On 17 March 2020, the UK chief scientific adviser, Patrick Vallance, said that keeping the number of UK deaths below 20,000 would be a good outcome from the pandemic. That number was on par with the number of lives that seasonal flu takes each year, the most deadly infectious disease in Britain until then. Two years in, we’ve now crossed 200,000 deaths: 10 times higher than initially expected. What have we learned about Covid-19 in that timespan, and what old beliefs and myths from the early pandemic still persist?
First, Covid-19 is a disease that can also kill young people, especially those who are unvaccinated. The idea that Covid is only a threat to older people is still prevalent. But consider that the US has passed a million deaths, and roughly a quarter of those deaths are in people of working age, that is those under 64. Another quarter are in people between the ages of 65 and 74. This is not a disease that just kills over-80s as the prime minister, Boris Johnson, reportedly messaged: “Hardly anyone under 60 goes into hospital … and of those virtually all survive. And I no longer buy all this NHS overwhelmed stuff. Folks I think we may need to recalibrate … There are max 3m in this country aged over 80.”
However, the fatality rate of Covid-19 has also reduced massively 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 fatality rate. The fatality rate is now estimated to be less than seasonal flu for all age groups. This progress is due to mass vaccination, better clinical management in hospital, and discoveries of new therapies and drugs.
One thing that has changed significantly from the early stages of the pandemic is that having Covid-19 multiple times is now likely. This virus continues to evolve, and new variants have emerged with immune escape, meaning they can better reinfect those who have had Covid-19 before. Avoiding infection has become more difficult as the virus has become increasingly transmissible: we have seen that estimates of R0, the theoretical number of people each new case goes on infect in a population with no immunity, rocket as new variants have emerged. The original wildtype was estimated to have an R0 of 3.3. Delta was estimated at 5.1, with the ability to reinfect people. Omicron (BA.1) brought this up to 9.5, with BA.2 moving this up to 13.3. Estimates from South Africa put our current dominant strain BA.4/BA.5 at 18.6. While this type of estimate must be interpreted carefully, as the growth of these new variants is due to multiple factors, including transmissibility and immune escape, the BA.4/5 variant has been compared with measles, which has been considered the most infectious disease.
The available vaccines still work well to protect us from serious illness, but the protection they offer wanes fairly rapidly, so we need regular boosters offered to the population to protect against severe infection. Ideally, these would be tailored towards Omicron, of which the recent variants have been sublineages. The UK is still not committing to offering boosters to those over 50, which seems a bad decision given the risks it entails going into winter, and knowing that vaccination is the best protection from severe disease.
Anthony Fauci and other experts have indicated that we are probably exiting the emergency phase of Covid-19, as it becomes another disease in public health to manage among the many that make people ill. It’s important to ensure the Covid-19 response is proportional and takes account that for most people, other concerns have taken over, including the rising cost of living and mental health. A recent poll in the US found that for the first time in two years, the majority of Americans didn’t see Covid-19 as a major threat. While experts might disagree, some recognition of what people think and prioritise is important.
Public health is a delicate balancing act between government intervention and individual freedom. While public policy can guide individual decisions such as bans on indoor smoking, speed limits on roads and vaccination requirements for certain jobs, people also like to make their own choices about their behaviour. The jump in mixing and social contacts indicates that people like to be in close contact with other people – and for many, given that Covid has been largely defanged by science, they’re willing to take the risk of getting bitten to live in a way that they choose and gives them quality of life. Long Covid is a continual challenge as the virus circulates and must be closely monitored and addressed.
Whatever your take on the pandemic, and the various country responses, now is a moment to acknowledge the toll this disease has taken. The lives lost before their time. The faces of those 200,000 people. Their families, their children, their loved ones. The challenge for the scientific community – and for governments – is how we can do better next time.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
