Room for optimism as we head into the dark days of lockdown
It’s going to be a rough old winter. But that doesn’t mean that we shouldn’t have some optimism about the future.
Covid could well be with us for years, even decades, to come. Experts believe, though, that we should be able to find a way out of the current cycle of lockdown and rule relaxation.
A vaccine, mass testing and better treatments may not provide a total solution individually. Working together, however, they can take us back to lives similar to how they were pre-Covid.
“We might be back to some semblance of normality by summer time next year,” says Professor Julian Hiscox, from the University of Liverpool. “But we won’t be ‘back to 2019’ for five years,” he predicts.
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Some scientists believe that to manage the virus, our way of life may need to change forever.
If we could skip ahead several years, the mostly widely held view is the virus will still be around, but as what’s known as an endemic infection.
That is not to say life will be the same as it is now.
We should have reached a new relationship with the virus where it is significantly less disruptive to our lives. This follows the pattern of previous pandemics.
A vaccine or multiple infections across a lifetime may give enough immunity to stop the virus being as deadly.
“This will settle down over decades,” Professor Mark Woolhouse, from the University of Edinburgh, said in an interview with the BBC. “The problem is what happens over those decades. I don’t see a route that isn’t painful in one way or another.”
First, we have to get through the winter months.
Today marks the eve of another lockdown and the expectation is that the colder months will be a trial for all of us.
Winter is party time for respiratory infections anyway, as we spend more time indoors and the cool temperatures help viruses survive.
The government is firefighting a virus that will spread rapidly if restrictions are eased too much.
The UK has already gone from a very quiet summer to averaging more than 20,000 cases a day. The virus is currently spreading four times faster than the government’s worst-case scenario which predicted a second wave could be more deadly than the first.
It is hoped the four-week lockdown will address this by bringing the R-number down below one. In Wales, restrictions are being relaxed from next week. Leaders there hope its two-week ‘circuit breaker’ will have had an impact.
Spring should bring better times ahead. People move outdoors more, which makes it harder for the virus to spread. It can be hoped that mass testing currently being trialled in Liverpool will be offered to everyone.
Finally, there is the prospect of a vaccine, which promises to offer some kind of way out, although uncertainty remains.
Sir Jeremy Farrar, chairman of the Wellcome Trust and a member of the Government’s Scientific Advisory Group for Emergencies (Sage), said a vaccine breakthrough would “enhance trust and sense of confidence in where the pandemic is going”.
Speaking in a personal capacity, he said: “We will know before the end of the year from the early vaccines that are now in late-stage clinical trials,” adding: “I believe that more than one of those vaccines will prove to be effective and safe.”
He explained: “They may not be perfect, we’ve become used to perfect vaccines, but generally these first wave of vaccines are not perfect but they’re safe and they are effective and they will change the nature of the pandemic.
“They will, I believe, enhance trust and sense of confidence in where the pandemic is going. They will prevent, I hope, more people getting severely ill and they may also dent transmission itself, so they will have a big impact.”
Several vaccines, including one being developed by Oxford University, are known to be in the final stages of testing on volunteers before they can be approved for general use.
It has been suggested that people may need to have booster shots, after a study found antibody levels against Covid-19 can fall quickly.
The Real-Time Assessment of Community Transmission (React) findings suggested immunity was “waning quite rapidly”, which could lead to an increased risk of reinfection.
Professor Paul Elliott, director of the React programme, added: “It’s possible that people might need booster vaccines.
“For some viruses there’s lifelong immunity, for the coronaviruses that doesn’t seem to be the case and we know that the immunity can fluctuate so, yes, this is something that needs to be looked at very carefully.”
There are 11 vaccines around the world that are in the final stages of testing. Experts are waiting for results to understand how effective they are, what kind of protection they offer and how long that might last.
Vaccines for other diseases vary. Some stop you catching the infection, others just make the disease less severe and not everybody responds in the same way. Members of the government’s scientific advisory group hope to get data soon on how a Covid vaccine performs.
'Moderately optimistic'
But we should not expect a magic bullet.
Professor Hiscox is “moderately optimistic” the first generation of vaccines will keep some people out of hospital, but “won’t necessarily” stop people from catching and spreading the virus. And he warns that some of the people most vulnerable to Covid, such as the elderly, might get the least protection from a vaccine.
For Professor Woolhouse, a vaccine “would clearly be a game-changer”. But the history of medical research shows it is “unwise” to rely on it arriving on time. Even then he is “nervous about the logistics” of vaccinating millions of people. A vaccine will lead to some “really difficult decisions”, he says, about lifting restrictions when people may not be completely protected.
It has to be hoped, then, that measures introduced, along with increased testing and the emergence of a vaccine, will have a major impact. But it doesn’t discount the prospect of a third wave at some point into next year.
A third wave of the coronavirus pandemic has already left nearly 50,000 Americans hospitalised, with experts fearing several hospitals will soon be put under severe strain. According to The Covid Tracking Project, hospitalisations rose in 47 states over the last month, with a total of 47,502 people hospitalised as of Sunday – the highest level seen since the summer. In Wisconsin, a record of more than 1,200 patients are hospitalised and nearly 90 per cent of intensive care unit beds are in use.
Shelter
“A third wave in the UK is certainly possible,” Professor Woolhouse told the BBC. “And if neither the second nor the third waves are anything like big enough to induce herd immunity, and we don’t have a vaccine, then a fourth wave is possible. I don’t think it will settle down at all in the next 18 months.”
Some degree of social distancing is likely to continue even with a vaccine next year, says Professor Hiscox, but it will be “less stringent”. He also believes at-risk groups may still need to “shelter” themselves, or take extra precautions, because of uncertainty about the amount of protection.
“What you might not be able to do is be an 18-year-old back from university who goes and hugs granny who is 85,” he says.
But he warns that going back to normality will require a vaccine that both stops people getting sick and prevents them spreading the virus. That, he says, will take five years.
“For most people,” says Professor Woolhouse, “I suspect life has changed to some degree forever, I don’t think there is a going back. There is a ‘new normal’.”
For Professor Pagel, it is “possible Covid might become like an annual flu, more people will be fine than now”. But that would make winter tougher than we’re used to, creating a a “double flu season”.
