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The constant mantra is that the virus must be suppressed and contained. But how do you do this when people can be contagious without knowing they have it? Where can it be spread silently because people don’t develop symptoms?
The nation was once paralyzed at immense cost to the economy, education, and health in general. And now, with the increase in cases, there is the threat of new national restrictions, while much of the country has already found itself in a partial lockdown again. But are we fighting a losing battle? Instead, do we need to learn to live with the virus?
It’s ‘absolute chaos’ now
Professor Carl Heneghan, director of the Center for Evidence-Based Medicine at the University of Oxford, says the current situation is “total chaos” with a constant stream of new restrictions and schools sending year-round groups home when only a person tests positive. All this at a time when the level of contagion is still very low.
This, says Professor Heneghan, is the consequence of trying to suppress the virus. Instead, he argues that we should accept that it is here to stay and try to minimize risks, while balancing it against the consequences of the actions we take.
In particular, he is concerned that the Covid test is actually so sensitive that it detects what an effectively killed virus is, as it detects traces of it months after the person has ceased to be infectious.
“We need to slow down our thinking. But every time the government sees an increase in cases, it seems to panic,” he said.
Hospital admissions matter ‘not cases’
The argument put forward by Professor Heneghan and several other experts is that diseases should be given more importance than cases. While hospital admissions have started to rise, they are still incredibly low compared to spring and the rise is much more gradual than it was.
What’s more, rising admissions for respiratory illnesses and sadly deaths is what you would expect to happen at this time of year as you move into fall and winter, when these viruses always spread the most.
Some years are worse than others. In 2017-18 there were 50,000 additional deaths during the winter compared to the rest of the year, mainly due to cold weather, a virulent strain of the flu, and an ineffective vaccine.
In fact, Professor Robert Dingwall, a sociologist and government adviser, believes that the public may well now be at the stage where they are “comfortable” with the idea that thousands of people will die from Covid just as they do. of flu. .
He believes that it is only a particular element of public health and scientific leadership that cares about reducing the level of infection and criticizes politicians for not being “brave enough” to be honest with the public in the sense that the virus will be present “forever and”. a day “even with a vaccine.
What is the risk of loosening our grip?
The problem with relying on hospital admissions is that it can be found behind the curve. Hospital cases are the result of infections from a few weeks ago, so if they get out of hand, more draconian measures may be needed than they would have otherwise.
The other problem, says Professor Christina Pagel, from University College London, is “Long Covid” – patients still fighting months after an infection. She says it would be “irresponsible” to allow the virus to spread, as it is still less than a year old and we are still not sure what the long-term risks are.
He also says that if infection rates rise in the youngest and healthiest age groups, it will be difficult to prevent it from spreading to the most vulnerable.
Professor Mark Woolhouse, an infectious disease expert at the University of Edinburgh, agrees that this is a risk. But he argues that the government must “carefully balance the damage” from Covid with the consequences that come from trying to contain it. He says there is already growing evidence that “the cure has been worse than the disease” due to broader societal costs.
The death toll has undoubtedly been terrible. More than 40,000 deaths are related to Covid.
The burden of those has fallen on the very old. The average age of death has been greater than 80 years.
And if you look at the age-adjusted death rates, which take into account the size and age of the population, you can see that while 2020 has certainly been a bad year compared to recent years, what has been seen in terms of people dying is not completely in sync with recent history. It is actually comparable to what happened in the 2000s.
How can the vulnerable be protected?
Professor Woolhouse says the lockdown simply postponed the problem, but had the benefit of buying time, which he believes could now be used to better protect the vulnerable.
That means an intensive goal of nursing home testing to prevent the virus from entering: Four out of 10 deaths have occurred among nursing home residents. Similar measures will be taken to protect fragile people who receive care in their own homes.
Beyond that, Professor Woolhouse says what is needed is a “chain of trust” whereby more care is taken when having contact with a person who is at higher risk. That, he says, may mean not seeing them if you think it has been in crowded places where it may have been exposed.
And naturally, people in higher-risk groups will take more precautions than those who don’t – something that just didn’t happen in February and March until the extent of the virus’s spread was understood.
This should be a consideration, say many health experts, starting in the 50s. But of course it should be commensurate with the risk.
While it starts to go up at 50, it is still very slim. But then it increases directly with age, which is quite unusual for an infectious disease. Perhaps the easiest way to understand it is to think of it like this: An infection with the virus essentially doubles the risk of death you face in any given year from injury or illness. The older it is and the less healthy it is, the greater the risk in both respects.
The other factor to consider is that doctors are in a much better position to treat serious illnesses. Two steroid treatments have been found to reduce the risk of death in critically ill patients, while a lot has been learned about how Covid behaves, meaning that hospitals will be better prepared for problems like blood clots and kidney damage.
It means that many are confident that the scale of deaths observed above will not repeat itself.
What about herd immunity?
Allowing, or perhaps accepting, some diffusion also brings us to perhaps the most contentious point, immunity. There are high hopes that a vaccine will be developed. But what if it isn’t? Or what if it doesn’t trigger a strong enough immune response in older age groups?
Then it will depend on getting enough younger people vaccinated to build herd immunity. Will they do this with a vaccine that has been produced so quickly to protect them against a virus that is unlikely to cause complications?
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The other way immunity develops is through exposure. Like other coronaviruses, all the evidence on Covid points to infections giving people some immunity which is later lowered, but is followed by reinfections that cause milder illnesses. Over the years, this is likely to lead to coronavirus becoming another of the seasonal viruses that we experience each year. Although, as always, you have to take into account the fact that it is a new virus, so scientists are learning more about it all the time.
That process could take years, even decades, some think. But others are more optimistic. Professor Sunetra Gupta, University of Oxford, believes that there may already be more immunity than we think due to a combination of natural immunity and more exposure than detection suggests; says that the antibody markers that are relied upon to identify past exposure are not as reliable for this particular virus.
She says allowing young, healthy people to be exposed during the winter will be beneficial for years to come. “This is how we have always handled viruses. Why is this so different? If we continue to introduce restrictions and lockdowns while we wait for a vaccine, it will be young people who will suffer the most, particularly those from more disadvantaged backgrounds. We cannot continue to do this It would be an injustice. “
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