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How we can live with COVID

By Dr John Sydenham

The omicron variant of COVID shows that the virus will be a serious threat to older people and those with health problems for the foreseeable future.  Omicron also shows that COVID will threaten to overwhelm the NHS with every new mutation.  Although these facts are now clear the NHS is still operating in the hope that COVID will  eventually be beaten but this is increasingly unlikely.

We are getting new waves of COVID every four months or so. The virus is rapidly mutating so this trend of new waves every few months is likely to continue.

If we want to be free of COVID restrictions there are three adjustments that must be made.  The first is that the speed of producing vaccines for new variants needs to be increased.  The second is that COVID vaccines should be available at pharmacies and GP Surgeries like flu vaccines.  The third is that the NHS will need to develop new infrastructure to deal with COVID and speedily adopt new drugs and boosters.

Pfizer is predicting a 4 month development time for a COVID Omicron vaccine.  This means that pharmaceutical companies will almost certainly be able to cut the production time for new COVID vaccines to under 3 months over the next couple of years.  As these "variant" vaccines are produced the at-risk population should be able to organize their own vaccinations as they do for flu.  The residual protection from previous vaccines, including boosters and new drugs, will be needed to make this a feasible approach.  New drugs such as Astra Zeneca's AZD7442 (Evusheld), Pfizer's Paxlovid and others  mean that there are now effective treatments for those seriously affected or hospitalised by COVID.  These are reducing risk of death from COVID to acceptable levels and mean that from January 2022 lock downs and other public health control measures will not be the best approach to dealing with COVID.  COVID wings and new medicines will be sufficient.

The possibility of sudden waves of COVID that have partially escaped from control by vaccines means that NHS hospitals will need overflow capacity. The overflow capacity would consist of buildings that have special facilities for treating COVID and would act as "COVID isolation wings". Ideally these would be physically separate from the hospital.  COVID creates huge pressure on hospitals because COVID patients need more space:

"Nearly half the general hospital beds previously reported as “unoccupied” by the NHS are not in fact available for non-covid patients, due to infection control measures" (HSJ Analysis)

This problem of COVID patients reducing bed availablity would be solved by COVID wings.  The principle design consideration for the COVID wings would be that they can be mothballed for months or even years without decaying.  If, by some good fortune a drug that cures COVID is invented in the next 10 years the COVID wings would be converted to ordinary wards.

The NHS will also need to carry an excess of workers between COVID waves so that it can staff the COVID wings.  This will make the NHS more expensive but should greatly improve NHS performance when COVID is quiescent.  The poor retention of staff in the NHS is largely due to understaffing and bad management so if the NHS has an excess of staff who are managed well it will solve its staff retention problems. (See  The State of Medical Education and Practice in the UK.)

If we are to re-open our societies we will have to accept about 40,000 - 50,000 COVID deaths a year in the UK.  This is perhaps 30% higher than the death rate for flu in a normal year but is the price that will have to be paid for life to return to normal.  And life must return to normal.

Eventually a drug or universal vaccine that cures COVID will be developed but we should not wait for this to happen before re-opening society.

13/12/2021


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