To get close to normality we must accept the pandemic is not over yet
For some politicians “learning to live with Covid” is a mantra that means allowing high numbers of infections. However, we may get closer to normality if we accept that we cannot yet return to full normality.
In comparison with other countries with high vaccination rates, the UK still has high numbers of new infections (see Table). This is a consequence of inconsistent messaging and an inefficient test and trace system. High number of infections are self-perpetuating as they make contact tracing less effective. The right strategy to control the pingdemic is to reduce the number of cases, rather than tracing fewer contacts.
The NHS is not coping
In this new phase of the pandemic the falling apart of the NHS, rather than Covid deaths, has been the main problem. Underfunded and understaffed even before the pandemic started, the NHS is no longer coping. The number of patients waiting for treatment has increased, waiting lists are longer, whilst A&E and ambulance services have been unable to cope. The US is in a similar predicament.
Since mid-July the number of daily Covid admissions to hospitals has exceeded 700: this really makes it more difficult for the NHS to catch up with the backlog. In an international comparison the NHS has lost its rating as the best healthcare system in the world.
Currently the Covid R number is about 1, which means that the number of new infections is static. However, this is likely to change in autumn as we move back indoors and schools reopen. It is difficult to make predictions but, again, hospital admissions are likely to be the main problem. The emergence of new variants would make things worse.
The UK and UK have lost their edge on vaccinations
In the vaccination campaign both the UK and the US have lost their edge (see Table): other countries now have higher vaccination rates. For the US the problem has been vaccine hesitancy, which is linked to politics. Vaccine hesitancy and reluctance to wear face masks are more common amongst supporters of Donald Trump’s libertarian ideology.
For us in the UK one problem has been hesitancy in authorising the use of vaccines in the 12-17 age group. There are benefits from vaccinations in adolescents, despite the lower Covid mortality, but the use of mRNA vaccines has been associated with myocarditis and pericarditis in this age group, though at a very low frequency and with symptoms that are usually mild and of short duration.
Risk-benefit analyses favour vaccination (Journal of the Pediatric Infectious Diseases Society, 16 July) and a number of countries started vaccinating their 12 to 17-year-old months ago. Conversely JCVI, the body that makes vaccine recommendations in the UK, dragged its feet until 19 July, when it advised against the use vaccines below the age of 18 with a few exceptions.
Vaccinations for adolescents
Just two weeks later though, having come under pressure from the four UK chief medical officers, JCVI relented a bit and announced the vaccination of all 16- and 17-year-olds but just with the first dose, as myo-pericarditis side-effects are more common after the second dose. This policy on the vaccination of adolescents makes the UK an outlier in international vaccination policies, according to an editorial in the British Medical Journal (22 July).
Vaccination of adolescents needs to be voluntary and based on an informed decision, but it could be the best way to protect their health and minimise disruption to their education. It may also be the only way to get closer to herd immunity.
Some countries have started using vaccine passports to restrict access to indoor venues as a strategy to reduce risk and increase vaccine uptake. Boris Johnson seems reluctant to go down this route.
Another challenge is that the effect of vaccination wanes with time. Thus, a third dose booster is likely to be required at some stage, but we need more data to establish whether this is definitely advantageous and when.
Boris Johnson has failed in the first year of the pandemic with repeated delays in introducing effective control measures. Vaccination has been a success story, mostly because it was delivered by the NHS. In this third phase of the pandemic Boris Johnson confused approach and libertarian ideology may become, again, a liability.
Read more by Giuseppe Bignardi