With Covid mutating, it's clearer than ever that
we must eliminate this virus
Devi
Sridhar
Unless this government stops dithering and works to
eradicate Covid-19, more variants are bound to emerge
Wed 23 Dec
2020 14.36 GMT
An
emotional rollercoaster is probably the best way to describe the past few
weeks. The UK government has lurched from allowing Christmas bubbles to
cancelling Christmas altogether. Weeks after an effective vaccine was approved,
the virus turned a new corner. Some have argued the new mutation is nothing to
worry about – viruses mutate all the time. Others think it’s cause for panic.
The truth lies somewhere in between.
With
limited information available about the new variant, the lesson from 2020 is to
move early and enforce precautions rather than wait for things to unfold. When
the government delayed a lockdown in the spring that would have reduced the
death rate, Britain learned the hard way that it’s better to prevent an
emerging disaster than to wait and watch. As Scotland’s first minister, Nicola
Sturgeon, put it: if you see a train speeding towards you, do you wait to see
if you get hit, or quickly react to avert the crash?
Scientists
are concerned about three aspects of this variant in particular. First, does it
spread faster, therefore making suppression harder? According to Nervtag (the
New and Emerging Respiratory Virus Threats Advisory Group), the Covid variant
that seems to have emerged in the south-east of England is up to 70% more
transmissible. There’s also a concern that this variant spreads more easily
among children (although there is no hard evidence for this). Until now,
younger children haven’t transmitted to the same extent as older children and
adults; if their infectivity increases as a result of the variant, there will
be a new set of challenges about how to safely reopen schools in the new year.
But just
because the virus spreads faster does not mean that it has worse health
outcomes. Nor is there evidence that it results in a higher rate of
hospitalisation for those testing positive. Moreover, although many have asked
whether the variant could present challenges for the Covid vaccine, or evade
our natural immune responses, scientists are optimistic that our vaccines will
still work. It’s also likely that, with the technology now available to produce
successful Covid vaccines, scientists could tweak the vaccine in response to
changes in the variant.
Despite the
fear and uncertainty surrounding this new situation, there are still reasons to
be positive. Few would have predicted that we’d have at least three effective
and safe vaccines against Covid-19 by the end of 2020. The Pfizer vaccine is
already being rolled out in the UK; Moderna’s vaccine has been approved in the
United States; and the AstraZeneca vaccine is not far behind. We now have PCR
testing, rapid lateral flow tests that can give results within minutes,
antibody testing and therapeutics that mean survival rates today are much
better than they were a few months ago.
While we
know these vaccines can stop severe symptoms in those infected with Covid-19,
we don’t yet know whether they can also stop vaccinated people being infectious
to others. Neither do we know how long vaccines will provide protection for,
nor whether governments should prepare for yearly vaccination projects for
their entire populations, as they do with flu. Building herd immunity will
require vaccinating 80-90% of the population – a huge task, even in normal
times.
The larger
problem is that this is a virus that likes to jump across species. It did this
in Denmark, jumping from humans to mink and back again. The more the virus
circulates, the more likely it is that mutations and variants will emerge,
making it harder to suppress. The responsibility for this new variant can
partly be attributed to those who argued against restrictions, believing that
allowing the virus to run rampant in young people while shielding the vulnerable
would allow immunity to develop. What they didn’t foresee is that such
conditions are ripe for variants to emerge. Unless we suppress the virus, it
will probably mutate further. This could make our current vaccines ineffective,
or lead to reinfections.
Now more
than ever, it’s clear why we need a proactive strategy to eliminate Covid
altogether. The government has often delayed and dithered, reacting to
outbreaks rather than seeking to prevent them. The flight bans imposed by other
European countries show that, while the UK may be hesitant at suspending
international travel, other countries are perfectly willing to act to control
the spread of the variant.
It’s no
longer enough to just flatten the curve, or treat Covid-19 like a yearly flu.
This will devastate our economy and society and run down our health services.
The model of living with the virus and allowing it to run through the
population has failed. Even Sweden, once hailed by some as an example of how to
avoid harsh measures, has been hamstrung by outbreaks, run out of hospital beds
and asked its Scandinavian neighbours for help.
What does
this mean for all of us now? While scientists continue to assemble the data and
advise governments on how best to proceed, we should each be focusing on how to
avoid getting the virus and passing it on to others, and learning sustainable
ways to live under restrictions for the dark winter months ahead. Quite simply:
avoid indoor, poorly ventilated and crowded settings; don’t go into other
people’s homes; keep your distance; meet outside; wear face coverings on public
transport and in shops; and err on the side of caution.
Ignore
those who say Covid-19 isn’t a big deal or suggest easy solutions and silver
bullets. Just because the government guidance permits behaviour that is
irresponsible, and enforcement may be lax, doesn’t mean it is safe. In the
absence of strong and effective leadership, we’ve all been placed in a position
of individual responsibility: take care of yourself, your loved ones and your
community, and remember that, while older and vulnerable people are most at
risk of dying, younger people can also get seriously ill. Now is not the time
to play Russian roulette with your health.
Prof Devi
Sridhar is chair of global public health at the University of Edinburgh
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