The pandemic has changed, but the idea that it’s over is false. Omicron represents a major variant, taking over the UK in a similar way to Delta last summer and Alpha last winter. The ubiquitous narrative that the pandemic is over exists because most people (including the government) now believe in at least one of the three great myths of the Omicron era. We must overcome these myths in order to first predict the future and secondly to do something to prepare for it. The first myth is that the coronavirus is now endemic and just another disease we have to live with. Unfortunately, we have to live with Covid. But the word “endemic” is commonly used in epidemiology to describe a disease that does not spread out of control due to a lack of public health measures – in a sense it means a predictable disease. This clearly does not (yet) describe Covid. Globally, we have just experienced by far the highest wave of pandemic cases to date with Omicron’s BA.1 variant. Many countries in Europe, including the United Kingdom, experience a significant second Omicron wave (BA.2) a few months after the first. Neither was anticipated and they are rapidly changing our assessment of coronavirus progression and impact on protection against vaccination or previous infection. Chief physician Chris Whitty recently warned that new waves would come, but we do not know when or how they will be. People have declared Covid endemic after every previous wave and there is nothing special about this last wave – they are still wrong. Covid is likely to become endemic – at some unknown time – but even then, endemicity certainly does not necessarily mean mild. There is a significant global burden of ill health and death, for example, from endemic diseases such as tuberculosis and malaria. As it is, trying to ignore an illness that is still so unpredictable is like turning your back on a hungry tiger in the undergrowth. Next, we must dispel the myth that the coronavirus develops into a milder one and each new variant will be milder than the previous one until it becomes a common cold. New variants of Covid have appeared rapidly in the last two years. Each variation of concern has created several offshoots – like our current BA.2 wave – but most of the new game-changing waves we’ve seen come from variations that have evolved completely independently of each other. Omicron did not evolve from Delta and Delta did not evolve from Alpha, Beta or Gamma. Instead, they came from different previous executives. There has been no progress through successive variations, nor has there been a building towards “mildness”. It is also not true that viruses always evolve to become milder. What drives evolution is transmission: the variants that infect more people will thrive. Because most Covid transmission occurs while humans have little or no symptoms, severity is not the driving force behind evolution, but a byproduct of any mutation that improves transmission and how they interact with existing levels of immunity. For Alpha and Delta, this led to more seriousness and for Omicron (somewhat) less seriousness, but this was an evolutionary accident. The next variation could easily be more serious again. While many assume that the other four coronaviruses that cause the common cold started as epidemics and then became the common cold today, we have no idea if this lasts for years, decades or centuries, or even if it is inevitable. We just do not know much about the long-term evolution of new coronaviruses in humans. Finally, there is the pernicious myth that we have somehow “finished” our vaccination program and it does not make sense to wait to return to normal. The UK has a high level of vaccination, especially in older, more vulnerable populations, and the initial release of two doses to adults has been largely completed. Unfortunately, immunity to vaccines declines over a period of months – mainly against infections, but also against serious illness and death. Boosters help, but they also mean that it is more an issue if you are aware of the vaccine than just being vaccinated. Most children remain completely unvaccinated. About a third of those over the age of 12 have not yet received their souvenir in the UK and we have just started another souvenir tour for people over the age of 75 or clinically extremely vulnerable. Most children, meanwhile, remain completely unvaccinated. As more and more people are vaccinated, infected or both, the way the virus will evolve to improve transmission is to become better at avoiding our immune system, as Omicron did. This means that existing vaccines (targeting old strains) and previous infection will become less able to protect us from a new infection as tens of thousands of people discover the second (or more) Covid infection. As Professor Danny Altmann argues, instead of relying on frequent boosters of the same vaccines, we need to develop better and longer lasting ones. We are currently pushing existing vaccines to their limits with high levels of infection, but instead we should support them by reducing transmission. Returning to normal behavior does not bring us back to normal life. It takes us back to a life of more disorder, more disease, and more stress in the NHS. But we can certainly learn to live better with Covid. We must rediscover our ambition to improve public health as we did in the 18th and 19th centuries. We can introduce serious infrastructure upgrades: better ventilation, less congestion, increased air purification and sterilization, more green spaces, changed work practices. We can also tackle inequalities with improved sickness pay and housing and population health. All of this is beneficial beyond Covid. We can do it, but we must first stop believing in these persistent myths.
