Delaying and preventing infection as much as possible through this pandemic was a worthwhile strategy. In early 2020, there were few treatments, limited testing and no vaccines. The costs of those lockdowns were big, but the effort to buy time paid off. In that time, science has transformed Covid from a deadly virus to a much less serious, nasty disease – one that is manageable at home, for the vast majority of those vaccinated. It has, largely, defanged it.
But even as we have had success treating and preventing serious infections, Sars-CoV-2 has become increasingly transmissible. ONS survey data indicates that one in 15 are positive in England, with similar numbers for the other three nations. While the good news is that the Omicron variant is resulting in less severe disease and a smaller fraction of hospitalisations, so many people are infected and isolating that critical services are struggling with staffing. This is what is driving governments to rethink isolation policies, and ask whether they are becoming more disruptive than the virus itself.
In England the prime minister announced today that restrictions including masking requirements will be removed from next week, and self-isolation requirements will be reviewed in March. I think this is largely reasonable – all governments face the question of how to approach this new landscape.
For policymakers, it’s a bit like landing an aeroplane on an icy landing strip. The fuel of public patience is running low; and wear and tear, in the form of economic and social damage, has built up over two years in a holding pattern. The need to land is obvious, and we have the tools to do so, but it’s still a tricky feat in current conditions.
There are now clearly three camps of scientists voicing opinions on what is happening and what to do in the coming weeks. This can be confusing for the public.
The first group still seem to see the virus as the same deadly one of March 2020, despite the massive scientific progress in managing it, and they suggest extremely cautious measures. The second say they’ve been right all along in that mass infection is unavoidable; this is the “let it rip” group. They ignore the dramatic difference that mass vaccinations and treatments have made – avoiding serious illness from Covid-19 now is wholly different from 2020.
The third group – where I sit – have evolved their position as the data and tools, namely vaccines and therapeutics, have also evolved to transform Covid-19 into something more akin to other infectious diseases that we control and manage. My analysis has consistently responded to the latest evidence.
First, we now have safe and effective vaccines that protect the vast majority of people from hospitalisation and death. Recent data from the UK Health Security Agency shows that unvaccinated people are between three and eight times more likely to be hospitalised with Covid-19. Early in the Omicron wave, New Yorkers who were not vaccinated were more than eight times more likely to be hospitalised than New Yorkers who were fully vaccinated. If everyone who was offered a vaccine and booster would take it, the pandemic would be effectively over in richer countries.
And while our current vaccines don’t stop us getting infected, major investment is being made in next-generation vaccines that offer sterilizing immunity, meaning they stop infection completely in those getting two doses.
Next, we have exciting home treatments on the horizon for Covid-19, two in particular. The first is Pfizer’s Paxlovid and the second is Merck’s molnupiravir. Both are seen by scientists as groundbreaking because early trial data showed they significantly reduced the chances of hospitalisation and death in high-risk patients. The pills aren’t affected by new variants such as Omicron as they don’t target the spike protein where most mutations have occurred. And unlike vaccines, which must be taken weeks before infection to be effective, these treatments can help fight active infections.
Antivirals need to be tied to a good diagnostic system as the pills need to be taken as soon as possible after confirming Covid-19 diagnosis and symptoms. This means we need a smooth system for getting tested, getting a prescription from a medical professional and starting the course of oral pills. Although, because of current supply issues, rather than general population use they will be targeted at older people and those who are more vulnerable due to health conditions such as heart disease, cancer or diabetes.
What does all this mean in terms of living with Covid-19? We still need to test. We still need to vaccinate and combat misinformation. We need to encourage people to wear medical-grade masks such as N95s in crowded and indoor settings. Employers need to recognise and support employees who have been identified as in a shielding group. We also need to review isolation and other policies so they remain safe, but are less disruptive to the functioning of society.
We will still need to monitor Covid-19 in public health, as we do other diseases. When people say it will be “endemic”, that doesn’t mean harmless. Endemic means that we accept a circulation of a disease because elimination or eradication is perceived as too difficult. Malaria, dengue and measles are endemic in certain parts of the world even though they are all serious diseases. Malaria was endemic in the United States until the government decided to eliminate it.
This is part of a larger question about how much we continue to alter what “normal” social relations are, given the circulation of Sars-CoV-2. Humans are social: we need to hug, dance, sing and recognise each other’s faces and smiles. A sense of community and connection are vital to wellbeing too. Public health is not about one disease; it is broadly about wellbeing, which includes mental health and being able to pay the rent, feed your family, stay warm through winter and have a meaningful role in society.
Slowing the spread of Sars-CoV-2, even stopping it completely in certain countries, helped save lives. It allowed two transformative antiviral pills to be made available. It allowed doctors to develop better ways of treating patients, and to understand what we’re facing. It allowed a better understanding of transmission and risk.
But now, two years into this pandemic, we need to find a better way of living alongside Sars-CoV-2 using the tools we have. We have created ways to minimise the impact of Covid-19. And now is the time to start to recover and heal as a society and move forward, treating this virus like we do other infectious disease threats.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
• This article was amended on 21 January 2022. The prime minister’s announcement about the removal of some restrictions relates to England, not the UK.
