In September we published this blog, asking whether or not Covid-19 had been tamed in the UK - and suggesting 10 reasons for continuing concern. The dramatic rise of a new variant (a scenario we anticipated) at a time when the other points we raised still apply, suggests the need for continuing caution.

A brave new world?

As I write (in September) Covid cases in England have been falling steadily for a week. In July it's reported that Covid-19 claimed only a quarter of the lives that heart disease, dementia and cancer each claimed in an average week. With nearly 80% of people aged 16+ in the UK having now received two vaccinations, this may help explain the improving situation. And even before the rollout of the vaccine, fewer than one per cent of people who caught Covid died. Now, scientists say that figure is ten times smaller.

This seems to be confirming the assessment of Health Secretary Sajid Javid earlier this summer: ‘We cannot eliminate it, instead we have to learn to live with it.’

As a result, life has pretty much returned to normal across most of England. In London, places like Covent Garden are thronged with visitors and there are long queues for the local theatres. Even on the Tube, where mask wearing is still officially required by tfl, many people are simply ignoring this and no one seems to be enforcing mask-wearing.

So, has Covid-19 been largely tamed in the UK? Is it now the equivalent of seasonal flu, where sadly 10,000 – 30,000 will die in a typical year but not hundreds of thousands, meaning life can continue as normal without the need for lockdowns or special preventative measures?

Or Covid complacency?

There are a number of reasons to suggest we shouldn’t be over-complacent:

• 20% of adults still aren’t fully vaccinated – that’s more than 9 million people (plus children).
• Being fully vaccinated is a big help but unfortunately it doesn’t provide 100% protection against Covid and doesn’t fully prevent you transmitting Covid.
• The protection from vaccination also wanes over time. For those vaccinated first (older people and healthcare workers) it could be as low as 50% by winter.
• Fully vaccinated people are far more likely to develop symptoms if they catch the Delta strain compared with earlier strains – and the Delta variant is now the dominant one in the UK.
• Fewer people are being admitted to hospital than at the peak, but there are still nearly 7,000 patients in hospital with Covid (nearly 1,000 in ventilator beds), taking up beds, medical facilities and healthcare time that may be needed for other patients, putting additional strain on the NHS.
• Meanwhile, in Scotland, Covid cases have roughly doubled every week since restrictions eased, leading to an increase in hospital admissions.
• Covid-19 isn’t just potentially fatal. 945,000 people in private households (i.e. not in hospitals or care homes) currently report suffering from long Covid.
• Covid can mutate, particularly where large numbers of people become infected. For example, a new strain of the Delta variant has been suspected after an event attended by 53,000 people in Cornwall led to a sharp spike in cases among younger people. Mutations sometimes prove more transmissible and/or more resistant to vaccination.
• We may have relatively high rates of vaccination in the UK but many countries don’t. Travel to and from countries with low vaccination rates combined with unrestricted socialising in the UK could lead to new and more dangerous variants being imported, seeded and then spread here before anyone realises it.
• The NHS is already under unprecedented pressure this summer, with senior doctors describing the situation as feeling like, 'the worst winters most of us can recall.' With many medics already burnt out after after unremitting pressure, what capacity will be left if we see a fresh Covid wave as winter approaches?

It's also important to consider timing. We’re lucky to be in the summer here in the UK. This means much socialising is outdoors, where the virus finds it harder to spread. It is also easier to leave windows open in homes, workplaces and public transport – providing the ventilation that also reduces Covid-risk. And schools, colleges and universities are on holiday, a further risk-reducer. As winter approaches, all these protective factors will diminish, as students are back in the classroom and the cold weather drives people indoors, making them also more reluctant to leave windows open.

Do we need to walk and chew gum?

The Daily Mail was right to point out recently that, at this favourable time when it comes to Covid rates, we shouldn’t forget other significant continuing health risks such as diabetes, heart failure and cancer. Our guiding principle as a charity is that prevention beats cure. So we fully support action to reduce this kind of health risk, wherever feasible, to save lives and reduce pressure on the NHS.

However, we don’t see this as a binary option – either we focus on Covid or we focus on the other health risks. For example, those most vulnerable to dying from Covid have included people who are obese and those suffering from long term health conditions. More focus on reducing preventable illness can reduce the most serious effects of both Covid and a range of other health risks.

Similarly, action to prevent the spread of Covid now, while conditions are favourable, could reduce the risk of another Covid wave this winter – meaning less demand for hospital beds, ventilators and the time of doctors and nurses, allowing them to concentrate on diagnosing and treating patients with other serious illnesses and make progress catching up with the backlog of outstanding cases.

That’s why we recommend:

• Action NOW to improve ventilation systems in schools, colleges, universities, workplaces, pubs, restaurants and entertainment venues, so we’re ready for the winter, when having windows open will no longer be feasible – as we know ventilation is an important factor in reducing Covid risk.  
• Sustained initiatives to combat vaccine scepticism and encourage higher levels of vaccination, including greater use of social media. Case studies of vaccine deniers who have died from Covid or are now suffering from long Covid may help here. While vaccinations don’t provide 100% protection they do  reduce the risk of infection, transmission and serious illness - and also the risk of new and potentially more dangerous mutations emerging.
• Continued border controls (with entry for people who are fully vaccinated and can show negative Covid tests) until the rest of the world has been vaccinated, to reduce the risk of importing new variants.
• Compulsory mask-wearing on public transport, with effective enforcement. People who have no choice other than to use public transport to get to work, to school, university or college, or for medical appointments, shouldn’t be placed at unnecessary risk.

Michael Baber, September 2021 - and republished December 2021