“Living with the virus” doesn’t mean “doing nothing about it”

A post suitable for April Fool’s day when lateral flow tests will no longer be provided free to everyone.

From ‘herd immunity’ to today, Covid minimisers are still sabotaging our pandemic progress 

Dr William Hanage is a professor of the evolution and epidemiology of infectious disease at Harvard and co-director of the Center for Communicable Disease Dynamics www.theguardian.com 

So, is that it? After wave upon wave of infections, the combination of vaccination and Omicron’s comparatively mild (though still serious) properties has led the UK to declare the pandemic, essentially, over.

After two lockdowns, a huge burden on healthcare and at last an extremely prompt and effective vaccination campaign, the UK has still registered more than 160,000 lives lost to the pandemic, roughly half of them in the Alpha wave.

And in case you hadn’t noticed, “herd immunity”, much like Godot, has stubbornly failed to arrive and expel the virus from the population. Nobody should be under any illusions that it could have been much worse. Poor Peru was hit by dreadful waves of infection before vaccines could be deployed; it has lost roughly three times as many people as the UK, accounting for population.

It should be astonishing given these facts, but some stubborn voices have continued to argue that in the autumn of 2020 we should have rushed to remove restrictions on all except those most at risk – who would be somehow saved by untested, implausible means gathered together under the heading of “targeted protection”. At that point no vaccines were widely available, and the effective therapies we now have against Covid were pie in the sky. Shockingly, there are now attempts to rehabilitate these ideas in parts of the media.

Reaching back to relitigate such already-discredited approaches is nonsense. And worse, it makes reasonable discussions about pandemic management that much harder. Distraction has always been the goal of such revisionism. We saw this around targeted protection, we saw it in early arguments that Covid was “just the flu”, we saw it when many people were still arguing that PCR tests were overcounting cases in the UK in the fall of 2020, even as hospital beds and ventilator wards filled up and the death toll steadily mounted.

The point of all those fights was to play down the seriousness of the disease and ultimately to blunt our response to it. It started with saying the pandemic wasn’t a real threat, and, when that became undeniable, it became about declaring it over or past, again and again. As I wrote in April 2020, instead of a single peak, we got a mountain range. Ultimately, these arguments – despite being lost individually – seriously hampered the possibility of a real, sustainable strategy emerging to help us handle the grim pandemic terrain.

To want a sustainable strategy is not about being a “Covid hawk”. March 2022 is very different from October 2020. To suggest that restrictions might be relaxed once vaccination has been deployed is a reasonable discussion. Before that point it was guaranteed to lead to more preventable transmission, more serious illness, more hospitalisations and more deaths.

How our pandemic response should change is a question I get asked all the time. And my answer is always the same: what do we want to achieve? The minimum is to avoid healthcare being overwhelmed. But healthcare gets compromised when things like elective surgeries and screening are delayed – which will happen if huge numbers of staff and patients are sick. And this has indeed happened, over and again, as a result of uncontrolled transmission of the virus in the community.

Here’s a basic pandemic strategy fit for 2022: maintain awareness of the situation with cross-sectional testing of the population to determine how much virus is around, and combine it with wastewater surveillance to spot any rapid changes. Aggressively investigate any new variants because we can expect them, and they could still make a lot of people sick, fast. Make sure people who are in a vulnerable category get treatment early in infection, when it is most likely to help. Above all, emphasise being “up to date” with your vaccination status rather than “fully vaccinated” or “boosted” because we don’t know what might be needed in future.

And we should not forget other effective measures that we have known about for ages. A century and a half ago, we started to think seriously about cleaning the water we drank, after repeated cholera epidemics that killed Queen Victoria’s Prince Albert, alongside many others, mostly poor and without a gaudy memorial on the south side of Hyde Park. We could do the same for the air we breathe now with better ventilation. What about improved sick pay? It enables people who are infectious with Covid or anything else to not infect people in the workplace, by staying at home.

These interventions would blunt future pandemics of respiratory infections. And they would help in the autumn and winter of this year, when Covid and influenza will be tussling for pole position. Hell, you don’t need to talk about future pandemics to advocate for the benefits of such structural change, it’s clear right now.

After almost all interventions were removed, the UK has been predictably buffeted by a wave of BA.2 infections. For now, it appears that the disease is comfortingly similar to BA.1, by which I mean readily handled by the great majority of vaccinated folks. But to insist that future variants will be similar is a gamble, not a policy. Rather than maintaining its world-beating scientific effort to understand the properties of the variants as they emerge, the UK is scaling back funding. It doesn’t end because you want it to. Every time you’ve heard a voice state it’s time to “live with the virus” remember that doesn’t mean doing nothing about it.

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