Are you finding it difficult to keep up with the Covid story? You are not alone. Early in this series of essays on the subject, I recalled that in the 1960s the Medical Research Council's Common Cold Research Unit showed coronaviruses to be extremely infective by the respiratory route, spread in tiny droplets in breath. The scientists' efforts to find a vaccine were frustrated by the virus's propensity to keep mutating. Well, I think we all now have some insight into their frustration.
Two years have now passed since the virus started striking us and it is not only still here, but almost one in 10 of us now in Scotland is infected. England and Wales are close behind. This is despite a very high vaccination rate and antibodies being present in 99% of the population.
The much better news is that the latest manifestation of the virus (which now comes in several subvariants of earlier ones, mainly omicron) is much less dangerous to most people and even healthy older folk rarely feel very ill. The main symptoms have changed: runny nose, sore throat, headaches and general malaise are the main ones, cough is less common, and loss of smell and shortness of breath are uncommon. The potentially fatal complications of pneumonia and blood clots seem to be very unusual now.
About half the people who are in hospital with Covid have it as a benign accompaniment to other more serious illness, while those who are admitted because of Covid only rarely need intensive care. Nevertheless, there are still deaths, almost exclusively in over 75-year-olds with other serious conditions. In other words, it seems likely that the current mutations are more like other respiratory viruses that we have become used to, all of which kill older people like me. These viruses are ageist, and no Johnsonian legislation can fix that.
The national all-cause mortality statistics are now approaching normality (that is, the average over the past five years) with Covid-related deaths substituting for deaths related to other things. The person we used to think of as the grim reaper has changed but the harvest is similar now after two years of what might be thought of by Charon on his ferry as a bumper one. Why is this? Again, you are not alone in wondering.
It seems possible that vaccination is effective in preventing serious complications of the infection but presence of antibodies in our blood has almost no effect on transmission. This is not what vaccination does usually, but it could be an explanation if the harmful effects are a consequence of high dose exposure and vaccination knocks out most of the inhaled virus, leaving a smaller army to invade cells, reproduce and trigger the secondary harmful immune reactions. This is me speculating – I know of no evidence for this, so you can call it a hypothesis.
Another idea, more likely, is that the virus is not influenced at all by the vaccines but has changed its behaviour radically. Doctors on the front line think this is the case – their patients are not as sick as in the earlier waves. Or it could be a combination. It is important for us to find out, and scientists are working on this, as future vaccine development and management strategies depend on the answers.
For now, the main worry is the burden on the NHS and the remarkable staff who are struggling to cope with both the huge numbers of admissions and the backlog of urgent work of other sorts accumulated over two years. This is made much worse by the fact that many of them catch the virus themselves and have to stay off work as a consequence. From this comes clear advice to all of us, whatever governments say. This is:
• Wear a face covering when indoors and in public transport
• Continue hand-washing/sanitation as before
• If you develop cold symptoms, stay at home and do a lateral flow test
• If positive, self-isolate for a week
• If negative, stay home until the symptoms resolve and repeat the test in a day or two
• If you are elderly or frail, take care when visiting or having visitors indoors and avoid crowds
• If you are meeting elderly or vulnerable people indoors, wear masks and handwash
• Get the vaccine when offered – it still seems to protect against going into hospital
It is pretty obvious that we have to learn to live with Covid in the long-term until both it and we reach an equilibrium; we may assume it is here to stay. To be asked to wear a mask is not an infringement of our liberty but is simply a request to be considerate of the health of those around us. We shall all have to get used to this for the foreseeable future if we want the NHS to be able to cope. Most of us are well used to these measures already, and in the Far East people have been doing so for decades.
As the public notices used to say when I was a child: 'Coughs and sneezes spread diseases'. This is still true, and we know how to reduce risks both for ourselves and, particularly, for the vulnerable. While so many people have the virus, remember how it spreads and please act accordingly.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own