First, Covid-19 is a disease that can also kill young people, especially those who have not been vaccinated. The idea that Covid is only a threat to the elderly still prevails. But consider that the US has passed one million deaths, and about a quarter of those deaths are in working-age people, meaning people under 64. Another quarter is in people aged between 65 and 74. This is not a disease that just kills the over 80s as the Prime Minister, Boris Johnson, is reported to have sent a message: “Almost no one under 60 goes to hospital… and of those almost all survive. And I don’t buy all that NHS gushing anymore. Guys, I think we might need to recalibrate… There are at most 3 million in this country over the age of 80.” However, the death rate of Covid-19 has also decreased massively over time. At the start of the first wave in 2020, a third of hospitalized patients died, putting the disease on par with Ebola’s fatality rate. The fatality rate is now estimated to be less than seasonal flu for all age groups. This progress is due to mass vaccination, better clinical management in the hospital and the discovery of new treatments and drugs. One thing that has changed significantly since the early stages of the pandemic is that Covid-19 is now more likely. This virus continues to evolve and new variants have emerged with immune escape, meaning they can re-infect those who previously had Covid-19. Avoiding infection has become more difficult as the virus has become increasingly contagious: We have seen that estimates of R0, the theoretical number of people each new case infects in a non-immune population, have arisen new variations. The original wild type was estimated to have an R0 of 3.3. Delta was estimated at 5.1, with the ability to re-infect humans. Omicron (BA.1) raised it to 9.5, with BA.2 raising it to 13.3. Estimates from South Africa put the current dominant BA.4/BA.5 strain at 18.6. While this type of estimate should be interpreted cautiously, the BA.4/5 variant was compared to measles, which has been considered the most infectious disease. Available vaccines still work well to protect us from serious disease, but the protection they offer is waning fairly quickly, so we need regular boosters offered to the population to protect against serious infection. Ideally, these would be adapted to Omicron, whose recent variants have been sublines. The UK is still not committed to offering souvenirs to the over 50s, which seems a poor decision given the risks involved in going into winter and knowing that vaccination is the best protection against serious illness. Anthony Fauci and other experts have suggested that we are likely moving out of the emergency phase of Covid-19 as it becomes another public health disease to manage among the many that make people sick. It is important to ensure that the Covid-19 response is proportionate and takes into account that for most people, other concerns have taken over, including the rising cost of living and mental health. A recent US poll found that for the first time in two years, a majority of Americans did not see Covid-19 as a major threat. While experts may disagree, it is important to recognize what people think and prioritize. Public health is a delicate balancing act between government intervention and individual freedom. While public policy can guide individual decisions, such as indoor smoking bans, road speed limits, and vaccination requirements for certain jobs, people also like to make their own choices about their behavior. The jump in mingling and socializing shows that people like to be in close contact with other people – and for many, since Covid has been largely hacked by science, they are willing to risk being bitten for a living in a way they choose that gives them quality of life. Long Covid is an ongoing challenge as the virus circulates and must be closely monitored and treated. Whatever your view of the pandemic and the responses of various countries, now is the time to acknowledge the toll this disease has taken. The lives lost before their time. The faces of these 200,000 people. Their families, their children, their loved ones. And how the challenge for the scientific community – and for governments – is how we can do better next time.
