With an update vaccine just licensed where are we now with Covid19?

Back in February when England dared to introduce its “living with Covid19” policy – the first of the UK regions to do so – they were accused of risking the lives of thousands, perhaps millions. At that time, supposedly more sensible, less reckless, leaders in the other UK regions, including N. Ireland, said they would not play “covid-roulette” with the lives and wellbeing of their citizens. Most sensible people back then were livid with the English policy and rightly so said The Independent newspaper, which was scathing in its coverage. The Royal Colleges too, who knows a thing or two about medicine and infection, had been in unison in their condemnation of such a dangerous scheme. Why was Boris not listening to the experts the Independent worried and noted his key advisors, Patrick Vallance and Chris Whitty, had been absent without comment for weeks.

Up to that point scientific experts had guided us through the pandemic. Without them and their ingenious computer models, we would, we were told, be perhaps half a million citizens worse off. Sensible orthodoxy created by these experts back in March 2020 was essential to our success in fighting the virus we were reminded. But the fact was that the science had moved on as it became clearer that; cloth-mask wearing, hand sanitization and lockdowns were much less effective than had been thought yet there was, in February 2022, strong defiance by many experts to moving on and living with Covid19.

It has been a distressing two and a half years since Covid19 first came into our lives. Since February, in spite of the experts’ horror and dire warnings, normality has returned; sporting events, weddings, music festivals, shopping, leisure-travel and even visiting the sick. Perhaps visiting the sick is less normal and more precarious as hospitals and care homes keep a strict eye on their infection control procedures. Yet much of the normal social interactions, the things that make us human are, well, normal again. So, where are we now that we are all living with Covid19 as an endemic infection?

You would not think it but we had some of the highest Covid19 infection rates locally during June and July 2022, with at one time 1 in 17 people suffering from infection yet the key concerns about deaths and health service disruption have largely been mitigated. People are still dying of, or with, Covid19 and there certainly are Covid19 infected patients in hospital and in ICU but not at a level that creates alarm. We seem happy to move on and accept this collateral damage which I find slightly surprising.

Covid19 has certainly not gone away and we still don’t really understand this virus therefore trying to predict what will happen in the near future never mind in the next five years is impossible. As U.S. infection expert Michael Osterholm says, it is difficult to predict what will happen as his “crystal ball has a layer of mud when it comes to this virus”. For example, we now know that Covid19 is not a seasonal virus like common cold and influenza otherwise it would not have surged in the UK so aggressively in the early summer of 2022.

When we view the local statistics of people in hospital with Covid19, we need to appreciate they might be there because of Covid19 or just happened to have it when admitted for something else or, as happens with nosocomial diseases, contract it while in hospital. Dr John Campbell, not so much an infection expert more a commentator, is claiming that only 30% of hospitalised Covid19 patients are in hospital because of Covid19. If correct, this further supports the view that the Omicron variants of Covid19 are much less virulent. There is also of course a range of effective drugs to treat severe Covid19 symptoms, dexamethasone being the most successful.

The recent surge of infections is due to the B.4 and B.5 variants and a key feature of the surge is immune evasion. We know that a very high percentage of our population, more than 98%, has some immunity to Covid19 which is certainly contributing to better outcomes. What is not reported and may not be known is how this breaks down into immunity created by vaccination and immunity created by infection. This can easily be done and it is important because we need to understand how current population immunity should inform our future vaccination programmes. It might be, yet we don’t know, that natural immunity is superior to vaccine immunity.

The main vaccines used in the UK are vaccines focused on the spike proteins and based on the “wild type” of the virus. So it is good news that Moderna has secured a licence for a bivalent vaccine. It has been updated to include Omicron variant BA.1 and early data suggest it provides some immunity towards BA.4 and BA.5.

Covid19 is very much with us. In the US, for example, for the last 7 weeks, Covid19 caused 350 deaths a week making it the fourth most common cause of death. We now know that for this airborne virus, there is little protection from; masks, hand gels or lockdowns, so for primary prevention we need to keep focused on vaccination and we need to ensure that the public turn out for the autumn booster vaccine programme in greater numbers than they did for the Spring Booster. But then, the public may have moved on at a time when this virus remains a very real potential threat to public health.

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