Covid-19 not a ‘normal’ seasonal viral infection

The Covid-19 pandemic has not gone away, despite a statement to that effect by US president Joe Biden in September. Perhaps it will fade away in the next one to two years, like the Spanish Flu of 1918-1920, but it looks more like Covid-19 has become endemic and will be with us for the foreseeable future.

Is coronavirus sinking into the background, becoming one of those “normal”, seasonal viral infections, like influenza? Is it a matter of offering vaccines and boosters to those who are older and vulnerable, to reduce their risks, while the rest of us can live normal lives, no longer having to wear masks or socially distance? For now, for most of us, that looks to be the case.

However, there are critical differences between the flu and Covid-19 and greater but largely avoidable risks with the latter. Covid-19 illnesses can persist, debilitating even the young and previously healthy for weeks, months and sometimes years. Called Long Covid, it can occur even after a mild infection. The good news, however, is that vaccines and boosters reduce the risk of Long Covid. So, we should all keep our immune systems boosted, which is most safely done by keeping our vaccinations up to date.

Coronavirus mutations occur at a fast rate and in huge numbers. But the Omicron variant that appeared over a year ago, and various sub-variants that it has spawned since then, are remarkably efficient at transmission. Omicron causes milder levels of disease than earlier variants so that fewer of those infected experience symptoms; and many don’t see the need to isolate. Omicron’s transmission efficiency has meant that new variants that might cause more serious diseases have not caught hold.

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We can also attribute the relatively “good place” in which we, as a global community, find ourselves, at least in relation to Covid-19, to the remarkable effectiveness of our body’s final line of defence. Lymphocytes, developed in response to previous infection and Covid-19 vaccines, form the defence that continues to hold firm against the latest variants: BQ.1 and BQ.1.1. Most of us in Ireland are now protected from serious disease through both having had a Covid-19 infection and through being vaccinated.

In contrast, China’s zero-Covid policy was effective against the less transmissible earlier variants, but could not hold the line against the more transmissible Omicron. Popular pressure is forcing a relaxation of the strict lockdown and enforced quarantine measures. Moreover, its vaccination strategy, using less effective vaccines than those developed in the US and Europe, did not prioritise the elderly, in the mistaken hope that isolation would be sufficient to protect them. China’s brewing storm may further set back a global economic revival.

In Ireland, if (or more likely when) a day comes when the world’s luck runs out, and widespread transmission of a more serious and immune-evasive virus starts, be that a new Covid variant or a new virus, we need to be prepared to go back to masks, social distancing, and selected public health controls, at short notice. We may not have a lot of warning, depending on how well surveillance systems are working, but we know that we need to trust science, scientists and public health-led responses.

So, will it be possible for most of us to have a normal and fairly safe social life this new year? Yes, if we act with common sense and we exercise some vigilance. Here are some of the common-sense steps.

First, being vaccinated and boosted reduces your risk of serious disease, including Long Covid, and reduces your risk of infecting others. In the first few weeks after being boosted, it even reduces your risk of becoming infected, when in close contact with someone spreading the virus. The protection from boosters kicks in more quickly than that from the original vaccination. So if you are eligible for your next booster, and for a flu vaccine, consider going to a dedicated vaccination centre or a pharmacy for your Covid vaccine booster.

Second, some people will choose to socialise even if they have “just a cold” and will not bother to self- (antigen-) test. The cold weather, fuel poverty and the desire or need to have a normal new year will mean that pubs, restaurants, public transport, crowded shops and entertainment venues are all places where you are likely to be exposed.

Wearing a close-fitting mask, as much as possible, will reduce your risk not only of Covid-19 but also of the other airborne infections that are now rampant after years of control measures that have left our immune systems vulnerable. Eating and/or drinking in restaurants and pubs means you won’t avoid the risk. But minimising is better than maximising your risk.

Third, think of others. If you have symptoms — a cold, cough, sore throat, fever, or anything outside of normal — self-test. And if you are going to come into contact with someone who is at risk, consider self-testing beforehand, even if you don’t have symptoms. Antigen self-testing takes no more than 20-30 minutes and costs little more than the cost of a pint in a pub. This small investment in time and money could well protect a vulnerable relative from a stay in hospital.

So who will spoil the party this new year? Will it be the public health commentator who suggests a little caution and common sense, or will it be that tiny coronavirus that you carry into your home?

• Ruairí Brugha is emeritus professor at RCSI, University of Medicine and Health Sciences