What might ‘Living Safely with Covid’ look like?

Here’s the weekly column from our Director of Public Health Prof Dominic Harrison:

Case rates for Covid continue to fall rapidly across Lancashire as do Covid hospitalisations.

Of the continuing new cases, a surprising number are now re-infections, but this may not be entirely bad news. Of the new cases in the week to 2^nd February in Blackburn with Darwen, 18% were re-infections. People now re-infected with Covid will have had a first infection from the original Wuhan Covid strain, Alpha or Delta variants and then Omicron. Their new re-infection with Omicron will mean that they will be less likely to be symptomatic and less likely to be seriously ill or hospitalised as they will mostly have a robust immune response to their re-infection.

A new long term plan for ‘Living Safely with Covid’ is due out before the end of February. SAGE suggests that we still have a risk of a new globally transmitted variant, but that the most likely scenario for 2022 is that we will see smaller waves of the current variant. We might expect a further Omicron wave in the summer with a larger number of re-infections due to waning immunity, but with less risk of serious illness. We will almost certainly get a further Omicron wave in late autumn and winter as Covid becomes a seasonal and endemic disease.

Pandemic infectious disease spread is worldwide with high case rates, epidemic spread is at a high level but with outbreaks in specific communities or areas. Endemic transmission means that maybe 1% of the population is routinely infected (we currently have about 4% infected in the UK), or it can mean that R is at or below one, which means that every one person infected only infects one other person. If this happens, the disease is stable and not growing. If we can get R below 1, the disease could in theory be eventually eradicated, but this is rarely achieved in practice.

Management of endemic Covid should not require lockdowns or major public health control measures. We will need to keep monitoring for new variants and keep up enhanced infection control measures. We will need to improve national standards of ventilation in all public spaces and buildings and we will need to retain capacity to ‘step up’ responses at local authority levels if we get large outbreaks or new variants. People will need to stay at home if they have symptoms (just as we do with flu) but we may decide that we do not need statutory self-isolation periods and testing and tracing may be minimal.  Older and clinically vulnerable people will have a PCR test at home. If they get Covid symptoms they will test and if positive, will be immediately given anti-viral medication which, if taken within five days of symptoms, should reduce their likelihood of serious disease, hospitalisation or death. Vaccinations will continue annually for older and clinically vulnerable people and will be given alongside the annual flu vaccination.

Continued endemic transmission throughout 2022 might mean that most of the population, vaccinated or not, will risk an Omicron infection by winter. For most of us who are vaccinated and/or previously infected this will be a mild infection and will add to the robustness of our future immune response. A very small number however may still get some Long Covid symptoms – so we definitely do not advise trying to get infected to improve your immunity.

The wild card in this otherwise positive future is the possible emergence of a new ‘vaccine-escaping’ variant. The main way to minimise that risk is to rapidly make vaccines fairly and equally available across the world. Wealthier nations have not yet delivered on their promise to do this. It is now in our own interests to do so as quickly as possible.