Covid-19 is creeping back into the news cycle. As we head towards the autumn, disease rates are increasing in the community and a recent spike of interest in an Omicron subvariant, EG.5, which the World Health Organization has classified as a variant of interest, has caused concern among those whose memories of recent winters haven’t faded. There is an undeniable feeling of deja vu. So how worried should we be?
The WHO is tracking the spread of EG.5 globally, but notes that the risk posed to public health remains low. There is currently no indication of increased severity of infection or an increased hospitalisation rate with this new strain. For those who were asymptomatic or had a mild version of the disease, the continued talk of Covid may seem irrelevant or even scare-mongering. But for those who are suffering with long Covid, are immunocompromised or who lost a loved one during the pandemic, any news of increased prevalence of the disease must be worrying. These people know how devastating Covid can be.
Having watched the pandemic closely since the start, my key message on the current situation is that Covid-19 in 2023 is not Covid-19 in 2020. Hospital admissions for the disease in England in late July were 1.97 per 100,000 people, compared with more than 36 per 100,000 in January 2021. Today, we have effective and safe vaccines that protect against severe illness and death in the vast majority of cases, and we have considerable immunity in the population through a mix of vaccination and previous infection. Clinicians also have a better understanding of how to manage this disease. We have made less progress on helping those with long Covid but, fortunately, research to understand the underlying biology and how to develop treatments to help patients is under way.
Covid is now in the top 10 of public health problems (and still a major cause of death in many countries), but it is no longer the number one priority. It has layered on top of the existing mix of respiratory diseases such as flu and RSV that we grapple with each winter, alongside serious chronic health problems, such as heart and lung diseases, stroke, cancer, dementia and Alzheimer’s. As such, new variants will appear – and with them a seasonal rise in cases. But the advice for managing this variant and any others remains the same: get vaccinated, get treated if infected, and use masks and tests to help reduce transmission.
In Britain, only people over the age of 65 are eligible to receive a Covid booster this winter, which is disappointing. Similar to seasonal flu vaccines, or chickenpox vaccines, it would make the most rational sense from a public health perspective to offer vaccines at cost to those younger individuals and employers who want to pay privately for one and protect themselves.
Indeed, the UK’s Joint Committee on Vaccination and Immunisation (JCVI) and the UK Health Security Agency have said so themselves this week. Private boosters would mean less time off work ill, less time sick in bed and, from what we know so far, protection from some of the longer-term potential health effects of Covid, such as diabetes. Crucially, they would also relieve winter pressures on an already struggling NHS, and keep its staff – who we depend on so much – healthy and in work. The same could be said for those working in a number of sectors, from education in schools or universities, manufacturing or hospitality.
There is always a level of risk involved in living life, whether it’s driving on a motorway or getting on a crowded train in the middle of winter flu season. But it is important we stay level-headed as new subvariants emerge and mutate in the coming weeks and months. As news reports on infections increase, we must remember that we are no longer in a Covid emergency: we are in a phase of management, and the difference between crisis and non-crisis must be made clear in public messaging. There is a risk to crying wolf too many times. Otherwise, when a truly novel threat to humans does appear, such as sustained human-to-human transmission of avian flu, it might be hard to convey the extent of the challenge presented.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
