Regular coronavirus testing and mask wearing have become increasingly rare, and the Joint Committee on Vaccination and Immunisation (JCVI) in January described the UK's current COVID status as in "transition" from a "pandemic emergency response towards pandemic recovery". But is this the moment to lower our guard and declare the pandemic over?
Professor Maggie Rae, the current president of the Royal Society of Medicine's (RSM) epidemiology and public health section and former president of the Faculty of Public Health, says a firm 'no' to the question.
The veteran of four pandemics states: "The pandemic is not over. Pandemics are only declared when the WHO looks at the infection and the death rate round the world and determines that we are in a pandemic. So, it has to be the WHO who decides a pandemic is over. I believe they have not done so.
"Germany has just given €130 million to WHO to help it continue to protect the world from future health emergencies". This leads one to think that German leaders do not think the pandemic is over.
The current COVID picture from the UK is disquieting. Excess deaths provide one of the clearest indicators of COVID activity and ONS (Office for National Statistics) figures for the week ending 3 February 2023 indicate that these are 1.4% above the 5-year average in England and Wales. Moreover "novel coronavirus (COVID-19)" is cited in 469 of them, accounting for 3.7% of all excess deaths in England.
The two other drivers of the increase in excess deaths are cancer and congenital heart defects (CHD), which both increased during the pandemic as a result of pressures to the system from dealing with the virus.
In addition, China has had an explosion in COVID cases since the new year, which prompted the UK government to impose continuing travel restrictions on people entering the UK country from China. Variants emanating from there and from other countries are causing anxiety among experts in infectious diseases, who are calling for vigilance, especially about the so-called Kraken variant XBB.1.5 which, though mild, is also unstable.
Another stark indication that the pandemic is far from over is that 500,000 people in the UK are still shielding because the level of vaccine they can access does not give sufficient protection for people who are immunocompromised or ill.
Given these circumstances, Rae says, now is a time for continued action on COVID: "One of lessons of previous pandemics is that you should give as much attention to the period after the pandemic as you should to the beginning. But time and time again we see a major incident where the drama attracts attention and finance at the start, but then interest wanes and we do not give enough attention as it goes forward."
Roadmap to Health
What will it take to move the UK out of the post-pandemic phase into a more stable situation? In Rae's view there needs to be progress on the following:
- A government road map on how to navigate out of the pandemic and balance the overall protection of the population against infectious disease against the non-communicable killers like cancer and CHD
- An announcement of a national vaccination roadmap, as the last COVID boosters were offered in September 2022 (with a low uptake) leading to speculation about a move to an annual COVID/flu programme
- Look at lessons learned from the pandemic and incorporate them into planning for future possible health emergencies
- Continued work to combat vaccine hesitancy, particularly in the more deprived populations where the levels of Covid vaccination are the lowest
- Research on tixagevimab/cilgavimab (the combination of two human monoclonal antibodies sold as evusheld targeting the COVID spike protein) to establish how best to help the 'forgotten' 500,000 still shielding
- Campaigns to promote good personal hygiene in the general population to set good habits for the future
- Establish clearer guidelines for mask use in health settings, and for the public in crowded settings particularly when they have viral symptoms.
Sheena Cruikshank who is an immunologist and Professor in Biomedical Sciences and Public Engagement at the University of Manchester agrees that the pandemic is not over yet, and that Omicron is going to be part of life for the foreseeable future. She is also concerned about the emergence of immune-resistant strains and how well the current antivirals and monoclonals will work against them.
Prof Cruikshank says: "If we have still got a backdrop of as many cases as we have now, and we get avian flu on top of that, I do not even want to think about what that would be like."
Ventilation of buildings and public spaces is an area she thinks could play a vital role in combatting the current pandemic and reducing risks for the future. "Some of the infrastructure is not expensive compared with the cost of having people not working or ill," she explains. "There are benefits for respiratory conditions other than COVID too and huge benefits for the NHS."
Focus on Long COVID
In Prof Cruikshank's view, long COVID is not receiving the attention it deserves. She hears 'worrying things' about plans by the Government to cut services and is concerned about the difficulties that patients she sees have in obtaining a diagnosis even though it is measurable.
She says: "We need to get them into clinical trials and help them to feel better and join the workforce."
She expresses much concern about vaccine inequality across the world - which may be addressed by the WHO’s Pandemic Treaty, which is being put together to encourage the 194 member states to agree on a common and legally binding policy of pandemic prevention, preparedness, and response.
Professor Rae is in favour of the treaty, although she does not see how it can be enforced, as a way of preparing for future pandemics. She is clear that many lessons have been gained from our experience of COVID, the contrasting approaches adopted across the world, the bidding of richer countries to buy up PPE and vaccine. These lessons must be applied, to mitigate the impact of future health events.
"One of the things that unites professionals is a passion to fight health inequality," she states. "The people who suffer the worst in serious incidents and pandemics are the poorest. There is an ethical duty to be a voice for inequalities and to try to get equity across the population where we can."
But how likely is another pandemic? Rae is clear: "In public health we don’t say 'if' we say 'when'. We will have one in my lifetime, but we hope it's not as impactful as COVID."