Is the War Against COVID-19 Over?

In the mist of memory, we all still remember the Omicron wave and the scary rise in cases before Christmas in the UK. France shut its borders to the UK rendering French ski resorts barren of tourists. In retrospect, it was ludicrous. It became obvious to those of us looking at the London data on the spread of Omicron pre-Christmas, that this was not the ‘end of days’. Omicron was very much more contagious, perhaps two to three times more than previous variants. Cases rose at record-high rates in London, but ICU admission rates were essentially flat. Coincidentally, cases peaked a year to the day of the previous winter’s peak, when hospitals were crushed under the weight of critically ill COVID patients. This winter, cases seemed to have finally decoupled from critical illness. Here’s what we published just over a month ago - apart from cases that have dropped steadily as compared to that projected.

Data also shows that ninety-five percent of the critically ill patients were unvaccinated, reinforcing the already overwhelming evidence that the vaccination programme played a huge part in making COVID a not-so-scary disease. Furthermore, for those not vaccinated, Omicron can be considered a decent ‘dose’ of the virus that you just aren’t going to dodge. The situation in London foretold the pattern for every other major city. Omicron had effectively inoculated or reinoculated everyone vaccinated or otherwise, and the impact was, for most, a rotten cold. 

So, is it over? Every single public health authority figure I have heard speak about COVID, after the pitifully hopeful naivety of March 2020, has been hedging their bets.. Public announcements have been heavily caveated. I’m not going to hedge my bets: I am going ‘all in’ with a YES -  the pandemic is over. At least in the privileged, vaccine-stockpiled Northern Hemisphere.

In March 2020, we were truly terrified. People would ask me: “Doc, can you reserve a private ICU bed, in case I get it - I’ll pay you anything, anything.” (The answer was NO!) Now, two years later, the queries I get are more along the lines of: “Doc, do I really have to wait 10 days before I can go out on the town, I ain’t got a symptom and no-one cares.” 

The Liberatarian Manifesto’s view on this is that the market (we, the mob) is the best determinant of what’s what in the end, and whether one is a staunch anti-vaxxer or an obsessed data geek who looks at graphs all day, the market is all saying only one thing: the pandemic might be over, but we still have to deal with its aftermath. This is still a nasty virus. It provokes profound inflammatory damage even if asymptomatic. People can still lose their sense of smell and taste, or have it replaced by phantom rotten egg odours for an undetermined period of time. COVID activates profound cellular senescence chronic inflammation. While these acute issues are over, we will see a whole new speciality of post-COVIDitis grow over time as we start to recognise the long term impact of repeated infection. We are not advising people to avoid it at all costs. Instead, what we are now saying is that, while you should still try to avoid infection, we can now live with it.

Antivirals are still being developed and, inevitably, there will be online services to prescribe them after a positive home test, much like we prescribe  Tamiflu to reduce the number of days off work with the flu. As for boosters, well, for the vast majority of the planet the real questions is "when will I get my first dose?" This remains a miserable example of inequality reminiscent of so many infectious diseases. But for those in richer countries the answer to whether they should get a booster is very nuanced. If you do not want to have any issues when travelling and want to lower the risk of your results popping up as positive when you’re abroad, then take your booster. If you are young, fit, have great insulin sensitivity, have been exposed again and again and not got the virus, and can continuously measure your antibody count over time, then you have a decision to make. Essentially, it is an act of balancing the risk of a hyper-rare event WHEN you get the jab versus a relatively more common risk of bad things happening IF you get the infection. Personally, as an individual, I am looking forward to my next dose. I have not tested positive for the virus in two years despite staggeringly high levels of exposure, yet I am a wholehearted believer in as many safe doses, natural or artificial, as possible. That said, I still wear a mask on public transport, planes and in shops, but as a fit, young(ish!) person, I have very little fear of getting it, if at all. 

Vaccination status will still, for a good while yet, determine how easy it is to travel across borders. Testing and variant tracking remains an irritatingly excellent policy. But, does anyone even care anymore about the rules, and whether they are sensible? A small Twitter poll, albeit not globally representative of views, shed light on this. Already a couple of months ago, nearly seventy five percent of people still felt that Novak Djokovic should not have had any special treatment. Fair enough. But twelve percent of the pollers said the rules were bonkers and as policy follows votes, my bet is that such rules will not stay around forever. Interestingly, almost fourteen percent appeared completely disinterested, preferring to ask “Where’s my cheeseburger?” and presumably not giving a flying tennis racket about the pandemic any more. 

I do stand by the data-driven bet that our exposure, vaccination and immunity bodes well. This does still remain a (potentially very nasty) virus, deserving of great respect and further research, especially into optimising long-term sequelae and close monitoring of cases and variants. Poorer countries must be prioritised. Don't waste doses. Re-distribute. However, in the Global South, populations are younger and less diabetic - a godsend considering their weak hospital capacity. For the Global North, it’s unlikely that the virus will create further health-system meltdowns, economic lockdowns and the ongoing tragic loss of hundreds of thousands of lives. 

Fortunately, that’s one less war we need to fight.