Trust me, no one, even in public health or medicine, wants to talk or think about Covid-19. The trauma of those pandemic years is burnt into our minds. But, whether we want to deal with it or not, Covid-19 is still affecting all of us, and circulating at fairly high levels in Britain this month. While community surveys are no longer conducted by the Office for National Statistics to estimate overall cases, hospital data from England indicates that the weekly hospital admission rate for Covid-19 is at 4.64 for every 100,000 people, with the north-east region at 8.91.
These figures just cover people who are admitted to hospital and don’t reflect those suffering at home or attending GP clinics. While we were mainly fixated on death rates during the pandemic, the longer legacy concerns people who had and cleared the infection, but are still suffering – what is usually referred to as long Covid.
This chronic condition still has many questions hanging over it. We are still learning about its overall prevalence in the population (estimated at 5.5% of those infected in the UK in one study, and 15% in another study from the US), and there is continuing research on the underlying biology and immunology behind symptoms, including attempts to identify markers for diagnosis, as well as work towards promising treatments. Sufferers have had to fight first to have their condition recognised as “real” (instead of a figment of their imagination or a sign of mental weakness), and second for medical services to provide support and care.
Recent concerns about economic inactivity (that is, people who could be in the workforce or looking for employment, but aren’t) are tied to the growing percentage of those unable to function due to long Covid. A study in the Lancet in August 2021 estimated that 22% of people with long Covid were unable to work, and 45% were on reduced hours. A 2023 study from the US surveyed more than 15,000 people with prior Covid-19 infection and found that 40% who reported symptoms were unemployed. The authors, looking at the issue from an economic perspective, noted that “acute Covid is a pandemic; long Covid could be a mass disabling event”.
Fortunately, studies are also coming out that track and understand the condition and how to prevent it. A recent study in the New England Journal of Medicine found that vaccination strongly reduces the chance of serious problems of long Covid. The authors used health records from roughly 440,000 military veterans who had been infected with Sars-CoV-2 in the US to look at the impact of vaccination on reducing long-term symptoms linked to the disease.
The study found that the incidence of experiencing symptoms one year after infection decreased during the pandemic from 10.42 cases for every 100 people for unvaccinated individuals in the pre-Delta period, to 3.5 cases a 100 people for vaccinated individuals in the Omicron period. They estimate that roughly 72% of the reduction in long Covid was due to the vaccines, while 28% was linked to changing variants. The authors highlight the importance of vaccination in reducing lingering Covid symptoms, but say that even with vaccination and in the Omicron era, a substantial number of people suffer with long Covid after infection.
Where does this leave us? Currently in the UK, Covid is circulating at a high level. While vaccination rates were high in 2021 and into 2022, they have dropped off in recent years due to limited criteria on who can get one. Very few groups are eligible for an autumn booster: adults 65 and older, residents in care homes, frontline NHS and social care workers, as well as those in high-risk groups. The general population can get the Covid-19 vaccine, but it’s pricey, at nearly £100 a dose at Boots, for example. Compare this with the private cost of a flu jab at just under £22.
Given the constrained NHS budget, decisions have to be made on a cost-benefit basis on whether rolling out vaccines to the wider population (at a cost to government of £25 a dose), or subsidising the private cost of jabs, is worth the potential benefit. This benefit has been assessed by looking at what it would cost the NHS to admit people to hospital, and what the savings might be with vaccination. Given this new study, it’s worth looking at the benefit also in terms of savings to the economy of keeping people in good health and in the workforce, and reducing the cost of those seeking NHS services for long Covid.
In the US, Canada and Australia, Covid boosters are free for everyone, regardless of immigration or insurance status. France looks likely to continue its free booster policy into this autumn. Looking at other countries’ policies, the UK is the outlier in continuing to restrict free boosters to certain groups.
As we start to look ahead to winter, I hope that research groups will start publishing revised estimates of the costs and benefit of offering the Covid booster at no charge, or at the lower £25 cost that the government can procure shots at, to all those who want them. Calculations should include long Covid to truly reflect the cost of not vaccinating in terms of illness and staying off work, even if it doesn’t lead to hospital admission. Avoiding the population-level effects of illness is not only good for the individual but also for the NHS and the wider economy.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
