which is considered the most infectious disease.
Available vaccines still work well to protect us from serious illness, but the protection they offer is waning relatively quickly, so we need regular boosters offered to the population to protect us from severe infection. Ideally, they would be tailored to the Omicron, whose recent variants are sublines. The UK has not yet committed to offering boosters to those over 50, which seems a poor decision given the risks associated with entering winter and knowing that vaccination is the best protection against serious illness.
Anthony Fauci and other experts have pointed out that we may be moving out of the emergency phase of Covid-19 as it becomes another public health disease that needs to be managed among the many that make people sick. It is important to ensure that the response to Covid-19 is proportionate and takes into account that for most people, other issues have come to the fore, including the rising cost of living and mental health. A recent US poll found that for the first time in two years, a majority of Americans do not see Covid-19 as a major threat. Although experts may disagree, some recognition of what people think and prioritize is important.
Public health is a delicate balance between government intervention and individual freedom. Although public policy can guide individual decisions such as indoor smoking bans, road speed limits, and vaccination requirements for certain jobs, people also like to make their own choices about their behavior. The surge in mingling and socializing shows that people like to be in close contact with other people – and for many, given that Covid is largely debunked by science, they are willing to take the risk of being bitten, for to live in a way that they choose and gives them a quality of life. Long Covid is an ongoing challenge as the virus circulates and must be closely monitored and addressed.
Whatever your views on the pandemic and the responses of different countries, now is the time to acknowledge the toll this disease has taken. Lives lost before their time. The faces of these 200,000 people. Their families, their children, their loved ones. And how the challenge for the scientific community – and for governments – is how we can do better next time.
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