'Living with' Covid is failing - so what's Plan B?

For the UK as a whole, 69% of sequenced cases by July 11 were BA.5, compared to 21% for its sister sub-lineage, BA.4.

The remaining 10% were split evenly between BA.2 and BA.2.12.1 - the former the driver behind the UK’s last wave in March/April, and the latter a highly contagious variant which exploded in the New York region and became dominant in the United States at the end of May.

Since then, BA.2.12.1 has also been overtaken by BA.5. By the beginning of July, the Centres for Disease Control estimated that it was causing more than half of US cases.

Data from England also suggests that around half the “BA.5” cases are in fact yet another offshoot, known as BA.5.1, which is differentiated from its parent by a single mutation.

READ MORE: Is the NHS really in 'recovery' when the number of people treated has barely changed in a year?

So what can we expect from the BA.5 wave?

First detected in South Africa in February, BA.5 (in tandem with BA.4) led to a substantial wave of infections but only around a third of the hospitalisations compared to the original Omicron wave in December.

It first took off in a major way in Europe when it began spreading rapidly in Portugal at the end of April.

By the beginning of June it accounted for around 90% of Portuguese cases, before burning itself out. The entire BA.5 wave lasted around nine weeks from start to finish, but peaked after five.

The signals are that Scotland is heading in the same direction, with virus rates climbing from one in 50 to one in 17 over a five-week period up to the end of June but now stalling.

One in five cases in Scotland are reinfections, although the true figure is probably even higher since Public Health Scotland applies a 90-day cut off and there is anecdotal evidence of people testing positive again just 60 to 80 days after a prior Omicron infection.

PCR testing for Covid is still carried out routinely for all hospital patients, with a percentage of positive results sequenced, but most people in the community no longer have access to PCR tests (Image: PA)

Both BA.5 and BA.4 have mutations that make them particularly adept at outsmarting antibodies in order to cause repeat or vaccine-breakthrough infections, but cellular immunity - from T cells and memory B cells - continues to hold up well, and there is no evidence that either causes more severe disease.

Data from Qatar suggests that a prior natural Covid infection up to 14 months ago still provides around 97% protection against severe disease from the current Omicron subvariants, including BA.5, while South African data indicates that even two doses of Covid vaccine provide 87% protection against hospitalisation caused by BA.5 or BA.4 infections.

Given that nearly 80% of Scottish adults have also had a booster and 92% of over-75s have had the fourth-dose Spring booster, the impact on the NHS as far as serious Covid illness goes should be comparatively small.

The number of new Covid hospital admissions has been falling in Scotland since the end of June, suggesting that we have may have peaked with around 1,700 Covid positive patients in hospital by July 10. Roughly two-thirds will not have Covid as their primary diagnosis.

READ MORE: Why is airborne Covid spread the last pandemic taboo?

Nonetheless, there is an uncomfortable sense that “living with Covid” isn’t really working.

For one, it keeps going: no one anticipated substantial waves occurring only two to three months apart with little lasting immunity to infection, making it impossible for the NHS to remobilise elective care in anything like the hoped-for volumes.

The sheer scale of infections also means that the death toll from Omicron will soon exceed that caused by Delta, despite the latter being significantly more virulent.

It’s a numbers game.

Statistically, Covid is now no deadlier than flu - even for over 80s. But being “milder” - as Omicron is compared to Delta - is irrelevant if it is capable of infecting many more people, repeatedly.

While 150K were pre vax, we've had almost 50K deaths since last summer.

And despite Omicron being billed as "mild", very soon we'll have recorded more deaths in the Omicron era (6 mths so far) than in the Delta era (7 mths).

These are serious numbers. Take them seriously. 2/2 pic.twitter.com/m6gGT9i8pj

— Prof. Christina Pagel 🇺🇦 (@chrischirp) July 13, 2022

Despite antivirals and boosters, between January 8 and July 1 (the ‘Omicron wave’, to date) 22,787 deaths have been registered in the UK where Covid was certified as a cause of death; the ‘Delta wave’, dated from June 11 last year, claimed 23,512 lives.

The BA.5 variant is anything from around three to five times more transmissible than the original Wuhan Covid strain, mostly due to immune evasion.

Its other great advantage, of course, is to have spread in conditions where most mitigations had vanished.

READ MORE: Why Covid reinfections could be a much bigger problem than expected

So what’s Plan B?

No one expects another lockdown, but there has been a growing sense that heading into autumn and winter there may be a need to rethink how we “live with” Covid - especially if flu makes a comeback.

Professor Rowland Kao, chair of veterinary epidemiology and data science at Edinburgh University, said:“Treating it like it has gone is not helpful and by doing so we are causing a substantial but relatively low level of infections to persist.”

He suggested that increases in testing and isolation, encouraging people to wear more protective FFP2 masks, and physical distancing in higher risk setting could all be considered.

This was echoed by Professor Dale Fisher, chair of the World Health Organisation’s Global Outbreak Alert and Response Network, who said that “measures such as working from home, mask mandates, enabling more social distancing could be necessary if there is just too much transmission for the health system to cope with”.

The number of people in hospital with Covid during 2022 has exceeded previous waves and put the NHS under strain, even if the majority are not in hospital "because of" the infection

Dr Susan Hopkins, chief medical adviser for the UK Health Security Agency, said it is planning for an influenza wave - possibly from as early as September - with “at least one Covid wave in the autumn/winter”.

In the longer term, elective surgical hubs - separate from acute hospitals - will be essential for creating resilient, ring-fenced capacity to clear backlogs. Staffing them, as ever, will be the biggest challenge.

But pretending Covid is over, when it keeps on coming, is not sustainable.