People are suffering from “pandemic fatigue”. It has been a long two years and most of us have had to endure harsh and often unpredictable restrictions on our daily lives. Millions of people have died, livelihoods have been lost and economies have suffered. So it is understandable that many would cling to any hope that the COVID-19 pandemic is coming to an end. In some countries, the easing or complete removal of restrictions has given them that hope.
This sentiment has, in some ways, been fuelled by the Omicron variant, which has been shown to cause less severe disease, in adults at least, with one study from Imperial College London reporting that people infected with it were 40-45 percent less likely to be admitted for an overnight hospital stay than those infected with the Delta variant.
But the arrival of the Omicron variant, with its increased transmissibility and ability to evade at least some of the protection conferred by vaccines and previous infections, should remind us of how volatile the course of this pandemic can be.
The head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, issued a stark warning this month when he said, “It’s dangerous to assume that Omicron will be the last variant and that we are in the end game.”
While Omicron may be milder than Delta, although not mild, cases are continuing to soar, particularly across Europe. This suggests any hope that COVID-19 may soon become endemic, is misplaced.
In its most scientific terms, a disease is considered endemic once the number of cases becomes stable or static, not when the illness becomes less deadly. By this definition, COVID-19 is not yet endemic as cases are still on the rise. On the other hand, diseases such as malaria, which can kill 600,000 people a year, and dengue fever, which kills up to 25,000 people each year, are endemic in certain parts of the world.
So, when people, like the UK’s health secretary, Sajid Javid, talk about “learning to live with” COVID, the question to ask is: What would be considered an acceptable number of COVID-19 deaths in order for the world to carry on as normal? It is, of course, important to note that this approach would put the clinically vulnerable and the elderly, who have a much higher chance of dying from the virus, at a major disadvantage.
Some may argue that flu, which we have all come to terms with, kills up to 650,000 people each year worldwide, so surely we can live with COVID-19. But flu isn’t an endemic illness; rather we see waves of it during the winter months. And, although the flu virus and the SARS-CoV-2 virus are frequently compared, I am not convinced they should be. They cause two very different illnesses. COVID-19 is a multi-system inflammatory virus that is not only potentially deadly but can also lead to long-term health problems for people of all age groups. Flu, by contrast, typically affects only the respiratory system. This means millions of people worldwide may end up living with long COVID which in itself will have devastating effects on their livelihoods and the wider economy. In addition to this, COVID-19 deaths so far have significantly outnumbered flu deaths (although this includes deaths during the time before vaccines were widely available in wealthy countries and when we were still learning about the virus).
There is also some belief that any new variants that may arise in the future are likely to cause an even milder illness than Omicron. But there is nothing to substantiate this belief. It would only be true if the virus had anything to gain by causing a milder illness and keeping its host alive. Much of the SARS-Cov-2 transmission occurs in the days before a person develops symptoms and the first few days following the onset of symptoms. It is usually the host’s own immune response to the virus that causes much of the illness we have seen in those hospitalised with it. This is because the virus can cause an overstimulation of certain immune cells, which then become difficult to “turn off” as they start to attack healthy cells as well as infected ones. By the time the host becomes seriously ill, the virus has moved on to another person. This means there is no evolutionary pressure for the virus to become milder; we simply got lucky with Omicron.
So, as unpalatable as this may sound to many people, we are not yet in a position to start living with this virus. We must continue to adopt methods to suppress its spread until we are. This means putting measures in place to protect the most vulnerable by reducing their chances of getting the virus.
As COVID’s mode of transmission is airborne, we should equip schools and other buildings with air filters and look for innovative ways to improve airflow in areas where people might congregate for long periods of time. We must also accept that mask-wearing may become a part of our daily lives, much as it did in parts of Asia after MERS, a type of coronavirus first identified in 2012. But it has to be the right type of mask, with N95 or FFP2 masks being the most effective.
Also, vaccines are key, and getting them into the arms of people across the world remains paramount. Variants are more likely to arise where people remain unvaccinated. Those who are vaccinated are more likely to rid themselves of the virus more quickly compared with unvaccinated people. This means the virus has less time to multiply and less chance to mutate in those who are fully vaccinated. Pushing for global vaccine equity is in everyone’s best interests. We need to have at least 70-80 percent of the world’s population vaccinated to achieve global protection and significantly reduce the risk of illness. This sounds ambitious but it has been done before with the vaccine for polio, a disease that has been more or less eradicated worldwide. In addition, second-generation vaccines are being developed to tackle emerging variants more effectively and will be key to safeguarding us in the future.
It is not only the vaccines that need to be shared across the world. Antiviral treatments like molnupiravir and paxlovid, which have been shown to reduce the risk of hospital admission for those in the high-risk category who test positive for COVID-19, must also be made available. These drugs help stop viral replication which, in turn, can reduce the length of time someone is ill with COVID. A shorter illness means there is less time for mutations and variants to emerge. That is something we would all benefit from.
Continuing research into long COVID and a better understanding of the different ways this virus can affect our bodies may also lead to a time when we can consider living with this virus.
I have hope that a time will come when we are better protected from the effects of COVID-19 and equipped to deal with any emerging variants, but sadly that time is not quite now. We are in a much better position than we were two years ago and that is largely down to science, but we cannot yet claim that we are nearing the end of this pandemic.
Meningitis B: The signs and symptoms to look out for
Recent data and analysis from the UK Health Security Agency (UKHSA) shows that in mid-late 2021 there was an increase in the number of cases of meningococcal disease in teenagers and young adults, mainly caused by group B meningococcal disease (MenB) – with the majority of these cases detected in university students.
Meningitis B is caused by the bacteria Neisseria meningitidis. Meningitis can attack the brain and spinal cord and cause swelling in those areas as well as a serious infection of the bloodstream, called septicaemia. Approximately 10-15 percent of people infected with meningococcal disease will die, sometimes as quickly as within 24 hours after symptoms first appear. For those who survive, about one in five may experience a variety of long-term disabilities including hearing loss, brain damage, nervous system problems, kidney damage, loss of limbs, and scarring of the skin.
Commons signs and symptoms of meningitis and septicaemia are:
- Fever with cold hands and feet
- Drowsy or difficult to wake
- Confusion and irritability
- Severe muscle pain
- Pale blotchy skin, spots or rash
- Severe headache
- Stiff neck
- Dislike bright lights
- Convulsions or seizures
Early COVID-19 restrictions across the UK saw meningitis B cases fall to an all-time low in September 2021. But as restrictions eased and people were able to mix again, cases in teenagers, in particular, have begun to rise to levels higher than before the pandemic.
In the UK, teenagers are offered the meningococcal ACWY vaccine in an effort to protect them from some of the different bugs that can cause meningitis and the MenB vaccine is offered to infants. It is unclear exactly what is causing the rise in cases in these young people. One theory put forward by the authors of the report is that fewer people were exposed to the bacteria as a result of reduced mixing at the height of the pandemic. This meant that fewer people became immune, so when university campuses opened up there was an “immunity debt” which put them at risk of getting the illness.
The best thing students and young people can do to protect themselves from this serious illness is to take up the ACWY vaccine and to be alert to the symptoms of meningitis B so that they can seek medical help sooner rather than later.