As we head into another winter, Covid numbers have been ticking up. But how worried should we be about Covid these days – can we treat it like a cold, or have we become blase about an illness that could still pose a threat to elderly and clinically vulnerable people?
How does Covid compare to a cold or seasonal flu?
Seasonal flu has been a benchmark for Covid since early in the pandemic, and for some time Covid has had a lower mortality rate. Last winter Covid caused fewer deaths than flu – 10,000 versus just over 14,000, according to the UK Health Security Agency. However, Covid remains a more serious illness than a typical cold, with one study showing that for people who become ill enough to be hospitalised, Covid still has a higher risk of death. “The problem is a lot of people say they’ve got flu when they haven’t,” said Prof Paul Hunter, an expert in infectious diseases at the University of East Anglia. “Flu is not nothing – it is a nasty infection that typically kills 20,000 people in a winter.”
In terms of the overall impact on the health service, Covid is still likely to add to pressures this winter. “We’re not in 2020 or 2021 and that’s a good thing,” said Prof Christina Pagel, of University College London. “But we’re also not in 2019. We’ve still got a new disease that’s killing thousands of people each year and we’ve got long Covid.”
Do we still keep track of how many people are infected with Covid ?
Since the Office for National Statistics infection survey wrapped up in March, it has been hard to know how many people are infected in the UK. However, official UKHSA figures, which show infections in hospital, indicate whether infection rates are rising or falling. This week’s figures suggest that infections, which had been steadily increasing since August, are now going down again across all age groups.
Has Covid become a seasonal illness?
Last year, as new variants arrived in quick succession, there were multiple large waves of infection, including during the summer months. This hasn’t been the case in 2023, which some say indicates Covid is settling into a seasonal pattern, with indoor mixing and lower temperatures allowing the virus to spread more readily in winter. “In pandemics with relatively short durations of immunity you always get a series of gradually dampening waves as you move towards the endemic equilibrium,” Hunter said. “Seasonality will ultimately start playing a role. The other human coronaviruses generally follow a seasonal pattern where they peak between November and February.”
Is the possibility of new variants still a threat?
The so-called Pirola variant (official name BA.2.86) prompted unease after being detected in Denmark in July and steadily spreading to other countries. The strain has a large number of mutations, raising the risk that it could evade existing immunity or could have changed in a way that makes it more virulent or more infectious. This has not transpired to be the case with this particular strain. “There was a lot of hype but that’s been a bit of a damp squib,” said Hunter. “It’s still gradually increasing as a proportion of all infections but not dramatically so.”
The prospect of a new variant causing a dramatic resurgence may be receding but scientists remain alert to this possibility and continue to monitor the emergence of new strains – although England has dropped its wastewater surveillance programme. “It’s a confusing time,” said Prof Danny Altmann, an immunologist at Imperial College London. “If you live in my world, where you’re still looking at sequences of viruses, we’ve still got our guard up. But nobody has the stomach for that fight any more.”
If you have symptoms, should you stay off work, isolate, and do you need to test?
It is still advisable to stay at home and avoid social contact if you have Covid symptoms. However, views vary on testing. Shropshire community NHS trust apologised last week after issuing an email warning staff not to test for Covid because it could result in them “having to remain at home for longer than their symptoms persist”. Pagel said: “I think that’s just ridiculous. If there’s one place where you really don’t want to give people Covid, it’s in hospital. We have a staffing crisis in the NHS but this is such a bad way to deal with it. If you’re giving Covid to older people and those with other health conditions, they end up in hospital for longer, so you’re making bed issues worse and you end up with more people off work.”
Pagel says testing can still be valuable because returning to exercise too quickly after Covid can lead to a slower recovery – so if you know you’ve had Covid you can take it easy. And if you develop long Covid, knowing that you’ve had an infection can be useful for diagnosis.
Who is being offered a booster this time around?
This autumn, boosters are being offered to everyone over 65 years old and those who are clinically vulnerable. About 35% of over-65s have taken up this offer since 1 September. For those outside the eligible groups, it is not possible to pay privately for a Covid booster injection at a pharmacy, but this could change next year. There has been little demand for private vaccinations until recently because previously all over-50s were eligible for NHS vaccination. However, several companies, including Moderna, have recently submitted applications to the Medicines and Healthcare products Regulatory Agency to update their licences to allow them to supply vaccines in individual pre-filled syringes, which would make it easier for pharmacies to offer one-off doses.
Is long Covid still a problem?
As immunity builds up in the population, the chances of Covid turning into long Covid has reduced substantially, although the total number has become harder to track. In March, when the ONS recorded its last survey, an estimated 1.9 million people in the UK (2.9% of the population) said they believed they had long Covid (symptoms continuing for more than four weeks), with 381,000 of these (20%) reporting that their ability to undertake their day-to-day activities had been “limited a lot”. Last month, the ONS reported that record numbers in the UK – 2.5 million – were not working due to long-term ill health, with evidence that long Covid could be having an impact.
“We’re still seeing people every week coming to our clinic,” Altmann said. “It’s still a thing – still an enormous thing.”
