eTwo years ago, the World Health Organization declared COVID-19 a pandemic. It was obvious that the new coronavirus represented a historic threat to global public health. The impact of COVID-19 would continue for many years.
The world has responded in a remarkable way to this challenge. As countries fell into lockdown, mask-wearing, self-testing, and other measures became routine, the public became more comfortable with checking daily for infection.
Many people hoped for a day when COVID-19 would no longer be a major problem in the worst months of 2020. The UK seems to be in this phase thanks to its high immunity levels from previous infections and vaccinations.
The pandemic saw experts from Imperial College London play a crucial role in our understanding of the virus. They have performed world-leading epidemic modeling and conducted major trials of vaccine technology and treatments.
Where Are You Now?
It was agreed that strict social restrictions were necessary to avoid a catastrophic peak in hospitalizations due to the virus for the first year. This changed in 2021 when the Omicron and Delta variants of the virus caused waves of illness that peaked. However, major measures were not taken to stop the spread of the virus. Mass vaccination was able to lower the severity of COVID-19.
All COVID legal restrictions in England and Northern Ireland have been lifte. Only a few remaining in Scotland and Wales remain. Recent weeks have seen a significant drop in reported cases in the UK, from 275,000 infections per day at the beginning of January to 35,000 cases by February. However, daily infections have been rising in recent days.
This experience, combined with improved treatment, has led some to speculate that the worst of this pandemic is over. However, the Imperial experts that we spoke with agreed that there could be a new variant that will dramatically change the situation.
Professor Samir Bhatt from Imperial’s COVID-19 Respond Team, part of the School of Public Health explained that the pandemic seemed to be entering a “period of quietness” in high-income countries with high vaccination rates.
He said that the combination of vaccinations, natural immunity and drugs has reduced the rate of infection fatalities in older people to an extremely low level. However, it is still lower than seasonal influenza.
The situation elsewhere in the world could change, however, as countries with low vaccination rates are still likely to experience large epidemics from the virus.
“In the UK I believe we are entering a more stabilizing phase of the epidemic because of very high levels of protection from vaccination and infected,” stated Dr Anne Core from Imperial’s MRC Centre for Global Infectious Disease Analysis. She also worked with the COVID-19 Response Team.
“We are less likely to experience very large waves of hospitalizations or deaths than we have in the past, but variants can alter that.”
What Happens After Omicron
Although Omicron has resulted in less severe cases, scientists worry that there is no way to predict what the next Omicron variant will be.
“We are at a point where we don’t quite understand why certain variants are more severe than others, and we don’t know the entire breadth of this virus,” Professor Wendy Barclay of Imperial University’s Department of Infectious Disease said.
“It is risky to assume that the next Omicron-like variant will come along.”
“There might be a variant that solves Omicron’s problem of transmitting in an immune population in a very different way. It is possible to end up with a very severe variant that breaks down the vaccine and causes severe diseases.
Professor Anthony Gordon from Imperial’s Department of Surgery & Cancer is the UK Chief Investigator of the REMAP-CAP platform trial. This trial has been evaluating COVID-19 treatments in hospitals.
He explained that treatments can be divide into anti-inflammatories or antivirals. Professor Gordon explained that there are treatments that address inflammation, which is the body’s reaction to the virus.
“Anti-inflammatories will likely work if you have excess inflammation. It doesn’t matter how it happened.”
Professor Gordon believes that antivirals that target virus replication and infect cells will need to consider whether the virus has mutated. Different treatments might work better against different variants.
He said that the uncertainty surrounding the virus’s potential to mutate or change makes it even more important to continue research on COVID patient care so that clinicians can adjust treatments to suit changing circumstances.
There’s No Time To Be Complacent
Despite a positive outlook on the UK’s epidemic many scientists we spoke with were still concerned about complacency around cases numbers. COVID-19 continues to infect tens of thousands every day, putting thousands of people in hospital each week.
A medical perspective, Professor Danny Altmann from Imperial’s Department of Immunology and Inflammation said that he sees a real danger of the virus eroding recent gains in healthcare and quality of living.
“The planet missed out on any elimination or eradication of COVID in January 2020 because we did not have the vigilance necessary to stop it spreading across the globe,” Professor Altmann said. Professor Altmann stated that it was too late to do so.
“But I believe there are still options for countries to make other choices. The future of their economies, employment and other aspects will be influenced by how COVID-tolerant they are.
The Long Covid Issue
Over the past two decades, the focus of health officials and policymakers has been on the immediate effects of the virus in terms of hospitalizations and deaths.
In the initial months of the pandemic, the consensus was that most people who contracted COVID-19 would quickly recover. However, some people would need to be admitte and others would die. The reality was much more complex than that.
An Office for National Statistics survey published in January found that about 1.3 million people have long COVID – which is a broad term that refers to symptoms that last more than four weeks following an initial infection. It includes fatigue, loss in smell, and difficulty breathing.
Some people recover fully, but others have symptoms that last for months and no sign of recovery.
He stated, “The bottom line is we have acquired a large group of very desperately and chronically unwell individuals. We don’t know if that will last for one or two years, five years, five years, or ten years.”
This is an amazing new piece in the NHS healthcare puzzle that you cannot solve by trying harder. The implications of this in terms of number of clinics and nurses, doctors, radiologists, therapists, etc.
Professor Altmann expressed concern that long COVID could have a similar impact on the NHS to Chikungunya, South America. This viral disease, which is transmitte by mosquitoes and can cause debilitating joint pain for long periods of time, has had a devastating impact on Brazil’s health system. It has also caused a significant number of people to lose their jobs and put them in constant need of long-term care.
“You cannot build this infrastructure overnight without investing and training. The challenge is immense and could lead to the destruction of our healthcare system. Professor Altmann said, “I can’t emphasize it enough.”
When asked about the possibility that long COVID could be treate, Professor Anthony Gordon said it would take longer to find a way to treat persistent symptoms. More research is need to determine the long-term effects.
He explained that it will take more time to find the right treatment for these conditions.
Complex Immunology
The other problem that has complicated our response over the past year to COVID-19 is the increasing complexity of immune responses to the virus throughout the world. This has created a patchwork system of protection.
The situation was quite simple in January 2020. There were many people on the planet who had never seen the virus, but some had experienced similar ones as common cold viruses and SARS viruses.
We now have a world that has had many different experiences with COVID-19. Some people have been infected first with the original virus strain, while others are infecte with the Alpha, Beta, Gamma or Delta variants. Others may not have been infected at all, but they have received protection with one to three doses of vaccines.
These experiences are likely to have an effect on our immune response to future COVID variants, but it will take some time to understand the full implications of these combinations in terms of protection.
“If you took all of that variability into consideration, and said to me, “Would I bet my home on which universally best vaccine or approach? It’s not trivial and will require a ton of research to figure out,” Professor Danny Altmann stated on the matter.
The diversity of immune responses to the virus may also influence how it evolves over time. There is also the possibility of different COVID lineages co-circulating in different parts.
Wendy Barclay explained how Omicron and Delta, the most well-known variants in the past year, have important antigenic differences that mean that a vaccine based only on one will not always provide the best protection.
This is not all. Individuals’ past immune experiences could influence how they react to future vaccines and variants.
She said that South America, where many people first saw the Gamma variant, has a very different immune history to South Africa and the UK. They had Beta first or Alpha first.
“There are many immune histories around the globe and different variants that may be developed to do better or worse in different immune populations.
“It is possible that we will see the establishment of antigenically distinct lineages in the near to mid-term. These lineages will co-circulate.”
Scientists are worried about Omicron vaccine boosters because it could produce a suboptimal response to any Delta-like variants that might emerge.
The Next Pandemic
Most people see the end of COVID’s crisis phase as an opportunity to think about other priorities. But scientists believe that our experience with the pandemic has shown us why we must strengthen our defenses against the next threat.
While there are many arguments in the UK about whether or not we used the best strategy for managing COVID, the fact is that the country was not adequately prepared to handle a major epidemic.
We asked Professor Peter Openshaw [first photo] what the past two years had taught us. He noted that COVID-19 had shown how devastating pandemics can be to society and economy, and that it was important to keep adequate stockpiles of personal protective equipment (PPE) in case they happen again.
It also demonstrated the importance of acting immediately when a virus is suspect.
Professor Openshaw stated that for every few hours you wait, there is an exponential increase in cases. Once they are allowe to run, it is difficult to control outbreaks.
This view was shared by Professor Katharina Hauck [second photo], an expert in economics and the Deputy Director at Imperial’s Jamel Institute for Disease and Emergency Analytics.
Although there is an obvious tradeoff between protecting the economy and reducing the number of cases, Professor Hauck discovered that the tradeoff was often less severe in countries that implemented strict measures to prevent widespread transmission early.
“We don’t talk about too many deaths and we don’t speak about GDP losses in countries that have a slower response time, like the UK.
Imagine that countries trade-off deaths and GDP losses on different curves. Once countries have a high death/high loss curve, it’s very difficult to get back on a low death/low GDP loss curve.
According to Professor Wendy Barclay, one thing we can do to prepare for the next pandemic would be to make sure we have the infrastructure to quickly produce vaccines in multiple countries.
“From the UK perspective, I don’t want to be dependent upon a vaccine being made somewhere else in the globe. Low and middle-income countries need support to ensure they can produce vaccines so that they are not at bottom of the wait list.”
